Electrolytes

Question 1

hypokalaemia ecg changes

Answer 1

• u waves
• tall tented p waves
• increased pr interval

Question 2

hypokalaemia presentation

Answer 2

• muscle cramps and weakness
• lethargy
• palpitations

Question 3

hypokalaemia drug causes

Answer 3

• insulin
• salbutamol
• loop and thiazide diuretics
• laxatives
• steroids

Question 4

hypokalaemia other causes

Answer 4

• cushings
• conns
• d and v
• villous adenoma
• gitelmans syndrome
• barterrs syndrome
• liddles syndrome

Question 5

hypokalaemia management

Answer 5

• greater than 2.5 oral replacement

- less than 2.5 iv replacement

Question 6

hyperkalaemia ecg changes

Answer 6

• tall tented t waves
• sine wave appearance
• absent/small p waves
• broad qrs
• vf

Question 7

hyperkalaemia presentation

Answer 7

• arrhythmias
• palpitations
• chest pain
• constipation
• weakness

Question 8

hyperkalaemia drug causes

Answer 8

• spironolactone
• ace inhibitors
• suxamethonium
• blood transfusion
• excessive replacement

Question 9

hyperkalaemia other causes

Answer 9

• addisons disease
• dm with metabolic acidosis
• rhabdomyolysis
• renal tubular acidosis types 1 and 2
• burns

Question 10

hyperkalaemia management

Answer 10

• stabilise myocardium
• drive potassium in to cells
• sodium bicarbonate
• careful fluid resuscitation

Question 11

hyponatraemia presentation

Answer 11

• nausea and malaise
• headache
• irritability
• confusion
• seizures
• coma and death

Question 12

hyponatraemia causes (hypervolaemic)

Answer 12

• nephrotic syndrome
• cardiac failure
• liver cirrhosis
• renal failure

Question 13

hyponatraemia causes (euvolemic - urine osmolality >100)

Answer 13

• siadh

Question 14

hyponatraemia causes (euvolemic - urine osmolality <100)

Answer 14

• water overload
• severe hypothyroidism
• glucocorticoid insufficiency

Question 15

hyponatraemia causes (hypovolaemic - urinary sodium >20mmol/l)

Answer 15

• renal failure
• diuretic excess
• osmolar diuresis (increased glucose/urea)

Question 16

hyponatraemia causes (hypovolemic - urinary sodium <20 mmol/l)

Answer 16

• diarrhoea
• vomiting
• fistulae
• small bowel obstruction
• cardiac failure

Question 17

hyponatraemia management

Answer 17

• involve seniors, endocrine team and itu early on
  dependent on cause;
• hypovolaemia; 0.9% saline slowly. check u and es bd and aim not to exceed increasing sodium by greater than 10mmol in 24 hours
• hypervolaemia; fluid restrict and give furosemide
• euvolaemic; fluid restrict and consider further drugs
• risk of central pontine myelinosis if sodium level falls fast/replacement too quick so monitor gcs

Question 18

hypernatraemia presentation

Answer 18

• lethargy
• thirst
• weakness
• irritability
• confusion
• seizures
• coma and death

Question 19

hypernatraemia causes

Answer 19

• diarrhoea, vomiting, burns
• diabetes insipidus
• diabetic coma
• iatrogenic; excessive saline

Question 20

hypernatraemia management

Answer 20

• oral water
• if hypovolaemic can give 0.9% saline slowly, or consider 5% dextrose with senior
• risk of central pontine myelinosis if sodium level falls fast/replacement too quick so monitor gcs

Question 21

hypocalcaemia ecg changes

Answer 21

• prolonged qt interval

Question 22

hypocalcaemia presentation

Answer 22

• spasms; trousseau’s sign
• perioral paraesthesia
• anxious, irritable, irrational
• seizures
• muscle tone increased; smooth muscle wheeze
• orientation impairment
• dermatitis
• impetigo herpeteformis
• chvostek’s sign/cataracts/cm/choreoathetosis

Question 23

hypocalcaemia management

Answer 23

• mild symptoms; oral calcium
• kidney disease and vitamin d deficiency; alfacalcidol
• severe symptoms; 10ml 10% calcium gluconate over 20 minutes
• monitor patient with ecg

Question 24

hypocalcaemia causes

Answer 24

• drugs; furosemide
• hypoparathyroidism
• pseudohypoparathyroidism
• vitamin d deficiency
• acute pancreatitis
• acute rhabdomyolysis

Question 25

hypercalcaemia ecg changes

Answer 25

nil specific

Question 26

hypercalcaemia presentation

Answer 26

- bone pain and fractures - renal stones - polydipsia - polyuria - depression and irritability - abdominal pain - constipation - spasms

Question 27

hypercalcaemia causes

Answer 27

- drugs; thiazide diuretics and vitamin d - malignancy - primary hyperparathyroidism

Question 28

hypercalcaemia management

Answer 28

- correct dehydration - bisphosphonates 60 mg pamidronate infusion - furosemide; although dehydration may worsen hypercalcaemia - monitor patient with ecg - early involvement of endocrine team