Electrolytes and ABG

Question 1

Factors increasing renal K + loss

Answer 1

hyperkalemia, thiazides and loop diuretic, increased aldosterone (increased Na reabsorption and K+ excretion). Metabolic alkalosis, hypomagnesemia, increased non-reabsorbable anions in tubule lumen.

Question 2

Hypokalemia def:

Answer 2

K+

Question 3

SSx of hypokalemia

Answer 3

usually asymp if mild. N/V, fatigue, generalized weakness, myalgia, muscle cramps, constipation. if severe: arrhythmias, muscle necrosis, rarely paralysis.

Question 4

ECG changes in hypokalemia

Answer 4

U wave (low amplitude wave following a T wave), depressed ST, prolonged QT intervall. inverted T wave.

Question 5

Causes of hypokalemia

Answer 5

Decreased intake, increased loss (renal, GI), redistribution into cells (metabolic alkalosis, insulin, catecholamines, b2- agonist (ventoline) tocolytic agents, uptake into newly forming cells)

Question 6

treatment of hypokalemia

Answer 6

treat underlying cause, K+IV(KCl) or oral, K-sparing diuretics (spironolactone), restore Mg2+ if necessary,

NB k + replacement in diabetics, elderly, and patients with decreased renal function.

Question 7

Hyperkalemia def:

Answer 7

> 5,0 mEq/L.

Question 8

SSx in hyperkalemia

Answer 8

usually asymptomatic. may develop nausea, palpitations, muscle weakness, muscle stiffness, paresthesias, areflexia, ascending paralysis, hypoventilation.

Question 9

ECG changes in hyperkalemia

Answer 9

peaked and narrow T waves. decreased amplitude and eventual loss of P wave. prolonged PR interval. AV block, widening of QRS. ventricular fib, asystole.

Question 10

causes of hyperkalemia

Answer 10

sample hemolysis (MC), increased intake, cellular release (intravascular hemolysis, rhabdomyolysis, insulin deficiency, met acidosis, TLS, drugs: b-blocker, digitalis, succinylcholine), decreased excretion.

Question 11

treatment of hyperkalemia

Answer 11

treat underlysing cause, shift K+ into cells: insulin, b-agonist, NaHCO3´:, calcium gluconate: protect the heart, no effect on serum K+. Enhance K+ removal from body: furosemide, dialysis, kayexalate

Question 12

Nephrotic syndrome: def: and clinical

Answer 12

syndrome caused by different diseases (constalation of symptoms). Clinically characterized by heavy proteinuria (>3,5g/d) hypoalbuminemia, edema, hyperlipidemia, hypercoagulable state (due to loss of antothrombin III and protein C and S)

Question 13

Causes of nephrotic syndrome

Answer 13

Minimal change disease (MCD), FSGS, membranoproliferative glomerulonephritis, membranous glomerulopathy. Can also be secondary to another disease or drug.

Question 14

treatment of nephrotic syndrome

Answer 14

steroid, and treat underlying cause if due to secondary causes.

Question 15

acute kidney injury (AKI) def

Answer 15

Abrupt decline in renal function leading to increased nitrogenous waste products normally excreted by the kidneys

Question 16

clinical features of AKI

Answer 16

azotemia (increased BUN and Cr), abnormal urine volume (anuria, oliguria, polyuria)

Question 17

causes of AKI prerenal

Answer 17

caused by acute renal hypoperfusion. Intravscular volume depletion: bleeding, GI loss, renal loss, skin loss. decreased CO: CHF. Renal vasoconstriction: liver disease, sepsis, hyperca2+. Renal artery stenosis

Question 18

Causes of AKI renal/intrinsic

Answer 18

caused by an acute disease of renal parenchyma. Vascular: vasculitis, malignant HTN, thrombotic microangiopathy, cholesterol emboli, large vessel disease. Glomerular: GN, Interstitial: AIN, Tubular: ATN MC: ischemic or toxic.

Question 19

Causes of AKI: postrenal

Answer 19

caused by acute obstruction of urinary tract.
stones, blood clots, papillary necrotic tissue, urtehral disease, prostate disease. Bladder disease: cancer, neurogenic bladder.

Question 20

SSx of AKI

retention of nitrogenous waste products:

Answer 20

retention of nitrogenous waste products: NVD, foul taste, hiccup, dry crusted mouth, drowsiness, ALOC, neuropathy, pericardititis, GI bleed, coma

Question 21

SSx of AKI

Retention of salt and water

Answer 21

pulm edema, peripheral edema, ascites, pleural effusion.

Question 22

SSx of AKI

Retention of K +

Answer 22

weakness, ecg change: peaked and narrow T waves. decreased amplitude and eventual loss of P wave. prolonged PR interval. AV block, widening of QRS. ventricular fib, asystole.

Question 23

SSx of AKI

retention of acid

Answer 23

Kussmaul resp, hyperreflexia, hypotension.

Question 24

treatment of AKI

preliminary measures

Answer 24

prerenal: correct prerenal factors: optimize volume status and cardiac performace using fluids that will stay in the plasma
renal: adress reversible renal causes
postrenal: foley catheter, steting, nephrostomy, remove stones or strictures.

Question 25

treatment of AKI | complications

Answer 25

fluid overload: nacl restriction, high dose loop diuretics. adjust dosage of medications cleared by kidneys. definitive tx depends of etiology. renal transplant IS NOT a therapy for AKI:

Question 26

Diff diagnosis in proteinuria

Answer 26

nephritic or nephrotic syndrome, enal failure, DM, amyloidosis, increased BP, intersititial nephritis, heavy metals, multiple myeloma, pregnancy.

Question 27

Indications for renal replacement therapy

Answer 27

oliguria(anuria, hyperammoniemia, hyperkalemia, severe acidemia or azotemia, plum edema, uremic complications, severe electrolyte abnormalitoes, rhabdomyolysis, anasarca.

Question 28

indication for dialysis (?)'

Answer 28

Ccr 10,0 mg/dl. relative indication: ccr8 mg/d + accompanied SSx: chf/pulm edema, bleeding tendency, drug resistant hyper K+, uremic pericardititis, neurological symp, drug resistant metabolic acidosis, drug-resistant N and V

Question 29

Chronic kidney disease

Answer 29

progressive and irreversible loss of kidney function. GFR 3 months +- kidney pathology seen on biopsy or decreased renal size

Question 30

Chronic kidney disease: causes

Answer 30

glomerulonephritis, multisystem disease: DM, hypertensive nephropathy, acute pyelonephritis/tubulointersititial. Polycystic kidney disease, idiopathic, drugs, CT disease:

Question 31

clinical features of CKD

Answer 31

volume overload and htn, electrolyte and acid base balance disoders: metabolic acidosis, uremia

Question 32

Metabolic acidosis

Answer 32

deficient bicarbonate. (dec CO2, dec HCO3-, Dec pH, Causes: loss of HCO3 through diarrhea or renal dysfunction, accumulation of acids (latic acid or ketones), failure of kidneys to excrete H+,

Question 33

symptoms | Metabolic acidosis

Answer 33

headache, lethargy, N/V, diarrhea, coma, death

Question 34

Metabolic acidosis | compensation and treatment

Answer 34

increased ventilation, renal excretion of h+ ions, k + exchanges with excess H+ in ECF --> hyperkalemia. Treatment: Iv lactate solution.

Question 35

Metabolic alkalosis

Answer 35

Bicarbonate excess. Inc CO2, inc HCO3-, inc pH.

Question 36

Metabolic alkalosis | causes

Answer 36

excessive vomiting = loss of stomach acid, excessive use of alkaline drugs, certain diuretics, endocrine disorders, heavy ingestion antacides, severe dehydration.

Question 37

Metabolic alkalosis | symptoms

Answer 37

respiration slow and shallow, hyperactive reflexes: tetany, often related to depletion of electrolytes, atrial tachycardia, dysarrthmias.

Question 38

Metabolic alkalosis | treatment

Answer 38

electrolytes to replace those lost ,IV cholride containing solution, treat underlying disorder

Question 39

Renal cell carcinoma

Answer 39

Presentation: hematuria, mass in abdomen, flank pain, Other: weight loss, fever, night sweats, malaise, htn, hypercalcemia.

Question 40

DX of RCC

Answer 40

usg, ct, mri,

Question 41

treatment RCC

Answer 41

surgical resection. Advanced stages: HD IL2, IFN-alpha, bavacizumab, temsirolimus

Question 42

pyelonephritis def

Answer 42

is an inflammation of the kidney tissue, calyces, and renal pelvis. It is commonly caused by bacterial infection that has spread up the urinary tract or travelled through the bloodstream to the kidneys

Question 43

pyelonephritis: clinical picture

Answer 43

fever, dysuria, tachycardia, abdominal pain radiating to the back, nausea, and tenderness at the costovertebral angle on the affected side. Pyelonephritis that has progressed to urosepsis may be accompanied by signs of septic shock, including rapid breathing, decreased blood pressure, violent shivering, and occasionally delirium.

Question 44

pyelonephritis: TX

Answer 44

Antibiotics, fluids,

Question 45

Hypercalcemia

Answer 45

HyperPTH and maliganacy account for 90 %. lithium use, | symptoms: fatigue, depression, confusion, anorexia, N/V, pancreatitis.