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Flashcards in nephrology Deck (42):
1

acidosis and acidemia

acidosis= low serum bicarb
acidemia= serum pH<7.35

2

alkalosis and alkalemia

alkalosis= high serum bicarb
alkalemia=serum pH >7.45

3

effects of acidosis

decrease in force of cardiac contractions
decrease in vascular response to catecholamines
diminished response to the effects and actions of certain meds

4

effects of alkalosis

interferes w/ tissue oxygenation
interferes w/ normal neurological and muscular functioning

5

what causes oxy curve to shift to right

increased H ions (decrease in pH), increased CO2, increase in temp

6

mudpiles

methanol
uremia
DKA
paraldehyde
INH, IRON
Lactic acidosis
ethylene glycol
salicylates

7

used CAR (non anion gap)

ureteral sigmoid diversions
saline admin
endocrinopathies (addisons, spironlacone, hyper PTH)
diarrhea
carbonic anhydrase inhibitors
hyperalimentation
RTA

8

when are urine Anion gaps seen

urine anion gap>20 is seen in metabolic acidosis
If urine anion gap is 0 or negative but serum Anion gap is positive the source is most liley GI (diarrhea or vomitting)

9

when to use winters and summers formula

in metabolic acid base disorders...used to calculate respiratory compensation
Winters= metabolic acidosis (when projected CO2 is higher than actual there is respiratory alkalosis....when projected co2 is lower than actual there is concommittent respiratory acidosis)
summers= metabolic alkalosis (when projected CO2 is higher than actual there is respiratory alkalosis...when projected CO2 is lower than actual there is concommittent respiratory acidosis)

10

triple ripple

calculate the delta anion gap
tells if 3rd derangement

11

metabolic alkalosis

GI hydrogen loss

12

contraction alkalosis

basically is DEHYDRATION
loss of large volume of fluid and leave HCO3 in body then its more concentrated and get alkalosis
caused by: loop diuretics, thiazides, prolonged vomiting (if giving diuretic need to monitor this), sweat loses in pts w/ cystic fibrosis (cause H and Cl are secreted together)

13

what do you need to do if have metabolic derangment

check for compensation by summers or winters

14

what do you need to do if have respiratory derangement

check for compensation by looking for change in bicarb

15

what do you want to do before you get an ABG

allens test

16

causes of metabolic alkalosis

vomiting or NG suction, increase aldosterone secretion, loop/thiazide diuretic, hypercalcemia, hypokalemia, contraction alkalosis (massive diuresis, sweat losses in Cystic fibrosis), posthypercapnic alkalosis ( usually by mechanical ventilation)

17

posthypercapnic alkalosis

overcorrect someone's co2 (wrong ventilator setting)

18

2 basic categories of diseases when kidney's retain HCO3

differentiated by response to NaCl
1. chloride responsive (10) (these problems are telling kidney to retain HCO3 so NaCl won't help)
a. excess mineralocorticoid (cushings syndrome, conn's syndrome, exogenous steroid admin, bartter syndrome)

19

tx of chloride responsive

replace volume w/ NaCl if depleted
correct hypokalemia if present

20

tx of chloride resistant

treat underlying problem such as stop steroids, etc

21

can get metabolic alkalosis from blood (8 or more units)

true (due to citrate in blood)

22

waste products of metabolism

urea, creatine, uric acid

23

BUN increased w/ creatinine normal (>20/1)

prerenal azotemia
catabolic state w/ increased muscle breakdown
GI hemorrhage
High protein intake
drugs (tetracycline, steroid)

24

BUN increased and creatinine increased (>20/1)

postrenal azotemia (obstructive uropathy)
prerenal azotemia superimposed on renal disease
basicaly post renal stuff

25

decreased ratio w/ decreased BUN (<10/1)

acute tubular necrosis
low protein diet/ starvation/ liver disease
repeated dialysis
SIADH
pregnancy

26

decreased ratio w/ increased creatinine

rhabdomyolisis
muscular pts who get renal failure

27

purpose of urinalysis

detect systemic disturbances (endocrine abnormalities and metabolic disturbances)
detect intrinsic kidney/urinary system disorders (kidney disease/uti)

28

low specific gravity casues

diabetes insipidus
well hydrated
tubular damage and renal abnormalities

29

high specific gravity

diabestes
adrenal insuffieciency
hepatic disease
CHF
excessive water or other loss of water

30

severity of Na levels

>130= usually not treated
120-130= depends on symptoms and situations
120< panic level

31

sxs of hyponatremia

fatigue and malaise are first sxs

32

hypotonic hyponatremia

due to GI loses or renal loses
can result in sxs of neuronal cell expansion and cerebral edema
Nausea, HA, seizure, coma, death
tx- normal saline slow bolus (1000cc over 1 hours)

33

hypervolemic hyponatremia

cirhosis, renal failure, CHF
tx- restrict fluids 1000-1200
restrict Na1000-1200
can use loop diuretic

34

hypervolemic hypernatremia

Iatrogenic
Hyperaldosteronism

35

hypovolemic hypernatremia

renal loses (diuretics, renal disease)
extrarenal loses (sweating, diarrhea, fluid shifts (burns)

36

Euvolemic hypernatremia

diabetes inspidus
hypodipsia

37

hypervolemic hyponatremia

CHF
liver failure (cirrhosis)
nephrotic syndrome

38

hypovolemic hyponatremia

renal loss
extra renal loss

39

euvolemic hyponatremia

SIADH
hypothyroid
polydipsia
adrenal insuffieciency

40

pseudohyponatremia

increase glucose
increase lipids
increase proteins
increase urea

41

what causes hyperkalemia

renal failure
volume depletion
adrenal insuffieciency
ACE inhibitors
spironlactone
increase in K intake (oral or IV)
pseudohyperkalemia
decrease insulin
trauma
beta blockers
acidosis

42

what causes hypokalemia

renal loss (diuretics, hyperaldosteronism)
GI loss (vommiting or diarrhea)
decrese K intake
increase insulin
beta agonists (increase catecholamines)
alkalosis