FEN, Acid Base, Renal Flashcards Preview

Laughing Pedi > FEN, Acid Base, Renal > Flashcards

Flashcards in FEN, Acid Base, Renal Deck (105):
0

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

30

how to dx orthostatic proteinuria

first AM urine should be negative, and subsequent daytime one would be positive

31

protein / creatinine ratio suggestive of renal disease

Protein / Creatinine > 0.2

32

scenarios in which proteinuria can be benign (2)

1. concentrated urine (high spec grav)
2. alkaline urine

33

If 24 hr urine protein collection is done, what would lead to renal biopsy

>8mg/kg/day (halfway to 16 which is nephrotic...)

34

What is alport syndrome?

X linked dominant d/o w/ b/l sensorineural hearing loss, ocular defects, and renal failure in males
(two kidney planes landing on eyes that you can't hear)

35

unilateral flank mass should lead to what, and what should you consider

Multicystic dysplastic kidney disease:
dysplastic kidney, may have oligo prenatally. usu unilateral, 50% with other GU anomalies like UPJ obstrx, VUR, posterior valves, megaureter/duplication *think of this as causing the mass. And need VCUG

36

multicystic dysplastic kidney disease is associated with what?

hepatic fibrosis / portal htn (autosomal recessive polycystic kidney dz)

37

two presentations of autosomal recessive polycystic kidney dz (AR)

1. neonate w/ bilateral flank masses, oligo
2. older child w/ liver issue and kidney masses, TCP/splenomegaly

38

which polycystic kidney disease is associated w/ brain thing
-what is it and whats the trm

cerebral aneurysm in adult onset PCKD (autosomal dom)

39

What is nephronophthisis and what do you need to look for (3 things)

juvenile medullary cystic disease (Aut Rec), polyuria, enuresis, polydipsia, hyposthenuria (can't concentrate urine)
-assoc w/ short stature, eye problems/retinal disease**, anemia

40

mass from urethral meatus or round filling defect on IVP causing urinary obstruction and urinary retention?

ureteroceles

41

Grades of VUR and management?

VUR 1 and 2: periodic cultures, most self resolve
VUR 3: Abx and f/u VCUG, 1/2 resolve
VUR 4-5: surgery needed (moderate dilation of ureter and renal pelvis)
Females: Abx

42

Normal bladder size (wt)

age (yrs) + 2 (ounces)

43

newborn with palpable bladder and weak urinary stream.
Treatment and prognosis?

posterior urethral valves, prob: even w/ surgery they can get ESRD w/n 5 yrs!

44

UTI culture result dx
bugs? (3)

100,000 colonies or >10,000 on cath
three most common bugs: Ecoli, Klebsiella, Enterococcus

45

prune belly triad (Eagle Barrett syndrome)

1. lack of abd muscles
2. undesc testes
3. GU abnormalities w/ obstrx mostly

46

lipid issue in nephrotic syndrome

LDL / HDL is high, very high cholesterol

47

nephrotic syndrome and calcium issue?

low albumin, decreases bound AND AVAILABLE calcium, so you get low Ca

48

nephrotic syndrome and thyroid?

loss of thyroxine binding globulin, so functional hypothyroidism.

49

RBC casts suggests what

glomerular disease

50

3 causes of low complement (C3)

1. SLE
2. Post-strep
3. Membranoproliferative glomerulonephritis
(PMS: not in the mood to complement)

51

typically black teen male w/ progressive renal failure, not responding to steroids
Tx

focal and segmental glomerulosclerosis.. this sucks
Steroids don't work, use cyclophos or try ACEi or ARB

52

If you suspect Minimal change disease, but no response to steroids, consider what?

Then its likely focal segmental glomerulosclerosis

53

what kidney disease should NOT get steroids, and how do you know not to give... 1st step in management?

membranoproliferative GN b/c they may get severe htn, you don't give them if they have low C3 (also often an older female). Get Renal Bx instead.

54

peritonitis complication in minimal change nephrotic syndrome caused by what bugs? (3), mortality?

strep pneumo, ecoli, aseptic (5% mortality)

55

top three nephrotic syndrome?

1. Minimal change
2. focal segmental (increasing)
3. membranoproliferative

56

massive anasarca in newborn, large placenta, death by 1 yr from ecoli sepsis, what is dx?

autosomal recessive congenital nephrotic syndrome

57

tea colored, cola colored, rusty, smoky urine
hypertension
edema

Dx?

post strep GN

58

Berger dz?

IgA nephropathy

59

IgA nephropathy causes what sx?
indicator of poor prognosis

hematuria, often after URI
bad prognosis if persistent proteinuria

60

acid/base d/o in chronic renal failure and type of ca/phos issue?

1. metabolic acidosis (decr bicarb production by tubule so acid not excreted)
2. secondary hyperparathyroid (high because kidney is bad at getting rid of phosphorous and does get rid of calcium --> high PTH) --> decreased calcitriol leads to decr Ca absorption / incr ca loss)

61

Tx of common HUS in kids?

SYNSORB pk binds verotoxin in Ecoli o157 strain

62

define htn in kids?

>95% x 3!
STage 1: 95% - 99%+5
Stage 2: >99% + 5

63

treatment of hypercalciuria

thiazide and fluids (thiazide decreases urinary excretion of calcium (remember hyper-GLUC)

64

% of IgA nephropathy that get chronic renal disease?

15%

65

htn + prematurity

umbilical cath causing renal injury

66

htn + joint pain/swelling

SLE / connective tissue d/o

67

htn + flushing, palp, fever, wt loss

pheo

68

htn with weakness and muscle cramps

hypo K - hyperaldo problem!

69

htn + sexual development onset

enzyme def (CAH)

70

htn with pale color and edema

think renal dz (pallor from poor epo / anemia)

71

HTN w/ low BP in legs vs arms, decr femoral pulse

Coarct Ao

72

tx before surgery for pheo

alpha blockade before beta blockade (no unopposed alpha or htn crisis)

73

2 wk infant normal electrolyte lab values

creat -0.2-0.4, high phosphate, relative acidosis, increased FENA

74

don't use ACE i in what htn disease?

RAS b/l!!

75

diagnosing RAS? (3)

can do a random renin level (best after captopril premed)
can check MRA/CTA
US/Doppler - technique dep

76

water requirement rule for maintenance / day and /hr/

hour: 4-2-1
day: 100-50-20

77

fluid/electrolyte fluid for 10kg infant? 40kg child?

0.2% NS + 10 meq KCL x 24h
(1/4NS)

child: D5 1/4NS + 20mEQ KCL

78

1kg = how many ccs of fluid when calculating % loss (deficit) of fluid

1kg = 1000cc

79

Calculate fluid deficit of 10kg baby 10% dehydrated

0.10 x 10 x 1000 = 1kg = 1000cc

80

calculation for serum osmolality and what is normal

2 (Na) + 10 + [BUN/3 + Gluc/18]
Estimate with 2(Na) + 10
Normal 290

81

electrolyte abnormality causing seizure after hypernatremic dehydration

hypocalcemia

82

calculate free water deficit / excess

Wt x 0.6 = volume of distribution
(Na level x Vc ) / 140 (nl sodium) = new volume distr
New Vd - normal Vd = excess/deficit

83

Formula for FeNa

UNa x P Cr / UCr x PNa x 100

84

3 causes of nongap acidosis?

1. Renal loss of bicarb (RTA, carbonic anhydrase inhib)
2. GI loss of bicarb (diarrhea)
3. acid administration (HCl, parenteral nutrition)

85

anion gap formula, normal?

Na - (HCO3 + Cl)
normal 8-16

86

RTA type 1 features

Cannot excrete acid load so never w/ urine pH < 6!
renal stones, can get low K w/ Na salts

87

prob w/ bicarb admin in acidosis

blood will quickly equilibrate with increased bicarb and incr pCO2, but CSF will not catch up right away and will incr pCO2 w/o concomitant bicarb right away;, causing a low pH in CSF...

88

if urine pH <6, the diagnosis is NOT what?

RTA 1 (can't excrete acid)

89

where is defect in RTA 1

distal tubule where you excrete acid from NH4 production

90

UNa for prerenal

<20 is the clue for prerenal azotemia

91

clue for renal azotemia in urine sodium

UNa >30

184

RTA 1 vs 4

both can acidify urine, but four can have hyperkalemia

185

two drugs potential use in siadh if fluid rstrx fails

demeclocycline
fludrocortisone

186

two chemo agents that can cause hyponatremia and how

cylcophos decreases water excretion
vincristine causes siadh

187

diabetes drug that can cause hyponatremia

chlorpropamide

188

what is the total body sodium in water tox?
what is the urine concentration of na

normal
high urine Na

189

what is the total body sodium in pseudohyponatremia (like in high TG)

total body na high (water is high, but volume is low so total na looks low)

190

low calcium effect on ekg

long qt

191

low magnesium effect on ekg

long pr or qt

192

hypokalemia ekg changes

flat T, st depr, pvcs

193

hyperkalemia ekg changes

peak t, no p, wide qrs, EMD

194

best replacement fluid for toddlers oral

glucose 2-2.5%
na 60-90 meq

(teens water)

195

appropriate correction of hypernatremia

slow: no more than 10-12 in 24 hours

196

for every 1L of maintenance fluid, how much Na, CL, K do you need?
How do you figure out deficit Na?

30mEq Na
20meq K
20 meq Cl

Can figure out deficit electrolytes too by multiplying ECF deficit (60% deficit) x 140meq. (This is the 0.6 volume of distribution for Na!)