Category: speciality

Hypokalaemia

Hypokalaemia (low potassium), is a common problem. It is found in 14% of outpatients and 20% of inpatients, however only 4-5% of those are of clinical significance.

Severity

  • Severe: <2.5 mEq/l OR Symptomatic – Look for Hypomagnesaemia
  • Moderate: 2.5-2.9 mEq/l (No or Minor symptoms)
  • Mild: 3.0-3.4 mEq/l  (Usually asymptomatic)

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COVID-19 (DKA/HHS)

Experience is showing that those with diabetic patients with COVID-19 are more likely to develop DKA/HSS. However, treating them with the traditional large amount of fluid is detrimental to their chest, if they have Covid-19

Hence the following has been developed from the Guy & Thomas’ guidance – CLICK HERE

High Clinical Suspicion of Covid-19

  • Clinical: Fever ≥37.8°C plus any of; cough, short of breath, myalgia, headache, sore throat
  • CXR: consistent with Covid-19

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Hyponatraemia

Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.

  1. Symptoms Severity – these are not exclusive to hyponatraemia and may be due to other disease processes (esp. if the low sodium is long-term)
  2. Sodium Level – the sodium concentration doesn’t always correlate to the clinical picture, and is dependant on speed of change, and co-morbidities
  3. Rate of Drop – the faster sodium levels drop the more symptomatic the patient often is (i.e. with long term hyponatraema the patient may be profoundly hyponatraemic but asymptomatic)
  4. Co-morbidities – Increasing sodium too quickly risks osmotic demyelination. How well will the patient cope with treatment?

Emergency treatment (hypertonic saline) is generally indicated in those with Severe Symptoms ONLY

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Hyperosmolar Hyperglycaemic State (HHS)

HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it.

Patients with HHS are often elderly with multiple co-morbidities, and they are always very sick.

Definition

  • Hypovolaemia
  • Hyperglycaemia – generally ≥30mmol/l
  • High Osmolality – generally ≥320mosmol/kg (Calculation= 2[Na] + [Glucose] + [Urea])
  • & NOT:
    • Acidotic – pH >7.3, HCO3 >15mmol/l
    • Ketotic – blood <3mmol/l, Urine <2+

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Hypomagnesaemia

Classification

  • Normal: 1.1-0.7
  • Mild: 0.69-0.5
  • Moderate: 0.49-0.4
  • Severe: <0.4

Signs/Symps (normally <0.5)

  • MSK: Muscle Twitch, Tremor, Tetany, Cramps
  • CNS: Apathy, Depression, Hallucination, Agitation, Confusion, Seizure
  • CVS: Tachycardia, Hypertension, Arrhythmia, Digoxin Toxicity
  • BioChem: Hypokalaemia, Hypocalcaemia, Hypophosphataemia, Hyponatraemia

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