Fluid And Electrolytes, Intravenous Nutrition,special Diets And Vitamin Deficieny

Question 1

Magnesium

Answer 1

-Essential constituent in many enzymes systems
- involved in energy generation
- not well absorbed from the Gi
- Largest stores are in the skeleton
- Side effects generally occur with high doses of- eg. Diarrhoea
- interrupt treatment and restart at a reduced dose if side effects do occur

Question 2

Zinc deficiency

Answer 2

Only give when there is evidence

• deficiency occurs in inadequate diet,malabsorption, trauma,burns and protein losing conditions
• its used to treat Wilson’s disease (rare inherited abnormality of zinc absorption)
• Trace the amount of zinc usually included in parenteral nutrition

Question 3

TPN? Total parenteral nutrition

Answer 3

Indications -
- undernourished patients for suregery
- chemotherapy
- radiation therapy
- Major surgeries
- prolonged GI disorders of the GI tract
- Coma,trauma,refusal to eat, some patients with renal or kidney failure

Question 4

What’s included in a TPN?

Answer 4

Amino acids
Glucose
Fats
Electrolytes
Trace elements
Vitamins

Eg. Nutri flex

Question 5

What are special diets?

Answer 5

Preps that have been modified to eliminate a particular constituent from a food (eg. Gluten free diet)

Question 6

What is Phenylketonuria?

Answer 6

Body can’t break down an amino acids - phenylalanine
- so its managed by restricting dietary intake of phenylalanine
- aspartame contribute to phenylalanine instake (inform patients of aspartame containing products)

Symptoms -moldy breath,tremors,epilepsy, eczema and brain damage

Question 7

Hyperkalaemia

Answer 7

> 5.5

Signs and symptoms= arrhythmia,muscle weakness, N/V, weak pulse, SOB

Treatment = C big K die so, Calcium gluconate 10%. B agonist/binder, insulin + glucose, diuretics,dialysis

Causes= K sparring diuretics,Ace I, Arbs, NSAIDs, Heparins, cyclosporine, trimethoprim

Question 8

Hypokalaemia

Answer 8

<3.5

Arrhythmias, muscle twitching, muscle cramps/weakness,paralysis

Potassium supplement, IV, correct low magnesium, KCL solution

Causes = diuretics, corticosteroids,insulin,laxatives, B-agonists, aminoglycosides

Question 9

Hyponatraemia

Answer 9

Constipation, convulsions, coma
Mental status changes

Sodium chloride or sodium bicarbonate

Causes = SSRI,Lithium,carbamazepine, TCAs

Question 10

Hypernatraemia

Answer 10

Thirst,dry mouth,dehydration,diabetes insidious

IV sodium chloride + glucose 5 %

• diuretics, prednisolone,effervescent tabs,androgens and oestrogens

Question 11

Hypercalcaemia

Answer 11

Arrhythmias,dehydration,coma,polyuria

• biophosphates (pamidronate disodium), calcitonin, corticosteroids

Laxatives, antacids,vitamin D compounds

Question 13

Hypocalcaemia

Answer 13

Muscle cramps

Calcium supplements,calcium gluconate IV, Vitamin D and calcium, correct hypomagnesmia too

Vitamin D deficiency, biosphosphates, phenytoin

Question 14

Hypomagnesmia

Answer 14

ECG changes, Nystagmus, confusion,seizures

Magnesium sulphate

Alcoholis,, diarrhoea, stoma, fistula, ppi

Question 15

Hyperphosphataemia

Answer 15

Muscle cramps, bone pain and joint pain

Calcium acetate, calcium carbonate,sevelamer,lanthanum

Hypo parathyroidism, high vitamin D, DKA

Question 16

Phosphorus (phosphate)

Answer 16

Oral phosphate supplements and vitamin D required in small number of patients with hypophosphataemic vitamin d resistant rickets

• phosphate infusion occasionally used in alcohol dependence
• phosphate depletion occurs in severe ketoacidosis
• sevelamer and lanthanum licensed for the treatment of hyperphosphataemia (for patients of haemodialysis and peritoneal dialysis)

Question 17

What is acute porphyria

Answer 17

Metabolic disorder where you’re not producing enough Haem

This is hereditary

Some meds when given to people who have a haem biosynthesis deficiency can be very very dangerous - these drugs include - anabolic steroids, antidepressants and sulphonylureas

Cause severe abdominal pain

1 in 7500 ppl are effected

Question 18

Porphyria crisis

Answer 18

Certain drugs where great care is needed for people that have acute porphyria’s

• screen relatives and advice on dangerous interactions

Treatment = Haem arginate IV Infusion!!

Question 19

Acute prophyria signs and symptoms

Answer 19

• severe abdominal pain
• pain in chest and legs, back
• constipation, diarrhoea
• nausea and vomitting
• red/brown urine
• muscle pain, tingling, numbness and weakness or paralysis

Question 20

Vitamin A

Answer 20

Function - helps boots immune system (fight infection and illness)
- helps vision in dim light
- keeps skin healthy

SOURCES - Cheese, Eggs, oily fish , liver

Pregnancy - too much vit A can be harmful to unborn babies - avoid in pregnancy (do not eat liver or liver products during pregnancy)

Question 21

Vitamin B

Answer 21

Deficiency in vitamin B other than B12 is very bare in the UK
- Treated with thiamine (b1), riboflavin(B2), nicotinamide
- wernikes encephalopathy. And korsakoffs psychosis are severe deficiency states especially seem in chronic alchoholism (treat with IV vitamin B) - followed by oral thiamine long term

• Folic acid and vitamin B12 used in treating megoblastic anaemia
• pyroxidine B6 is rare and may occur during the treatment with isoniazid or penicillamine
• Follinic acid used in cytotoxic therapy

Question 22

What’s the treatment for vitamin B deficiency?

Answer 22

Thiamine (b1)
Riboflavin(b2)
Nicotinamide

Question 23

What’s the the treatment of Wernickes encephalopathy and Korsakoffs psychosis

Answer 23

IV vitamin B followed by oral thiamine

Question 24

Megoblastic anaemia

Answer 24

Folic acid and vitamin B12

Question 25

Isonazid, penicllamine side effects

Answer 25

Pyrioxidine (b6)

Question 26

Used in association with cytoxic therapy

Answer 26

Folinic acid - available as calcium folinate

Question 27

Vitamin C - ascorbic acid is essential in what?

Answer 27

Scurvy!! Bleeding gums are a symptom

Question 28

Vitamin D

Answer 28

Prevention and the treatment of rickets Eg.ergocalciferol (colcalciferol,vitamin D2), Colcalciferol (vitamin d3), alfacalcidol and calcitriol - occurs with limited sunlight exposure and diet deficiency - paricalcitol - synthetic vitamin D analogue - for the prevention and treatment of secondary hyperparathyroidism associated with chronic renal failure

Question 29

Individuals at risk of vitamin D deficiency

Answer 29

Dark skin ( African, African - Caribbean, south Asian origin) skin is less efficient at synthesising vitamin D INDIVIDUALS OVER 65 Individuals with low or no sun exposure (eg. Houebounds or confined indoors or cover skin for cultural reasons) - pregnant and breastfeeding - especially, teenagers and young women - children under 4

Question 30

Vitamin E - tocopherol

Answer 30

Little scientific evidence of value Very low amounts linked to neuromuscular activities in young children

Question 31

Vitamin K

Answer 31

-production of blood clotting factors - proteins for the normal calcifications of bones - fat soluble(patients with fat malabsorption may become deficient) - Menadiol sodium phosphate (water soluble synthetic vitamin K derivative)- can be given orally to prevent vitamin K deficiency - Oral coumarin anticoagulants interfere with vitamin K metabolism and their effects can be antagonised by giving vitamin K

Question 32

FAT SOLUBLE Vitamins

Answer 32

ADEK!!!!! KEDAAAAA KEDAAAAAAA

Question 33

Neural tube defects

Answer 33

- neural tube defects - congenital defects caused by incomplete closure of neural tube within 28 days of conception (examples Spina ,Bifda,encephalocele,anencephaly) Main risk factors - Maternal folate deficiency, Maternal vit b12 deficiency, previous history of infant with neural defects, smoking, obesity, diabetes and using antiepileptic drugs)

Question 34

Neural defects supplementation during pregnancy

Answer 34

Supplement with folic acid before conception and until 12 weeks of pregnancy High dose recommended for women at higher risk eg, women with sickle cell anaemia, previous history of child with defect, receiving antiepleptic meds or diabetic)