metabolic

Question 1

causes hyperK

Answer 1

AKI // meds // met acidosis // addisons // rhabdo // massive blood transfusion

Question 2

drugs that cause hyperK

Answer 2

ACEi // ARBs // sprinolactone // ciclosporin // heparin // (BB in kidney failure)

Question 3

ECG hyperK

Answer 3

tented T waves // loss of p // broad QRS // sinudoidal wave // v fib

Question 4

mild, moderate, severe hyperK

Answer 4

mild 5.5-5.9 // moderate 6-6.4 // severe >6.5

Question 5

mx hyperK

Answer 5

IV calcium gluconate (stabilise cardiac membrane) // IV dextrose+insulin (shift K from ECF –> ICF) // calcium resonium, diuretisc, dialysis (remove K)

Question 6

relationship with K ions and H ions

Answer 6

they compete with each other - high K means less H can enter cells and vice versa

Question 7

causes hypoK alkalosis

Answer 7

vomiting // thiazide + loop diuretics // cushings // conn’s

Question 8

causes hypoK acidosis

Answer 8

diarrhoea // renal tubular acidosis // acetazolamide

Question 9

what other deficiency can cause hypoK

Answer 9

hypoMg

Question 10

symptoms hypoK

Answer 10

weakness, hypotonia

Question 11

ECG hypoK

Answer 11

U wave // small T wave // prolonged PR // St depression

Question 12

hypoK with hypertension

Answer 12

Cushings // conns // liddles

Question 13

hypoK w/o hypertension

Answer 13

diuretics // GI loss (diarrhoea or vomitting) // renal tubular acidosis // Bartters

Question 14

inheritance Liddle’s

Answer 14

dominant

Question 15

features liddles

Answer 15

hypertension + hypoK alkalosis

Question 16

mx LIddles

Answer 16

amiloride or triamterene

Question 17

inheritence Bartters

Answer 17

autosomal recessive

Question 18

mechanism Bartters

Answer 18

defective Cl absorption from NaKCl transporter (work like loop diuretics)

Question 19

most common cause hypercalcaemia in non-hospital patients

Answer 19

primary hyperparathyroid

Question 20

most common cause hypercalcaemia in hospital patients

Answer 20

malignancy

Question 21

how does malignancy cause hyperCa

Answer 21

PTHrP from tumour eg squamous cell lung cancer // bone mets // myeloma

Question 22

invx hyperCa

Answer 22

PTH

Question 23

other key causes hyperCa

Answer 23

sarcoid // vit D intoxication // acromegaly // thyrotoxicosis // thiazides // dehydrated // addisons // pagets

Question 24

symptoms hyperCa

Answer 24

bones, stones (kidney), groans , psychic moans // corneal calcification // HTN

Question 25

ECG hyperCa

Answer 25

short QT

Question 26

initial mx hyper Ca

Answer 26

rehydration with saline (3/4L per day)

Question 27

secondary mx hyper Ca

Answer 27

bisphosphonates // calcitonin // loops (can worsen U+Es)

Question 28

causes hypo Ca

Answer 28

vit D def (osteomalacia) // CKD // hypoparathyroud // rhabdo // mg deficiency // blood transfusion // acute pancreatitis

Question 29

invx hypo Ca

Answer 29

history + PTH

Question 30

symtoms hypo Ca

Answer 30

tetany - muscle twitch or spasm // perioral parasthesia // depression // cataracts

Question 31

hypo Ca ECG

Answer 31

prolonged QT

Question 32

trousseaus sign hypo Ca

Answer 32

blood pressure cuff --> occlude brachial artery (above systolic) --> carpal spasm

Question 33

chvoteks sign hypo Ca

Answer 33

tapping parotid --> facial twitch

Question 34

mx hypo Ca

Answer 34

IV calcium gluconate + ECG monitoring

Question 35

indications urgent mx hypo Ca

Answer 35

carpal spasm, tetany, seizure, prolonged QT

Question 36

Mg relationship with Ca

Answer 36

Mg required for PTH secretion and action on targets // so low Mg --> low Ca and little response to Ca or Vit D mx

Question 37

causes hypo mg

Answer 37

diuretics and PPI // parenteral nutrition // diarrhoea // alcohol // hypoK and hyperCa // metabolic disorders

Question 38

how does hyperCa cause hypo Mg

Answer 38

hyperparathyroid ism

Question 39

symptoms hypoMg

Answer 39

(similar to hypoCa) // paraesthesia, tetany, seizure, arrhythmia, decreased PTH, ECG --> hypoK, digoxin toxicity

Question 40

mx hypo Mg if <0.4

Answer 40

IVmagnisium (if tetany, arrythmia, seizure)

Question 41

mx hypoMg >0.4

Answer 41

oral mg salts

Question 42

se mg salts

Answer 42

diarrhoea

Question 43

relationship between Na, K, H

Answer 43

sodium exchanged for K and H (reduces them both)

Question 44

causes hyper Na

Answer 44

dehydrated // osmotic diuresis eg HONK // diabetes insipidus // too much saline

Question 45

risk of correcting hyperNa too quickly

Answer 45

cerebral oedema --> seizure, coma, death

Question 46

rate to give saline hyperNa

Answer 46

no more 0.5 mmol/hr

Question 47

inheritence and defect liddles syndrome

Answer 47

autosomal dom // disorder Na channels in distal tubule --> increased Na

Question 48

symptoms Liddles

Answer 48

HTN + hypoK alkalosis

Question 49

mx LIddles

Answer 49

amiloride or triamtrene (K sparing diuretic)

Question 50

causes of hypoNa with urinary Na >20 (5)

Answer 50

Na depletion = diuretic, addisons, renal failure // others = SIADH, hypothyroid

Question 51

causes hypoNa with urinary Na <20