deck 2 Flashcards
hyponatremic hypovolemia
diarrhea emesis burns third spacing urine na - low (cause you are concentrating)
hypervolemia hyponatremia
CHF nephrotic syndrome renal failure sepsis if leaky decreased albumin from protein losing enteropathy cirrhoses
euvolemic hyponatremia
SIADH water intoxication - psychogenic or dilute formula glucose hypothyroidism glucocorticoid deficiency
8 month old baby with gastroenteritis. Na 160, Cl elevated, Bicarb 14, HR 220, BP 60/30. What is your initial management. Once stable what is your ongoing fluid management?
ABCs 20 cc/kg NS then ongoing fluid management once stable determine how long to correct Na over - initial Na 145-157 correct over 24 hours 158-170 over 48 hours 171 -183 72 hours 184-196 over 96 hours
correction rate 10-12 mmol/day
typically fluid D5 1/2 normal saline with 20 KCl
1.25-1.5 maintenance (because they are dehydrated)
check your sodium often
Change in Serum Sodium
= (Fluid Sodium - Serum Sodium) / (Total Body Water + 1)
Total Body Water = (Wt in kg * % Water)
noctural enuresis
2 parents with enuresis, 75% chance of enuresis
causes for nocturnal enuresis:
delayed maturation in cortical mechanism
sleep disorders
OSA
severe constipation
Don’t make as much ADH at night
Motivational therapy – limited evidence, try it
Fluid restrict, void before bed, caffeine
If doesn’t work, conditioning therapy – 30-60%, curative
Alarm system, usually better in kids > 6-7
meds - symptomatic
1st line DDAVP
2nd oxybutinin
3rd imipramine
Struvite stone, which organism
proteus
foreign body
urinary stasis
protein in a teenage girl
1st test - 1st AM urine x 2 then move on to other tests
in general if 3+ on dipstick more likely to be a fixed proteinuria, more likely to be a glomerular or tubular issue
when do sperm die in torsion
4-6 hours
painless testicular masses
varicocele hydrocele spermatocele inguinal hernia idiopathic
painful scrotal masses
epididymitis
testicular torsion/appendicular torsion
orchitis
trauma
most common flank mass
hydronephrosis
most common abdo mass
multicystic dysplastic kidney
types of rhabdo
- exertional
- non trauma exertional - hyperthermia, metabolic
- non trauma non exertional - drugs, toxins, , infections
What is DMSA
functional and anatomical information
better visualizes focal renal parenchymal abnormalities
also can compare kidney function between the two
look for scarring and pyelo
What is MAG3
look at obstructive and non obstructive hydronephrosis, as well as different function between the two kidneys
3 things VCUG can tell you
- reflux
- PUV
- bladder shape and function
Alport’s disease
X linked dominant in 85% the rest are different types
start on high frequency loss
eye stuff - anti - lento conus (eye stuff), macular flex, corneal erosion, anterior lenticonus is pathognomic for Alport’s
renal disease - hypertension
type 4 collagen
prognosis for boys: 15% by 15 years old, 75% by age 30, hearing loss is gradual
for ladies - mild in general, some can have findings later in life (milder)
Prognostic factors in Alport’s
- gross hematuria
- nephrotic syndrome
- on biopsy have prominent glomerular basement membrane thickening
What percentage of patients with nocturnal enuresis will spontaneously improve each year?
15% per year
Do acute hydroceles hurt?
might have discomfort, but should be okay and tolerate feedings
Causes of HUS
Infectious causes of HUS: - E. coli, S. pneumo, Shigella , HIV Medications - chemo (cyclosporine and tacrolimus) Genetic HUS Any disease with microvascular disease - lupus, HELLP, antiphospholid
Places you can get organism
uncooked meat well water contaminate vegetables unpasteurized milk/apple cider petting farms (usually E. coli, sometimes shigella)
What is the incidence of CNS involvement in HUS?
the majority have CNS involvement, most are mild - lethargy, irritability, non specific encephalopathic features, seizures, stroke
microvascular thrombosis
What’s the prognosis for HUS?
<5% mortality but 50% of children need dialysis during the acute phase
70% fully recover, 30% have chronic renal insufficiency
