Y2 IMBALANCES OF ELECTROLYTES, METABOLITES, HORMONES ETC.

Question 1

Symptoms of hyponatraemia.

Answer 1

• altered conscious.
• confusion
• nausea
• vomiting
• fitting

same as hypernatraemia

Question 2

symptomatic hyponatraemia is?

Answer 2

life-threatening

Question 3

loss/gain of Na+ is from the?

Answer 3

ECF only

Question 4

Na+ is confined to the?

Answer 4

ECF

Question 5

if ECF volume is too high?

Answer 5

kidneys excrete Na+ which is followed by water.

Question 6

if ECF volume is too low?

Answer 6

kidneys retain Na+ to retain water

Question 7

by what two mechanisms does hyponatraemia develop?

Answer 7

• reduced sodium

- increased water

Question 8

how do you treat hyponatraemia?

Answer 8

• if due to too little sodium, give the patient sodium.

- if due to too much water, restrict fluids.

Question 9

sodium is controlled by?

Answer 9

mineralocorticoid activity

Question 10

how does mineralocorticoid control sodium?

Answer 10

sodium is retained in exchange for potassium +/or hydrogen ions.

Question 11

which steroids have mineralocorticoid activity?

Answer 11

• aldosterone.

- cortisol.

Question 12

excess mineralocorticoid activity causes?

Answer 12

sodium retention

+ thus water retention

Question 13

little mineralocorticoid activity causes?

Answer 13

sodium loss

+ thus water loss

Question 14

ADH is released?

Answer 14

by the posterior pituitary in response to stimuli.

Question 15

ADH acts on the?

Answer 15

renal tubules

Question 16

ADH acts on the renal tubules to cause?

Answer 16

water reabsorption - i.e. anti-diuresis.

Question 17

increased ADH causes?

Answer 17

concentrated urine i.e. water retention

Question 18

reduced ADH causes?

Answer 18

dilute urine i.e. water loss

Question 19

the concentration of urine is assessed as?

Answer 19

urine osmolality

Question 20

concentrated urine can be described in terms of osmolality as?

Answer 20

high osmolality

Question 21

dilute urine can be described in terms of osmolality as?

Answer 21

low osmolality

Question 22

another name for ADH?

Answer 22

arginine vasopressin

Question 23

how does ADH cause water reabsorption?

Answer 23

countercurrent multiplication

Question 24

in SIADH what is meant by inappropiate?

Answer 24

inappropiate with regards to the osmolal state

Question 25

what may cause reduced H2O loss?

Answer 25

SIADH

Question 26

symptoms of hypernatraemia?

Answer 26

• altered conscious.
• confusion
• nausea
• vomiting
• fitting

same as hyponatraemia

Question 27

what causes hypernatraemia?

Answer 27

• increased Na+ intake
• reduced Na+ loss
• increased H2O loss
• reduced H2O intake

Question 28

what are causes of increased Na+ intake?

Answer 28

• IV meds
• near-drowning
• malicious

Question 29

what causes increased H2O loss?

Answer 29

diabetes insipidus

Question 30

when water is lost, which compartment does the majority come from?

Answer 30

ECF

Question 31

hypernatraemia is commonly seen in?

Answer 31

diabetic ketoacidosis.

- esp. if vomiting.

Question 32

management of hypernatraemia?

Answer 32

• if due to too little water: give them some water.

- if due to excess sodium: give them a loop diuretic.

Question 33

oedema is a sign of?

Answer 33

effective circulating vascular volume depletion.

• body secretes ADH and aldosterone to try and restore volume but most retained water just ends up in interstitial fluid, making the problem worse.

Question 34

what can be inferred from a patient with oedema?

Answer 34

they have too much water and sodium

Question 35

management of oedema?

Answer 35

loop diuretic e.g. furosemide

Question 36

hyponatraemia, hyperkalaemia and hypoglycaemia are suggestive of ?

Answer 36

adrenal insufficiency

Question 37

symptoms of hypercalcaemia?

Answer 37

• dehydration, confusion and polyuria (excessive thirst).

bones, groans, stones and psychic moans.
i.e. osteopenia/fractures, abdominal pain (pancreatitis, ulcers), renal stones, depression.

Question 38

symptoms of hypocalcaemia?

Answer 38

• paraesthesia
• muscle cramps/weakness or tetany,
• fatigue
• bronchopasm or laryngospasm
• fits

Question 39

signs of hypocalcaemia?

Answer 39

• chvostek’s sign (tap over facial nerve causes tetany).
• trousseau sign (carpopedal spasm -hands/wrist, feet/ankle)
• ECG: QT prolonged