U&Es Interpretation
24K - views

U&Es Interpretation

Similar presentations


Download Presentation

U&Es Interpretation




Download Presentation - The PPT/PDF document "U&Es Interpretation" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.



Presentation on theme: "U&Es Interpretation"— Presentation transcript:

Slide1

U&Es Interpretation

Dr Dan Taylor FY1

Slide2

Urea & Electrolytes

Components Urea

Creatinine Sodium Potassium Calcium

Magnesium Phosphate Urea Cycle converts ammonia to urea in the liver A less toxic metabolite

Transported to the kidneys where it is excreted

Slide3

Urea & Electrolytes

Components

Urea Creatinine Sodium

Potassium Calcium Magnesium Phosphate

Creatine is produced by the liver and used as part of fast energy stores by binding to phosphate (phosphorylation)Creatine phosphate then broken down to make ATP + creatinine waste product

Transported to the kidneys where it is excreted at a steady and constant rate

Creatinine concentration a specific marker of renal function but depends on muscle store

Slide4

Urea & Electrolytes

Components

Urea Creatinine Sodium Potassium

Calcium Magnesium Phosphate

Main component of extra-cellular fluid Na content monitored by aortic/carotid bodies and as reflects fluid status by heart chamber stretch Juxtaglomerular apparatus monitors Na and causes renin release

Slide5

Slide6

Urea & Electrolytes

Components

Urea Creatinine Sodium Potassium

Calcium Magnesium Phosphate

Main intracellular electrolyte component Levels controlled by aldosterone at the DCT acting to increase K+ excretion Levels also vary with H+ ion concentration as they compete for transporter in the kidney

Slide7

Urea & Electrolytes

Components

Urea Creatinine Sodium Potassium Calcium

Magnesium Phosphate Calcium and phosphate both closely relatedGenerally stored within bone Levels controlled by PTH released from the parathyroid gland

PTH production affected by Mg2+ levels

Slide8

Slide9

Urea & Electrolytes

Components

Urea Creatinine Sodium Potassium Calcium Magnesium

Phosphate Vital electrolyte used in bone/teeth formation but also nerve conduction and signalling Mostly found intracellular

Slide10

Doctor, can you please review the U&Es??

Urea 22.0 (2.5-7.5)

Creatinine 286 (45-100)Na 142 (135-145)K 5.6 (3.5-5.5)

Slide11

Problems?

Raised Urea

Dehydration GI bleed (urea rise in isolation) Increased protein breakdown (surgery, trauma, infection, malignancy)High protein intakeKidney damage

Raised Creatinine

Kidney damage

Increased lean body mass

Slide12

Acute Kidney Injury (AKI)

Rise in creatinine >50% from baseline or urine output <0.5ml/kg/

hr for 6+ hours Investigations Urine dipstick Bloods – FBC, U&Es, CRP, chemistry profile, PTH VBG – acidosis?/hyperkalaemia?Fluid balance chart (catherterise

patient)Stop nephrotoxins ?renal screen (if indicated) ?renal tract ultrasound (if severe)

Slide13

AKI

Pre-Renal (70%)

Hypovolaemia, Dehydration, sepsis Low BP, equal rise in urea and creat

IV fluid replacement May be complicated by ATN

Intrinsic Renal (20%)ATN (ischaemic/nephrotoxic), nephritis, glomerulonephritis Causative drugs,

hypovolaemic

episodes, haematuria, proteinuria

Dipstick blood +++/protein +++

Urine Protein-creatinine ratio (PCR) to quantify and monitor protein loss

Renal screen

Treat the underlying cause and give bicarbonate if indicated (protects the kidney)

Post-Renal (10%)

Urinary tract obstruction (stones/prostate/tumour/stricture)

Renal tract ultrasound indicated

Relieve the obstruction (

catherterise

/nephrostomy)

Nephritic screen

ANA

P-ANCA/c-ANCA

Anti-GBM

Complement screen

RhF

Hepatitis serology

Anti-phospholipid antibody

Renal ultrasound

Renal biopsy

Myeloma screen

FBC,

chem

/bone profile, LDH

Urinary

bence

-jones protein

Serum

immunoglobulins

Serum electrophoresis and

immunofixation

Skeletal survey

Creatine kinase

Slide14

Chronic Kidney Disease

Markers of damaged kidney function (proteinuria) or decreased

eGFR for >3 months Graded 1-5 based on eGFRCausesDiabetes and hypertension Chronic

glomerulonephritidies and inherited disorders/drugs Management Manage underlying cause Fluid restriction/low protein intake/ACE-inhibitor Treat complications Anaemia, hypertension, oedema, renal bone disease, hyperkalaemiaDialysis if

eGFR<15/complications

Indications for Dialysis

A

cidosis

E

lectrolyte abnormalities

I

ntoxication

O

verload

U

raemia (symptomatic or >60.0)

Slide15

Hypernatraemia (>155)

Reflects an inability to concentrate urine so more water is lost than salt

Concentrated serum

Causes Fluid loss without replacement Diarrhoea/vomitingBurnsDecreased access to water

Incorrect IV fluids Diabetes insipidus (no ADH)Osmotic diuresis Aldosterone increase Conn’s

Cushings

Signs and Symptoms

Dehydration/thirst

lethargy/weakness

Confusion/coma

Seizures

Ix

U&E

↑Na

↑urea/alb

Identify cause

Management

Increase oral water intake if dehydrated

IV fluids (dextrose and saline)

Correct use of IV fluids

Guide therapy by volume status and bloods

Slide16

Hyponatraemia (<135)

Does not necessarily indicate a depletion – depends on fluid state

Suggestion of an issue with sodium distribution in water

Causes Dehydrated Actual fluid lossEuvolaemicDistribution problem

Oedematous Dilution

Signs and Symptoms

Anorexia/nausea

Malaise/weakness

Confusion/coma

seizures

Ix

U&E

Urine and serum osmolality

Urine sodium

Management

Fluid restriction

Corrects distribution and dilution

Replace fluids IV

Pharmacological

Demeclocycline or vaptans

Slide17

Hyponatraemia

Dehydrated

High urinary Na (renal loss)Addison’s (low aldosterone)

Excess diuretic (thiazide/loop)Non-functioning kidneys Osmolar diuresisLow urinary Na (loss elsewhere)

DiarrhoeaVomitingBurns/heat/sweatingSmall bowel obstruction

Euvolaemic

High urine osmolality (concentrated)

SIADH

Low urine osmolality (dilute)

Water overload

Hypothyroidism

Addison's

Too much dextrose

Overloaded

Renal failure

Cardiac failure

Low protein states

Liver failure

Nephrotic syndrome

Slide18

Hyperkalaemia (>6.5)

Emergency as may lead to myocardial excitability and ventricular fibrillation

Be aware of artefactual results: haemolysis, delayed analysis, contamination

Causes Impaired renal excretion K+ sparing diuretics AKI/CKD

Hypoaldosteronism Addison’s DiseaseACE-i/ARBsRelease from cells Acidosis

Cell lysis/burns

Tumour lysis syndrome

Rhabdomyolysis

Signs and Symptoms

Fast irregular pulse

Palpitations

Chest pain

Light headedness

Ix

U&E

ECG

Management

Check the patient and ECG – repeat

1.) 10mls 10% IV calcium gluconate

2.) 2.5mg salbutamol nebs

3.) Insulin + glucose (10u in 50ml 50% dextrose)

4.) dialysis/haemofiltration

Slide19

Hypokalaemia (<2.5)

Very common electrolyte abnormality

Related to Mg concentration if it is also low K+ will not correct

Causes Diuretics (thiazide and loop)AlkalosisVomiting and diarrhoeaRenal tubular damage

Cushing’s/steroids ConnsVillous adenoma

Signs and Symptoms

Usually asymptomatic

Hypotonia/

hyporeflexia

Palpitations

Ix

U&E & Mg

ECG

Management

Oral replacement (

sando

K)

IV replacement – slowly & diluted

Slide20

Hypercalcaemia (>2.6)

Calcium involved in cell signalling and muscle function

Adjusted calcium values in relation to albumin as calcium bound to albumin readily

Causes 1⁰ hyperparathyroidism 3⁰ hyperparathyroidism Malignancy

Bony metastases MyelomaPTHrp Vitamin D excessSarcoidosis

Signs and Symptoms

Bones, stones, groans & psychic moans

Bone pain & path #

Abdo pain/

n+v

Tiredness/weakness

Confusion/depression

Polydipsia/polyuria

Ix

Ca

and Po4

Raised together – malignancy

High

Ca

, low Po4 – PTH driven

Myeloma screen

Identify malignancy

Management

Correct dehydration aggressively

IV bisphosphonate

Slide21

Hypocalcaemia (<2.2)

May be artefactual due to low albumin and also if phosphate is high (renal failure) as PO4 chelates calcium rendering it useless

Causes

OsteomalaciaAcute pancreatitis Hypoparathyroidism (iatrogenic)Pseudohypoparathyroidism

Hypomagnaesia Vitamin D deficiency Renal failureHigh phosphate Failure to retain Ca

Failure to activate Vit D

Signs and Symptoms

Cramps

Peri-oral paraesthesia

spasms

Chovsteks/

Trousiers

Anxiety/irritability

Confusion/disorientation

seizures

Ix

Bone profile

ECG

Management

Calcium replacement orally

IV calcium gluconate if severe

Alfacalcidol in renal failure

Slide22

Case

48 year old gentleman presents with a 4/52 history of increasing fatigue and anorexia

He has also noticed he has lost some weight and that his skin, especially around his armpits looks darker than usual He complains of feeling lightheaded on standing and occasionally even when sitting

Slide23

Case

BP sitting 110/65, standing 83/45

FBC – Hb 122, WCC 8.4, plt 352U&Es – Na 130, K 5.9, urea 9.2

, creat 112LFTs – normal TFTs – normal

Slide24

Case

What are the investigative abnormalities?

What are the immediate management steps?Patient assessment and ECG Correct hyperkalaemia IV fluids What is the underlying cause?Addisons Disease (autoimmune, infective, infiltrative, metastatic disease)

How can this be confirmed?Short synacthen test What is the management? Steroid replacement

Slide25

Any questions?

Slide26

Slide27