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MBBS - Year 3 > Urology - Water and Electrolytes > Flashcards

Urology - Water and Electrolytes Flashcards

1
Q

What are the 5 Rs for IV fluid prescription

A

Resuscitation
Routine Maintenance
Replacement
Redistribution
Reassessment

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2
Q

What is resuscitation

A

give IV fluid to patients who are in shock or have hypovolaemia

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3
Q

what is routine

A

for patients that are nil by mouth or in coma

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4
Q

what is replacement

A

excessive fluid loss - i.e. vominting, diarrhoes

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5
Q

what is redistribution

A

Internal fluid loss - pleural effusion, oedema etc, common in sepsis - fluid leak into interstitial compartment

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6
Q

what is reassessment

A

always reassess to see if its working or if more is needed

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7
Q

when is resuscitation needed

A

for hypovolaemic and are haemodynamically unstable

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8
Q

what is shock

A

inadequate perfussion of tissues

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9
Q

what are the signs of clinical shock

A

Low SBP (<100mmHg) - cool peripheries
Tachycardia (>90bpm) - high or deteriorating EWS
Tachypnoea (>20rpm) - Responce to PLR
Delayed CRT - confusion/decreased LOC

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10
Q

what is the optimal fluid and rate for resuscitation

A

need sodium to match patient
saline or hartmans (130-154mmol/L)
use bolus doeses - 500mL over 15mins
then further doses of 250-500mL up to 2000mL

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11
Q

what is the difference between hartmans and saline

A

Hartman’s has potassium 5mmol and bicarb 20mmol. plus others such as calcium and magnesium

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12
Q

what is the difference between crystaloids and colloids

A

colloids are starch based - more expensive and has shown to be not as good - NO colloids for recuss

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13
Q

what is needed to take in over 24hrs for routine management

A

Sodium ~1-2 mmol/kg/day
Potassium ~1-2 mmol/kg/day
Chloride ~1-2 mmol/kg/day
Glucose 50-100 g/day (= 200-400 kCal)
Water 25-30 ml/kg/day

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14
Q

fluid volume and rate depends of weight and rate. for Kg of 65-75 what is the volume and rate

A

2,100mL at 85mL/hr

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15
Q

what is mainly lost in upper GI

A

tends to be vomiting - very chloride and potassium rich

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16
Q

what is lower GI loss

A

loss of small K+ and Cl-. therefore hartmans is ok

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17
Q

when do you reasess

A

after 15mins
24hrs for routine

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18
Q

what si the normal concentration of HAS used in sepsis and resess

A

4.2%

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19
Q

what in 20% HAS used

A

paracentisis - large vloume of albumin rich is lost

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20
Q

how much fluid is in 1 packed red cell bag

A

1 unit is 280mL

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21
Q

what are some serous issues with transfusions

A

Febrile, Allergic and Hypotensive Reactions
Haemolytic Transfusion Reactions (Acute/Delayed)
Post-Transfusion Purpura (due to thrombocytopaenia)
Transfusion-Associated Circulatory Overload (TACO)
Transfusion-Associated Dyspnoea (TAD)
Transfusion-Related Acute Lung Injury (TRALI)
Transfusion Transmitted Infections
Graft vs. Host Disease
Uncategorised (e.g. necrotising enterocolitis)

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22
Q

what is platelt shelf life and composition

A

pooled or single donor
shelf life - 5-7 days

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23
Q

how much volume is in Fresh frozen plasma

A

300mL

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24
Q

what is in cryoprecipitate

A

Fibrinogen, Factors VIII and XIII, and von Willebrand Factor

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25
Q

what is the east of england major haemorrhage protocol

A
  1. Get senior help
  2. Guidance as to what should make you suspect massive haemorrhage
  3. Initial resuscitation is still with IV fluids: crystalloid or colloid, it doesn’t matter, bleeding out = death otherwise
  4. Major Haemorrhage Pack1 = Blood + FFP, Pack 2 = Blood + FFP + Platelets + Cryo
  5. Stop the bleeding! (= senior help)
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26
Q

what do you give for hyponatraemia

A

check is symptomatic - confusion etc
treated in ICU
give NaCl slowly

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27
Q

what do you give for diabetes

A
  1. Normal saline
  2. initial bolus of 500ml-1L, then the first hourly bag do not contain KCl
  3. If BP remains low despite initial boluses escalate immediately
  4. Every bag after this should have potassium added as long as serum K+ ≤ 5.5:
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28
Q

what do you give for AKI

A

Sepsis and hypovolaemia – ABCDE care
Toxicity – Drugs, poisons, and iodinated contrast media
Obstruction – Bladder outflow or ureteric, +/- associated infection
Primary Renal Disease – e.g. nephritic and nephrotic syndromes

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29
Q

what % of total body calcium is in bone

A

99%

30
Q

what is the noraml serum calcium levels

A

2.2-2.6mmol/L

31
Q

what is the corrected serum calcium equation

A

corrected calcium (mmol/L) = Ca measured (mmol/L) + 0.020 or 0.025 (40 - albumin (g/L)

32
Q

protein bound calcium is not excreted by the kidneys
true or false

A

true

33
Q

what is the normal dietary intake of calcium

A

700-1000mg

34
Q

what regulates calcium reabsorbption

A

PTH
Vitamin D
Calcitonin

35
Q

what is some of the functions of calcium

A

bone structure, nerves, woulnd healing, muscle contraction etc

36
Q

how is calcium regulated by PTH

A

acts via G protein couped receptor:
stimulate osteoclast
inreases serum calcium

37
Q

do PTH and calcitonin both have the same effect

A

PTH and calcitonin have opposite actions

38
Q

does serum calcium increase or decrease serum calcium

A

calcitonin reduces serum calcium

39
Q

what is the chemical name of vit D

A

25 hydroxylation - 1,25 DHCC

40
Q

how does liver disease cause reduced vit D

A

liver makes vit D precurser

41
Q

what are some causes of hypocalcaemia

A

hypoparathyroidism, Vit D deficiency, fat embolism, hyperphosphataemia, rhabdomyolysis, pancreatitis, transfusion leading to rapid infusion of albumin

42
Q

**what are 2 signs of hypocalcaemia

A

chvostek sign
trousseau sign

43
Q

what are some signs and symptoms of hypocalcaemia

A

muscle cramp, seizures, bronchospasms, long QT syndrome, heart failure, cataracts, altered mental status, personality disturbance

44
Q

what is commonly in exam qusetins

A

chvostek sign
trousseau sign

45
Q

what is chvosek sign

A

tap facial nerve and facial spasm will occur on same side

46
Q

what is trousseaus sign

A
47
Q

what are some causes of hypercalcaemia

A

maligancy, sarcoidosis, thiazides, renal failure

48
Q

how does renal failure cause high calcium

A

increase PTH

49
Q

how do thiazides cause increased calcium

A

increases ca reabsorbsion in proximal tubule

50
Q

forusamide is used for what

A

loop diuretic - increases calcium secreted - hypercalcaemia

51
Q

signs and symptoms of hypercalcaemia

A

muscle shock, fatigue, short QT, pancreatitis, polyuria (DI, ARF, CKD),

52
Q

management of hypercalcaemia

A

hydration
lower serum calcium - furousamide
give bisphosphonate

53
Q

what is normal plasma potassium levels

A

3.5-5mmol/L

54
Q

what is potassium used for

A

cellular membrane potential, acid-base homeostasis, vascular tone, hormone secretion, glucose and insulin metabolism

55
Q

how does the body regulate potassium

A

depends on age
90-95% excreted, transcellular potassium shift

56
Q

how is potassium maintained in homeostasis

A
57
Q

what is cellular potassium shift

A

insulin drives potassium into the cells

58
Q

what is treatment for high potassium

A

high potassium in blood treatment is insulin and beta agonism (salbutamol)

59
Q

where is the majority of potassisum reabsorbed

A

65-70% at proximal tubule by passive trasport
10-25% in thick ascending limb of Henle - NKCC2 chanel
fine adjustment in collecting tubule

60
Q

how do new diuretcs act - furosamide

A

inhibits NKCC2 cjhnel so calcium cannot get into tubule cell

61
Q

what 3 things cause K to enter cells

A

concentration gradient - K+ driven to blood
electrical gradient
K+ permeability (how many K+ channels are open)

62
Q

what are the 4 factors which regulate potassium

A

aldosterone, plasma K, distal flow rate, distal Na delivery

63
Q

easiest way to get low potassium

A

alot of urine

64
Q

what is the max potassium flow rate

A

20mmol/hr
NEVER reach this
40mmol in 6-8hrs is normal

65
Q

what is cardioplegia

A

stopping the heart intentially - e.g. heart transplant - give a lot of potassium

66
Q

causes of high potassium

A

heparin, increased intake, ACE inhibitors, spironalactone, cyclosporin, trimethoprim

67
Q

management of hyperkalaemia

A

1st calcium gluconate - to protect heart
insulin and glucose
albuterol
furosemide
sodium bicarbonate

68
Q

ECG findings of hyperkalaemia

A

tall T wave
small/absent p wave
ST depression
prolonged QRS

69
Q

56 years old Mr John is referred by his GP to the clinic after he has found potassium of 6.3 on his routine bloods. He was recently started on Ramipril 5mg by his GP for HTN.
Likely cause
What are the management steps?

A

ramipril
stop ramipril
treat calcium gluconate and

70
Q

what is the first line radiological investigation

A

Ultrasound
safe, cheap and can tell acute, chronic or obstruction

71
Q

what is the normal size of the kidney

A

fist - 10-12cm

72
Q
A

MBBS - Year 3 (13 decks)

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