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Renal > Renal 2019 Quiz 1 > Flashcards

Renal 2019 Quiz 1 Flashcards

1
Q

Essential for Nerve conduction, muscle contraction, hormone release, blood coagulation, intracellular signaling, and enzyme regulation

A

Calcium

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2
Q

99% of Calcium could be found in

A

Bone

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3
Q

Normal range of Calcium levels…

A

8.5-10.5mg/dL

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4
Q

• Ionized calcium is roughly how much percentage of total Plasma calcium

A

50%

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5
Q

• For each 1 g/dL decrease or increase in albumin, the ionized calcium increases or decreases by

A

0.8 mg/dL

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6
Q

• The risk of precipitation of Calcium Phosphate crystal in soft tissues is greatly increased when the solubility product of Ca and PO4…

A

GREATER THAN 55 mg2/dL2

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7
Q

PTH will lead to

A

Increase in Calcium and Decrease in Phosphorous

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8
Q

• The most active form of Vit D which increase the absorption of Calcium from the GI….

A

CALCITRIOL

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9
Q

• Calcitonin effects on calcium include…..

A

decrease bone resorption, enhance renal excretion and cell reuptake

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10
Q

• Hypoparathyroidism and Vitamin D deficiency cause

A

Hypocalcemia

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11
Q

• Caused by Renal tubular disease, Renal failure and Magnesium depletion

A

Hypocalcemia

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12
Q

• Acute pancreatitis causes

A

Hypocalcemia (Ca chelated by the lipolytic products produced by the inflamed Pancreas)

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13
Q

• Enhanced bone formation or hungry bone syndrome causes

A

Hypocalcemia

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14
Q

• Septic shock causes hypocalcemia by

A

suppressing PTH release and suppressing the conversion of 25(OH)D3 to 1,25(OH)2D3

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15
Q

Hyperphosphatemia effect on calcium

A

Hypocalcemia

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16
Q

• Phenytoin, phenobarbital and Rifampin cause hypocalcemia by

A

increasing the metabolism of Vitamin D (Blood transfusion treated with citrate as well as radiocontrast agents containing EDTA chelates Calcium leading to hypocalcemia)

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17
Q

• Signs and Symptoms of Hypocalcemia include

A

Muscle Cramps involving legs and back

					- Tetany
					- Cataract
					- Dementia, depression and psychosis due to 							encephalopathy
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18
Q

What is Trousseau’s sign…

A

spasm of the hand as a result of reduction of blood supply to the hand –apply blood pressure cuff to forearm and maintain BP at 20mmHg above systole pressure for 3 minutes. Non-specific common in hypokalemia, Hypomagnesia, and Hyperkalemia.

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19
Q

What is • An involuntary twitching of the facial muscle elicited by a light tapping of the facial nerves….

A

Chvostek’s sign

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20
Q

• The ECG in hypocalcemia typically shows prolongation of….

A

QTc and ST interval

21
Q

• Treatment for Acute severe hypocalcemia tetany

A

IV calcium gluconate
Give 3 vials/syringes of 10 mL of 10% Cal Gluconate over 10 minutes each or 1 vial/syringe of calcium chloride 10%.
May be followed by continuous infusion of 20-30 mL of Cal gluconate in 1L D5W over 12-24 hours- AVOID CAL CHLORIDE

22
Q

• Elemental Calcium contents of calcium preparation such as calcium gluconate, chloride and carbonate:

A

Calcium Gluconate-90mg elemental Ca/1g
Calcium chloride-270mg elemental Ca/1g
Calcium Carbonate-400mg elemental Ca/1g

23
Q

What is the Active form of Vitamin D appropriate for patient with renal failure

A

Calcitriol

- In renal failure conversion of Vit D to Calcitriol is insufficient—give 0.5-2 ug/day
- Use calcium carbonate as phosphate binding agent instead of Aluminum containing 	agents cause they cause dementia
24
Q

MAJOR CAUSES OF HYPERCALCEMIA…

A

Hyperparathyroidism Cancer
Excess
Vit D

25
Q

• Sarcoidosis causes hypercalcemia by

A

Increasing the activation of Vit D

26
Q

• Immobilization (bed rest) can cause

A

Hypercalcemia due to increased bone resorption

27
Q

• Clinical manifestations of hypercalcemia include

A

N/V

  • Constipation
  • Anorexia
  • Abdominal pain
  • Renal concentration disorders (Nocturia,polydipsia,polyuria)
28
Q

• Elevated Plasma Calcium level >12 mg/dL is associated with what signs and symptoms

A

Confusion

  • Delirium
  • Psychosis
  • Stupor
  • Coma
29
Q

• ECG changes associated with Hypercalcemia

A

Shortened QTc interval

30
Q

• Calcium levels of >18 mg/dL are associated with what

A

Shock, Renal Failure, and Death

31
Q

• In hyperparathyroidism the Ca levels are…

A

rarely >12 mg/dL but ionizes ca levels are almost always elevated. Hypophosphatemia is present

32
Q

• In Hypercalcemia of malignancy, what is the Ca level?

A

> 12 mg/dL

33
Q

• In a patient with normal renal function, what is the treatment of Hypercalcemia?

A
  • NS and Furosemide (diuretics)
    - Maintain fluids at 3L/day
    - Monitor K (add K to IV NS)
    - Any other Tx based off symptoms
34
Q

• Normal Range of Phosphorous levels…

A

2.5-4.5 mg/dL

35
Q

• Hormones regulating Phosphorous…

A

PTH, VitD,Calcitonin, Cortisol

36
Q

• Tumor Lysis syndrome and Fleet-phospho-soda can cause

A

Hyperphosphatemia

37
Q

• Renal failure can do what to phosphate

A

Cause Hyperphosphatemia

38
Q

• Bisphosphonates and Vitamin D cause what to phosphate

A

Hyperphosphatemia

39
Q

• Acidosis can cause what to phosphate

A

Hyperphosphatemia

40
Q

• What is the phosphate binding agent of choice

A

Calcium containing salts

41
Q

Name of the Phosphate binding Copolymer….

A

Sevelamer (Renagel)

42
Q

What can Refeeding syndrome do to Phosphate, K+,and Mg+ levels..

A

Hypophosphatemia
Hypokalemia
Hypomagnesemia

43
Q

• Insulin and Glucose can cause what to phosphate…

A

Hypophosphatemia

44
Q

• Phosphorus levels on Patients receiving TPN will be

A

LOW

45
Q

• Side effects of Neutra-Phos include…

A

Diarrhea

46
Q

• What is the normal dose of IV Phosphorous?

A

15 mmol infuse over 3 hours

47
Q

• The content of Phosphorous products in mmol:

A
  • 8mmol per 250 mg packet or tablet of oral Neutra-Phos or K-Phos
  • 3mmol/mL of the sodium or potassium Phosphate injections
48
Q

• What are the Potassium, Sodium, and Phosphate contents of a 5 mLvial of:

A
  • Sodium Phosphate: 20 mEq sodium and 15 mmol Phosphate

- Potassium Phosphate: 22 mEq potassium and 15 mmol Phosphate

Renal (4 decks)

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