Term
| biochemical signs of dehydration |
|
Definition
increase in urea. the increase is disproportionately higher than the increase in creatinine.
there is an increase in albumin. plot these on a graph to see the trend
increase in heamatocrit (PCV) packed cell volume
urine out decreases, skin turgor decreases |
|
|
Term
| most useful clinical signs for predicting 5% dehydration in children |
|
Definition
reduce skin turgor
increased cap refill time
increased reap rate |
|
|
Term
| how is mild, moderate and severe dehydration classified in children according to % weight loss? |
|
Definition
mild up to 5% weight loss
moderate up to 10% weightless
severe is > 10% weight loss |
|
|
Term
when prescribing IV fluids, remember the 5 R's
what are they? |
|
Definition
resuscitation
routine maintenance
replacement
redistribution
reassessment |
|
|
Term
| what fluids would you give to resuscitate a hypovolemic dehydrated pt? |
|
Definition
| 500ml fluid challenge over 15 mins of crystalloid e.g. 0.9% normal saline |
|
|
Term
| routine maintenance fluids for adults |
|
Definition
25-30ml/kg/day of water
1mmol/kg/day of K+, Na+ and Cl-
50-100g/day of glucose to limit starvation ketosis |
|
|
Term
| in children receiving iV fluid replacement what needs to be measured and when? |
|
Definition
| measure plasma electrolyte concentrations and blood glucose when starting and then at least every 24 hours |
|
|
Term
| mx of mild-moderate dehydration in children? |
|
Definition
| oral rehydration therapy. no IV fluids are required |
|
|
Term
| how to calculate replacement fluids in children? |
|
Definition
| their weight in KG x % dehydration x 10 |
|
|
Term
| MAINTENANCE FLUID REQUIREMENT FOR CHILDREN?? |
|
Definition
100ml/kg for first 10kg
50ml/kg for next 10kg
20ml/kg for remainder |
|
|
Term
| mx for isotonic and hypotonic dehydration in children? |
|
Definition
| 0.9% saline and 5% dextrose |
|
|
Term
| mx for hypertonic dehydration in children |
|
Definition
0.9% and 5% dextrose but replace slowly over 48 hours
monitor sodium and aim to reduce is < 0.5mmol/L/hour |
|
|
Term
| electrolyte derangement caused by loop diuretics and thiazides |
|
Definition
low Na
low K
High bicarbonate
High urea |
|
|
Term
there are 2 biochemical pictures of abnormal kidney function. Low GFR and tubular dysfunction.
describe features of both |
|
Definition
in low GFR: increased urea, creatinine, K+, H+, Po34+, urate
in tubular dysfunction: normal urea and creatinine, low K+, low urate, low bicarbonate, low phosphate. High H+ |
|
|
Term
| a falsely low calcium result may occur when which protein is low? |
|
Definition
|
|
Term
for 70kg man how much body weight is water?
of the water weight how much is intracellular and how much is extra cellular?
of the extracellular compartment, how much in intravascular i.e blood? |
|
Definition
60% water so this is 42L
from this 2/3 in intracellular (28) and 1/3 extracellular (14L)
1/3 of extracellular fluid is intravascular i.e. blood (5L) |
|
|
Term
| if you gave fluid resus with normal saline where would it mainly distribute? how much would replace the blood volume |
|
Definition
| normal saline stays mainly in extravascular space. this means 1/3 would replace blood volume. this is because 1/3 of the extracellular fluid is intravascular fluid i.e blood. |
|
|
Term
| if you gave fluid resus with normal saline where would it mainly distribute? how much would replace the blood volume |
|
Definition
| normal saline stays mainly in extravascular space. this means 1/3 would replace blood volume. this is because 1/3 of the extracellular fluid is intravascular fluid i.e blood. |
|
|
Term
| hypertonic glucose is an irritant to veins. what must be done after each admin? |
|
Definition
| flush with normal saline and inspect the cannula site |
|
|
Term
| liver failure and fluid replacement: special considerations? |
|
Definition
| these pts have raised body sodium so avoid normal saline for maintenance fluids |
|
|
Term
| pancreatitis and fluid resus: special considerations? |
|
Definition
| aggressive fluid resus required due to 3rd space loss |
|
|
Term
max amount of K+ that can be infused in a peripheral line is?
what is the giving rate of K+ per hour? |
|
Definition
| 40mmol/L max can be given safely in a peripheral line at a rate of 20mmol/h |
|
|
Term
| what happens if you gave K+ faster than 20mmol/h? |
|
Definition
| you risk systole, cardiac dysrhythmias and thrombophlebitis depending on the size of the vein. |
|
|
Term
| if you are giving K+ at >40mmol/h what vein should this be given in? |
|
Definition
via a central venous catheter
for rates > 10mmol/h use ECG monitoring |
|
|
Term
| functions of angiontensin II |
|
Definition
constriction of EFFERENT arteriole
peripheral vasoconstriction
stimulates adrenal cortex to produce aldosterone |
|
|
Term
| functions of angiontensin II |
|
Definition
constriction of EFFERENT arteriole
peripheral vasoconstriction
stimulates adrenal cortex to produce aldosterone |
|
|
Term
| ECG features of hypokalemia |
|
Definition
prolonged QT
prolonged PR
U waves |
|
|
Term
| list 3 things that regulate plasma K+ levels |
|
Definition
aldosterone
acid base
insulin |
|
|
Term
| ECG changes in hyperkalemia |
|
Definition
Tall tented T waves
small P waves
widened QRS complex
asystole |
|
|
Term
| in a pt with hyperkalemia the ECG shows tall tented T waves, broad QRS complexes with bradycardia. why is bradycardia a worrying sign? |
|
Definition
| because systole might occur |
|
|
Term
| dose of atorvastatin for secondary prevention? |
|
Definition
|
|
Term
| how to monitor LFTS for statin therapy |
|
Definition
do LFTs at baseline, 3m and 12months
stop rx if serum transaminase rise to a persist 3x upper reference range |
|
|
Term
|
Definition
malignancy
primary hyperparathyroidism
PTH that is normal or raised suggests primary hyperparathyroidism. |
|
|
Term
| in dehydration the urea is disproportionately raised in comparison to creatinine. why is this? |
|
Definition
this is because some urea is reabsorbed with water absorption that occurs in dehydration.
we would also expect concentration of serum proteins and electrolytes to increase due to the relative decrease in intravascular fluid volume. |
|
|
Term
| a pts blood Na is 120mmol/L you decide to check urine osmolality. what does this need to be > in order to diagnose SIADH? |
|
Definition
|
|
Term
| hypoxia and respiratory alkalosis. come off a flight? |
|
Definition
PE.
respiratory alkalosis from the hyperventilation. |
|
|
Term
| mx of hyperkalemia if K+ > 6.5mmol/L or if there are ECG changes? |
|
Definition
calcium gluconate 10% 10-20ml slow injection titrated to ECG response
10U actrapid in 50ml of 50% glucose IV over 10 mins
nebulised salbutamol
correct acidosis with sodium bicarbonate infusion |
|
|
Term
| in the Wells score for PE, what is the cut off that makes PE likely or not likely? |
|
Definition
> 4 PE likely.. do CTPA straight away. if delay for scan give LMWH whilst they wait
< 4 PE unlikely.. do D dimer. if positive do CTPA. |
|
|
Term
| sensitivity and specificity of D dimer |
|
Definition
| it is sensitive but not specific |
|
|
Term
|
Definition
sinus tachycardia
right bundle branch and right axis deviation. |
|
|
Term
| primary prevention: for statins what dose and what risk factors does the pt need for you to start them on statins? |
|
Definition
10 year CVS risk 10% or >
most type 1 diabetics
CKD if eGFR <60ml
DOSE: atorvastatin 20mg for primary prevention
if non HDL cholesterol has not fallen by 40mmol consider titrating up to 80mg |
|
|
Term
secondary prevention using atorvastatin
what is the dose and what factors would make you initiate treatment? |
|
Definition
known
PVD or
CVD or
IHD or
atorvastatin 80mg |
|
|
Term
| what is the cut off for using the QRISK2 tool in pts? |
|
Definition
< 84 years age
those aged 85 or more are at high risk of CVD due to their age |
|
|
Term
| which class of diuretics classically cause hypercalcemia? |
|
Definition
|
|
Term
what are the main causes of hypercalcemia?
SAVe the MPs Drug PAD acronym lol (shite I know) |
|
Definition
malignancy
primary hyperparathyroidism
sarcoidosis
vit D intoxication
acromegaly
thyrotoxicosis
drugs: thiazides
dehydration
addisons
pagets disease of bone |
|
|
Term
| what common findings would you see in ABG of a panic attack? |
|
Definition
Respiratory alkalosis from hyperventilation
pO2 will be normal as there is no prolem with o2 gas exchange |
|
|
Term
| multiple red/yellow vesicles on extensor surfaces AKA eruptive xanthoma. what does this indicate? |
|
Definition
|
|
Term
| what is the anion gap in DKA? |
|
Definition
|
|
Term
| pt has diarrhoea due to GI bicarb loss. what would the anion gap be? |
|
Definition
normal
normal range of anion gap is 10-18 |
|
|
Term
| causes of normal anion gap in ABG results? |
|
Definition
gastrointestinal bicarb loss from gastroenteritis, fistula
Addisons disease
ammonium chloride injection
drugs: acetazolamide
renal tubular acidosis |
|
|
Term
| causes of raise anion gap in ABG results? |
|
Definition
poisoning: salicylates, mathanol
DKA
lactate: shock, hypoxia
urate: renal failure |
|
|
Term
hyponatremia can be due to sodium loss or water excess.
list one reason for pseudohyponatremia |
|
Definition
| hyperlipidemia as there is an increase in serum volume. |
|
|
Term
list causes for sodium depletion due to renal loss.
in this case urinary sodium would be >20mmol/L |
|
Definition
diuretics
addison's
diuretic stage of renal failure |
|
|
Term
| causes of raised plasma osmolality? |
|
Definition
dehydration
increased glucose in diabetes mellitus |
|
|
Term
| what is the effect of low plasma osmolality on ADH secretion? |
|
Definition
it inhibits ADH secretion. why?
well there are already fewer solutes in the plasma. ADH secretion will retain more water thus dilute the plasma even more.The body doesnt want this to happen therefore it inhibits ADH secretion |
|
|
Term
the modification of diet in renal disease MDRD uses which 4 parameters to provide an estimated GFR?
what does the cockcroft-gault equation add in addition to these four paraments? |
|
Definition
serum creatinine
age
gender
race (black or not black)
cockcroft-gault also adds in pt weight |
|
|
Term
| what is the gold standard for calculating GFR? |
|
Definition
| inulin infusion measurement. |
|
|
Term
| what are the key principles when interpreting ABGS? |
|
Definition
primary changes in bicarbonate are metabolic
primary changes in pCO2 are respiratory |
|
|
Term
metabolic acidosis with increased anion gap?
LUKD |
|
Definition
lactate: shock, hypoxia
urate: renal failure
Ketones: DKA
Drugs/toxins: salicylates, ethanol, methanol, biguanides |
|
|
Term
metabolic acidosis with normal anion gap?
RADPAD |
|
Definition
Renal tubular acidosis
Addisons
Diarrhoea
Pancreatic fistula
Ammonium chloride ingestion
Drugs: acetazolamide |
|
|
Term
a pt is hyponatremic but their urinary sodium is < 20mmol/L
what does this mean? |
|
Definition
it means the sodium loss is occurring extra renal.
this could be due to diarrhoea, vomiting, sweating or burns etc. |
|
|
Term
causes of hypernatremia and mx
DODE |
|
Definition
Dehydration
Osmotic diuresis e.g. hyperosmolar non ketotic diabetic coma
Diabetes insidious
Excess saline infusion
mx: correction of hypernatremia should be down at a rate no greater that 0.5mmol/hour. this is so you don't precipitate cerebral oedema. |
|
|
Term
magnesium deficiency can cause hypokalemia
name other causes of hypokalemia |
|
Definition
vomiting
diuretics
cushings
conns
diarrhoea
acetazolamide
renal tubular acidosis |
|
|
Term
ECG manifestations of hyponatremia
signs: confusion, restlessness, somnolence, nausea, seizures and coma |
|
Definition
wide QRS
bradycardia
elevated ST going onto
VT or VF |
|
|
Term
|
Definition
lethargy
twitching
weakness and irritibility
signs are mostly neurological as water moves out from intracellular to extracellular space and this causes cells to shrink. |
|
|
Term
| causes of pseudo hyponatremia? |
|
Definition
high plasma lipids or proteins
high plasma glucose as this draws out intracellular water and dilutes the serum. |
|
|
Term
hyponatremia can be hypovolemic, euvolemic and hypervolemic.
list some examples for each |
|
Definition
hypovolemia with urine <20mmol/ salt: vomiting, diarrhoea, burns
hypovolemia urine Na >20mmol/L: diuretics, renal failure
euvolemic Na<40 and osmol<100: acute water load, psychogenic, tea/toast/beer diets
euvolemic hyponatremia Na>40 osmol>100: SIADH, hypothyroid, chronic waterload
hypervolemic Na<20mol/l: CCF, Nephrotic syndrome, primary polydipsia
hypervolemic Na>20mmol/L: renal failure or disease. |
|
|
Term
| what is the osmolality in SIADH? |
|
Definition
it is inappropriately raised >100mOsmol/kg
Na in urine is commonly more than>30mmol
there is hyponatremia |
|
|
Term
|
Definition
serum osmolality is reduce <275
urine osmolality is raised >100
Na in urine is raised
there is hyponatremia in plasma |
|
|
Term
| which medication can be used to treat hyponatremia associated with SIADH. what is its MOA? |
|
Definition
demeclocycline.
it blocks ADH and induces partial nephrogenic diabetes insipidus |
|
|
Term
| what is the complication of correcting hyponatremia too quickly? |
|
Definition
| central pontine myelinolysis |
|
|
Term
hyperkalemia is define at K+ > 5.5
what is severe hyperkalemia define as? |
|
Definition
|
|
Term
| ECG changes in hyperkalemia |
|
Definition
peaked T waves
broad QRS
small P waves
prolonged PR interval
bradycardia progressing to systole
sine wave pattern |
|
|
Term
| which electrolyte derangement precipitates digoxin toxicity? |
|
Definition
|
|
Term
| signs if hypokalemia. which other electrolyte might be low and needs to be corrected? |
|
Definition
tetany
muscle weakness
hypotone
hyporeflex
constipation
cramps
light headedness
magnesium may also be low and this needs to be corrected or else it will be difficult to correct hypokalemia. |
|
|
Term
| how to treat mild hypokalemia? |
|
Definition
| PO K+ supplements sando K 2 tabs every 8 hours |
|
|
Term
which hormone is predominantly involved in calcium and phosphate homeostasis?
what is the overall effect |
|
Definition
the hormone is parathyroid hormone
the overall effect is increased serum calcium and decreased serum phosphate.
PTH release triggered by decreased serum calcium concentration. the result of this is increased osteoclast activity releasing calcium and phosphate from bones. in the kidneys more calcium is absorbed and less phosphate. there is increased production of 1,25 dihydroxy vitamin d3 by kidneys |
|
|
Term
| calcitrol is the active form of vitamin D what is its fancy name> |
|
Definition
|
|
Term
| what is the effect of decreased Mg on PTH? |
|
Definition
it prevents release of PTH and this may cause hypocalcemia
this means low mg is associated with hypocalcemia as well as hypokalemia. it also makes you have diarrhoea, |
|
|
Term
| how much of calcium in the body is bound to albumin? |
|
Definition
|
|
Term
| corrected calcium how do you do it? |
|
Definition
add 0.1mmol to calcium for ever 4g/L that albumin is below 40g/L
this is because calcium is 40% bound to albumin |
|
|
Term
BONES stones
groans and psychic moans
are signs of which electrolyte disturbance? |
|
Definition
hypercalcemia
abdo pain
vomiting
constipation
polyuria
depression
anorexia
weightloss
tiredness |
|
|
Term
| what can HIV do to calcium levels? |
|
Definition
| cause hyper or hypo. it can cause both |
|
|
Term
| a pt has hypercalcemia and you are trying to distinguish whether this is due to cancer or hyperparathyroidism. how would you distinguish between them? |
|
Definition
malignancy: low albumin, Chlorine and K+. there may be alkalosis, Increased phosphate and ALK phos.
pointers towards hyperparathyroidism would be suggested by increased PTH |
|
|
Term
| mx of acute hypercalcemia |
|
Definition
correct dehydration with IV saline
bisphosphonates: pamindronate
chemotherapy if malignancy |
|
|
Term
|
Definition
flu symptoms
bone pain
low phosphate
confusion
thirst
taste disturbance
nausea
osteonecrosis of the jaw |
|
|
Term
| signs and symptoms of hypocalcemia |
|
Definition
cramps
perioral numbness
carpopedal spasm = Trousseus sign
seizures
anxious
muscle tone increase in smooth mucle: dysphagia, colic, wheeze
Chovsteks sign - facial muscle twitching
dermatitis
impetigo herpetiformis: can occur in pregnancy |
|
|
Term
| what is hyper phosphate commonly due to? |
|
Definition
chronic kidney disease.
treated with phosphate binders e.g. Sevelamer |
|
|
