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Flashcards in FEN, Acid Base, Renal Deck (105)
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Maintenance electrolyte requirements, Na, K, Chloride

PSC: 1, 2, 3
Potassium: 1 meq/kg/day
Sodium: 2 meq/kg/day
Chloride: 3 meq/kg/day

1

easy maintenance fluid req for wt >20kg

60cc/hr + 1cc/kg/hr

2

Calculating % of dehydration by skin turgor and mucus membranes
-normal/slightly decreased skin turgor
-decreased
-markedly decreased
-cold/dry

normal skin, slightly dry mucus membranes: 3-5%
decreased skin, dry mm 6-10%
markedly decr skin, parched cotton mouth 10-15%
Cold/cry, parched >15%

3

When does pulse go up and resp go up with % dehydration, and when does orthostatus start

6-10% BP still normal
10-15%: orthostatic

4

cause of late seizure in child with hypernatremic dehydration?

hypocalcemia

5

how to correct hypernatremic dehyration?

Calculate 48 hour water req, and give slowly over this time
use hypotonic (0.2%NS)

6

volume of distribution of Na? Calculation

0.6 x body weight

7

Quick and easy way to look at urine lytes and determine if dehyrated?

UNa < 10!

8

FeNa to determine dehydration vs renal failure

1% renal failure

9

Syndrome w/ Incr risk of renal artery stenosis due to renovascular disease?

Williams

10

possible causes of htn in NF? (4)

1. pheo
2. CoA
3. RAS
4. tumor

11

Clue to renal artery stenosis (4)

1. renal asymmery
2. acute incr BP
3. ARF w/ ACEi
4. refractory htn

12

causes of Renal artery stenosis? (4 etiology)

1. fibromuscular dysplasia: string of beads
2. syndrome: Williams
3. athero
4. idiopathic

13

4 syndromes assoc w/ pheo

1. NF
2. Von hippel landau
3. sturge weber
4. MEN2

14

In child w/ endo syndrome with htn/pheo what are the other things to look for? what is dx?

MEN2
higher risk for thyroid and hperparathyroid Ca

15

dx in child with HTN, wt loss, hyperglycemia, dilated cardiomyopathy

pheo

16

Dx steps for pheo

24 urine metanephrines, plasma metanephrines more sens in kids.
If high, check abd MRI/CT and MIBG/octreoscan

17

nephrotic syndrome mortality?

5%

18

three top bugs in nephrotic syndrome peritonitis?

1. Strep pneumo**
2. E. coli
3. aseptic

19

hx of large placenta and massive anasarca
finnish autosomal recessive
dx and cause of death?

congenital nephrotic syndrome
Ecoli sepsis

20

define microscopic hematuria

>/= 3 RBC/hpf x 2 fresh voided urines

21

urine pos for blood could mean what? next step?

+ hemoglobin, myoglobin, porphyrins.
Obtain a UA!! (dip can't tell, UA can)...

22

UA findings for myoglobinuria, hemoglobinuria

myoglobinuria 1-2 cells and dark urine
hemoglobinuria will have jaundice and anemia, but no hematuria / RBC in urine

23

5 things to know if you get microscopic hematuria to guide work up? If none present, next step?

Just repeat UA in 2 wks unless:
Proteinuria
HTN
Abd pain
Dysuria
FH Kidney dz

24

If Microscopic hematuria repeatedly (persistent hematuria), management should be what next and why?
What else to look for?

Check for hypercalciuria in random urine sample
.look for Urine Ca/Cr > 0.25
-may also see crystals in urine and have abd pain/dysuria even w/o frank stones

25

Urine Calcium / Creatinine ratio < 0.2-0.25 should prompt what work up / management in microscopic hematuria?

24 urine collection, in which value >4mg/day of total calcium would indicate hypercalciuria, therefore need for renal US to look for stone

26

Urine Calcium / Cr ratio < 0.2 in eval for microscopic hematuria

should check for UPJ obstruction with renal ultrasound to look for structural abnormalities

27

Relationship between sickle cell and renal disease?

trait and disease can cause hematuria

28

consider dx in child w/ microscopic hematuria after injury/trauma

UPJ obstruction (very large kidney)

29

confirmatory test for suspected UPJ

after hydronephrosis found, get renal scan to show delayed excretion from that kidney, and consider VCUG in opposite kidney b/c risk of VUR