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Flashcards in PCCN Renal Deck (16)
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1
Q

What influences water reabsorption?

A

ADH = vasopressin

2
Q

What influences sodium reabsorption?

A

Aldosterone

3
Q

Why is GFR used to measure renal function?

A

The lower the GFR, the less filtrate (urine) is produced

  • *GFR effected by:
  • epinephrine ↑BP by vasoconstriction, but ↓renal blood flow and GFR
4
Q

Hyperkalemia

  • causes
  • pt presentation
  • ECG changes
  • Treatment
A

K > 5.5 [causes heart to slow down]

**CAUSED by ACE inhibitors, ARBs, BB, K-sparing diuretics; ↑cell destruction (crash injuries, burns, rhabdomyolysis, acidosis), obvi renal failure

**↓HR, ↓BP, lethargy, confusion, cramping, diarrhea, irritability to flaccid paralysis, oliguria

  • *ECG:
  • ST segment depression
  • peaked/elevated T waves
  • wide QRS
  • prolonged PR interval (1°AVB)
  • flat or absent P waves
  • asystole

Tx K>6.5
insulin to drive into cell
Kayexalate- removes K in stool
Hemodialysis

5
Q

Hypokalemia

A

K <3.5

CAUSED by alkalosis, diuretic therapy, vomit, diarrhea, NG suction, starvation, ↑corticosteroids

**↓HR, ↓BP, lethargy, confusion, cramping, diarrhea, irritability to flaccid paralysis, oliguria

  • *ECG:
  • ST segment depression (same for hyperK)
  • flat or inverted T waves
  • VT, Vfib, PVCs

Tx K>6.5
KCl and Mg replacement

6
Q

Hypernatremia

A

Na >145

↑ECF: ↑Na + H2O retention = overhydration (pt has wt gain, ↑BP, pulm edema, dyspnea, edema)

↓ECF: ↑Na (w/o water retention) = dehydration (weak, thready pulse and ↑HR)

ppl with head injury, lose thirst mechanism and irregular ADH; when ADH low (diabetes insipidus) pee alot.

Rx causes: mannitol, NS infusions, laxatives, antacids and ↑mineralcorticoids.

NO ECG CHANGES!!!

7
Q

phosphate important for what?

A

ATP, O2 delivery, enzyme fxn

…bones, cell membranes

8
Q

SIADH

A

syndrome of inappropriate antidiuretic hormone (ADH) secretion (SIADH) is defined by the hyponatremia and hypo-osmolality resulting from inappropriate, continued secretion or action of the hormone despite normal or increased plasma volume, which results in impaired water excretion. ==> HYPONATREMIA

9
Q

s/s Hypocalcemia

A

cramps, paresthesias, tetany, seizures

10
Q

What happens to Ca when pt on prolonged bedrest?

A

body thinks it doesn’t need the Ca and leaves bones for the blood, high Ca levels

hypercalcemia enhances digoxin

11
Q

Why do you need to hang Mg before K?

A

low Mg liberates K from inside cell to ECF, causing ↑renal secretion of K–> hypokalemia.

Hang/correct Mg first of K will continue to be excreted.

12
Q

Normal electrolyte levels

A
Na    135-145
K       3.5-5.0
Ca    9.0-10.5
Mg         1.8-3
Cl       96-106
P        3.0-4.5
13
Q

Hypercalcemia

A

Ca >10.5

cause: move out of beone, hyperparathyroidism, thiazide diuretics

Pt: HTN, lethargy, confusion to coma, fatigue, muscle weakness, N/V, constipation, anorexia

ECG: shorten ST seg, AVB–>cardiac arrest

14
Q

Hypocalcemia

A

Ca <8.5

cause: diarrhea, diuretic use, vit D def, hypoparathyroidism

ECG: prolonged QT interval and ST seg

15
Q

Hypophosphatemia

A

P <3.0

Cause: chronic alcoholism, malabsorption

Pt: muscle pain/tenderness, seizures, muscle weakness/wasting, PLATELET DYSFUNCTION, ↓BP↑HR

16
Q

Problems seen with renal failure

A
hyperkalemia
hypocalcemia
HTN
Acidosis
anemia
Azotemia