Clinical Chemistry

Front 1

Assessing hyponatremia

Back 1

1. Volume status

- hypovolemic

- euvolemic

- hypervolemic

2. Urine Na

Front 2

Causes of hypovolemic hyponatermia

1. urine Na<10

2. urine Na>20

Back 2

1. extra-renal salt losses - dehydration, vomiting diarrhea

2. renal salt losses - diuretics, ACEi, nephrogenic, mineralcorticoid deficiency

Front 3

Causes of euvolemic hyponatremia

Back 3

-SIADH

- postoperative hyponatremia

- hypothyroid

- psychogenic polydipsia

Front 4

Causes of hypervolemic hyponatremia

Back 4

- CHF

- liver disease

- kidney disease

Front 5

Causes of hypovolemic hypernatermia

1. urine Na<10

2. urine Na>20

Back 5

1. Dehyrdration, GI losses, skin losses

2. osmotic diuresis, diuretics with poor water intake, renal disease

Front 6

Causes of euvolemic hypernatermia

Back 6

- diabetes insipidus (ADH deficiency - can be a result of head injury or surgery)

Front 7

Causes of hyperkalemia

Back 7

Medications (potassium sparing diruetics)

Acidosis (metabolic or respiratory)

Cellular destruction (crush injury, rhabdo)

Hemolysis

Intake (supplements, diet)

Nephrons (renal failure, renal tubular acidosis)

Excretion (decreased mineralcorticoid activity)

Front 8

Causes of hypokalemia

Back 8

- GI (vomitting and diarrhea)

- medications (thiazide and loop diuretics, aminoglycosides,B2 agonists)

- shifts (insulin, alkalosis)

- endocrine (DKA)
- renal (renal tubular acidosis)

Front 9

symptoms of hypokalemia

1. mild

2. severe

3. ECG changes

Back 9

1. mild hypokalemia usually asymptomatic

2. severe: muscle weakness, cramps, myalgia, tremor, constipation

3. wide PR, flat T waves, ST depression

Front 10

treatment of hypokalemia

Back 10

- PO or IV supplmentation

- spironolactone if resistant

Front 11

symptoms of hyperkalemia

1. mild

2. severe

3. ECG changes

Back 11

1. malaise, palpatations, light-headedness, muscle weakness

2. arryhtmia if severe

3. small p waves, peaked T waves, wide QRS

Front 12

1. symptoms of hypernatermia

2. treatment

Back 12

1. lethargy, thirst, weakeness, irritability, confusion, coma, fits, signs of dehydration
2. PO water or IV dextrose 5%

Front 13

symptoms of hyponatremia

1. mild

2. moderate

3. severe

Back 13

1. Nausea, anorexia, malaise

2. Headache, weakness, irritability, confusion, weakness, low GCS

3. Seizures

Front 14

treatment of hyponatremia

Back 14

fluid restriction or cautious rehydration (risk of central pontine myelenosis

Front 15

hypercalcemia

1. causes

2. symptoms

3. treatment

Back 15

1. Parathyroid hormone excess, (ademona, hyperplasia), Amyloidosis, Renal failure (increased PO43-), Addison's disease (adrenal calcification), Overdose of vitamin D, Muscle primaries, Bone metastasis

2. Symptoms: 'bones, stones, groans and moans', abdo pain, constipation, nausea, polyuria, polydipsia, depression, anorexia, weight loss, weakness Signs: renal stones, hypertension, ectopic calcification, cardiac arrest ECG: decreased QT

3. Correct dehydration (0.9% saline) Bisphosphanates

Front 16

hypocalcemia

1. causes

2. symptoms

3. treatment

Back 16

1. With increased PO43- CKD Hypoparathyroid Pseudohypoparathyroid Acute rhabdomyolysis Vitamin D deficiency Hypomagnesaemia. With normal or decreased PO43- Osteomalacia (with increased ALP) Acute pancreatitis Over-hydration Respiratory alkalosis (low ionized Ca2+ due to low pH)

2. Symptoms - cramps, spasms, (carpopedal) perioral numbness, anxious, irritable, Signs – seizures, increased muscle tone, confusion, dermatitis, ECG – long QT

3. Oral or IV calcium

Front 17

24 hour maintenance fluid regime

Back 17

2L 5% dextrose + 1L .09% saline + additional 60mmol K

Front 18

In cases of metabolic acidosis, it is important to calculate what? How is this done?

Back 18

anion gap

(Na+) - (Cl- and HCO3-)

(normal anion gap 4 - 12mmol)