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General Flashcards

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1
Q

What is hypovolaemia?

A

Overall fluid deficit in the body

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2
Q

What are three general causes of hypovolaemia?

A
  • Poor fluid intake
  • Excessive fluid loss
  • Third space loss of fluid
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3
Q

What is third space loss of fluid?

A

Where fluid remains in the body but has shifted from the intravascular space to another compartment within the body

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4
Q

What is hypervolaemia?

A

Excess of fluid in the body

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5
Q

What is hypervolaemia also known as?

A

Fluid overload

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6
Q

What are the symptoms of fluid overload?

A
  • Rapid weight gain
  • Pitting oedema in arms, legs and face
  • Swelling in the abdomen
  • SOB secondary to pulmonary oedema
  • High BP
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7
Q

What are the early symptoms of hypovolaemia?

A
  • Headache
  • Fatigue
  • Weakness
  • Thirst
  • Dizziness
  • Sunken eyes
  • Dry, less elastic skin
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8
Q

What are the more severe symptoms of hypovolaemia?

A
  • Oliguria
  • Cyanosis
  • Abdominal and chest pain
  • Hypotension
  • Tachycardia
  • Cold peripheries
  • Altered mental status
  • Weak, thready pulse
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9
Q

What is severe hypovolaemia also known as?

A

Hypovolaemic shock

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10
Q

What is normal urine output for an adult?

A

0.5-2ml/kg body weight per hour

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11
Q

Na concentration in mild hyponatraemia:

A

130mmol/L

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12
Q

Na concentration in moderate hyponatraemia:

A

125-129mmol/L

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13
Q

Na concentration in severe hyponatraemia:

A

<125mmol/L

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14
Q

What are the clinical features of hyponatraemia?

A
  • Gait instability
  • Falls
  • Concentration and cognitive defects
  • Nausea
  • Vomiting
  • Headache
  • Confusion
  • Reduced consciousness
  • Seizures
  • Cardiorespiratory arrest
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15
Q

What is the biggest danger in hyponatraemia?

A

Cerebral oedema

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16
Q

What are the potential causes of hyponatraemia if the urinary Na is >30mmol/L?

A
  • SIADH
  • AVP (ADH)-like drugs
  • Salt-wasting
  • Vomiting
  • Hypoadrenalism
  • Cerebral salt-wasting
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17
Q

What is SIADH?

A

Syndrome of inappropriate ADH secretion (SIADH) is characterised by hyponatraemia secondary to the dilutional effects of excessive water retention.

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18
Q

What are the potential causes of hyponatraemia if the urinary Na is <30mmol/L?

A
  • Heart failure
  • Portal hypertension
  • Nephrotic syndrome
  • Hypoalbuminaemia
  • Third space loss
  • GI loss (D&V)
  • Previous diuretic use
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19
Q

In mild-moderate hyponatraemia you treat with _____ _________.

A

Fluid restriction

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20
Q

What is the management of severe hyponatraemia?

Study These Flashcards
A

1) Give hypertonic saline with close monitoring and serial blood tests
2) After a 5mmol/L rise stop infusion and treat according to the underlying diagnosis

21
Q

Na concentration in hypernatraemia:

22
Q

If urine osmolality < plasma osmolality look for ________ ________.

Study These Flashcards
A

Diabetes insipidius

23
Q

What are the causes of low volume hypernatraemia?

Study These Flashcards
A
  • Sweating
  • Vomiting
  • Diarrhoea
  • Diuretics
  • Kidney disease
24
Q

What are some causes of normal volume hypernatraemia?

Study These Flashcards
A
  • Fever
  • Extreme thirst
  • Diabetes insipidus
  • Lithium
25
What are some causes of high volume hypernatraemia?
- Hyperaldosteronism | - Excessive IV saline
26
What are the ECG changes seen in hyperkalaemia?
- Tall-tented T waves - Small P waves - Widened QRS leading to a sinusoidal pattern and asystole
27
What are the causes of hyperkalaemia?
- AKI - Metabolic acidosis - Addison's disease - Rhabdomyolysis - Massive blood transfusion - Burns or other severe injuries - Poorly controlled diabetes
28
What drugs can cause hyperkalaemia?
- Beta blockers - K sparing diuretics - ACE inhibitors - Angiotensin II receptor blockers - Spironolactone - Ciclosponrin - Heparin
29
What are the symptoms of chronic hyperkalaemia?
- Muscle weakness - Numbness - Tingling - Nausea
30
What are the symptoms of acute-onset hyperkalaemia?
- Heart palpitations - Dyspnoea - Chest pain - Nausea/vomiting
31
K concentration in hyperkalaemia:
>5.5mmol/L
32
At what levels does hyperkalaemia become an emergency?
Greater than 6.5mmol/L
33
What is the treatment for hyperkalaemia in patients with ECG changes?` Why are they used?
IV calcium salts to stabilise the resting cardiac membrane potential.
34
How can hyperkalaemia be treated?
- IV calcium salts - IV insulin combined with an infusion of glucose - Nebulised β-2 adrenoceptor agonists can augment the effects of the insulin and glucose
35
Why does hyperkalaemia tend to be associated with acidosis?
Because as K levels rise fewer hydrogen ions can enter the cell.
36
Mild hypokalaemia levels are:
<3.5mmol/L
37
Sever hypokalaemia levels are:
<2.5mmol/L
38
What are the symptoms of mild hypokalaemia?
- Hypertension | - Abnormal heart rhythm
39
What are the symptoms of severe hypokalaemia?
- Muscle weakness - Myalgia - Tremor - Muscle cramps - Constipation - Flaccid paralysis - Hyporeflexia (absence of reflexes)
40
What are the causes of hypokalaemia?
- Diarrhoea - Excessive perspiration - Vomiting - Pancreatic fistulae - Adenoma - Drugs - Diabetic ketoacidosis - Polyuria - Magnesium deficiency - Primary hyperaldosteronism (Conn's syndrome) - Cushing's syndrome - Renal tubular acidosis
41
What medications cause hypokalaemia?
- Loop diuretics - Thiazide diuretics - Amphotericin B - Cisplatin - Acetazolamide
42
What is the management of hypokalaemia?
- Correct any other underlying electrolyte abnormalities such as magnesium deficiency - Administer KCL in NaCl solution at a maximum rate of 20mmol/hour
43
What are the likely causes of hypokalaemia when seen with metabolic alkalosis?
- Vomiting - Thiazide and loop diuretics - Cushing's syndrome - Conn's syndrome (primary hyperaldosteronism)
44
What are the likely causes of hypokalaemia when seen with metabolic acidosis?
- Diarrhoea - Renal tubular acidosis - Acetazolamide - Partially treated diabetic ketoacidosis
45
What are the likely causes of hypokalaemia when seen with hypertension?
- Cushing's syndrome - Conn's syndrome (primary hyperaldosteronism) - Liddle's syndrome - 11-beta hydroxylase deficiency*
46
What are the likely causes of hypokalaemia when seen with hypotension?
- Diuretics - GI loss (e.g. Diarrhoea, vomiting) - Renal tubular acidosis (type 1 and 2) - Bartter's syndrome - Gitelman syndrome
47
What are the ECG features of hypokalaemia?
- U waves - Small or absent T waves (occasionally inversion) - Prolonged PR interval - ST depression - Long QT
48
Rhyme to remember ECG changes in hypokalaemia:
In hypokalaemia, U have no Pot and no T, but a long PR and a long QT

Learning Objectives Stage 2 (2 decks)

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