Flashcards in Renal Deck (197)
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
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
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)
When should Na be added to TPN?
do not add Na to IVF for 24-72h or until serum Na is <140
How should hyponatremia be interpreted?
as excessive fluid intake; heme dilution
How should hypernatremia be interpreted?
as inadequate fluid intake or insensiblewater loss; heme concentration
Which state is more common in the preterm infant: hyper or hypo natremia?
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
What is the Na requirement of preterm infants after the transitional period?
What is the Na content of NS?
What is the Na content of 1/2 NS?
What is the Na content of 1/4 NS?
Why is a positive K balance important?
to facilitate optimal growth
When should K be added to TPN?
don't add K until UOP is well established and K is falling
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
What is the mechanism of pre-renal failure?
essentially due to hypoperfusion of the kidney
- systemic hypoperfusion
- regional renal hypoperfusion
What is the prognosis of prerenal failure?
reversible if diagnosed early > can prevent intrinsic renal failure and subsequent need for transplant
What can cause pre renal failure?
1) maternal medications
2) antepartum hemorrhage
3) cardiogenic shock
5) postpartum hemorrhage
8) obstruction of venous return
10) septic shock
11) metabolic problems
12) polycythemia/ hyperviscosity
14) medications that reduce blood flow
What maternal medications can induce prerenal failure in the neonate?
1) ACE inhibitors
3) Cyclooxygenase inhibitors (celebrex)
What antepartum hemorrhage conditions can result in prerenal failure in the neonate?
2) Fetomaternal transfusion shortly before birth
4) cord accidents
What cardiogenic conditions can result in prerenal failure in the neonate?
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
What postpartum hemorrhage conditions can result in prerenal failure in the neonate?
2) subgaleal hemorrhage
3) adrenal hemorrhage
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)
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)
How can metabolic conditions can result in prerenal failure in the neonate?
both are r/t impaired myocardial fx
What medications can induce prerenal failure in the neonate?
2) ACE inhibitors
3) phenylephrine eye gtts
What is the mechanism of post renal failure?
kidney damage due to mechanical obstruction of urine flow somewhere in the urinary sytem
What is the most common cause of hydronephrosis in male infants?
posterior uretheral valves