Renal/Hepatic Assessment EXTRAS

Question 1

Why should you be extra cautious extubating patient post-parathyroidectomy?

Answer 1

Hypocalcemia induced laryngospasm!

Question 2

What are some s/s associated with hyponatremia?

Answer 2

-HA
-confusion
-fatigue
-muscle cramps
-malaise

Question 3

What are some s/s associated with hypernatremia?

Answer 3

-restlessness
-lethargy
-tremor/muscle twitching

Question 4

What are some s/s associated with hypokalemia?

Answer 4

-muscle weakness/cramps
-ileus
-dysrhythmias, U wave

Question 5

What are some s/s associated with hyperkalemia?

Answer 5

-skeletal muscle paralysis, malaise, GI upset

Question 6

What are some s/s associated with hypercalcemia?

Answer 6

-confusion
-hypotonia
-decreased DTR
-abd pain

Question 7

What are some s/s associated with hypocalcemia?

Answer 7

• irritability
  -seizures
  -hypotension
• post parathyroidectomy hypocalcemia induced laryngospasm

Question 8

Which induction agents are excreted renally?

Answer 8

barbiturates

Question 9

Which NMBA’s are excreted renally?

Answer 9

• pancuronium
• vecuronium

Question 10

Which cardiovascular drugs are excreted renally?

Answer 10

• atropine
• digoxin
• glycopyrrolate
• hydralazine
• milrinone

Question 11

Why is blood loss a particular concern for renal dx patients?

Answer 11

Blood loss activates baroreceptors –> increases SNS outflow –> increases afferent arteriole constriction –> DECREASES RBF

Question 12

Why should morphine and demerol be avoided in renal dx patients? What are their active metabolites?

Answer 12

Morphine and Demerol are cleared by the kidneys. Morphine active metabolite is morphine-6-glucuronide, demerol active metabolite is normeperidine.
–> LIFE-THREATENING RESP DEPRESSION

Question 13

What does uremia do to vWF?

Answer 13

vWF synthesis is affected by uremia. Pre-surgical DDAVP may be a consideration.

Question 14

Could we possibly see hypoparathyroidism or hyperparathyroidism with AKI? Why?

Answer 14

Hyperparathyroidism. “Parathyroid in overdrive” in an attempt to stimulate Ca reabsorption in an injured kidney

Question 15

Which is better for renal patients: NS or LR?

Answer 15

NS. No K in NS

Question 16

Which pressor agent is superior in regards to renal protection? How so?

Answer 16

Vasopressin. Preferentially constricts the EFFERENT arteriole instead of afferent arteriole, preserving GFR.

Question 17

What is GFR in stage 1 of CKD?

Answer 17

GFR > 90 mL/min/1.73m^2

Question 18

What is GFR in stage 2 of CKD?

Answer 18

GFR 60-89 mL/min/1.73m^2

Question 19

What is GFR in stage 3 of CKD?

Answer 19

30-59 mL/min/1.73m^2

Question 20

What is GFR in stage 4 of CKD?

Answer 20

15-29 mL/min/1.73m^2

Question 21

What is GFR in stage 5 of CKD?

Answer 21

<15 mL/min/1.73m^2

Question 22

Which class of diuretics is 1st line treatment for HTN in CKD?

Answer 22

Thiazide diuretics

Question 23

What are treatment options for hepatorenal syndrome?

Answer 23

Midodrine, octreotide, albumin

Question 24

What are treatment options for portopulmonary HTN?

Answer 24

PDE-I’s, NO, prostacyclin analogs, endothelin receptor antagonists

Question 25

Should you consider an elective surgery in a patient with a MELD score of >16?

Answer 25

No. Consider alternatives and transplant

Question 26

What if you determine your patient has a MELD score of 10-15 during your pre-assessment?

Answer 26

In the presence of portal HTN: Consider TIPS before elective procedure In the absence of portal HTN: proceed to OR, careful monitoring

Question 27

Can you proceed with scheduled surgery if your patient has a MELD score of less than 10?

Answer 27

Yes

Question 28

What two paralytic agents can you consider giving to patients with hepatic dysfunction d/t not being metabolized by the liver?

Answer 28

Succinylcholine and cisatracurium

Question 29

Alcoholism _______ MAC of volatile anesthetics

Answer 29

increases

Question 30

Up to __% of the liver can be resected in a normal, healthy patient.

Answer 30

75%