Renal-Panre Flashcards

Question

Hyponatremia

Answer 1

Na⁺ < 135 mEq/L | ● Almost always due to ↑ADH → impairs kidney’s ability to excrete free water

Answer 2

Causes: SIADH, Drugs (thiazides, ACEI), vomiting/diarrhea, psychogenic polydipsia

Answer 3

S/S: Headache, N/V, muscle cramps, ↓DTRs, neuro changes (confusion, lethargy, coma, seizure CNS issues due to cerebral edema; hypotonicity cause water to shift into cells

Answer 4

Labs, serum osmolality help determine if true hyponatremia | ○ True hyponatremia is Hypotonic Hyponatremia

Answer 5

If hypervolemic/euvolemic: Water restriction +/- diuretics ○ If hypovolemic: Normal saline fluids (expands volume to ↓hypovolemic stimulus for ADH secretion)

Answer 6

central pontine myelinolysis

Answer 7

Spurious: Hemolysis of blood sample ○ ↓ excretion: Renal insufficiency, meds (ACEI, spironolactone), adrenal insufficiency ○ Cellular shift: cell lysis (burns), tissue injury (rhabdomyolysis), tumor lysis syndrome, metabolic acidosis (DKA), meds (𝛃-blockers) ○ ↑ intake: food (bananas, tomatoes

Answer 8

Asymptomatic or n/v, areflexia, weakness, flaccid paralysis, arrhythmias

Answer 9

Repeat blood draw to confirm, check glucose and bicarb;

Answer 10

tall peaked T | waves, wide QRS, PR prolongation, loss of P waves

Answer 11

ECG changes and/or K⁺ > 6.5 mEq/L → emergent treatment ○ C BIG K ■ C alcium gluconate to stabilize cardiac cell membranes ■ B icarb and/or I nsulin PLUS G lucose to shift K⁺ into cells *most rapid way to shift K⁺* ■ K ayexalate to ↑ GI loss ○ Also can give 𝛃-agonist (albuterol) to ↑cellular reuptake of K⁺ ○ Eliminate extra K⁺ from diet ○ Loop diuretics will ↑ urinary loss of K⁺ ○ Dialysis in severe cases

Answer 12

K ■ C alcium gluconate to stabilize cardiac cell membranes ■ B icarb and/or I nsulin PLUS G lucose to shift K⁺ into cells *most rapid way to shift K⁺* ■ K ayexalate to ↑ GI loss

Answer 13

K⁺<3.5 mEq/L ● Causes ○ Cellular shift: insulin, 𝛃2-agonists, alkalosis ○ GI loss: vomiting/diarrhea, chronic laxative use ○ Renal loss: diuretics (loop, thiazide) ○ Hypomagnesemia

Answer 14

Fatigue, muscle cramp/weakness, ileus, ↓DTRs, paresthesias, rhabdomyolysis, ascending paralysis

Answer 15

Labs-K, Mg, glucose, bicarb; ECG shows T wave flattening, U waves

Answer 16

Treat underlying cause, PO/IV K⁺ repletion If hypoK is not responding to K⁺ repletion, check Mg level because ↓Mg will make fixing K⁺ harder

Answer 17

Ca⁺⁺ > 10.2 mg/dL | ● Causes: Hyperparathyroidism, malignancy

Answer 18

Stones, bones, abdominal groans, psychic moans ○ Kidney stones, osteopenia/fractures, constipation, weakness, fatigue, altered mental status, depression, ↓DTRs

Answer 19

Labs, Ca⁺⁺, ECG shows short QT interval

Answer 20

``` Saline diuresis (NS, furosemide), “loops lose calcium” ○ Avoid thiazide diuretics as they ↑Ca reabsorption ○ If Ca⁺⁺ > 14 mg/dL, use calcitonin and bisphosphonates as well ```

Answer 21

Ca⁺⁺<8.5 mg/dL ● Causes: Hypoparathyroidism (post-surgical, idiopathic), vitamin D deficiency, hypomagnesemia, pancreatitis, drugs (PPI)

Answer 22

Abdominal muscle cramps, tetany, perioral and finger paresthesias, ↑DTRs, diarrhea; Chvostek sign: Facial spasm from tapping on facial nerve ○ Trousseau sign: Carpal spasm with BP cuff inflation

Answer 23

Ca⁺⁺, PTH and Mg, ECG shows prolonged QT interval

Answer 24

Underlying disease, IV/PO calcium, Mg if needed | ○ HypoCa will not correct in setting of hypoMg

Answer 25

Causes: similar organisms to cystitis: E. Coli , gram neg uropathogens ( Proteus, Enterobacter

Answer 26

UTI symptoms + evidence of upper urinary tract disease | ● Flank pain, CVA tenderness, fever/chills, tachycardia

Answer 27

UA and culture, CBC, blood cultures | ● Will see WBC casts

Answer 28

Mild cases: Outpt with fluoroquinolone, push fluids, close f/u ● Complicated cases: Admission, IV antibiotics (fluoroquinolone, 3rd/4th generation cephalosporin), IV fluids ○ Pregnancy, comorbid conditions, severe N/V, toxic appearing

Answer 29

Deficiency of water: ↓ in total body water → hypernatremia (hypertonic dehydration

Answer 30

Clinically → often expanded to include 2 main types: Isotonic dehydration and hypertonic dehydration

Answer 31

Mild: headache, thirst, fatigue, sunken eyes, dry mucous membranes, ↓ skin turgor, oliguria, concentrated urine ▸ Mod-severe: lethargy, muscle cramping, altered mental status, ↓ renal function, coma; Sx of hypovolemia → hypotension, tachycardia, ↓ pulse, pre-syncope/syncope ▸ Infants: listlessness, sunken fontanelles, tearless crying, ↓ # of wet diapers

Answer 32

Mild: oral rehydration ▸ Mod-severe: correct hypovolemia first with isotonic IV solution (eg. normal saline, Ringers lactate), then correct any water deficit with hypotonic solution (eg. 5% dextrose, 0.45% NaCl)

Answer 33

``` volume-deficit [hypovolemia]) How: ECF fluid & electrolytes are lost ≈ equal amounts Etiologies: Hemorrhage, burns, vomiting, diarrhea Labs: Na: 135-145 mEq/L ```

Answer 34

``` (water-deficit) How: ECF water loss > solute loss Etiologies:Watery diarrhea, profuse sweating Labs: Na: >150 mEq/L ```

Answer 35

Anomaly that usually occurs as a fusion of the lower poles of both kidneys; both kidneys are typically functional & have their own separate ureters

Answer 36

Associated conditions: hydronephrosis (80%) often due to vesicoureteral reflux or ureteropelvic junction obstruction, renal calculi, urinary stasis (↑ risk of infection), genital anomalies (eg. bicornuate uterus), & several syndromes (eg. Turner)

Answer 37

``` S/Sx: most pts are asymptomatic & fused kidney is usually found incidentally (eg. antenatal U/S); pain & hematuria can occur with obstruction or infection ```

Answer 38

For obstructive uropathy → postnatal U/S, creatinine ▸ UTI → U/A, urine culture, voiding cystourethrogram

Answer 39

most pts do not need any therapeutic interventions; urology referral for renal calculi, obstructive uropathy, infections

Renal-Panre Flashcards

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