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

Biochemistry: U&Es Flashcards

(49 cards)

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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

Study These Flashcards
A

Hypomagnesaemia

21
Q

Causes of Hypomagnesaemia

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A

PPIs

Diuretics

22
Q

ECG changes of Hypomagnesaemia

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A

Prolonged QT

Torsades de pointes

23
Q

Management of Hypomagnesaemia

Study These Flashcards
A

IV Magnesium over 24 hours

- can cause diarrhoea

24
Q

Hypophosphataemia can lead to

Study These Flashcards
A 
RBC haemolysis
WBC + PLT dysfunction 
Muscle weakness
Rhabdomyolysis
CNS dysfunction
25
Causes of hypophosphataeamia
``` DKA Alcohol excess Acute liver failure Re-feeding syndrome Primary hyperparathyroidism Osteomalacia ```
26
Management of hypophosphataemia
Phosphate sandoz
27
Management of hyperphosphataemia
``` Bi-phosphonates Calcium acetate (calcium-phosphate binder) ```
28
Need for calcium in body
Contributes to muscle function - skeletal muscles - heart - also affects nerves
29
Symptoms of mild - moderate hyponatraemia
``` Nausea + vomiting Dizziness Confusion Headache Muscle cramps ```
30
Symptoms of severe hyponatraemia
Seizures Coma Respiratory arrest
31
Causes of hyponatraemia | - urinary sodium > 20mmol/L
Hypovolaemia, renal loss, depletion: - Diuretics - Addison's - Renal failure Euvolaemic - SIADH - hypothyroidism
32
Causes of hyponatraemia | - urinary sodium < 20mmol/L
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
Management for mild hyponatraemia (130-134)
Fluid restriction <800ml/day + loop diuretics
34
Management for moderate hyponatraemia (120-129)
Hypertonic saline (2.7%) slow infusion
35
Management for severe hyponatraemia (<120)
Bolus hypertonic saline + Vasopressin (ADH receptor agonist)
36
Side effects of correcting sodium levels quickly
Osmotic demyelinationation syndrome | "central pontine myelinosis"
37
Spastic quadriceps Pseudobulbar palsy Emotional lability
Osmotic demyelinationation syndrome | "central pontine myelinosis"
38
Causes of pseudo-hyponatraemia
Hyperlipidaemia (increase serum volume) Blood taken from arm with recent IV fluids Donating blood
39
``` Jittery movements Increased muscle tone Hyperreflexia Convulsions Drowsiness Coma ```
Hypernatraemia
40
Causes of hypernataemia
Due to dehydration - fever - hot environment - diarrhoea - vomiting - diabetes insipidus
41
Management for moderate hypernatraemia (150-169)
Replace deficit slowly over 48 hours
42
Management for mild hypernatraemia (146-149)
Manage underlying cause
43
Management for severe hypernatraemia (>170)
IV Fluids
44
Side effects of hypernatraemia management
Can cause cerebral oedema - bradycardida - gaze paresis
45
Hyponatraemia caused by dilution effects of excessive water retention
Syndrome of inappropriate ADH secretion (SIADH)
46
Causes of SIADH
``` Cancer - Small cell lung cancer (ectopic SIADH) - Prostate - Pancreas Neuro - stroke - SAH - Subdural haematoma - Meningitis/ encephalitis Porphyrias Drugs ```
47
Drug causes of SIADH
``` Sulphonylureas SSRIs Carbamazepine Tricyclic Antidepressants Vincristine Cyclophosphamide ```
48
Management of SIADH
Fluid restriction Demeclocycline ADH Receptor blockers (Tolvaptan)
49
Name an ADH receptor blocker
Tolvaptan

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