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Health Assessment Exam 4 > Renal > Flashcards

Renal Flashcards

(85 cards)

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1
Q

Front

A

Back

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2
Q

What percentage of total body water (TBW) is water?

A

~60%

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3
Q

Where is extracellular fluid (ECF) found?

A

Outside cells (ISF + Plasma)

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4
Q

Which compartment is more immediately altered by the kidneys?

A

ECF

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5
Q

What mediates osmolar homeostasis?

A

Osmolality sensors in anterior hypothalamus

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6
Q

What does vasopressin (ADH) do in osmoregulation?

A

Promotes water reabsorption

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7
Q

What cardiac hormone acts on kidneys to reduce Na+/H2O reabsorption?

A

ANP

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8
Q

What organ senses volume changes to activate RAAS?

A

Juxtaglomerular apparatus (JGA)

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9
Q

What triggers RAAS activation?

A

↓ Volume at JGA

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10
Q

Normal sodium range?

A

135–145 mEq/L

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11
Q

Sodium level contraindicating surgery?

A

<125 or >150 mEq/L

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12
Q

Most common cause of hyponatremia in hospitals?

A

Over-resuscitation + ↑vasopressin

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13
Q

Symptoms of sodium imbalance are primarily ___.

A

Neurological

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14
Q

Key symptoms of severe hyponatremia (<120)?

A

Seizures, respiratory arrest, death

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15
Q

Risk of rapid sodium correction?

A

Osmotic demyelination syndrome

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16
Q

Hyponatremic seizures treatment?

A

3% NaCl at 3-5 mL/kg over 20 min

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17
Q

Max Na+ correction rate?

A

1.5 mEq/L/hr

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18
Q

Common causes of hypernatremia?

A

Evaporation, ↓ intake, DI, NaHCO₃, GI loss

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19
Q

Symptoms of hypernatremia?

A

Lethargy, tremor, seizures, death

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20
Q

Hypernatremia treatment in hypovolemia?

A

Normal saline

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21
Q

Hypernatremia treatment in euvolemia?

A

Water replacement (PO or D5W)

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22
Q

Hypernatremia treatment in hypervolemia?

A

Diuretics

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23
Q

Safe sodium reduction rate?

A

≤0.5 mmol/L/hr or ≤10 mmol/L/day

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24
Q

Normal potassium level?

A

3.5–5.0 mEq/L

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25
What percentage of K+ is extracellular?
<1.5%
26
How does aldosterone affect potassium?
↑K+ excretion in distal nephron
27
Common renal causes of hypokalemia?
Diuretics, hyperaldosteronism
28
GI causes of hypokalemia?
N/V/D, malabsorption
29
What shifts potassium intracellularly?
Alkalosis, insulin, beta-agonists
30
Unique food causing hypokalemia?
Excess licorice
31
EKG finding in hypokalemia?
U wave
32
Best way to administer potassium?
PO > IV (if absorbable)
33
IV K+ dosing guideline?
10-20 mEq/hr via CVC
34
Effect of 10 mEq IV K+ on serum K+?
↑ ~0.1 mmol/L
35
First-line treatment for hyperkalemia?
IV calcium
36
Effect of hyperventilation on potassium?
↑pH by 0.1 ↓K+ by 0.4–1.5 mmol/L
37
Insulin dose for hyperkalemia?
10u IV insulin ± 25g D50
38
EKG progression in hyperkalemia?
Peaked T → no P → wide QRS → sine wave
39
Avoid these in hyperkalemia
Succinylcholine, hypoventilation, LR
40
Normal ionized calcium level?
1.2–1.38 mmol/L
41
Most calcium is stored in the ___.
Bone (99%)
42
What affects ionized calcium levels?
Albumin & pH
43
↑pH effect on ionized Ca++?
↓ Ionized Ca++ (more albumin-bound)
44
Key hormones regulating calcium?
PTH, Vitamin D, Calcitonin
45
Major cause of hypocalcemia post-op?
↓PTH from thyroid/parathyroid surgery
46
Why does blood transfusion cause hypocalcemia?
Citrate binds calcium
47
Classic emergency from low calcium post-thyroidectomy?
Laryngospasm
48
First-line treatment for Torsades?
2g IV magnesium sulfate
49
Hypermagnesemia cause?
Over-treatment (e.g., OB Mg drips)
50
Symptoms of high Mg++ (>10 mEq/L)?
Paralysis, apnea, cardiac arrest
51
Treatment of high Mg++?
Diuresis, IV calcium, dialysis
52
Where are kidneys located?
Retroperitoneal, T12–L4
53
Functional unit of kidney?
Nephron
54
% of CO to kidneys?
20% (~1–1.25 L/min)
55
Part of kidney most vulnerable to ischemia?
Medulla (LOH area)
56
Main kidney functions?
Regulate EC fluid/osmolarity, BP, acid-base, excrete waste
57
Hormones made by kidney?
Renin, EPO, Calcitriol, Prostaglandins
58
Best test for long-term renal function?
GFR
59
Normal GFR?
120–140 mL/min
60
Most accurate GFR measurement?
Creatinine clearance (110–150 mL/min)
61
Normal serum creatinine?
0.6–1.3 mg/dL
62
Normal BUN?
10–20 mg/dL
63
Normal BUN:Creatinine ratio?
0.41736111111111107
64
High BUN:Cr ratio (>20:1) suggests ___.
Pre-renal azotemia
65
Normal urine output?
0.5–1 mL/kg/hr or 30 mL/hr
66
Definition of oliguria?
<500 mL/day
67
Significance of >50% IVC collapse on US?
Volume depletion
68
Definition of AKI?
Rapid decline in kidney function over hrs–days
69
Classic AKI markers?
↑SCr by 0.3 in 48h, 50% rise in 7 days, ↓CrCl 50%
70
Most common hospital AKI type?
Pre-renal
71
Treatment for pre-renal AKI?
Fluids, pressors, maintain MAP
72
Diagnostic clue for pre-renal AKI?
BUN:Cr > 20:1
73
Clue for intrinsic (renal) AKI?
BUN:Cr < 15:1
74
Clue for post-renal AKI?
Obstruction + variable BUN:Cr
75
Most dangerous AKI complication in anesthesia?
Uremic bleeding
76
CKD leading causes?
Diabetes, hypertension
77
When is dialysis indicated?
Volume overload, hyperkalemia, acidosis, uremia
78
Best IV fluid in AKI/CKD?
Normal saline
79
Avoid these drugs in CKD?
Morphine, Demerol, drugs with active metabolites
80
Key pre-op lab for CKD surgery?
K+ < 5.5 mEq/L
81
Dialysis timing before elective surgery?
Within 24h
82
Best reversal combo in CKD?
Neostigmine + glycopyrrolate
83
Why avoid ACE-I/ARBs on day of surgery?
↑Risk of hypotension
84
Morphine metabolite of concern in CKD?
Morphine-6-glucuronide
85
Toxic Demerol metabolite?
Normeperidine

Health Assessment Exam 4 (10 decks)

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