Week 9: Biochemical Tests 2 Flashcards
What are the signs and symptoms of hypernatraemia using the mnemonic?
FRIED SALT
Flushed Skin/Low-grade Fever
Restlessness/Irritation/Confusion
Increased BP + Fluid Retention
Edema (Peripheral + Pitted)
Decreased urine output + dry mouth
Skin flushed
Agitation
Low-grade fever
Thirst
What are the signs and symptoms of hyponatraemia using the mnemonic?
LOW SODIUM
Level of Consciousness (Altered)
Orthostatic Hypotension
Weakness (Muscles)
Seizures
Osmolality (low)
Diarrhoea
Increased ICP
Urine Osmolality (high)
More bowel sounds/stomach cramping
What is the reference range for Calcium?
2.2-2.6mmol/L
What are the causes for reduced calcium levels? (5)
Renal failure
Raised phosphate levels (phosphate binds to calcium readily)
Hypoparathyroidism
Low Magnesium levels
Deficiency/Malabsorption
What are the causes for raised calcium levels (hypercalcaemia)? (4)
Malignancy
Hyperparathyroidism
Hyperthyroidism
Dehydration
At what value would be considered as high calcium level? (1)
> 2.65mmol/L
What would be considered as a medical emergency regarding high calcium levels? (2)
> 3.75mmol/L = risk of MI.
How should hypercalcemia be managed? (2)
- Fluids
- If no response, IV Bisphosphonates.
What are the signs and symptoms of hypercalcaemia? (6)
BACK ME
Bone Pain
Arrhythmias, Abdominal Pain
Cardiac Arrest, Constipation
Kidney Stones
Muscle Weakness
Excessive Urination
What factors can cause reduced levels of Magnesium (hypomagnesemia)? (3)
Diuretics
Liver Disease
Diarrhoea
What main factor can increase the Mg levels? (1)
Renal impairment
Explain the general relationship between magnesium and calcium. (2)
Mg helps transport Ca + K+ ions in and out of the cell.
Hence, low levels of Mg = low levels of Ca/K.
What are the initial signs and symptoms of hypomagnesemia? (4)
Appetite Loss
Nausea
Vomiting
Increased Fatigue
Give e.g. of at risk groups of developing hypomagnesemia. (4)
GI disease
T2DM
Alcohol dependence
Older adults
Explain the main functions of phosphate. (3)
Maintains energy levels.
Muscle and nerve function
Bone growth
What are the severity ranges for hypophosphatemia? (3)
Mild = 0.6-0.79mmol/L
Moderate = 0.3-0.59mmol/L
Severe = <0.3mmol/L
State the treatment options for each severity type of hypophosphatemia. (2)
Mild = No tx needed
Moderate = Phosphate Sandoz 1-2 tablets TDS
Severe = Sodium glycerophosphate 21.6%, IV 40mmol given as 2 x 20mmol/L (20ml) in 500ml glucose over 12 hours (normal renal function)
What are the signs and symptoms of hypokalaemia? (7)
7L’s
Lethargy
Low, Shallow Respiratory Failure
Lethal Cardiac Dysrhythmias (weak pulse)
Lots of urine (frequent and in large vol.)
Leg Cramps
Limp (weak) muscles
Low BP (severe)
What are the signs and symptoms of hyperkalaemia? (6)
MURDER
Muscle Weakness
Urine output (low or none)
Respiratory Failure (muscle weakness)
Decreased cardiac contractility (weak pulse/ low HR)
Early Muscle Twitching/Cramps
Rhythm changes: Tall peaked T waves, prolonged PR interval.
Explain how potassium binders are used to treat hyperkalaemia. (4)
Can be used in CKD Stage 3b-5 or HF patients if they:
Have confirmed HF with LVEF <= 40%
Have serum K of 6.0mmol/L and NOT taking or are on suboptimal dose of RAAS inhibitors due to hyperkalaemia.
Not on dialysis.
What is the patient criteria for using potassium binders? (3)
Had acute episodes of hyperkalaemia (6-6.4mmol/L)
There’s a clinical case to restart that witheld RAASi therapy at lower dose once resolved.
K+ on repeat testing is between 5.5-6.4mmol/L.
What are the dosing regimens for Patiromer Calcium? (3)
Initial: 8.4g OD
Titrate in doses of 8.4g at intervals of at least 1 week.
Max. dose 25.2g per day (8.4g TDS)
What are the dosing regimens for Lokelma (SZC)? (3)
Initial: 10g TDS up to 72 hrs
Maintenance: 5g OD adjusted acc. to K+ levels.
Can range from 5g on alternative days to 10g OD.
How often should K+ levels be checked when patient is on K+ binders? (4)
1-2 weeks AFTER:
- <4mmol/L: reduce dose of binder
- 4-5.3mmol/L: continue
->5.3mmol/L: Increase dose of binder.
How often are the K+ levels assessed after the patient is stable on K+ binders?
Monthly
At what K+ level should you consider deprescribing K+ binders?
<5mmol/L without ongoing agents acting on RAS.
What are the main functions of red blood cells? (4)
Carries oxygen to the tissues.
Returns C02 from tissues.
Carries haemoglobin in the blood.
Most abundant cell in the blood.
What does a low Hb level indicate?
Patient has anaemia.
What is HCT? (2)
A.K.A. Haematocrit
Indicates RBC proportion that make up the blood pool.
What is MCV? (2)
A.K.A. Mean Cell Volume
Average size of RBC.
What is MCH? (2)
Mean Corpuscular Haemoglobin
Average amount of Hb in RBC.
What is MCHC? (2)
Mean Corpuscular Haemoglobin Concentration
Average conc. of Hb inside an average sized cell.
What main parameter indicates that the patient is suffering from microcytic/macrocytic anaemia? (2)
High MCV = Macrocytic
Low MCV = Microcytic
What key parameters indicate the patient is suffering from microcytic anaemia? (3)
Low:
- RBC
- Hb
- MCV
What is the common cause of microcytic anaemia?
Iron Deficiency Anaemia
What are causes of iron deficiency anaemia? (3)
- Inadequate diet
- Deficient Absorption
- Blood loss:
- Menorrhagia
- GI bleeding e.g. oesophagitis, peptic ulcer, carcinoma, colitis, diverticulitis or haemorrhoids.
Explain the management of iron deficiency anaemia. (3)
Oral:
- Iron supplement e.g. ferrous sulphate 200mg OD (65mg elemental iron)
- Continue until normal levels are reached and for 3 months after.
Parenteral:
- In presence of malabsorption e.g. Ferinject, Cosmofer
How much should haemoglobin rise over a 3-4 week period in microcytic anaemia?
20g/L
How often should the haemoglobin be checked in microcytic anaemia? (3)
Within 4 weeks:
Adequate response - continue and recheck FBC in 2-4 months.
Inadequate - assess compliance, tolerance and refer if lack of response after 2-4 weeks.
Why is it important to take a thorough medication history for patients who present with iron deficiency anaemia? (2)
NSAIDs and warfarin can cause GI bleeding.
What is the key parameter that indicates the patient has macrocytic anaemia? (1)
MCV is raised.
What are the key parameters that indicate vitamin B12/folate deficiency? (2)
Raised MCV
Low Haemoglobin
What are the common signs and symptoms that indicate macrocytic anaemia? (6)
Tiredness
Weakness
Dyspnoea
Sore Red Tonuge
Diarrhoea
Mild Jaundice
Explain the management process for folate deficiency macrocytic anaemia. (1)
Give oral folic acid 5mg daily.
Explain the management process for B12 deficiency macrocytic anaemia. (3)
- Replenish stores with hydroxocobalamin:
- 1mg IM alternate days for 2 weeks.
- Maintenance 1mg IM every 3 months for life.
Which other type of patients can also get macrocytic anaemia?
High, chronic alcohol intake.
- Hb + RBC is normal
- MCV is raised
What is aplastic anaemia? (1)
- Aplasia of the bone marrow i.e. pancytopenia.
What is Haemolytic anaemia? (1)
Accelerated RBC destruction.
Give e.g. of cases that causes haemorrhage leading to anaemia. (3)
Trauma
GI bleed
Surgery
Give e.g. of chronic diseases that can cause anaemia. (3)
Carcinoma
RA
Renal Failure
What is another name for white blood cells?
Leucocytes
What are the 5 types of white cells in the peripheral blood?
Neutrophils (70%)
Eosinophils (2%)
Basophils (<1%)
Lymphocytes (20%)
Monocytes (7%)
What is the main function of neutrophils? (1)
Ingest + kill bacteria, fungi and damaged cells.
What type of infection causes a rise in neutrophil levels? (1)
A.K.A. Neutrophilia
occurs in bacterial infections.
What type of infections cause reduced levels of neutrophils? (2)
A.K.A. Neutropenia
Occurs in viral infections, acute leukaemia.
What is a C-reactive protein (CRP)? (3)
- Protein produced in acute phase response.
- Synthesised in the liver.
- Rises within 6 hrs of an acute event.
What is the main function of the platelets?
Causes mechanical plugging of haemorrhoage and start coagulation.
What factors can cause a rise in platelet count (thrombocytosis)? (3)
Malignant disease
Autoimmune disease
Inflammation
What factors can cause low platelet count (thrombocytopenia)? (2)
Drugs
Leukaemia
What is Erythrocyte Sedimentation Rate (ESR)? (2)
Measure of acute phase response.
Used to monitor chronic inflammatory conditions.
What pathological processes can occur that affect the ESR? (5)
Immunological
Infective
Ischaemic
Malignant
Traumatic
