Category: Abnormal Investigations

Hyperkalaemia

Hyperkalaemia can cause life-threatening emergencies particularly cardiac arrhythmias. A widely used definition is extracellular [K+] ion concentration ≥ 5.5 mmol/L. Complications increase with severity and hyperkalaemia may be classified as: Mild 5.5-5.9 mmol/l Moderate 6.0-6.4 mmol/l Severe ≥ 6.5 mmol/l Causes Always consider the cause of hyperkalaemia. Emergency treatments only temporarily lower potassium levels to

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Hypernatraemia

Hypernatraemia is defined as a sodium above 145 mmol/L with severe being more than 150 mmol/L.

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Hypokalaemia

As an FY1 you will frequently see hypokalaemia and most trusts have guidelines that should be used in the first instance. The advice below is informal & based on broad day to day practice. It should never replace clinical judgement and escalation for senior support if indicated. The UK Medicines Information group have provided information

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Hyponatraemia

Hyponatraemia (serum Sodium <135 mmol/L) is one of the most common electrolyte abnormalities you will see and so a systematic approach to identifying the underlying cause and management is vital. We will use the algorithm below from ESE which is far easier to use than the antiquated system of first assessing their volume status. Recommended Investigations

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Paracetamol Overdose

As an FY1, you will encounter these either during clerking shifts or you may look after them on the ward. As it is quite common, the information below is to help give you an overview. For management, use Toxbase, the login should be on your trust intranet or from A&E. The app allows you to sign

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Jaundice & Deranged LFTs

As the FY1, you will see patients with liver dysfunction either on the take or deranged LFTs when you are reviewing bloods. A focused approach can save you time & help you find the likely underlying cause to start investigating. It can also help you identify red flags that prompt urgent escalation. Red flags (urgent

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Acute Kidney Injury

AKI is very common affecting around 20% of inpatients & it is important to recognise promptly and correctly to avoid complications. In this article, we give a quick overview of the assessment and management followed by a detail information on each step. Quick Overview Severity: Graded by the extent of creatinine rise from baseline or

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Refeeding Syndrome

Defined as a collection of electrolyte abnormalities associated with a massive intracellular shift of electrolytes. Associated with aggressive nutritional rehabilitation of malnourished patients in e.g. malignancy, chronic organ dysfunction, inflammatory conditions (e.g. pancreatitis, colitis), the perioperative period as well as anorexia nervosa. Clinical features Sequelae of hypophosphataemia, hypokalaemia, hypocalcaemia, hypomagnesaemia, e.g.Congestive heart failure, peripheral oedema,

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Hypophosphataemia

The UK Medicines Information group have provided excellent guidance on how to replace phosphate. Clinical features Generally asymptomatic if mild Can cause many systemic features CNS & MSK: weakness/myalgia, lethargy, confusion, seizures Cardiorespiratory failure Rickets/Osteomalacia if chronic Causes Malabsorption D&V Refeeding syndrome Investigations Check the calcium, U&Es, renal function Treatment Use local guidelines or consider

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Hypocalcaemia

Alongside strengthening bone, calcium is used in the clotting cascade, in muscle contraction, and in nerve-signalling. As such, low levels can lead to coagulopathy, smooth and skeletal muscle-spasms, heart problems, altered sensation and even seizures. Acute hypocalcaemia that is severe (<1.9 mmol/L) or symptomatic can be life-threatening and necessitates urgent treatment. It is often initially

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