RENAL

Question 1

PRERENAL LABS

Answer 1

• BUN:Creatine >20:1
• Urine Na <20
  -Urine is concentrated
  -Urine osmo >500 HIGH
  -Specific gravity: >1.020 HIGH
• Fractional excretion of Na <1%
• Response to Lasix >40mL

Question 2

INTRARENAL LAB

Answer 2

• BUN:Creatine 10-15:1
• Urine Na >20
  -Urine is dilute
  -Urine osmo <300 low
  -Specific gravity: <1.010 low
• Fractional excretion of Na >1%
• Response to Lasix: No response

Question 3

HYPOCALCEMIA S/S

Answer 3

• Anxiety
• Irritability
• Twitching around the mouth
• Laryngospasms
• Seizures
• Chvostek sign
• Trousseau sign
• Torsades VT

Question 4

HYPOCALCEMIA CAUSES

Answer 4

• Acute pancreatitis
• Hyperkalemia
• Hypoparathyroid
• Vit D deficiency
• Hypoalbuminia
• Chronic renal failure
• Alkalotic States (hyperventilation, vomiting)
• Massive infection of subq tissues

Question 5

HYPOCALCEMIA TREATMENTS

Answer 5

• IV fluids
• Calcium Gluconate
• Calcium Chloride
• Vit D
• Correct resp alkalosis

Question 6

CALCIUM NORMAL LEVELS

Answer 6

8.5-10.5

Question 7

HYPERCALCEMIA S/S

Answer 7

• Lethargy
• Fatigue
• AMS
• Decreased DTR
• Abdominal pain
• Constipation
• Muscle weakness
• N/V
• Metallic taste
• Anorexia
• Weight loss
• Kidney stones

Question 8

HYPECALCEMIA CAUSES

Answer 8

• Renal disease
• Hypokalemia
• Hyperparathyroid
• Prolonged bed rest
• Malignancies

Question 9

HYPERCALCEMIA TREATMENT

Answer 9

• IV NS for diuresis
• Furosemide
• R/O hypokalemia
• Glucocorticoids
• Decrease GI absorption of Ca
• Mithracin IV
• Calcitonin or Etidronate
• Decreased Ca release from bones

Question 10

POTASSIUM NORMAL LEVELS

Answer 10

3.5-5

Question 11

HYPERKALEMIA S/S

Answer 11

• Muscle weakness
• Irritability
• Nausea
• Diarrhea
• Muscle cramps
• Pain
• Peak T-waves
• Widening QRS
• Loss of P waves
• Bradycardia
• PEA

Question 12

HYPERKALEMIA CAUSES

Answer 12

• Renal failure
• Burns (early)
• Massive crush injuries
• Excessive K intake
• Metabolic Acidosis
• Adrenocortical insufficiency

Question 13

HYPERKALEMIA TREATMENT

Answer 13

• Calcium Chloride or Gluconate
• Sodium Bicarb
• Insulin/Glucose
• Albuterol
• Correct acidosis
• Kayexalate
• Dialysis

Question 14

HYPOKALEMIA S/S

Answer 14

• Muscle weakness
• Decreased reflexes
• N/V
• Paralytic Ileus
• Abdominal distention/gas
• Shallow respirations
• Mental depression
• VTACH
• VFIB

Question 15

HYPOKALEMIA CAUSES

Answer 15

• Diuretics
• Hyperchloremic metabolic alkalosis
• Acute alcoholism
• Uncontrolled diabetes
• Excessive perspiration
• Excess production of aldosterone
• Cirrhosis

Question 16

HYPOKALEMIA TREATMENT

Answer 16

• KCL
• Correct alkalosis by replacing chloride
• IV LR
• Correct hypomagnesemia

Question 17

SODIUM NORMAL LEVEL

Answer 17

135-145

Question 18

HYPERNATREAMIA S/S

Answer 18

• Hypovolemia hypernatremia: thirst, tachycardia, orthostasis, hypotension, dry sticky mucous membrane.
• restless
• irritability
• Obtundation > stupor > coma

Question 19

HYPERNATREMIA CAUSE

Answer 19

• Loss
• Dehydration
• Diuresis
• Mannitol
• DKA
• HHs
• DI

Question 20

HYPERNATREAMIA TREATMENTS

Answer 20

• Evaluate Urine Na
• If > 20 patient is hypervolemic
• Correct slowly to prevent edema
• D5W or 0.45 NS
• Sodium restriction
• Vasopressin for DI

Question 21

HYPONATREMIA S/S

Answer 21

• Edema
• Fatigue
• Muscle cramps
• Diarrhea
• Abdominal cramps
• Weakness
• Lethargy
• Confusion
• Decreased DTR
• Seizures
• Coma
• Brain herniation

Question 22

HYPONATREAMIA CAUSES

Answer 22

• Fluid overload
• Heart Failure
• Cirrhosis
• Excessive water intake
• Excessive infusion of D5W
• SIADH

Question 23

HYPONATREAMIA TREATMENT

Answer 23

• Water restriction (if not hypovolemic)
• Loop diuretics
• 0.9 NS if dehydrated
• Water intoxication? Avoid hypotonic fluids
• If acute and severe? 3%

Question 24

MAGNESIUM NORMAL LEVEL

Answer 24

• 1.5-2.5

Question 25

HYPERMAGNESEMIA S/S

Answer 25

- Decreased DTR - Respiratory depression - Respiratory arrest - Bradyarrhythmia - Hypotension - Lethargy - Coma - N/V - Flushing

Question 26

HYPERMAGNESEMIA CAUSES

Answer 26

- Renal failure - Laxative abuse - Antacid abuse - Iatrogenic OD

Question 27

HYPERMAGNESEMIA TREATMET

Answer 27

- Stop intake - Give Calcium - Give furosemide is renal function OK - May need dialysis

Question 28

HYPOMAGNESIMIA S/S

Answer 28

- Hyperreflexia (Chvostek or Trousseau) - VTACH - PSVT - Sensitivity to Digoxin - Insulin resistance - - Hypokalemia - Hypocalcemia - Hypophosphatemia - Agitation - Confusion - Impedes correction of low K

Question 29

HYPOMAGNESIAMI CAUSES

Answer 29

- Chronic alcoholism (most common) - Vomiting - Diarrhea - NG suction - Malabsorption - - Post CABG - Acute MI - DKA - HHS - Hyperparathyroidism - Nephrotic syndrome - Diuretics - ETOH - Digoxin - Cisplatin - Malnutrition - Enteral or parenteral feedings

Question 30

HYPOMAGNESEMIA TREATMENT

Answer 30

- Replace max 1g/min

Question 31

PHOSPHATE NORMAL LEVEL

Answer 31

3-4.5

Question 32

HYPOPHOSPHATEMIA S/S

Answer 32

- Similar to hypercalcemia - Lethargy - Fatigue - AMS - Decreased/absent DTR - Abdominal pain - - Peptic ulcer - - Constipation - Muscle weakness - - Hypoventilation -

Question 33

HYPOPHOSPHATEMIA CAUSES

Answer 33

- Increase in cellular uptake of phosphate with TPN administration - Alcoholism - Increase glucose administration

Question 34

HYPOPHOSPHATEMIA TREATMENT

Answer 34

- Oral or IV phosphate supplement

Question 35

HYPERPHOSPHATEMIA S/S

Answer 35

- Similar to Hypocalcemia - Anxiety - Irritability - Twitching around mouth - Laryngospasm - Seizures

Question 36

HYPERPHOSPHATEMIA CAUSES

Answer 36

- Decreased renal excretion and or renal failure

Question 37

HYPERPHOSPHATEMIA TEATMENT

Answer 37

- Phosphate binders: aluminum hydroxide (Amphojel, Basagel) - Calcium Carbonate (Caltrate)