Day 9 - GU2 ARF, Acid-Base, Lytes Flashcards Preview

Step 2 DIT Rapid Review > Day 9 - GU2 ARF, Acid-Base, Lytes > Flashcards

Flashcards in Day 9 - GU2 ARF, Acid-Base, Lytes Deck (20):
1

Tx CKD

Stop smoking; Aggressive control of bp

2

DDx metabolic acidosis w/ normal anion gap - How serum K+ be useful in narrowing?

Low serum K+ - seen w/ diuretic use, RTA type 1 & 2, diarrhea, Fanconi syndrome; High serum K+ - Addison's disease, RTA type 4, Potassium-sparing diuretics, Hyperalimentation (i.e., TPN)

3

Pseudohyponatremia

Serum volume expanded by substance like lipid or protein, amount of sodium per volume decreased although sodium per water appropriate; Different from hypoosmolarity (pulls water out of cells, diluting serum Na)

4

Vol status in pt w/ hyponatremia due to: Thiazide diuretics

Dehydrated (hypovolemic) or euvolemic

5

Vol status in pt w/ hyponatremia due to: SIAD

Euvolemic

6

Vol status in pt w/ hyponatremia due to: hepatic cirrhosis

Hypervolemia

7

Vol status in pt w/ hyponatremia due to: Addison's disease

Hypovolemia

8

Vol status in pt w/ hyponatremia due to: Hypothyroidism

Euvolemia

9

Vol status in pt w/ hyponatremia due to: Renal failure

Hypovolemia

10

Vol status in pt w/ hyponatremia due to: psychogenic polydipsia

Euvolemic

11

Urine & serum osmolality in following cause of euvolemic hyponatremia: SIADH

Urine Na > 20 or FENA > 1%; Urine osmolality > 100

12

Urine & serum osmolality in following cause of euvolemic hyponatremia: Psychogenic polydipsia

Urine Na

13

Urine & serum osmolality in following cause of euvolemic hyponatremia: Thiazides

Recall: hypovolemia or euvolemia; Urine Na > 20; Urine osmolality > 100

14

Urine & serum osmolality in following cause of euvolemic hyponatremia: Alcoholism

Urine Na

15

Urine & serum osmolality in following cause of euvolemic hyponatremia: Hypothyroidism

Urine Na

16

DDx hypovolemic hyponatremia based on urine Na levels

Urine Na 20: Renal losses - Thiazides, salt-wasting renal diseases, partial urinary tract obstrx, adrenal insufficiency (including inadequate mineralocorticoid or Addison's)

17

DDx hypervolemic hyponatremia based on Na levels

Urine Na 20: Renal failure

18

Rapid correction of hyponatremia - Complication & it p/w

Central pontine myelinolysis (osmotic demyelination) p/w (within 48 hrs; imaging changes not seen for 4 weeks after event) dysarthria, paraparesis, quadriparesis, behavioral disturbances, lethargy, coma; correction greater than 12 meq/L over 24 hrs (same rate for hypo & hyper natremia): over 20 meq/L, almost always get CPM OR correct hyponatremia to over 140

19

Etiologies of SIADH

CNS disease, pulm disease (esp. SCLC), Drugs (NSAIDs, antidepressants, antipsychotics, carbamazepine, ecstacy, vasopressin/DDAVP), HIV/AIDS, major abdominal/thoracic surgery

20

Tx emergency hyperkalemia

Stat EKG, repeat K+, D50, Insulin (lasts 4-6 hrs), CALCIUM GLUCONATE OR CHLORIDE (first thing if EKG changes), NaHCO3, Albuterol neb, Kayexalate; Furosemide or Lasix, Replace Mg if

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