Acid/Base AKI - Exam 1 Flashcards
a drop in osmotic pressure will lead to an increase in what 4 things? _____ will be decreased
Increased:
Sympathetic nervous system output
RAAS activity
ADH levels
Thirst
decrease: ANP
an increase in osmotic pressure will lead to an decrease in what 4 things? _____ will be decreased
decreased:
Sympathetic nervous system output
RAAS activity
ADH levels
Thirst
increased: ANP -> Atrial natriuretic peptide (ANP)
What is the net goal of normal balance of sodium and water?
Net Goal = Modify (1) water intake, (2) water and Na retention by the kidney, and (3) vasoconstriction
loss of body fluids
often accompanied by decreased fluid intake
What am I?
isotonic fluid volume deficit
What is the treatment for isotonic fluid volume deficit? What can happen if tx is given in excess? What do you give to combat this?
0.9% NS
NS in excess can lead to hyperchloremic metabolic acidosis. Avoid being overly aggressive with administration!
Use bicarb solution if needed
inability to get rid of water and/or sodium, or excess water/sodium intake usually due to overadministration of IV fluids.
edema
bounding pulses
What am I?
What is the tx?
Isotonic Fluid Volume Excess
IV Loop diuretics
persistent: dialysis
restrict fluid and sodium intake
fatigue
SOB
N/V
Hyperreflexia
carpopedal spasm
+ Trousseau or Chvostek sign
What am I? What is the underlying cause? What is also commonly seen in conjuction?
What is the tx?
Hyperphosphatemia
impaired renal excretion of phosphate
low calcium
limit phoshate intake
phosphate binders
avoid processed foods
restore renal function
What are some causes of hypokalemia? What organ system does it effect the most?
poor intake
**insulin
beta-agonists
**loop diuretics
alkalosis
muscles!! skeletal, smooth and CARDIAC
muscle weakness, fatigue, cramps, constipation, hypotension, palpitations, dysrhythmias
**What will the EKG look like on a pt with hypokalemia?
ECG - flattened T waves → prolonged QT → U wave → ST depression
When thinking about low potassium what other electrolyte do you also want to check? What are 2 other contributing factors towards hypokalemia?
always check magnesium level!!
Metabolic alkalosis
Medication adjustments
_____ is a very common complication of both AKI and CKD. Name some common causes
hyperkalemia
inadequate renal excretion
cellular breakdown
excessive/severe muscle contraction
ACE/ARB, Beta-blockers, excessive intake
**What does the EKG look like on a pt with hyperkalemia? What is a highlighted GI s/s?
ECG - peaked T waves → loss of P waves → widened QRS → sine wave
Diarrhea
What is the treatment for hyperkalemia? (IN ORDER)
- If cardiac/arrhythmia present: 10 mL of 10% calcium gluconate IV over 2-3 minutes with cardiac monitoring
- IV 10 U of regular insulin IV followed immediately by 40mL of 50% dextrose (D50W)- can add on inhaled albuterol
- remove K through 1 of 3 options:
GI cation exchangers Sodium polystyrene sulfonate (SPS, Kayexelate), zirconium cyclosilicate (Lokelma), patiromer (Veltassa)
Loop or thiazide diuretics if also volume overloaded
hemodialysis
You give 10 mL of 10% calcium gluconate IV over 2-3 minutes with cardiac monitoring to help reduce _____. How long does it take to go into effect? How long should it last?
hyperkalemia
Takes effect in 1-3 min
lasts 30-60 min
IV calcium gluconate potentiates cardiac toxicity of _____; consider
_____ of calcium if it must be used
digoxin
slower infusion
Why do you give insulin in hyperkalemia? How long does it take to go into effect? ______ is common to see after insulin is given. How do you combat this?
Rapid reduction of plasma K+ by forcing into cells
takes effect in 10-20 minutes, peaks in 30-60 minutes and lasts 4-6 hours
Hypoglycemia is common
Usually follow with 10% dextrose at 50-75 mL/h, glucose monitoring
Not necessary to give if glucose 250+ mg/dL
What is the MOA for GI cation exchangers? name the 3 common ones. Which one works the fastest? Which one is the cheapest?
Exchanges Na+ for K+ in GI tract, ￪ fecal K+ excretion
Sodium polystyrene sulfonate (SPS, Kayexelate) -> cheapest
zirconium cyclosilicate (Lokelma)- > fastest
patiromer (Veltassa)
What is the major SE of GI cation exchangers?
constipation, decreases magnesium and potassium
for hyperkalemia tx which drug class diuretics is preferred? What is the most effective and reliable removal of potassium method?
LOOP!!
Hemodialysis
_____ is low Na in the context of normal Sosm. What is the tx?
isotonic hyponatremia
tx: mainly focused on gradually correcting underlying cause and monitoring for changes in osmolality/tonicity
____ is low Na in the context of high serum osmo. Why does this occur? What is the tx?
Hypertonic hyponatremia
Another osmotically active molecule is present (Glucose, radiocontrast, mannitol)
tx: mainly focused on gradually correcting underlying cause and monitoring for changes in osmolality/tonicity
_____ is caused by inappropriate salt loss. What is the major medication contributor? What is an extrarenal cause? What is the tx? What is the tx for SEVERE?
Hypovolemic hyponatremia
V/D, burns, dehydration
diuretics
if not severe, IV rehydration with isotonic 0.9% NS will correct - raises serum Na by 1 mEq per L
severe: increase Na by 4-6 mEq/L as soon as possible. Hypertonic saline (3% saline in 100 mL IV bolus)
______ in sodium is retained, but H2O retention is disproportionately larger than Na retention. Commonly seen in ______
Hypervolemic hyponatremia
nephrotic syndrome
________ is commonly seen in SIADH, hypothyroidism, psychogenic polydipsia, beer potomania. ____ and ___ can help us have an idea of ADH activity
Euvolemic hyponatremia
UNa+ and Uosm
