Mksap 16 Nephro Part 03

Front 1

DDx of hypokalemia

Back 1

cellular redistribution, kidney (diuretics) or GI losses, decreased intake

Front 2

conditions that result in increased intracellular uptake of serum K

Back 2

marked leukocytosis (myeloprolif disorders), B2 agonists, epinephrine, insulin, Vit B12 repletion, systemic alkalosis; toxicity to barium, chloroquine, quetiapine, risperidone

Front 3

rare syndrome that presents with acute episodic muscle weakness, often following a high carbohydrate meal or strenuous exercise

Back 3

hypokalemia periodic paralysis

Front 4

this amount of 24 hour urine K excretion suggests ongoing urinary potassium losses

Back 4

>30meq/L

Front 5

formula for urine potassium-crea ratio

Back 5

(meq/g) = Urine Potassium (meq/L) × 100 [(mg × L)/(dL × g)] ÷ Urine Creatinine (mg/dL)

Front 6

interpretation of urine K-crea ratio

Back 6

>20 in kidney potassium wasting, <15 suggests cellular reditribution, decreased intake or extrarenal K loss

Front 7

used for patients with concomitant metabolic acidosis due to renal tubular acidosis and hypokalemia

Back 7

potassium citrate

Front 8

the most efficient intervention that enhances intracellular potassium uptake

Back 8

IV insulin +/- glucose

Front 9

evolution of EKG changes in hyperkalemia

Back 9

peaked T waves with a shortened QT interval initially, followed by an increased PR interval and QRS duration, decreased P wave amplitude, and eventually a sinoventricular pattern heralding ventricular standstill

Front 10

NOTE: Severe leukocytosis (leukocyte count >120,000/microliters [120 × 109/L]) and thrombocytosis (platelet count >600,000/microliters [600 × 109/L])

Back 10

can result in the release of intracellular potassium in serum specimens.

Front 11

how to diagnose pseudo-hyperkalemia related to leukocytosis

Back 11

by repeating a serum potassium measurement in a sample carefully transported to the laboratory without agitation immediately following phlebotomy or measurement of whole blood potassium in uncentrifuged specimens using ion-specific electrodes also confirms the diagnosis

Front 12

what does TTKG estimate?

Back 12

the ratio of the potassium level in the CCD to that in the peritubular capillary; capacity of kidney to excrete K in the setting of hyperK

Front 13

formula for TTKG

Back 13

[Urine Potassium ÷ (Urine Osmolality/Plasma Osmolality)] ÷ Serum Potassium

Front 14

how to interpret TTKG

Back 14

>10 under normal conditions; < 10 indicates kidney defect in K excretion

Front 15

how is IV calcium given in hyperkalemia?

Back 15

every 5 minutes until ECG changes resolve

Front 16

When is IV calcium contraindicated in hyperkalemia?

Back 16

digoxin toxicity

Front 17

onset and duration of effect of glucose insulin solution in hyperkalemia

Back 17

within 10 minutes and is sustained for 4 to 6 hours

Front 18

Caveat with using sodium polystyrene sulfate in hyperkalemia

Back 18

use sorbitol-free preparation - sorbitol implicated in GI necrosis and bleeding

Front 19

treatment of mild-moderate hyperkalemia

Back 19

dietary potassium restriction to less than 2500 mg/d

Front 20

DDx of hypophosphatemia

Back 20

chronic alcohol use, critical illness, malnutrition

Front 21

presentation of hypophosphatemia

Back 21

<2 symptomatic weakness, <1 resp muscle weakness, hemolysis, rhabdomyolysis

Front 22

when to correct low phos with IV?

Back 22

<1

Front 23

NOTE: When hypophosphatemia is due to increased cellular uptake or extrarenal phosphate loss,

Back 23

the 24-hour urine phosphate excretion is less than 100 mg/dL (32.3 mmol/L) and the fractional excretion of phosphate is less than 5%

Front 24

risks of IV phosphate treatment

Back 24

hypocalcemia and AKI

Front 25

maximum dose of IV phosphate

Back 25

doses of phosphate should be restricted to 80 mmol over 12 hours

Front 26

DDx of hyperphosphatemia

Back 26

advanced CKD, increased cell turnover, cell injury, or exogenous phosphate administration

Front 27

normal reference range for the anion gap

Back 27

8 to 10 meq/L ± 2 meq/L

Front 28

correction of anion gap in hypoalbuminemia

Back 28

For every 1 g/dL (10 g/L) decrease in serum albumin, for example, the expected or “normal” anion gap falls by approximately 2.3 meq/L (2.3 mmol/L).

Front 29

define lactic acidosis

Back 29

serum lactate level greater than 4 mg/dL

Front 30

MOA fomepizole

Back 30

inhibitor of alcohol dehydrogenase that prevents the formation of toxic acid metabolites

Front 31

formula for corrected bicarbonate

Back 31

24- change in AG

Front 32

interpretation of delta delta

Back 32

if measured HCO3 > corrected bicarb - concomitant MAlk in addition to HAGMA; if measured HCO3 < corrected - concomitant NAGMA + HAGMA