Flashcards in FEN, Acid Base, Renal Deck (105)
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
easy maintenance fluid req for wt >20kg
60cc/hr + 1cc/kg/hr
Calculating % of dehydration by skin turgor and mucus membranes
-normal/slightly decreased skin turgor
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%
When does pulse go up and resp go up with % dehydration, and when does orthostatus start
6-10% BP still normal
cause of late seizure in child with hypernatremic dehydration?
how to correct hypernatremic dehyration?
Calculate 48 hour water req, and give slowly over this time
use hypotonic (0.2%NS)
volume of distribution of Na? Calculation
0.6 x body weight
Quick and easy way to look at urine lytes and determine if dehyrated?
UNa < 10!
FeNa to determine dehydration vs renal failure
1% renal failure
Syndrome w/ Incr risk of renal artery stenosis due to renovascular disease?
possible causes of htn in NF? (4)
Clue to renal artery stenosis (4)
1. renal asymmery
2. acute incr BP
3. ARF w/ ACEi
4. refractory htn
causes of Renal artery stenosis? (4 etiology)
1. fibromuscular dysplasia: string of beads
2. syndrome: Williams
4 syndromes assoc w/ pheo
2. Von hippel landau
3. sturge weber
In child w/ endo syndrome with htn/pheo what are the other things to look for? what is dx?
higher risk for thyroid and hperparathyroid Ca
dx in child with HTN, wt loss, hyperglycemia, dilated cardiomyopathy
Dx steps for pheo
24 urine metanephrines, plasma metanephrines more sens in kids.
If high, check abd MRI/CT and MIBG/octreoscan
nephrotic syndrome mortality?
three top bugs in nephrotic syndrome peritonitis?
1. Strep pneumo**
2. E. coli
hx of large placenta and massive anasarca
finnish autosomal recessive
dx and cause of death?
congenital nephrotic syndrome
define microscopic hematuria
>/= 3 RBC/hpf x 2 fresh voided urines
urine pos for blood could mean what? next step?
+ hemoglobin, myoglobin, porphyrins.
Obtain a UA!! (dip can't tell, UA can)...
UA findings for myoglobinuria, hemoglobinuria
myoglobinuria 1-2 cells and dark urine
hemoglobinuria will have jaundice and anemia, but no hematuria / RBC in urine
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:
FH Kidney dz
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
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
Urine Calcium / Cr ratio < 0.2 in eval for microscopic hematuria
should check for UPJ obstruction with renal ultrasound to look for structural abnormalities
Relationship between sickle cell and renal disease?
trait and disease can cause hematuria
consider dx in child w/ microscopic hematuria after injury/trauma
UPJ obstruction (very large kidney)