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 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? (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? (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 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.