Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
44 Cards in this Set
- Front
- Back
|
Workup for AG metabolic acidosis
|
-Check for Ketonuria
-If negative ketones check for lactate: lactic acidosis uremia: renal failure tox screen: Methanol, ethylene glycol,(OG greater than 10) salicylates, paraldehyde(OG less than 10) |
|
|
Causes of anion gap metabolic acidosis
|
DKA, alcohol
Lactic Acid in shock, infection, hypoxia Renal Failure Salicylates, ethylene glycol, methanol |
|
|
Causes of non anion gap metabolic acidosis
|
Renal Tubular Acidosis
Diarrhea Acetazolamide Addison's Disease Pancreatic Fistulae |
|
|
Causes of Metabolic Alkalosis
|
Vomiting
Diuretics Burns |
|
|
Type 1 RTA pathophysiology
|
Defective Distal H+ secretion
|
|
|
Type 2 RTA
|
Decreased Proximal Reabsorption of HCO3
Fanconi's Multiple Myeloma Amyloidosis, Acetazolamide |
|
|
Type 4 RTA
|
Hypoaldosteronism:
Decreased Renin -Diabetic Nephropathy, NSAIDs, Chronic Interstitial Nephritis Decreased Aldosterone Synthesis ACEI, ARB, Heparin, Adrenal Disorders Decreased response to Aldosterone Potassium Sparing Diuretics, TMP-SMX, Tacrolimus |
|
|
Etiology of Non anion Gap Metabolic Acidosis
|
RTA
Diarrhea Acetazolamide Addison's Disease Pancreatic Fistulae |
|
|
Etiology of Metabolic Alkalosis
|
Vomiting
K depletion Burns Base Ingestion |
|
|
Anion Gap
|
Unmeasured Anions- Unmeasured Cations
Normal is 10-18 |
|
|
Treatment of Hyponatremia
|
Free Water Restrict
Remove Stimulus for ADH: Volume Replete, Treat Pulmonary Pathology Demeclocycline Normal Saline useful only to Rx volume depletion |
|
|
Tx of Hypovolemic Hyponatremia
|
Normal Saline
|
|
|
Tx of Hypervolemic Hyponatremia
|
Free water restrict +/- diuresis
|
|
|
Tx of SIADH
|
Free water restrict+ rx underlying cause
|
|
|
If symptomatic hyponatremia or failure to increase Na
|
Hypertonic Saline plus loop diuretic
Consider Demeclocycline |
|
|
Causes of SIADH
|
Pulmonary Pathology: pneumonia, asthma, COPD, SCLC, positive pressure ventilation
Intracranial Pathology: Trauma, stroke, hemorrhage, tumors, infection Drugs: Carbamazepine, Chlorpropramide, TCA, Cyclophosphamide, Opiates Miscellaneous: Pain, Nausea, post op state |
|
|
Hypovolemic Hypernatremia
|
Uncontrolled DM, Mannitol
Diarrhea, Insensible |
|
|
Euvolemic Hypernatremia
|
Diabetes Insipidus
|
|
|
Hypervolemic Hypernatremia
|
Hypertonic Saline Administration
|
|
|
Workup in Hypernatremia
|
Volume Status :
If hypovolemic determine whether renal(Uosm 300-600; Una >20) or extrarenal(Uosm>600; Una<20) losses If Euvolemic check Uosm to evaluate for complete or partial DI |
|
|
Treatment of Hypernatremia
|
Replete free H20 deficit(formula)
Recheck sodium frequently Restore access to H20 Correct Volume Status -Hypovolemic hypernatremia: 1/4 or 1/2 NS -Hypervolemic hypernatremia: D5W plus loop diuretic Treat central DI with Desmopressin Treat Nephrogenic DI by treating underlying cause if possible |
|
|
DI
|
ADH deficiency(central) or renal ADH resistance(nephrogenic)
|
|
|
Causes of Central DI
|
Trauma, surgery, hemorrhage, infection, tumour, hypoxia
|
|
|
Causes of Nephrogenic DI
|
Drugs: Lithium, amphotericin, demeclocycline, foscarnet
Metabolic: Hypercalcemia, Severe Hypokalemia Tubulointerstitial: Polycystic, sickle cell, sjogren's |
|
|
Treatment of Central DI
Treatment of Nephrogenic DI |
Desmopressin
Treat underlying cause if possible; salt restriction+thiazide diuretics |
|
|
Polyuria
|
Greater than 3 L urine output per day
|
|
|
Causes of polyuria
|
Osmotic diuresis(uncontrolled DM, mannitol, urea) or water diuresis
|
|
|
Workup for Polyuria
|
Perform a timed urine collection and measure Uosm
24hr osmole excretion rate=24hr UOP x Uosm >1000 mOsm/day=osmotic diuresis <800 mOsm/day=water diuresis |
|
|
Etiology of Osmotic Diuresis
|
Uncontrolled DM
Mannitol Urea: recovering ARF, high protein feeds(TPN, tube feeds), GI bleed, corticosteroids NaCl administration |
|
|
Treatment of Osmotic Diuresis
|
Address underlying cause, replace free water deficit if present
|
|
|
How to replace free water deficit
|
Via IVF or enteral feeds
Free H20 deficit formula Correct serum Na at rate of <0.5 mEq/l/hr to avoid cerebral edema |
|
|
Water Diuresis Etiology
|
DI or primary polydipsia
|
|
|
Workup of DI
|
Uosm: Partial 300-600 Complete <300
Water Deprivation test |
|
|
Water Deprivation Test
|
Deprive until Posm>295 and Uosm<300, then administer Desmopressin--
if Uosm increases by > 50%=central DI if Uosm unchanged=nephrogenic DI |
|
|
Tx of DI
|
Central: Desmopressin
Nephrogenic: treat underlying cause if possible ; salt restriction plus thiazide diuretics |
|
|
Type 1 RTA Etiology
|
Sjogren's, SLE, Hepatitis, Nephrocalcinosis, mm
|
|
|
Type 2 RTA
|
Decreased proximal reabsorption of HCO3; Etiology:Fanconi's, amyloidosis, MM, acetazolamide
|
|
|
Type 4 RTA
|
Hypoaldosteronism
Etiology: Decreased Renin due to Diabetic Retinopathy, NSAIDs, Chronic Interstitial Nephritis Decreased Aldo synthesis: ACEI, ARBs, heparin, primary adrenal disorders Decreased Response to Aldosterone Potassium sparing diuretics, TMP-SMX, tacrolimus, tubulointerstitial disease |
|
|
S/S Hyponatremia
|
Lethargy
Disorientation Cramps N/V/anorexia Delirium Seizures CN palsies Decreased DTRS |
|
|
What can be done to prevent amphotericin b nephrotoxicity?
|
Salt loading may be beneficial in renal vasoconstriction caused by amphotericin B since volume expansion decreases the release of vasoconstrictors and increases the secretion of the vasodilators. In salt loading, 1 liter of isotonic saline is given over the 60 minutes prior to amphotericin B administ
Lipid-based formulations (liposomal amphotericin B) can also be used. |
|
|
Treatment of Hyperkalemia
|
1. Calcium Gluconate 1-2 amps IV
2. Insulin 10 Units IV+1-2 amps D50W 3. Bicarbonate 1-3 amps IV 4. B2 agonists albuterol 5. Kayexalate 30-90 g PO 6. Diuretics Furosemide 80 mg IV 7. Hemodialysis |
|
|
Defn of Acute Renal Failure
|
Acute deterioration in renal function manifesed by increased Cr. Cr>20% baseline if baseline 2.5 mg
|
|
|
What is florinef
|
Fludrocortisone
|
|
|
What is Midodrine
|
Alpha 1 agonist used in orthostatic hypotension
|
