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The One Deck To Rule Them All > Biochemistry: U&Es > Flashcards

Biochemistry: U&Es Flashcards

1
Q

Muscle weakness
Cramps
Cardiac arrhythmia
Ascending paralysis

A

Hypokalaemia

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2
Q

Causes of hypokalaemia

A

With HTN:

  • Cushing’s syndrome
  • Conn’s syndrome (Primary hyperaldosteronism)
  • Liddle’s syndrome

Without HTN:

  • Diuretics
  • Vomiting + Diarrhoea
  • RT Acidosis (T1 + T2)
  • Bartter’s syndrome (kidney disease)
  • Gitelman syndrome (kidney disease)
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3
Q

ECG changes in hypokalaemia

A 
Torsades de pointes 
U waves
T wave inversion 
ST depression
Prolonged QT
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4
Q

Management of hypokalaemia

A

IV Saline + Potassium (over 4 hours)

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5
Q

ECG changes in hyperkalaemia

A

Tall-tented T waves (anterior leads)
Small P waves
Wide QRS

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6
Q

Causes of hyperkalaemia

A 
AKI 
RT Acidosis (T4)
Metabolic acidosis 
Addison's 
Rhabdomyolysis 
Blood transfusion
Drugs 
Food
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7
Q

Drug causes of hyperkalaemia

A
  • Diuretics
  • ACE Is
  • ARBs
  • Spironolactone
  • Ciclosporins
  • Heparin
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8
Q

Food causes of hyperkalaemia

A
  • Bananas
  • Kiwis
  • Avocados
  • Spinach
  • Tomato
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9
Q

How to stabilise cardiac membrane during hyperkalaemia

A

Calcium gluconate

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10
Q

Shifts potassium from extracellular to intracellular

Short term management

A

Insulin + dextrose infusion

Nebulised salbutamol

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11
Q

Removes potassium from body

A

Calcium resonium
Loop diuretics
Dialysis

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12
Q

Peri-oral parasthesia
Tetany (muscle twitching, cramps)
Depression
Cataracts

A

Hypocalcaemia

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13
Q

2 signs seen in hypocalcaemia

A

Trousseau’s sign
- carpal spasm when taking BP

Chvostek’s sign
- tapping on facial nerve anterior to the ear induces twitching of the facial muscles due to hyper-excitability

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14
Q

ECG changes in hypocalcaemia

A

Prologned QT
Torsades de pointes
AF

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15
Q

Causes of hypocalcaemia

A 
Osteomalacia (Vit D deficiency)
CKD
Hypoparathyroidism
Pseudo-hypoparathyroidism 
Rhabdomyolysis
Mg deficiency 
Blood transfusion 
Acute pancreatitis 
Respiratory alkalosis
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16
Q

Management of hypocalcaemia

A 
Calcium gluconate (IV)
 - 10ml of 10% solution over 10 mins
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17
Q 
Renal stones
Painful bones
Abdominal groans
Psychiatric moans 
Thrones (polyuria + polydipsia)
A

Hypercalcaemia

  • Stones, bones, groans, moans and thrones (toilet)
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18
Q

Causes of hypercalcaemia

A 
Primary hyperparathyroidism 
Malignancy 
  - myeloma
  - Squamous cell lung cancer
Sarcoidosis 
Hyperthyroidism 
Thiazide diuretics
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19
Q

Management of hypercalcaemia

A
  1. Rehydration (3L per day)
    IV 0.9% saline
  2. Biphosphonates
      • IV Pamidronate
      • Calcitonin (salmon)
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20
Q

Tetany
seizures
arrhythmias

A

Hypomagnesaemia

21
Q

Causes of Hypomagnesaemia

A

PPIs

Diuretics

22
Q

ECG changes of Hypomagnesaemia

A

Prolonged QT

Torsades de pointes

23
Q

Management of Hypomagnesaemia

A

IV Magnesium over 24 hours

- can cause diarrhoea

24
Q

Hypophosphataemia can lead to

A 
RBC haemolysis
WBC + PLT dysfunction 
Muscle weakness
Rhabdomyolysis
CNS dysfunction
25
Q

Causes of hypophosphataeamia

A 
DKA
Alcohol excess
Acute liver failure
Re-feeding syndrome
Primary hyperparathyroidism 
Osteomalacia
26
Q

Management of hypophosphataemia

A

Phosphate sandoz

27
Q

Management of hyperphosphataemia

A 
Bi-phosphonates 
Calcium acetate (calcium-phosphate binder)
28
Q

Need for calcium in body

A

Contributes to muscle function

  • skeletal muscles
  • heart
  • also affects nerves
29
Q

Symptoms of mild - moderate hyponatraemia

A 
Nausea + vomiting 
Dizziness
Confusion 
Headache 
Muscle cramps
30
Q

Symptoms of severe hyponatraemia

A

Seizures
Coma
Respiratory arrest

31
Q

Causes of hyponatraemia

- urinary sodium > 20mmol/L

A

Hypovolaemia, renal loss, depletion:

  • Diuretics
  • Addison’s
  • Renal failure

Euvolaemic

  • SIADH
  • hypothyroidism
32
Q

Causes of hyponatraemia

- urinary sodium < 20mmol/L

A

Depletion, extra-renal loss:

  • Diarrhoea + vomiting
  • Sweating
  • Burns
  • Rectal adenoma

Hypervolaemic (water excess)

  • Secondary hyperaldosteronism (HF + liver cirrosis)
  • Nephrotic syndrome
  • IV Dextrose
  • Psychogenic polydipsia
33
Q

Management for mild hyponatraemia (130-134)

A

Fluid restriction <800ml/day + loop diuretics

34
Q

Management for moderate hyponatraemia (120-129)

A

Hypertonic saline (2.7%) slow infusion

35
Q

Management for severe hyponatraemia (<120)

A

Bolus hypertonic saline + Vasopressin (ADH receptor agonist)

36
Q

Side effects of correcting sodium levels quickly

A

Osmotic demyelinationation syndrome

“central pontine myelinosis”

37
Q

Spastic quadriceps
Pseudobulbar palsy
Emotional lability

A

Osmotic demyelinationation syndrome

“central pontine myelinosis”

38
Q

Causes of pseudo-hyponatraemia

A

Hyperlipidaemia (increase serum volume)
Blood taken from arm with recent IV fluids
Donating blood

39
Q 
Jittery movements 
Increased muscle tone
Hyperreflexia 
Convulsions 
Drowsiness
Coma
A

Hypernatraemia

40
Q

Causes of hypernataemia

A

Due to dehydration

  • fever
  • hot environment
  • diarrhoea
  • vomiting
  • diabetes insipidus
41
Q

Management for moderate hypernatraemia (150-169)

A

Replace deficit slowly over 48 hours

42
Q

Management for mild hypernatraemia (146-149)

A

Manage underlying cause

43
Q

Management for severe hypernatraemia (>170)

A

IV Fluids

44
Q

Side effects of hypernatraemia management

A

Can cause cerebral oedema

  • bradycardida
  • gaze paresis
45
Q

Hyponatraemia caused by dilution effects of excessive water retention

A

Syndrome of inappropriate ADH secretion (SIADH)

46
Q

Causes of SIADH

A 
Cancer
 - Small cell lung cancer (ectopic SIADH)
 - Prostate 
 - Pancreas 
Neuro
 - stroke
 - SAH
 - Subdural haematoma
- Meningitis/ encephalitis
Porphyrias 
Drugs
47
Q

Drug causes of SIADH

A 
Sulphonylureas 
SSRIs
Carbamazepine 
Tricyclic Antidepressants
Vincristine 
Cyclophosphamide
48
Q

Management of SIADH

A

Fluid restriction
Demeclocycline
ADH Receptor blockers (Tolvaptan)

49
Q

Name an ADH receptor blocker

A

Tolvaptan

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