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senior clerkship lectures > Critical value and management priority Laboratory Emergency > Flashcards

Critical value and management priority Laboratory Emergency Flashcards

1
Q

what is the key advantage of the POCT ?

A

turnaround time is the key advantage of point of care testing

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2
Q

what is the main cause of diabetes insipidus ?

A

hyposecretion of ADH

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3
Q

what does ADH do ?

A

causes the kidney to release less water

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4
Q

what is the sodium level in DI ?

A

hypernatremia

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5
Q

what is the relationship between ADH and sodium levels ?

A

inversely proportional

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6
Q

what are the classifications of diabetes insipidus ?

A

cranial - decreased ADH secretion
nephrogenic - resistance to ADH
gestational - degradation of ADH
primary polydipsia - deficit in osmoregulation of thirst

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7
Q

what is the presentation of diabetes insipidus ?

A

polyuria - more than 3 litres a day
chronic thirst
nocturia
bladder can be grossly enlarged and palpable

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8
Q

what investigations are required for the diagnosis of diabetes insipidus ?

A

Biochem: plasma glucose
sodium U+E
urine specific gravity
plasma and urine osmolality

24 hour urine collection

fluid deprivation test

MRI of the pituitary

Renal US

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9
Q

what is the normal osmolality of urine ?

A

300-800

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10
Q

if the urine osmolality increases after the desmopressin test what is the most likely diagnosis in relation to DI ?

A

cranial DI

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11
Q

if the urine osmolality does not increase after the desmopressin test what is the most likely diagnosis ?

A

nephrogenic DI

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12
Q

if the urine osmolality is higher than 800 in both the fluid deprivation test and in the desmopressin test what is the most likely diagnosis ?

A

primary polydipsia

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13
Q

what is the level at which we diagnose hypercalcemia ?

A

more than 2.6 mmol on two occasions following correction of serum albumin concentration

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14
Q

what are the different classifications of hypercalcemia ?

A

mild - 2.6 - 3

moderate - 3.01 - 3.4

severe - more than 3.4

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15
Q

what are the most common causes of hypercalcemia ?

A

malignancy
primary hyperparathyroidism

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16
Q

what drugs cause hypercalcemia ?

A

thiazide diuretics
lithium
vitamin d and a

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17
Q

what could affect the calcium levels while taking a blood sample ?

A

prolonged tourniquet

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18
Q

what are the clinical features of hypercalcaemia ?

A

arrhythmia
ECG
moans
bones
stones
psychic overtones

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19
Q

patient comes with chest symptoms, increased serum ACE and hypercalcemia what is the most likely diagnosis ?

A

sarcoidosis

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20
Q

what is the treatment for hypercalcemia ?

A

IV crystalloids and correction of hypovolemia
bisphosphonates may be used
calcitonin as a second line

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21
Q

what are the stages of acute kidney injury?

A

stage 1 - more than 0.3 increase in create within 48 hours or 1.5 to 1.9 folds increase within 7 days

stage 2 - 2 to 3 fold increase of creatinine from baseline in 7 days

stage 3 - more than 4 mg increase or more than 3 fold increase from baseline in 7 days plus anuria for 12 hours

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22
Q

what are the stages of AKI ?

A

onset phase
oliguric phase
diuretic phase
recovery phase

23
Q

patient complaining of GERD and comes with signs of hypercalcemia what is thee most likely diagnosis ?

A

milk-alkali syndrome

24
Q

what is the biochemistry in renal AKI vs pre renal AKI ?

A

in pre renal :
U:Cr - > 40: 1
BUN:Cr - > 20:1

in intrinsic :
U:Cr - < 40:1
BUN:Cr - < 20:1

25
Q

what are the biochemical changes in plasma in AKI ?

A

everything is increased except
sodium bicarbonate and calcium

26
Q

what does an AKI with a negative urinalysis indicate ?

A

usually indicates a prerenal cause but drugs must still be considered

27
Q

which diuretics cause potassium loss and which don’t ?

A

1- loop cause potassium loss in the urine
2- aldosterone antagonists liike spironolactone cause hyperkalemia

28
Q

what are the main causes of hyperkalemia ?

A

1- decreased urinary excretion ( drugs, addisons, renal failure )
2- extracellular shift

29
Q

what are the causes of extracellular shift in hyperkalemia ?

A

insulin deficiency
beta blocker
digoxin

30
Q

what drugs cause hyperkalemia ?

A

ACE inhib
ARBS
spironolactone

31
Q

what falls under renal failure in the causes of hyperkalemia ?

A

rhabdomyolysis
tumor lysis syndrome

32
Q

what are the ECG changes in hyperkalemia ?

A

peaked T wave
widening of the QRS complex

33
Q

what is the algorithm for investigation of hyperkalemia ?

A

find if its an artifact first
check if the patient is on potassium raising medications
AKI or CKD ?
if not consider extracellular shifts

34
Q

what are the 3 treatment ideas associated with hyperkalemia ?

A

cardio-protective
causing intra-cellular shift
increasing potassium loss

35
Q

what are the treatments for each treatment idea in hyperkalemia ?

A

cardioprotective - if there are any ECG changes then give calcium gluconate

what are the drugs that cause intracellular shift - sodium bicarb, insulin and dextrose, beta 2 agonist ( inhalation )

methods to increase potassium loss - loop diuretic , cation exchange, dialysis

36
Q

hyponatremia with a normal plasma osmolality differential ?

A

artifactual hyponatremia
appropriate hyponatremia

37
Q

what are the risk factors for acute pancreatitis ?

A

hypertriglyceridemia
hypercalcemia
ERCP
Surgery

38
Q

what is classic presentation of acute pancreatitis ?

A

epigastric pain radiating to the back
which is relieved by leaning forward

39
Q

investigations for acute pancreatitis ?

A

amylase, lipase (more specific)

40
Q

what is the management of acute pancreatitis ?

A

fluid resus

41
Q

what is myoxedema coma ?

A

a severe complication of hypothyroidism

42
Q

what is the classic presentation of myxedema coma ?

A

An obese elderly woman with yellowish skin, a hoarse voice, a large tongue, thin hair, puffy eyes, ileus, and slow reflexes.

anterior neck scar may be present

43
Q

what is the management for myxedema coma ?

A

L-thyroxine 0.2-0.5 mg IV bolus, followed by 0.1 mg IV OD until oral therapy is tolerated

44
Q

what is the cause of adrenal insufficiency ?

A

adrenal crisis is due to insufficient cortisol

45
Q

when is adrenal insufficiency seen ?

A

in addison’s

46
Q

what is the clinical picture of adrenal insufficiency ?

A

increased skin pigmentation
hypotension
hyponatremia
hyperkalemia
increased ACTH

47
Q

what are the triggers for adrenal crisis ?

A

1- following stress
2- sudden withdrawal of adrenocortical hormone
3- bilateral adrenalectomy

48
Q

how is a diagnosis of adrenal insufficiency made ?

A

An ACTH (Short Synacthen) test
avoid hydrocortisone before the test by 8 hours

49
Q

what would be a positive synacthen test ?

A

normally thee cortisol level should rise to 20
below it keda positive

50
Q

what are the signs associated with acute pancreatitis ?

A

grey turner’s
cullen’s sign
fox signw

51
Q

what are the ABG findings associated with aspirin overdose ?

A

acute overdose is followed by respiratory alkalosis due to hyperventilation followed by metabolic acidosis

52
Q

what is an important cause of tetany ?

A

hypomagnesiumenimea

53
Q

what is the most likely cause of tetany in a patient with chronic pancreatitis ?

A

hypokalemic alkalosis

senior clerkship lectures (25 decks)

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