Question: Electrolyte Imbalance in Papilledema?

[Slade009]

---

Members do not see this ad.

So I don't rmbr where I came across this but the question was basically:
What kind of electrolyte imbalance is seen in Papilledema?
Options:
1.) Hypokalemia
2.)Hypernatremia
3.)Hypomagnesemia
4.)Hypocalcemia
5.)Hypercalcemia
Before looking at the options I came up with Hyponatremia cause a decrease in serum Na would make the serum hypo osmolar pushing water into the cells increasing ICP but that wasn't an option. So I picked Hypernatremia instead based on the common presentations of seizure, stupor and coma in increased ICP. What am I missing?

 

[EmergDoc2B]

Im leaning toward hypocalcemia.
I read an article in up to date that had mentioned that papilledema is a rare but recognized complication of hypocalcaemia with primary or surgically induced hypoparathyroidism.
Im curious to know what the answer is and why.

 

[Slade009]

Based on SEIZURES we can deduce the options to only hypocalcemia and hyponatermia which isn't an option (not hypomagnesemia because you would need a severe decrease in Mg++ levels which wouldn't be the case in ICP).
But still how do you get hypocalcemia from ICP anyway? Still confused.
What if the increased pressure is what is causing the seizures via impingement on nerves and not the electrolyte abnormality, can this be the case?

 

[syoung]

papilledema (optic disc swelling) is usually caused by ICP due to 2ndary effect of mass effect
it can be seen w/ malignant HTN, communicating hydrocephalus, and GBS

Not sure about the electrolyte abnormality.

Was there a metabolic alkalosis? Thyroid surgery? Chronic renal failure? Acute pancreatitis?

 

[Slade009]

Non of those were mentioned or else it would have been easier. I can't seem to find the source or else I would have backtracked to find the answer. I think I stumbled upon it when I was going through some random university exams. I wrote it down on a notebook to try to solve the question myself.

I'm starting to wonder if there's anyone in this forum who can even answer this lol.

But yes everything you mentioned with Papilledema is solid, and thanks for the additional info cause I didn't GBS could lead to it also. After researching, Papilledema is very rare in GBS and still the mechanism is unknown as to how it causes it.

 

[dfib slim]

Non of those were mentioned or else it would have been easier. I can't seem to find the source or else I would have backtracked to find the answer. I think I stumbled upon it when I was going through some random university exams. I wrote it down on a notebook to try to solve the question myself.

I'm starting to wonder if there's anyone in this forum who can even answer this lol.

But yes everything you mentioned with Papilledema is solid, and thanks for the additional info cause I didn't GBS could lead to it also. After researching, Papilledema is very rare in GBS and still the mechanism is unknown as to how it causes it.

Although rare, hypocalcemia can do it.

http://www.djo.org.in/articles/23/2/bilateral-papilledema-in-hypocalcemia.html

 

[Slade009]

Finally an answer. So basically it states that the mechanism is unclear and that it is treatable by treating the underlying cause (hypocalcemia). It also mentions that in a person with Papilledema + history of muscle spasm = suspect Hypocalcemia (possibly from hypoparathyroidism). I found it interesting that the Cranial Pressure wasn't necessarily Increased with the Papilledema in 82% of the patients. Thanks Dfib.

 

[syoung]

The inc ICP is only in 20% of papilledema pts

 

[Jabbed]

I would expect hyponatremia to accompany papilledema more commonly than hypocalcemia. Not sure that this question / answer is clinically relevant.

 

[Slade009]

The inc ICP is only in 20% of papilledema pts

That is exactly what I said lol. I said 82% didn't have an increase so that leaves ~20% with an increase in cranial pressure.

I would expect hyponatremia to accompany papilledema more commonly than hypocalcemia. Not sure that this question / answer is clinically relevant.

I also suspected hyponatremia. Yes maybe this isn't clinically relevant like most small and nit-picky details that we prepare for in the Step 1 but this was a random question I had for some Path exam months ago. There's nothing wrong with increasing knowledge, especially of something that appeared on a test.

 

[Jabbed]

I also suspected hyponatremia. Yes maybe this isn't clinically relevant like most small and nit-picky details that we prepare for in the Step 1 but this was a random question I had for some Path exam months ago. There's nothing wrong with increasing knowledge, especially of something that appeared on a test.

No, but it was more a criticism of the test writer. The question intentionally obscures clinically relevant information with minutia.

 

[dfib slim]

Are you sure it wasn't asking rapid treatment of which may cause papilledema?

 

[Slade009]

Jabbed: That may be your point of view but as far as I'm concerned researches are the fundamentals to new discoveries and patient management. Who knows what this could lead to in the future, maybe it's something whose clinical significance we don't know about yet and in the near future will be aware of. As far as I'm concerned the question didn't obscure nothing as the person who probably wrote it already assumed the information of ICP->Papilledema and seizures (possibly from hyponatremia) was already known by students. I think the test writer was trying to enlighten us on a new research paper he/she came about.

DFib: Yeah I'm sure it was worded exactly as I typed it.

 

[mcloaf]

Jabbed: That may be your point of view but as far as I'm concerned researches are the fundamentals to new discoveries and patient management. Who knows what this could lead to in the future, maybe it's something whose clinical significance we don't know about yet and in the near future will be aware of. As far as I'm concerned the question didn't obscure nothing as the person who probably wrote it already assumed the information of ICP->Papilledema and seizures (possibly from hyponatremia) was already known by students. I think the test writer was trying to enlighten us on a new research paper he/she came about.

This is a Step 1 forum, not necessarily the place to focus on an in class exam question based on a research paper your professor read.

 

[Slade009]

This is a Step 1 forum, not necessarily the place to focus on an in class exam question based on a research paper your professor read.

I notice the obvious. I didn't know what the question came from and how clinically relevant it was until I read that article up there. So excuse me if my question made you guys feel like it wasn't important, cause if so you needn't reply to it. Even though this is a Step 1 forum we all post questions regarding exams and things/concepts we don't understand. No offence to anyone if I have said anything that offended them. If I knew this wasn't relevant I would not have posted this question.

We're all here to learn, well at least most of us are.

 

[mcloaf]

You're right captain obvious. I didn't know what the question came from and how clinically relevant it was until I read that article up there. So excuse me if my question made you guys feel like it wasn't important, cause if so you needn't reply to it. Even though this is a Step 1 forum we all post questions regarding exams and things/concepts we don't understand. No offence to anyone if I have said anything that offended them. If I knew this wasn't relevant I would not have posted this question.

We're all here to learn, well at least most of us are.

Calm down.

I'm happy to agree to disagree with you as far as what's relevant/worth knowing for step 1 or posting on this subforum. It shouldn't be too much to ask of you to interact with people who disagree with you without name-calling or thinly veiled insults.

 

[Jabbed]

I notice the obvious. I didn't know what the question came from and how clinically relevant it was until I read that article up there. So excuse me if my question made you guys feel like it wasn't important, cause if so you needn't reply to it. Even though this is a Step 1 forum we all post questions regarding exams and things/concepts we don't understand. No offence to anyone if I have said anything that offended them. If I knew this wasn't relevant I would not have posted this question.

We're all here to learn, well at least most of us are.

It wasn't a personal attack on you, I was just offering my opinion on the question's value.

Did not mean to offend.

 

[Slade009]

I notice the obvious. I didn't know what the question came from and how clinically relevant it was until I read that article up there. So excuse me if my question made you guys feel like it wasn't important, cause if so you needn't reply to it. Even though this is a Step 1 forum we all post questions regarding exams and things/concepts we don't understand. No offence to anyone if I have said anything that offended them. If I knew this wasn't relevant I would not have posted this question.

We're all here to learn, well at least most of us are.

Well obviously you took offence mcloaf lol. There changed it. I don't mean to sound like I'm insulting but that's sometimes how the internet makes it seem. Words sound different than when written out, especially when one has a sarcastic tone. As for interaction, I don't mind criticism but you were trying to belittle me telling me my thread shouldn't have been posted. I feel like in my quest for knowledge no one should be telling me what is and is not of importance. Frankly I don't need people to tell me what I should and should not post either. You could have just let that be the end of this thread before you posted on this

Personally, I benefited from this posting by getting the question answered which is what I'm thankful for. The rest of the comments/remarks I don't care about since they were just opinions as to whether or not this should have been posted, when in actuality they are wrong because they are justifying their basis on clinical relevance per se. A lot of diseases are not clinically relevant and are just tested topics based on concepts. Lesch-Nyhan Syndrome is a very rare disease 1:380,000 and so is Pheochromocytoma 1000 per year yet we're tested on every single detail of theirs. The chances of you ever encountering a Pheochromocytoma are slim to none unless you're planning on becoming an Endocrinologist or in the ER. So point is never demotivate people to study and learn, no matter how clinically irrelevant something may seem to you.

None taken Jabbed. My bad if you took any offence🙂

 

[mcloaf]

As for interaction, I don't mind criticism but you were trying to belittle me telling me my thread shouldn't have been posted.

That was not my intention, though I was probably a little more direct and less tactful than I meant to be.

I just think sometimes on a forum of highly driven med students stressed about step 1 we sometimes lose the forest for the trees in terms of where we direct our efforts and attention in studying.

 

[seminoma]

So I don't rmbr where I came across this but the question was basically:
What kind of electrolyte imbalance is seen in Papilledema?
Options:
1.) Hypokalemia
2.)Hypernatremia
3.)Hypomagnesemia
4.)Hypocalcemia
5.)Hypercalcemia
Before looking at the options I came up with Hyponatremia cause an a decrease in serum Na would make the serum hypo osmolar pushing water into the cells increasing ICP but that wasn't an option. So I picked Hypernatremia instead based on the common presentations of seizure, stupor and coma in increased ICP. What am I missing?

How would this not depend on the underlying cause of the increased ICP?

 

[Slade009]

Mcloaf: Rmbr the Step 1 is not stressful, Life is.

Seminoma: I don't quite get your question. Are you asking why the Papilledema (in this case) is caused by the hypocalcemia and not the ICP?

 

[Jabbed]

How would this not depend on the underlying cause of the increased ICP?

Question is essentially asking which electrolyte abnormality is associated with ICP.

 

[Slade009]

Question is essentially asking which electrolyte abnormality is associated with ICP.

Technically the question is asking which electrolyte abnormality is associated with Papilledema not ICP. In general, ICP causes Papilledema but in this case the Papilledema had very little or nothing to do with ICP since ~80% of the patients had no ICP but they had Papilledema. I guess they were also tying in Hypoparathyroidism as a possible cause to the Papilledema.

Clincally they mention:

However treatment should be started early to prevent optic atrophy. Barr, MacBryde and Sanders reported a 21 year old patient with idiopathic hypoparathyroidism who had bilateral papilledema and increased cerebrospinal fluid pressure which improved following the initiation of calcium supplements.[9]

 

[seminoma]

Question is essentially asking which electrolyte abnormality is associated with ICP.

Sure, but ICP has many etiologies... Say you get hypertensive hemorrhage, then maybe you could say hypernatremia.

Really strange and vague question imo.