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Renal Medi > 9-10 > Flashcards

9-10 Flashcards

1
Q

What is the purpose of the TTKG?

A

Assess renal K secretion by cortical collecting ducts.

K urine • Osm serum)/(Osm urine • K serum

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2
Q

Hyperkalemia is serum K >

A

5.5 mmol/L

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3
Q

Hyporeninemic hypoaldosteronism can cause ___

A

Hyperkalemia

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4
Q

Renal resistance to ___ can cause hyperkalemia

A

Mineralcorticoids

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5
Q

Addisons and Schmidts syndrome can both cause

A

Hyperkalemia

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6
Q

Does hypo or hyperkalemia lead to v fib?

A

Both can

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7
Q 
EKG findings with K=
6
7
9
10
A

6- peaked t waves, flattened p waves, increased PR interval
7- widened QRS
9- deep S waves, merging of S and T waves
>10- v fib, arrest

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8
Q

Give Calcium Gluconate IV when ___

A

K>6
Requires emergency reduction
Abnormal ECG

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9
Q

Medications used to redistribute K into cells, to reduce plasma K

A
  • 10 units IV insulin, then 50 ml of 50% dextrose
  • albuterol along with insulin and glucose
  • IV bicarbonate (only if pt also has metabolic acidosis)
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10
Q

Hypokalemia is K<

A

3.5 mmol/L

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11
Q

So what is normal K?

A

3.5-5.5 mmol/L

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12
Q

In hypokalemia, If urine K is high (>15) think ____.

If it is low (<15) think ____.

A

Renal loss

Extrarenal loss

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13
Q

Torsades De Pointes can result from ___

A

Severe hypokalemia (<2.5)

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14
Q

In hyperkalemia think about what cation first? Hypo?

A

Ca first

Mg first

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15
Q

What is the most abundant electrolyte in the human body? Where is it mainly located?

A

Ca
Bone (inactive) - 99%
Ionized Ca is active elsewhere

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16
Q

In response to low Ca levels, the ___ releases ___

A

Parathyroid gland releases PTH

17
Q

In the kidney, modulation of Ca occurs where?

A

Distal nephron

18
Q

How do the following affect Ca in the urine?

  1. Acidosis
  2. Alkalosis
  3. Loop diuretics
  4. Mannitol diuretics
  5. Thiazide diuretics
  6. Amiloride diuretics
A
  1. Hypercalciuria
  2. Hypo
  3. Hyper
  4. Hyper
  5. Hypo
  6. Hypo
19
Q

False vs true hypercalcemia

A

False: increased total Ca from increased total proteins (does not change ionized, active Ca)
True: increased free plasma Ca

20
Q

Increases in albumin of 1 g/dL increases plasma Ca by ___

A

0.8-1 mg/dL

21
Q

Cancer-related things that can cause hypercalcemia

A 
Neoplastic disease
Primary adenoma
Primary diffuse hyperplasia
Cancer
Multiple endocrine neoplasia
22
Q

Other things things that can cause hypercalcemia (CHIMPANZEES)

A 
C – Calcium supplementation
H – Hydrochlorothiazide, hyperparathyroidism
I – Iatrogenic, immobilization
M – Multiple myeloma, milk-alkali syndrome, medication (e.g Lithium)
P – Parathyroid hyperplasia or adenoma
A – Alcohol, Acromegaly, Addisons 
N – Neoplasm
Z – Zollinger Ellison syndrome
E – Excessive vitamin D
E – Excessive vitamin A
S – Sarcoidosis
23
Q

PTH acts (quickly/slowly)

A

Quickly

Moment to moment

24
Q

Treatment of hypercalcemia

A 
Saline
Loop diuretics 
Dialysis
Calcitonin
Steroids
IV bisphosphonates
25
Q

Causes of hypocalcemia

A 
Renal failure
Vitamin D deficiency
Mg deficiency
Acute pancreatitis
Hypoparathyroidism and pseudo-
Infusion of phosphate, citrate, or Ca free albumin
26
Q

Causes of hyperphosphatemia

A 
Renal failure (stage 4 or 5, when GFR<25)
Hypoparathyroidism
27
Q

Clinical manifestations of hyperphosphatemia

A

Formation of Ca-P complexes in soft tissue, joints, and kidneys

28
Q

Hyperphosphatemia treatment

A

Aluminum salts
Ca salts
Mg salts
*all bind P to reduce absorption

29
Q

Causes of hypophosphatemia

A 
Inadequate intake
Increased excretion (PTH, genetics)
30
Q

Clinical manifestations of hypophosphatemia

A

Metabolic encephalopathy
RBC, leukocyte, and platelet dysfunction
Decreased muscle strength

31
Q

What is the second most abundant intracellular cation in the human body? It is an essential cofactor for ____ and regulates ___

A

Mg
ATPase enzymes
PTH

32
Q

Causes of hypermagnesemia

A

Renal insufficiency

Hemolysis

33
Q

Clinical manifestations of hypermagnesemia

A

Cardiac conduction delays
Depressed contractility
Vasodilation

34
Q

Treatment of choice for hypermagnesemia

A

Hemodialysis

35
Q

Causes of Hypomagnesemia

A

PPIs
Diuretics
Common in hospitalized pts
Likely caused by doc

Renal Medi (11 decks)

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