Week 9: Biochemical Tests 2 Flashcards

1
Q

What are the signs and symptoms of hypernatraemia using the mnemonic?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the signs and symptoms of hyponatraemia using the mnemonic?

A

LOW SODIUM

Level of Consciousness (Altered)
Orthostatic Hypotension
Weakness (Muscles)

Seizures
Osmolality (low)
Diarrhoea
Increased ICP
Urine Osmolality (high)
More bowel sounds/stomach cramping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the reference range for Calcium?

A

2.2-2.6mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes for reduced calcium levels? (5)

A

Renal failure
Raised phosphate levels (phosphate binds to calcium readily)
Hypoparathyroidism
Low Magnesium levels
Deficiency/Malabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the causes for raised calcium levels (hypercalcaemia)? (4)

A

Malignancy
Hyperparathyroidism
Hyperthyroidism
Dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

At what value would be considered as high calcium level? (1)

A

> 2.65mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would be considered as a medical emergency regarding high calcium levels? (2)

A

> 3.75mmol/L = risk of MI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How should hypercalcemia be managed? (2)

A
  1. Fluids
  2. If no response, IV Bisphosphonates.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the signs and symptoms of hypercalcaemia? (6)

A

BACK ME

Bone Pain
Arrhythmias, Abdominal Pain
Cardiac Arrest, Constipation
Kidney Stones

Muscle Weakness
Excessive Urination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What factors can cause reduced levels of Magnesium (hypomagnesemia)? (3)

A

Diuretics
Liver Disease
Diarrhoea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What main factor can increase the Mg levels? (1)

A

Renal impairment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Explain the general relationship between magnesium and calcium. (2)

A

Mg helps transport Ca + K+ ions in and out of the cell.
Hence, low levels of Mg = low levels of Ca/K.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the initial signs and symptoms of hypomagnesemia? (4)

A

Appetite Loss
Nausea
Vomiting
Increased Fatigue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Give e.g. of at risk groups of developing hypomagnesemia. (4)

A

GI disease
T2DM
Alcohol dependence
Older adults

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Explain the main functions of phosphate. (3)

A

Maintains energy levels.
Muscle and nerve function
Bone growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the severity ranges for hypophosphatemia? (3)

A

Mild = 0.6-0.79mmol/L
Moderate = 0.3-0.59mmol/L
Severe = <0.3mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

State the treatment options for each severity type of hypophosphatemia. (2)

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the signs and symptoms of hypokalaemia? (7)

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the signs and symptoms of hyperkalaemia? (6)

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Explain how potassium binders are used to treat hyperkalaemia. (4)

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the patient criteria for using potassium binders? (3)

A

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.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the dosing regimens for Patiromer Calcium? (3)

A

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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the dosing regimens for Lokelma (SZC)? (3)

A

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 well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How often should K+ levels be checked when patient is on K+ binders? (4)

A

1-2 weeks AFTER:
- <4mmol/L: reduce dose of binder
- 4-5.3mmol/L: continue
->5.3mmol/L: Increase dose of binder.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How often are the K+ levels assessed after the patient is stable on K+ binders?
Monthly
26
At what K+ level should you consider deprescribing K+ binders?
<5mmol/L without ongoing agents acting on RAS.
27
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.
28
What does a low Hb level indicate?
Patient has anaemia.
29
What is HCT? (2)
A.K.A. Haematocrit Indicates RBC proportion that make up the blood pool.
30
What is MCV? (2)
A.K.A. Mean Cell Volume Average size of RBC.
31
What is MCH? (2)
Mean Corpuscular Haemoglobin Average amount of Hb in RBC.
32
What is MCHC? (2)
Mean Corpuscular Haemoglobin Concentration Average conc. of Hb inside an average sized cell.
33
What main parameter indicates that the patient is suffering from microcytic/macrocytic anaemia? (2)
High MCV = Macrocytic Low MCV = Microcytic
34
What key parameters indicate the patient is suffering from microcytic anaemia? (3)
Low: - RBC - Hb - MCV
35
What is the common cause of microcytic anaemia?
Iron Deficiency Anaemia
36
What are causes of iron deficiency anaemia? (3)
1. Inadequate diet 2. Deficient Absorption 3. Blood loss: - Menorrhagia - GI bleeding e.g. oesophagitis, peptic ulcer, carcinoma, colitis, diverticulitis or haemorrhoids.
37
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
38
How much should haemoglobin rise over a 3-4 week period in microcytic anaemia?
20g/L
39
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.
40
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.
41
What is the key parameter that indicates the patient has macrocytic anaemia? (1)
MCV is raised.
42
What are the key parameters that indicate vitamin B12/folate deficiency? (2)
Raised MCV Low Haemoglobin
43
What are the common signs and symptoms that indicate macrocytic anaemia? (6)
Tiredness Weakness Dyspnoea Sore Red Tonuge Diarrhoea Mild Jaundice
44
Explain the management process for folate deficiency macrocytic anaemia. (1)
Give oral folic acid 5mg daily.
45
Explain the management process for B12 deficiency macrocytic anaemia. (3)
1. Replenish stores with hydroxocobalamin: - 1mg IM alternate days for 2 weeks. - Maintenance 1mg IM every 3 months for life.
46
Which other type of patients can also get macrocytic anaemia?
High, chronic alcohol intake. - Hb + RBC is normal - MCV is raised
47
What is aplastic anaemia? (1)
1. Aplasia of the bone marrow i.e. pancytopenia.
48
What is Haemolytic anaemia? (1)
Accelerated RBC destruction.
49
Give e.g. of cases that causes haemorrhage leading to anaemia. (3)
Trauma GI bleed Surgery
50
Give e.g. of chronic diseases that can cause anaemia. (3)
Carcinoma RA Renal Failure
51
What is another name for white blood cells?
Leucocytes
52
What are the 5 types of white cells in the peripheral blood?
Neutrophils (70%) Eosinophils (2%) Basophils (<1%) Lymphocytes (20%) Monocytes (7%)
53
What is the main function of neutrophils? (1)
Ingest + kill bacteria, fungi and damaged cells.
54
What type of infection causes a rise in neutrophil levels? (1)
A.K.A. Neutrophilia occurs in bacterial infections.
55
What type of infections cause reduced levels of neutrophils? (2)
A.K.A. Neutropenia Occurs in viral infections, acute leukaemia.
56
What is a C-reactive protein (CRP)? (3)
1. Protein produced in acute phase response. 2. Synthesised in the liver. 3. Rises within 6 hrs of an acute event.
57
What is the main function of the platelets?
Causes mechanical plugging of haemorrhoage and start coagulation.
58
What factors can cause a rise in platelet count (thrombocytosis)? (3)
Malignant disease Autoimmune disease Inflammation
59
What factors can cause low platelet count (thrombocytopenia)? (2)
Drugs Leukaemia
60
What is Erythrocyte Sedimentation Rate (ESR)? (2)
Measure of acute phase response. Used to monitor chronic inflammatory conditions.
61
What pathological processes can occur that affect the ESR? (5)
Immunological Infective Ischaemic Malignant Traumatic