Metabolic Medicine Flashcards
What is the recommended alcohol intake in UK?
Men and women are advised not to drink more than 14 units a week on a regular basis
What statin is given and the dose in the primary prevention of hyperlipidaemia?
Primary prevention: 10 year cardiovascular risk >= 10% OR most type 1 diabetics OR CKD if eGFR <60ml/min/m2
Atorvastatin 20mg OD
What statin is given and the dose in the secondary prevention of hyperlipidaemia?
Secondary prevention: Known ischaemic heart disease OR cerebrovascular disease OR peripheral arterial disease
Atorvastatin 80mg OD
What are the ECG changes seen in hyperkalaemia?
- Tall-tented T waves
- Small P waves
- Wide QRS complex (eventually becoming sinusoidal, sine wave)
- Ventricular fibrillation
- Asystole
What are the causes of hyperkalaemia?
- Acute Kidney Injury
- Drugs: Potassium sparing diuretics (Spironolactone), ACE-i, ARBs
- Metabolic acidosis (DM)
- Addison’s disease
- Rhabdomyolysis
- Massive blood transfusion
- Burns
In dehydration cases, what are the findings of urea and creatinine?
The urea will be raised disproportionately to the creatinine. The reason for this is that some urea is reabsorbed with the increased water reabsorption that occurs in dehydration.
Most serum proteins and electrolytes increase in concentration in dehydration due to the decrease in intravascular fluid volume. Serum haemoglobin and haematocrit are raised as the dehydration causes a relative polycythaemia.
What malignancy is most commonly associated with SIADH?
Small cell lung cancer
also: pancreas, prostate
What are some neurological causes of SIADH?
- Stroke
- Subarachnoid haemorrhage
- Subdural haemorrhage
- meningitis/encephalitis/abscess
What are the symptoms seen in hypocalcaemia?
- Tetany: Muscle twitching, cramping and spasm
- Perioral paraesthesia
- If chronic: Depression, cataracts
- ECG: Prolonged QT interval
What are the tests/signs seen in Hypocalcaemia?
Trousseau’s sign
- carpal spasm if the brachial artery occluded by inflating the blood pressure cuff and maintaining pressure above systolic
- wrist flexion and fingers drawn together
- seen in around 95% of patients with hypocalcaemia and around 1% of normocalcaemic people
Chvostek’s sign
- tapping over parotid causes facial muscles to twitch
seen in around 70% of patients with hypocalcaemia and around 10% of normocalcaemic people
What are some of the causes of hypocalcaemia?
- Vitamin D deficiency (osteomalacia)
- Chronic kidney disease
- Hypoparathyroidism (e.g. post thyroid/parathyroid surgery)
- Pseudohypoparathyroidism (target cells insensitive to PTH)
- Rhabdomyolysis (initial stages)
- Magnesium deficiency (due to end organ PTH resistance)
- Massive blood transfusion
- Acute pancreatitis
What is the management of hypocalcaemia?
- Acute management of severe hypocalcaemia is with intravenous replacement. The preferred method is with intravenous calcium gluconate, 10ml of 10% solution over 10 minutes
- Intravenous calcium chloride is more likely to cause local irritation
- ECG monitoring is recommended
- Further management depends on the underlying cause
Rapid correction in SIADH by raising serum sodium too rapidly may cause what condition?
Central pontine myelinolysis
What is the first line management for patients with hypercalcaemia?
IV fluid therapy.
The initial management of hypercalcaemia is rehydration with normal saline, typically 3-4 litres/day. Following rehydration bisphosphonates may be used. They typically take 2-3 days to work with maximal effect being seen at 7 days
Which drugs can lead to SIADH?
- SSRIs, tricyclics! sulfonylureas* carbamazepine vincristine cyclophosphamide
