Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

Um, I think maybe that might be it for a bit. Um, and this will be recorded. So any of your, um, friends or anybody in your year just let me know this is on. But, um, I'm gonna make a start because, um, there's a lot in end and I'm doing a bit of diabetic foot. Um, firstly, sorry, my name is Catherine. I'm in two and a lot of that stress at the minute. Um, currently working in spinal cord injury unit in S group. Um, it's a really good job and I previous to that, I was in endocrine and diabetic foot in the royal. Um, really good job if any of you get this, get the job in the future. Um, it's a really good one even if you're not keen on entering, um, really lovely team. But, um, I think these are all doing your finals. Isn't that right? Um Yeah, and also can everybody see, um, my screen for somebody just put a thumbs up in the chat and just so I'm not talking to myself if that's ok. Yeah, we can say, ah, thank you cheers. And, uh, can you see my sides Yeah. Yeah, great, thank you. And I, um, sorry, only a second. Ok. Um, it's recorded as I said, so I'll just make a start. Um, as you can probably see there's a lot of slides, but I'll not go through everything and I'll let you read a lot for yourself, but, um, for yourself. But, um, I try to make, I was thinking back to myself when I was doing my own finals. Um, Sometimes the notes aren't great that you get in uni and sometimes you just need concise information. So sorry, some of the sides might have a lot on them, but I do think it's important. Um And you can use this for notes, I think, you know, um but you can see what you think but um firstly, um just start with objectives. So um as you can see, we're gonna go through some electrolytes abnormalities. So gonna I'm gonna focus on hypocalcemia, hypercalcemia. Um And then go through low, high magnesium, um low, high potassium and a bit and hyponatremia. But II won't get through. You need a like a half an hour to talk about hyponatremia. But um ok, so thyroid disease, adrenal insufficiency, Cushing's syndrome, amega. Um and then diabetes including some of the emergencies. So we'll talk a bit about um hypo hyperglycemia, DKA diabetic, um diabetic keto ketoacidosis. Um And that used to send DK um and hh as well. Um And then we'll talk a bit about diabetic foot um And then there's, there's some M CTS. So it just listed there what's not covered. So if you are happy enough to just go through that we um yourselves, but, and the bulk of it is covered in the se OK. And that table is what you're expected to know. Um All right. So, um per these electrolyte abnormalities. So, if a blood is off, you need to know why, establish the cause you need to replace it and you need to treat it. So if you gain anything out of this whole powerpoint, um this week card, it has all the electrolytes. Um As you can see there, it shows you what at what value you need to give IV or oral replacement. Um We got this, somebody sent me this at the start of F one. I was not the elephant last year but um everybody, every F one all like to use my friends. We all just use this card. Um It just keeps your eye. Um So it just shows you at what level you need IV. Orals, mostly oral, the oral replacement. It's like two sachets BD means twice a day for three days. Um And then there's IV replacement. Um We used to do that in fluid balances. Um You do that in the Western Trust still, I don't think Northern and the Southern Trust, it still has um food balances on paper. But with Epic now and compass, it's all online. So, um you know, it kind of comes up for you but take a picture of that wee card and keep it, it's really, really handy. So, magnesium. So magnesium is a very important electrolyte. If it's off, you, you need to correct it before your calcium and your potassium is treated. Um, that's something, uh, an endocrine consultant told me and it, it works. So if you find on a word around somebody's magnesiums, magnesium's off, but also the potassium is crack, the magnesium and then repeat it and it should drive up the potassium. All right. So common causes uh medications. You'll find um PPI S like omeprazole. Uh it will cause not only hyponatremia hypo, um low magnesium as well. So you're better stopping that and thinking about, for example, like um an A HT antagonist, but always check your medications. And if somebody is having diarrhea, vomiting, you're thinking that's why the potassium is low. Um And then crack as appropriate as per the value or high, like how low it is. Um her oral intake. So, refeeding syndrome, just something for your exams as well. So somebody's not eating for or has really oral intake for greater than seven days. Um It may be due to disorders like um chronic pancreatitis and inflammatory bowel disease. They are long term like um parenteral nutrition or the cancer or they're on chemo or like they take a lot of alcohol, you need to check their electrolytes. So, send a bone prof profile, a bone profile will, will give you your adjusted calcium, your calcium, we always use, adjusted and it's also like corrected and then check, it'll also give you your uh, phosphate and then check your magnesium. Ok? And then a low albumin just something to note. Um, it's a, it's a good indication of somebody who's just lost a lot of weight and is malnourished. Um All right. And then tumor lysis syndrome, that's when cancer cells all break down and then release all these electrolytes into the bloodstream, which I make that can be become toxic. So you'll find if somebody's on chemotherapy. Um for example, and then if you're in a hematology or oncology job, you'll get bloods before and after the chemotherapy and some who have like bad kidney disease, they'll get it done more regularly because um for example, with CKD, it's more difficult to excrete electrolytes. So just keep a record. Just keep note of hypercalcemia. So high potassium, high uric acid levels, high phosphate and a low calcium. All right, they're just things to know and you will be asked about them in exams. So a lot of insulin is slight but it's just for your revision. So, hypocalcemia, as I said before we use adjusted. Um So less than 2.2 is a low calcium and it's just the normal range. Ok. So causes of that. Um So her intake um low if your magnesium's low as I said your calcium is gonna be low, Vitamin D deficiency and then some medications and then a lot of these diseases. All right. Um, and then there's a lot of like, could be toxic like um, glycol, like dry eyes, like poisoning cause that um, loop diuretics like plasmapheresis and stuff. So there's just some of the symptoms. Ok. So, perioral numbness and sometimes seizures. Ok. And paraesthesia, I'm trying to think of patients. I've seen a lot of them know when the calcium is really low, they can feel it, they can feel the tetany. Um, they'll get a lot of muscle cramps. Ok? Just for exams in real life don't do this. But, um, the, um, signs when you tap on the cheek. Ok. And it just causes like hyperexcitation of the facial nerve. Ok. And then your tosa sign, uh, sign. Ok. It's, um, carbo fal spasms. All right. So it causes thumb abduction and infection of this, uh, MCP joints. Ok. Um, so if you inflate the person's p pee the BP cuff, um, higher than the systolic BP for about three minutes should cause that spasm. Ok. And then just investigations, as I said, you do your bone profile, um, a load of other bloods. Ok. And then ecg most important thing, these patients with hypocalcemia, they need to be on telemetry if it's severe. Ok. Um, in many hospitals there's a hypocalcemia protocol, just use it of all the senior and they are at risk of prolonged QTC syndrome. All right. So they need to be on telemetry. Um, so if you have someone on a ward who has a really low calcium, you need to make sure they're on a monitor. All right. And then just management, depending on um, how severe it is. Um, if it's only nightly off, you give some ADL oral calcium and Vitamin D and then if not IV calcium gluconate or 10% normally they're given a bolus of that every 10 minutes and then they're given an infusion of it and that can run over 10 to 12 hours and, but it depends on the thing and what we wanna run it over and, and also some people who have refractory hypocalcemia, they will need to go to ICU. All right. So, hypercalcemia, it's the opposite. All right. Um, I've just noticed I minus 2.2. Sorry, it's greater than 2.6 for high calcium and it just does.