Chapter 9 - Blood And Electrolytes Flashcards by Noor Ali Shah

What’s included in chapter 9?

Different types of anaemia
Blood and Electrolytes
Vitamins

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Different types of anaemia

Sickle Cell Anaemia
G6PD deficiency 
Hypolastic
Haemolytic
Aplastic
Iron deficiency anaemia 
Megaloblastic

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Sickle cell anaemia

Might need folate supplements

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Hydoxycarbamide

Reduce frequency of sickle cell crisis which would lead to hospitalisation

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G6PD

More common in men

Mostly seen in Asian, African and south European Union

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Some drugs cause risk of haemolysis in G6PD deficiency

Quinolones like ciprofloxacin
Nitrofurantoin
Sulfonamide such as co-trimoxazole

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Drugs with higher risk in G6PD deficiency

Aspirin
Quinine
Sulfonylurea

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Hypoblastic and haemolytic anaemia

Can be treated with anabolic steroids

Various corticosteroids and pyridoxine

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Aplastic anaemia

Treated with anti-lymphocyte immunoglobulin

Given IV through central line - 12 to 18 hours each day for 5 days; can cause severe reaction first two days and immunosupression can occur

Rate response may increase if ciclosporin given as well

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Anaemia associated with erythopoietic deficiency

Can be seen in patients with chronic kidney failure

Treatment option eproietin

Eproietin beta - neonates with low birth weight (non benzoyl alcohol version)

Darbopretin long half life don’t have to administer frequently

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Iron deficiency anaemia

Quiet common

Important not underlying conditions like GI cancer or gastric erosion

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Prophylaxis with Iron

Menorraghea
Pre-term neonates with low birth weight
Pregnancy

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Iron

Oral version and m/r versions

Therapeutically m/r has no benefit except u can take once a day

Parenteral versions - iron dextrose, iron sucrose: when oral version ineffective or can’t rake; main side effect hypersensitivity anaphylaxis, eczema and asthma patients at higher risk

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Iron side effects

Constipation
Diarrhoea in patients with IBD taking m/r preparation
Discolour stools (black stools)

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Iron administration

On an empty stomach because absorbs better that way
But if can’t tolerate side effects it’s fine to take after food
Advise patient to take with orange juice rather than water because it absorbs better with vitamin c

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Megaloblastic anaemia

Usually due to lack of vitamin b12 also known as cyanocobalamine or folate

Establish underlying cause - pernicious anaemia causes malabsorption of vitamin b 12

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Total gastectomy or total iliolresection

B12 prophylactically

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Cyanocobalamin for b12 deficiency

Needs to be endorsed SLS

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Cyanocobalamin replaced by

Hydroxycobalomine because it can be retained longer in the body

Maintenance treatment usually up to 3 months by IM injections

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Folate deficiency

Due to pregnancy
Poor nutrition
Or even some antiepileptic medication

Folic acid treatment usually 4 months

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Folic acid use in

Methotrexate therapy as folate antagonist

Also folinic acid but to do with cytotoxic therapy

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Iron overload

Repeated blood transfusions

Treatment repeated venesection but if that’s contraindicated then iron chelating compound e.g desferrioxamine mesilate with ascorbic acid given separate from food and should be avoided in patients with cardiac dysfunction

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In what situations would we need to give someone fluid and electrolytes

Vomiting
Diarrhoea
Particularly sodium and water in these states

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Hyperkalaemia treatment >6.5mmol/l

Calcium gluconate 10% 
Soluble insulin 
Glucose 50%
Calcium polystyrene sulfonate
Salbutamol injection/nebuliser

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Oral potassium <3.5 Potassium bicarbonate Potassium chloride

Digoxin therapy Anti-arrhythmic Chronic diarrhoea Laxatives

Sodium bicarbonate

``` Chronic acidosis state Metabolic acidosis Renal tubular acidosis Dyspepsia Increasing pH of urine ```

Calcium supplementation

In children Pregnancy Osteoporosis

Hypocalcaemia

Calcium + vitamin D In the form of: Calcium carbonate or Calcium chloride

Hypercalcaemia treatment

``` Bisphosphonates Corticosteroids Calcitonin Phosphate salts Pamidronate Cinacalcet ``` Dietary restrict calcium Medicines - thiazides and vitamin D contribute

Hyperparythyroidism

Cinacalcet Paricalcitol Parathyroidectomy

What causes hypomagnesia

Diarrhoea or even alcoholism Can cause secondary hypocalcaemia and hypokalamia

Treatment for hypomagnesia

Magnesium sulphate injection

Phosphate supplements

Severe diabetic ketoacidosis Alcohol dependency Ricketts

Hyperphosphataemia

Calcium containing preparation - Sevelamer - Lanthanum

Acute Porphyria

Hereditary condition Certain medication unsafe - antihistamines, anabolic steroids, antidepressant, contraceptives, HRT, phenytoin, rifampicin, valproate plus many more

Trace element deficiency

Selenium | Zinc - zinc sulphate (trauma or burns)

Nutrition

IV infusion in addition to tube feeding Reason for tube feeding - renal or liver dysfunction, severely ill, major surgery

Parenteral feeding

Amino acids, glucose, fat, vitamins

Parenteral nutrition complications

Gall bladder slodging and colistasis

Phenylketonuria

Body can't metabolise phenylalanine Restrict dietary intake but still give sufficient small amount

Special diets

Cealiac disease - gluten free

Bleeding of gums

Scurvy causes bleeding of gums - lack of vitamin c

DEAK

Fat soluble vitamins

Water soluble vitamins

B and C

Retinol

Vitamin A

Lack of vitamin leads to ocular defects Helps with night vision

Vitamin A

Avoid in pregnancy

Vitamin A

Where can you find vitamin A

Eggs Butter Fish oils

Thiamine

Vitamin B1

Riboflavin

Vitamin B2

Pyridoxine

Vitamin B3

Cyanocobalamin

Vitamin B12

Thiamine given to

Alcoholics Wernicks encephalopathy Parenteral form pabrinex

Thiamine found

Cereal Bread Energy metabolism

Riboflavin

Energy metabolism: Milk Cereal

Pyridoxine

Used in protein metabolism Fish Meat

Cyanocobalamin

Red blood cell formation Vegans lacks in - meat, milk and cheese

Ascorbic acid

Vitamin C Orange juice Citrus fruit Antioxidant

Lacking vitamin c

Scurvy: Gingival bleeding Bleeding margins Petechia of skin

Vitamin D

Calciferol Ergocalciferol Cholecalciferol Alfacalcidol (Renally impaired) Too much lead to hypercalcaemia, too little rickets and osteomalacia

Vitamin E

Antioxidant Little evidence of benefit Found in whole grain

Blood clotting factors

Vit K Green leafy vegetables, nuts and fruits Given to newborn Can get water soluble version

Nicotinic acid

Inhibit synthesis of cholesterol and triglycerides

Protein and energy metabolism Found in kidneys and liver

Biotin

Beta-carotene

Carrot and peaches Antioxidants

Folate/folic acid

Kidney, liver and vegetables and helps with red blood cell formation Low risk of neural tubule defects - till 12 weeks Child at risk - family history, diabetes, cealiac disease, antiepileptic medicines

Chapter 9 - Blood And Electrolytes Flashcards

(66 cards)