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23 Cards in this Set
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Acute renal failure
lab |
=sudden decrease in renal function
h/p -possibly asymptomatic -fatigue, anorexia, oliguria, gross hematuria, mental status change, fever, rash, edema, HTN causes *pre, intra, post-renal lab *Azotemia = ↑ BUN, ↑ Cr *Fractional Excretion of Na (FeNa) < 1% = pre-renal *FeNa > 2% = intra-renal (ATN) *BUN: Cr > 20 = pre-renal |
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pre-renal renal failure causes
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*hypovolemia
-renal artery stenosis |
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intra-renal failure causes
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*ATN (drugs, toxins)
-golmerular disease -renal vascular disease |
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post-renal renal failure causes
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*Obstruction of renal calyces (bilateral)
*Obstruction of ureter b/l *obstruction of bladder |
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Fractional excretion of Na
equation what is it used for meaning |
equation
=(urine Na / serum Na) / (urine Cr / serum Na) used for *differentiate prerenal vs. intrarenal cause of acute renal failure meaning * <1% = prerenal & >2% = intrarenal (<1% FeNa means that body is not excreting sodium, meaning trying to retain sodium. Make sense cuz body is dehydrated (prerenal) and wants to retain sodium to keep water in) |
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BUN:Cr ratio
*prerenal *intrarenal *postrenal *normal |
>20:1 - prerenal
<10:1 - intrarenal 10-20:1 - normal OR postrenal *BUN & Cr are both free filtered by glomeruli, but BUN reasborption can be regulated while Cr reabsorption remain the same |
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uremia vs. azotemia
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*Azotemia is lab diagnosis of ↑BUN and ↑Cr
*Uremia = azotemia + symptoms of renal failure |
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Chronic kidney disease (CKD)
causes lab tx complications |
=takes several yrs to develop, won't occur until >90% sclerosed or necrotic
most common causes *DM and HTN lab * ↑ POTASSIUM (important cuz life-threatening) * Anemia (cuz erythropoietin not present) - ↓ Na, ↑ phosphate US *Shrunken kidney tx -restrict salt & protein, correct electrolyte abnormality -fix underlying problem -dialysis, transplant as needed complication -renal osteodystrophy (bone degeneration 2⁰ to ↓ serum Ca) -encephalopathy (ammonia) -severe anemia (erythropoietin) |
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Renal Tubular Acidosis
Types urine pH serum electrolyte |
Type 1
*pH > 5.3 *LOW serum K+ -serum bicarb variable Type 2 -urine pH <5.3 * serum Bicarb LOW -serum K+ low Type 4 *due to ALDOSTERONE DEFICIENCY * serum HIGH K+ |
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*** how to solve acid-base question
*equation *cut off value for bicarb & CO2 |
*pH = HCO3 / pCO2
*when compensated, pH will go TOWARD normal, but it will never reach normal. If it does, then you have mixed disorder *HCO3 = 24 *pCO2 = 40 mmHg |
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pH for alkalosis & acidosis cut off
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*acidosis = pH < 7.3
*alkalosis = pH > 7.42 -normal is pH = 7.4 |
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Anion gap
equation normal value |
=[Na] - [Cl] - [HCO3]
*8-12 is normal anion gap |
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causes of High anion-gap metabolic acidosis
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MUD PILES
M - Methanol U - Uremia D - DKA P - Paraldehyde I - Isoniazid L - Lactic acidosis (classically associated with shock) E - Ethanol & Ethylene Glycol (anti-freeze) S - Salicylates & Shock |
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differential for
Normal Anion Gap Metabolic Acidosis High Anion Gap Metabolic Acidosis Respiratory Acidosis Respiratory Alkalosis Metabolic Alkalosis |
Normal Anion Gap Metabolic Acidosis
-Diarrhea, RTA (renal tubular acidosis) High Anion Gap Metabolic Acidosis -MUD PILES Respiratory Acidosis -"think retaining CO2" so -COPD, respiratory depression Respiratory Alkalosis -"think blowing off CO2" so -high altitude, hyperventilation (DKA, kussmal) Metabolic Alkalosis -"think dehydration" -vomiting, diuretics |
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Hypernatremia
diagnostic value cause h/p tx complications |
value
*serum Na > 155 mEq/L (*) cause *DEHYDRATION h/p * "think cuz hyperNa is caused by dehydration, so h/p will be of dehydration too" -oliguria, thirst -weakness, mental status change tx *use Normal Saline then switch to 1/2 NS after hemodynamically stable (don't use hypotonic saline) -maximal Na reduction = 12 mEq/day complications *CEREBRAL EDEMA if too rapid hydration |
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Hyponatremia
diagnostic value cause h/p complication |
diagnostic value
* serum Na < 135 mEq/L cause *water retention (CHF, SIADH, etc) h/p -confusion, nausea, weakness -confusion/mental status change in hyper- or hypo- natremia complication *Central Pontine Myelinolysis if correct too fast |
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calculation of [Na+] for correction of hyperglycemia **
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add 1.6 mEq/L of Na for every 100 mg/dL glucose, >100mg/dL ex: so if glucose is 400 and sodium is 130, then 130+(1.6*3) for actual sodium level. cuz there are 3, 100s over initial 100 mg/dl glucose |
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Diabetes Insipidus
what is it types h/p lab tx |
*ADH-directed water reabsorption leading to DEHYDRATION and HYPERNATREMIA
types *Central - posterior pituitary doesn't secrete ADH *Nephrogenic - kidney doesn't respond to ADH - can result from Lithium Toxicity h/p -polyuria -polydipsia -signs of dehydration lab *↓ urine osmolality -↑ serum sodium tx *Central = Desmopressin (DDAVP) *Nephrogenic = Thiazide, Indomethacin |
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SIADH
cause h/p labs tx |
cause
*paraneoplastic syndrome - small cell lung cancer h/p -signs of hyponatremia (confusion, nausea, weakness) labs * ↓ serum osmolality * ↑ urine osmolality tx *DEMECLOCYCLINE (special for SIADH) -loop diuretic if symptomatic |
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Hyperkalemia
diagnostic value EKG tx |
diagnostic value
*serum K > 5.0 mEq/L EKG *TALL, PEAKED T-wave tx -calcium gluconate - tx cardiac effects but not hyperK -bicarb or glucose + insulin (drive K into cells) *severe case need dialysis |
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Hypokalemia
diagnostic value EKG tx |
dx
*serum K < 3.5 mEq/L EKG *U wave *flat T-wave tx -oral or IV KCl |
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Hypercalcemia
cause h/p tx |
cause
*hyper-PTH, neoplasm (PTH-related peptide) h/p *think "bones, stones, groans, moans for hyper-PTH" *bone fractures *kidney stones *GI symptoms *change in mental status tx *hydration *bisphophonate in case of excess bone resorption |
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Hypocalcemia
cause h/p tx |
cause
-↑ phosphate seen in chronic renal failure pt *Loop diuretic (loops lose calcium) h/p *Chovstek = tapping on facial nerve cause spasm *Trousseau = BP cuff cause carpal spasm (remember by "C"hovstek is tapping on "C"heek, and "T"rousseau is "T"ightening the cuff) tx -calcium, duh |
