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Neonatal Pathophysiology > Renal > Flashcards

Flashcards in Renal Deck (197)
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61

What is the renal threshold of bicarbonate in the neonate compared to an adult?

lower; FT: 21 MEq/L; PT: 18 MEq/L- may be as low as 14 MEq/L

62

What is the recommended TF for a VLBW PT infant?

90 mL/kg/d; may be better to decrease this to 70-80 if possible

63

What is the target serum Na for a VLBW PT infant?

target Na in transitional period is 140-145; on the higher side
(serum 130-135 is ok if the infant is on diuretics after the transitional period)

64

When should Na be added to TPN?

do not add Na to IVF for 24-72h or until serum Na is <140

65

How should hyponatremia be interpreted?

as excessive fluid intake; heme dilution

66

How should hypernatremia be interpreted?

as inadequate fluid intake or insensiblewater loss; heme concentration

67

Which state is more common in the preterm infant: hyper or hypo natremia?

hypernatremia

68

Why is it important for PT infants to have a positive Na balance after transitional period?

to facilitate optimal growth; don't overdo it if the baby has lung disease

69

What is the Na requirement of preterm infants after the transitional period?

2-4 MEq/kg/d

70

What is the Na content of NS?

0.154mEq/mL

71

What is the Na content of 1/2 NS?

0.075 mEq/mL

72

What is the Na content of 1/4 NS?

0.037 mEq/mL

73

Why is a positive K balance important?

to facilitate optimal growth

74

When should K be added to TPN?

don't add K until UOP is well established and K is falling

75

What are the effects of renal failure?

1) decrease in GFR
2) increase in waste products
3) fluid and electrolyte imbalance
4) the endocrine fx will be impaired as well

76

What is the mechanism of pre-renal failure?

essentially due to hypoperfusion of the kidney
- systemic hypoperfusion
- regional renal hypoperfusion

77

What is the prognosis of prerenal failure?

reversible if diagnosed early > can prevent intrinsic renal failure and subsequent need for transplant

78

What can cause pre renal failure?

1) maternal medications
2) antepartum hemorrhage
3) cardiogenic shock
4) hypothermia
5) postpartum hemorrhage
6) hypovolemia
7) cardiac
8) obstruction of venous return
9) hypoxia
10) septic shock
11) metabolic problems
12) polycythemia/ hyperviscosity
13) ECMO
14) medications that reduce blood flow

79

What maternal medications can induce prerenal failure in the neonate?

1) ACE inhibitors
2) NSAIDS
3) Cyclooxygenase inhibitors (celebrex)

80

What antepartum hemorrhage conditions can result in prerenal failure in the neonate?

1) TTTS
2) Fetomaternal transfusion shortly before birth
3) Abruption
4) cord accidents

81

What cardiogenic conditions can result in prerenal failure in the neonate?

birth asphxyia

82

How can hypothermia result in prerenal failure in the neonate?

a drop in core body temp greater than 2degrees Celsius can cause a severe decrease in GFR

83

What postpartum hemorrhage conditions can result in prerenal failure in the neonate?

1) IVH
2) subgaleal hemorrhage
3) adrenal hemorrhage

84

What conditions can cause a state of hypovolemia in the neonate that can induce prerenal failure?

1) dehydration/ poor feeding/ BM jaundice
2) increased GI losses (ex: pyloric stenosis and short gut)

85

How can septic conditions can result in prerenal failure in the neonate?

1) endotoxin effects on the heart
2) endotoxin effects on the blood vessels
3) edema with 3rd spacing (NEC)

86

How can metabolic conditions can result in prerenal failure in the neonate?

1) hypoglycemia
2) hypocalcemia

both are r/t impaired myocardial fx

87

What medications can induce prerenal failure in the neonate?

1) Indocin/ibuprofen
2) ACE inhibitors
3) phenylephrine eye gtts

88

What is the mechanism of post renal failure?

kidney damage due to mechanical obstruction of urine flow somewhere in the urinary sytem

89

What is the most common cause of hydronephrosis in male infants?

posterior uretheral valves

90

If the cause of post renal failure in the neonate is due to posterior urethral valves, what actions are indicated?

urology consult, urinary catheter needs to be placed, renal u/s, VCUG, resection of laser ablation of valves and a PT infant may require a vesicostomy