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### > Week 9: Biochemical Tests 2 > Flashcards

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

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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

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3
Q

What is the reference range for Calcium?

A

2.2-2.6mmol/L

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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

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5
Q

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

A

Malignancy
Hyperparathyroidism
Hyperthyroidism
Dehydration

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6
Q

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

A

> 2.65mmol/L

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7
Q

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

A

> 3.75mmol/L = risk of MI.

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8
Q

How should hypercalcemia be managed? (2)

A
  1. Fluids
  2. If no response, IV Bisphosphonates.
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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

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10
Q

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

A

Diuretics
Liver Disease
Diarrhoea

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11
Q

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

A

Renal impairment

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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.

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13
Q

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

A

Appetite Loss
Nausea
Vomiting
Increased Fatigue

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14
Q

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

A

GI disease
T2DM
Alcohol dependence
Older adults

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15
Q

Explain the main functions of phosphate. (3)

A

Maintains energy levels.
Muscle and nerve function
Bone growth

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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

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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)

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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)

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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.

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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.

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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.

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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)

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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.

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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.

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25
Q

How often are the K+ levels assessed after the patient is stable on K+ binders?

A

Monthly

26
Q

At what K+ level should you consider deprescribing K+ binders?

A

<5mmol/L without ongoing agents acting on RAS.

27
Q

What are the main functions of red blood cells? (4)

A

Carries oxygen to the tissues.
Returns C02 from tissues.
Carries haemoglobin in the blood.
Most abundant cell in the blood.

28
Q

What does a low Hb level indicate?

A

Patient has anaemia.

29
Q

What is HCT? (2)

A

A.K.A. Haematocrit
Indicates RBC proportion that make up the blood pool.

30
Q

What is MCV? (2)

A

A.K.A. Mean Cell Volume
Average size of RBC.

31
Q

What is MCH? (2)

A

Mean Corpuscular Haemoglobin
Average amount of Hb in RBC.

32
Q

What is MCHC? (2)

A

Mean Corpuscular Haemoglobin Concentration
Average conc. of Hb inside an average sized cell.

33
Q

What main parameter indicates that the patient is suffering from microcytic/macrocytic anaemia? (2)

A

High MCV = Macrocytic
Low MCV = Microcytic

34
Q

What key parameters indicate the patient is suffering from microcytic anaemia? (3)

A

Low:
- RBC
- Hb
- MCV

35
Q

What is the common cause of microcytic anaemia?

A

Iron Deficiency Anaemia

36
Q

What are causes of iron deficiency anaemia? (3)

A
  1. Inadequate diet
  2. Deficient Absorption
  3. Blood loss:
    • Menorrhagia
    • GI bleeding e.g. oesophagitis, peptic ulcer, carcinoma, colitis, diverticulitis or haemorrhoids.
37
Q

Explain the management of iron deficiency anaemia. (3)

A

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
Q

How much should haemoglobin rise over a 3-4 week period in microcytic anaemia?

A

20g/L

39
Q

How often should the haemoglobin be checked in microcytic anaemia? (3)

A

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
Q

Why is it important to take a thorough medication history for patients who present with iron deficiency anaemia? (2)

A

NSAIDs and warfarin can cause GI bleeding.

41
Q

What is the key parameter that indicates the patient has macrocytic anaemia? (1)

A

MCV is raised.

42
Q

What are the key parameters that indicate vitamin B12/folate deficiency? (2)

A

Raised MCV
Low Haemoglobin

43
Q

What are the common signs and symptoms that indicate macrocytic anaemia? (6)

A

Tiredness
Weakness
Dyspnoea
Sore Red Tonuge
Diarrhoea
Mild Jaundice

44
Q

Explain the management process for folate deficiency macrocytic anaemia. (1)

A

Give oral folic acid 5mg daily.

45
Q

Explain the management process for B12 deficiency macrocytic anaemia. (3)

A
  1. Replenish stores with hydroxocobalamin:
    - 1mg IM alternate days for 2 weeks.
    - Maintenance 1mg IM every 3 months for life.
46
Q

Which other type of patients can also get macrocytic anaemia?

A

High, chronic alcohol intake.
- Hb + RBC is normal
- MCV is raised

47
Q

What is aplastic anaemia? (1)

A
  1. Aplasia of the bone marrow i.e. pancytopenia.
48
Q

What is Haemolytic anaemia? (1)

A

Accelerated RBC destruction.

49
Q

Give e.g. of cases that causes haemorrhage leading to anaemia. (3)

A

Trauma
GI bleed
Surgery

50
Q

Give e.g. of chronic diseases that can cause anaemia. (3)

A

Carcinoma
RA
Renal Failure

51
Q

What is another name for white blood cells?

A

Leucocytes

52
Q

What are the 5 types of white cells in the peripheral blood?

A

Neutrophils (70%)
Eosinophils (2%)
Basophils (<1%)
Lymphocytes (20%)
Monocytes (7%)

53
Q

What is the main function of neutrophils? (1)

A

Ingest + kill bacteria, fungi and damaged cells.

54
Q

What type of infection causes a rise in neutrophil levels? (1)

A

A.K.A. Neutrophilia
occurs in bacterial infections.

55
Q

What type of infections cause reduced levels of neutrophils? (2)

A

A.K.A. Neutropenia
Occurs in viral infections, acute leukaemia.

56
Q

What is a C-reactive protein (CRP)? (3)

A
  1. Protein produced in acute phase response.
  2. Synthesised in the liver.
  3. Rises within 6 hrs of an acute event.
57
Q

What is the main function of the platelets?

A

Causes mechanical plugging of haemorrhoage and start coagulation.

58
Q

What factors can cause a rise in platelet count (thrombocytosis)? (3)

A

Malignant disease
Autoimmune disease
Inflammation

59
Q

What factors can cause low platelet count (thrombocytopenia)? (2)

A

Drugs
Leukaemia

60
Q

What is Erythrocyte Sedimentation Rate (ESR)? (2)

A

Measure of acute phase response.
Used to monitor chronic inflammatory conditions.

61
Q

What pathological processes can occur that affect the ESR? (5)

A

Immunological
Infective
Ischaemic
Malignant
Traumatic

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