Renal and electrolytes

Question 1

What effect can extracorporeal shock wave lithotripsy have on cardiac electrical conduction? What can be done to minimize this risk?

Answer 1

1. The shock wave can reach the heart during re polarization and send the heart into a deadly arrhythmia
2. Electrical synchronization can be used, meaning that the surgeon times the shocks to land on the R wave

Question 2

What is the MOA of Fenoldopam?

Answer 2

1. D1 agonist. Renal vasodilator that leads to naturesis and free water excretion

Question 3

When undergoing a TURP, absorption of glycine containing irrigation solution can cause what?

Answer 3

Hyperammonemia leading to CNS disturbances

Question 4

What are the electrolyte changes seen with SIADH?

Answer 4

1. Urine Na >20
2. Urine osmolarity > 100 mosm (usually 200-300)
3. FeNa > 1%
4. Dilutional hyponatremia
5. Low serum BUN and uric acid

Question 5

What patients are at risk for steep trendelenburg and what surgery may be CI?

Answer 5

1. Patients with intracerebral aneurysms are at risk in the steep Tburg position
2. This position is often used with robotic prostatectomy

Question 6

What is an absolute CI to shock wave lithotripsy?

Answer 6

Pregnancy

Question 7

What metabolic derangement can be seen with large amounts of transfused blood products? WhY?

Answer 7

1. Metabolic alkalosis

2. This is due to sodium citrate in the blood causing bicarb production

Question 8

What measure can you use to detect imminent kidney damage?

Answer 8

Creatinine clearance

Question 9

What are the lab values seen in pre renal AKI?

Answer 9

1. BuN/Cr > 20:1

2. FeNa< 1%