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CCE 2 - Medicine > Electrolyte Abnormalities > Flashcards

Electrolyte Abnormalities Flashcards

1
Q

Hypernatraemia symptoms

A

Lethargy, thirst, weakness, irritability, confusion, coma, seizures

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2
Q

Hypernatraemia signs

A

Dehydration

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3
Q

Hypernatraemia causes

A

Fluid loss without water replacement (diarrhoea, vomit, burns)

Diabetes insipidus

Osmotic diuresis

Primary aldosteronism

Iatrogenic

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4
Q

Hypernatraemia investigations

A

FBC - PCV
U&Es - Na, urea
LFTs - albumin

Raised serum Na

Raised PCV

Raised albumin

Raised urea

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5
Q

Hypernatraemia management

A

Water orally

Glucose 5% IV slowly

If hypovolaemic - 0.9% saline

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6
Q

Hyponatraemia signs and symptoms

A

Anorexia, nausea, malaise

Headache, irritability, confusion, weakness, decreased GCS, seizures

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7
Q

Hyponatraemia causes

A

Hypervolaemic - Heart failure, renal failure, liver failure, nephrotic syndrome

Euvolaemic - SIADH, primary polydipsia

Hypovolaemic - Dehydration, renal salt wasting syndromes, Addison’s disease

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8
Q

Hyponatraemia investigations

A 
Bloods
U&Es (inc. eGFR)
Random glucose
Cortisol
Osmolality
TSH

Urine
Sodium
Osmolality

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9
Q

Hyponatraemia management

A

Correct underlying cause

Asymptomatic - fluid restriction

Symptomatic - cautious rehydration with 0.9% saline. DO NOT go too quickly - central pontine myelinolysis may occur. Max rise in Na of 15mmol/L/day

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10
Q

Hyperkalaemia signs and symptoms

A

Fast, irregular heartbeat, chest pain, weakness, palpitations, light-headedness

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11
Q

Hyperkalaemia causes (6)

A

Renal failure, Addison’s disease, K+ sparing diuretics, massive blood transfusion, ace inhibitors

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12
Q

Hyperkalaemia treatment

A

Non-urgent (K <6mmol/L): treat underlying cause, review medications.

Urgent (evidence of myocardial hyperexcitability OR K >6.5mmol/L): emergency, insulin and dextrose infusion and IV calcium gluconate.

Insulin and dextrose drives carbohydrates into cells, which takes K+ with it —> reduces blood potassium

Calcium gluconate stabilises cardiac muscle cells and reduces risk of arrhythmias (cardioprotective, does NOT reduce K+)

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13
Q

Hyperkalaemia ECG signs

A

Tall, peaked T-waves
Flattening or absence of P waves
Broad QRS complex

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14
Q

Hypokalaemia signs and symptoms (8)

A

Muscle weakness, hypotonia, hyporeflexia, cramps, tetany, palpitations, light headedness, constipation

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15
Q

Hypokalaemia ECG

A

Small or inverted T waves
Prominent U waves
Long PR interval
Depressed ST segments

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16
Q

Hypokalaemia causes (6)

A

Diuretics, vomiting and diarrhoea, pyloric stenosis, Cushing syndrome, Conn’s syndrome, renal tubular failure

17
Q

Hypokalaemia treatment

A

If mild (>2.5mmol/L and no symptoms): give oral K+ supplement e.g. Sando-K. Review medications.

If severe: give IV K+ cautiously

18
Q

Hypercalcaemia signs and symptoms (4)

A

‘Bones, stones, groans and psychic moans’

Bones - weakness
Stones - renal stones, ectopic calcification
Groans - abdo pain, vomiting, constipation
Psychic moans - tiredness, weakness, confusion, depression

19
Q

Hypercalcaemia ECG

A

Decreased QT interval

20
Q

Hypercalcaemia causes (6)

A 
Malignancy (bone metastasis)
Primary hyperparathyroidism
Sarcoidosis
Vitamin D intoxication
Thyrotoxicosis
Lithium
21
Q

Hypercalcaemia investigations (9)

A

Albumin (low/normal - malignancy)
PTH (high - hyperparathyroidism)
Urea (raised - dehydration)
ALP - malignancy

FBC, protein electrophoresis, CXR, isotope bone scan

22
Q

Hypercalcaemia management

A
  1. Correct dehydration (0.9% saline)

2. Bisphosphonates

23
Q

From where and when is parathyroid hormone secreted?

A

Four parathyroid glands

Triggered by decreased serum calcium, controlled by negative feedback loop

24
Q

Actions of parathyroid hormone

A

Increase osteoclast activity which leads to Calcium and Phosphate being released from bones.

Increased calcium reabsorption in kidney

Decreased phosphate reabsorption in kidney

Increased renal production of 1, 25-dihydroxy-vitamin D3

25
Q

Vitamin D actions

A

Hydroxylated to 25-hydroxy-vit D in liver first

Then hydroxylated to calcitriol (1,25-dihydroxy-vit D) in kidney. This is the active form.

26
Q

What stimulates calcitriol production?

A

Decreased calcium and phosphate

Increased PTH

27
Q

Calcitriol actions

A

Increase calcium and phosphate absorption from gut

Inhibition of PTH release

Enhanced bone turnover

Increased calcium and phosphate reabsorption in kidneys

28
Q

Where is calcitonin made?

A

C cells of thyroid

29
Q

Calcitonin effects

A

Decreased calcium and phosphate

30
Q

Magnesium actions

A

Decreased magnesium prevents PTH release and may cause hypocalcaemia

CCE 2 - Medicine (5 decks)

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