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133 Cards in this Set
- Front
- Back
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What is the M in mudpiles?
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Methanol
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What is the U in mudpiles?
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Uremia/Uric acid
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What is the D?
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DKA
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What is the P?
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Paraldehyde
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What is the I?
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INH/Isopropyl
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What is the L?
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Lactic Acid
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What is the E?
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Ethylene Glycol
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What is the S?
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Sepsis/ASA
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What is the formula for anion gap?
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Na- (Cl+CO2)
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Normal AG is
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<=12
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What is anion gap acidosis
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metabolic acidosis because of ADDITION of acid (DKA)
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What is nonaniongap acidosis
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metabolic acidosis not related to acid (diarrhea)
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What amount of insulin do you give?
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IVP 0.1 unit/kg then GTT of 0.1units/kg/hr
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If K <3.3 with high bs
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HOLD INSULIN. Give K first
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What is the formula for Osmolarity
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OSM=2(Na) + (BUN/2.8) + (Glu/18)
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What is the outter part of kidney?
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cortex
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What is the inner part of kidney?
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medulla
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What is the functional unit of the kidney
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nephron
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What type of nephron is excretory and regulatory function?
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Cortical - 85%
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What type of nephron is concentration and dilution of urine?
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Juxtamedullary - 15%
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The filtrate that passes from the lumen of the glomerular capillary to the space of the Bowman's capsule
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glomerular filtrate
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A soln that has passed through a semipermeable membrane with very small pores. it usually contains only low molecular weight solutes
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ultrafiltrate
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what is a tuff of capillaries which filter fluids and waste
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glomerulus
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what is GFR?
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the amount of ultra filtrate formed per minute - 125mL/min. 180L/day
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The structure that contains the glomerulus and acts as a filter for urine?
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bowmans capsule
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WHat is the site of resorption of glucose, amino acids, metabolites, & electrolytes from filtrate
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proximal tubules
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Where are Na and Cl reabsorbed....and is responsible for concentrating the urine and controlling the water/solute exchange
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Loop of henle
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WHere does further reabsorption of h20 & electrolytes...and filtrate enters the collecting ducts
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distal convoluted tubule
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What is the structure that releases urine?
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collecting ducts
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What is the afferent arteriole of nephron?
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renal artery
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What is the peritubular capillary system?
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efferent arterioles
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what % goes to cortex?
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80%
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What are the 3 mechanisms of renal blood flow regulation?
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1. intrarenal autoregulation
2. sympathetic nervous system 3. REnin/angiotension/aldosterone system |
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What is the purpose of intra-renal autoregulation?
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maintain a constant GFR & maintain control of renal excretion of water and solutes
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If there is an inc BP then
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afferent arterioles constrict & efferent arterioles dilate
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if bp is decreased
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afferent arterioles dilate and efferent arterioles constrict
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what is the end product of muscle protein waste
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creatinine
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What is the normal range of creatinine
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0.5-1.5
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what is the range for BUN
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7-20
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What % of body fluid is intracellular
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40%
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a form of pressure exerted by proteins in blood plasma that pulls h20 into circulatory system
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colloid osmotic pressure
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force of ventricular contraction. due to blood pressure differential
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hydrostatic pressue
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what is the conc of particles in soln
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tonicity
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name the 3 hypotonic solutions
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0.25% NaCl, 0.45% Na Cl, 2.5% dextrose
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name the 3 isotonic
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0.9% saline, LR, D5w
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What electrolytes reside mostly outside of the cell
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Na and Cl
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What do renal prostaglandins do?
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Protect kidneys. cause dilation of afferent arteriole during ischemic insults to preserve renal function
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WHat meds should renal patients not have?
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NSAIDs
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What are renal prostaglandins stimulated by
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1. norepinepherine
2. angiotension 3. hypotension 4. ischemia |
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what does aldosterone do?
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Raas system to reabsorb water
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What does aldosterone do in distal tubules?
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Causes Na and H20 retention and potassium excretion
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what is the normal range for sodium
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135-145
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where is K reabsorbed
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proximal tubules
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What is the range for calcium?
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8.5-10.5
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what happens with hypercalcemia
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cardiac arrest, muscle weakness, fatigue
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What happens with hypocalcemia?
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prolonged QT, inverted T wave, dec CO, hypotension, sz, tetany, brady
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When do you get Chvosteks sign
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hypocalcemia
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what is the normal range of mag
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1.3-2.1
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What does Mag do?
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1. activate enzyme reaction.
2. protein and CHO metabolism 3. peripheral vasodilation 4. neuromuscular contractility |
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What happens with hypermag
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prolong QT, dysrhythmia, hypotension, lethargy, coma, weakness, dysphagia, dec reflexes
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what happens with hypomag
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torsades de pointe, confusion, ataxia, hyperreflexia, treamors, tetany
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What is the normal range for phosphorus
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2.7-4.5
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What does hyperphos do?
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muscle tetany, soft tissue calcification
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Hypo phos?
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change in level consciousness, muscle weakness, bleeding, GI, N/v
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What is the normal range for Cl?
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98-106
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How long does it take kidneys to kick in?
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6 hours
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how long does it take for full compensation?
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4-5 days
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The kidneys exrete fixed acids that perform...
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1. tubular secretion of acid
2. glomerular filtration of buffers 3. ammonia |
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sodium bicarb (regulation?)
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is filtered by the kidney and reabsorbed in the proximal tubules
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erythropoietin
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produced int he kidneys, stimulates bone marrow to produce RBC's
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What stimulates the kidney to produce erythropoietin?
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1. hypoxia
2. anemia 3. hypotension |
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What is the RIFLE criteria?
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tool to categorize patients based on their renal function according to
1. GFR 2. Creatinine (change from baseline 3. urine out put |
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What are the 3 phases of acute kidney injury?
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1. oliguric
2. diuretic 3. recovery |
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how long does oliguric phase last?
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5-15days
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how long does diuretic phase last
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1-2 weeks
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When does CRF occur?
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where GFR has been reduced to 10% of normal function
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what is ESRD?
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GFR <5% of normal function
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what type of insulin is often used for basal?
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NPH or lantus
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what is the standard concentration of iv insulin?
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100units/100mL
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What does ADH do?
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Vasopressin. causes kidneys to retain water and along with aldosterone, helps control bp
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What does corticotropin do?
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ACTH. controls the production and secretion of hormones by the adrenal glands. Growth hormone controls growth and development; promotes protein production
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TSH
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stimulates the production and secretion of hormones by the thyroid gland
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parathyroid hormone
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controls bone formation and the excretion of calcium and phosphorus
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Thyroid hormone
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regulates the rate at which the body functions
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aldosterone
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helps regulate salt and water balance by retaining salt and water and excreting potassium
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cortisol
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has widespread effects throughout the body; esp has anti-inflammatory action; maintains bs level, bp, and muscle strength. control salt and water balance
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Dehydroepiandrosterone (DHEA)
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has effects on bone, mood, and the immune system
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hormones produced in the adrenal glands
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1. aldosterone
2. cortisol 3. DHEA 4. EPI and Norepi |
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hormones produced in the pancreas
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Glucagon & insulin
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glucagon
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raises the bs level
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hormones produced in the kidneys
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erythropoietin & renin
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Hormones produced in the digestive tract
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Cholecystokinin, glucagon like peptide, & ghrelin
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Cholecystokinin
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controls gallbladder contractions that cause bile to enter the intestine; stimulates release of digestive enzymes from the pancreas
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Glucagon like peptide
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inc insulin release from the pancreas
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ghrelin
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controls the growth hormone release from the pituitary gland; causes sensation of hunger
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resistin
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blocks the effects of insulin on muscle
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leptin
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controls appetite
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central DI
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defect in release of ADH from pituitary
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Nephrogenic DI
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adequate pituitary function, but kidneys do not respond to ADH
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Causes of nephrogenic DI
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(adh insensitive): polycystic kidneys, pyelonephritis, congenital, mutliple myeloma, & amyloidosis
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What is the treatment for DI?
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1. pitressin
2. Lysine vasopressin 3. DDAVP |
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What will urine look like for SIADH?
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concentrated
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What are the functions of thyroid hormones
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1. maintenance of metabolic rate
2. glucose, fat and protein mobilization 3. sympathetic-like cardiovascular function 4. GI inc motility and GI secretions |
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What are causes of Thyroid storm?
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infection, DKA, ecclampsia, post partum, antiarrhythmics
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What do you not give during thyroid storm?
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ASA
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What is grave's disease
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autoimmune disease that alters normal mechanism that controls TH release.
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What is Secondary hypothyroidism?
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dysfunction of hypothalamus or pituitary
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What is the lifethreatening hypothyroid?
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Myxedema coma. hyponatremia, low bs, hypothermia, CV collapse
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The sole purpse of the parathyroid glands
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control calcium
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Hyper parathyroid=
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hypercalcemia
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What is the Adrenal Medulla?
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SNS, sec epi & norepinephrine. Not vital to survival
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What is the Adrenal cortex?
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secretes hormones. Vital to survival
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Pituitary form of cushings
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increased ACTH; increases glucocorticoid production
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cortisol/glucocorticoids
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reg by hypothalamus & ant pit.
stimulates glucose production, stimulates gluconeogenesis (from fats and proteins). dec inflammatory response. inc resistance to insulin |
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Adrenal form of Cushings
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tumor of adrenal gland
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Non-cushings
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ectopic tumor ....sometimes called cushings syndrome
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What kind of disease is cushings?
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hyperfunctioning adrenal
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What kind of disease is addisons
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hypofunctioning
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What is the diagnostic criteria for AKI/ARF
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-abrupt abs inc in cretinine
>=0.3 from baseline -% inc in creatinine >=50% oliguria of less than0.5mL/kg/hr for >6hrs |
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1st phase of ARF
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initiation phase. begins with initial insult & ends when oliguria develops
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2nd phase of ARF
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Urine output <0.5mL/kg/hr > 6hrs...
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anuria is
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<50-100 mL/24 hours
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3rd phase of ARF
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diuretic phase. Urine output >1mL/kg/hr
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4th phase of ARF
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recovery phase
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what mm Hg is considered abdominal compartment syndrome
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20 mmHg
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oliguria develops when the intraabdominal pressure exceeds
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15mmHg with anuria developing at pressures >30mmHg
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What is the treatment for abdominal compressure
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1. paracentessi
2. surgical decompression |
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What is the most common form of intrinsic ARF?
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ATN. Tuburlar injury...nephrotoxic, ischemic or multifactoral
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What is ATN like?
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heart attack for kidney
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Exogenous
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RCN, aminoglycosides,
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endogenous
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hemepigment (rhabdo or massive intravascular hemolysis)
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What is TIPS
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transjugular interhepatic portal shunt
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WHat dugs would you give to treat acute renal failure
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1. dopamine <5mcg/kg/min
2. loop diuretics 3. ANP 4. Thyroxine 5. IGF-1 |
