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MD2 Foundation > Acute Kidney Injury + Fluid Balance > Flashcards

Acute Kidney Injury + Fluid Balance Flashcards

1
Q

how much fluid is in the intravascular space?
interstitial?
intracellular?

A

3L
9L
30L

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2
Q

normal GFR is greater than

A

90ml/min

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3
Q

actions of angiotensin - 2

A

increase antidiuretic hormone
increase aldosterone
increase thirst
constrict the efferent arteriole

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4
Q

what is AKI

A

significant decrease in GFR (>50%) over a period of hours to days leading to electrolyte, fluid, and acid imbalaance with decreased urine output

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5
Q

how much urea is reabsorbed and why

A

50%

creates concentration gradient for reabsorption

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6
Q

how much creatinine is reabsorbed

A

0%

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7
Q

creatinine production is proportional to

A

muscle mass

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8
Q

amount of urine for oliguria vs anuria

A 
oliguric = <400mL/24hours
anuric = <100mL/24 hours
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9
Q

how much GFR is lost before creatinine begins to rise?

A

50%

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10
Q

what is pre-renal renal failure? what causes it?

A

due to decreased renal perfusion
shock (septic, anaphylactic, cardiogenic, hypovolemic)
or drugs (ACEI, NSAIDs)
can lead to ATN

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11
Q

how do ACEI and NSAIDs reduce GFR

A

Ang-II constricts the efferent arteriole

prostaglandins dilate the afferent arteriole

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12
Q

what is renal AKI

A

intrinsice damage done acutely to the kidney parenchyma eg. ATN
usually ischemia related or toxin related

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13
Q

managenent of acute tubular necrosis

A

dialysis to maintain removal of toxins etc
restore circulating volume in diuresis stages to prevent hypovolemia
sodium restriction, potassium restriction
remove nephrotoxic drugs

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14
Q

in suspected acute kidney injury, what does STOP stand for

A

Sepsis
Toxins
Obstruction
Parenchymal insult

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15
Q

investigations for AKI

A

URINALYSIS
renal tract ultrasound
ABGs (pH)
potassium

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16
Q

comparing pre-renal to ATN

A

in pre-renal you can usually still concentrate the urine and reabsorb sodium, will have higher osmolarity in pre-renal

17
Q

at what levels is hyperkalaemia concerning

A

> 6.5

18
Q

relationship between insulin and potassium levels

A

insulin causes potassium to be taken up into cells, causing hypokalaemia.
lack of insulin causes potassium efflux and hyperkalaemia

19
Q

what is SIADH and what does it cause

A

syndrome of innapropriate antidiuretic hormone
increases water reabsorption.
resulting hypervolemia often causes dilutional hyponatremia

20
Q

what is diabetes insipidus?

what are the 2 types

A

lack of ADH leading to polyuria, polydipsia
cranial (no release of ADH)
nephrogenic (ADH doesnt work)

21
Q

common cause of nephrogenic diabetes insipidus

A

lithium toxicity in bipolar

22
Q

extracellular volume mirrors (sodium) content

A

sodium

23
Q

how can we estimate intracellular volume

A

with sodium concentration
hyponatremia -> high intracellular volume
hypernatremia -> low intracellular volume

24
Q

adding 3L isotonic saline will increase extracellular fluid or intracellular fluid?

A

extracellular

the concentration of sodium will be unchanged so intracellular will be unchanged

25
Q

adding 3L of water to a patient will increase extracellular or intracellular fluid?

A

it will increase both
1/3 will say extracelllar
2/3 intracellular due to the dilutional hyponatremia

26
Q

addition or loss of sodium rich fluid will affect which compartment (intra or extracellular)

A

extracellular

27
Q

addition or loss of water will affect which compartment (intra or extracellular)

A

2/3 from intracellular

1/3 from extracellular

28
Q

why cant you correct chronic hyponatremia too quickly?

A

neurons make their own osmoles to maintain cell size. restoring sodium will cause the cells to shrink quickly. causes myelitis

29
Q

normal potassium

A

3.5-5mmol/L

MD2 Foundation (10 decks)

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