Chronic Renal Failure

Question 1

What is uremic syndrome?

Answer 1

GFR <10% of normal, inability of kidneys to regulate volume and effectively excrete waste

Question 2

Complications of uremic syndrome by system: 
CV
Electrolyte
Resp: 
Hematologic: 
GI 
Neuro
Endocrine

Answer 2

CV: heart failure 2/2 hypervolemia, HTN
Electrolyte: hyponatremia, hyperkalemia, hyper everyghing except i calcium could be hypo or hyper
REsp: pulmonary edema
Hematologic: normochromic, normocytic anemia: Treat with EPO and avoid transfusions if possible, platelet dysfunction, coagulopathy
GI: Full stomach!!!! delayed gastric emptying
Neuro: seizues, encephalopathy
Endocrine: Osteodystrophy (dystrophic growth of bone)

Question 3

Treatment for Renal issues that caused EKG changes:

Answer 3

10 mL of 10% calcium chloride IV infused over 10 minutes
Glucose (D10W) and 5-10 units of insulin for every 25-50 grams of glucose given
Sodium bicarbonate (50-100 mEq IV over 5-10 min)
B2 agonist

Question 4

Why is it that HCT may be low in renal pts?

Answer 4

ACD and also due to hemodilution from possible fluid overload. These pts can usually handle lower crit values

Question 5

Why no large doses of morphine in renal pts?

Answer 5

Because its metabolite 6 glucuronide can lead to prolonged respiratory depression and sedation

Question 6

Meperidine and renal failure-is it a no? Why or why not?

Answer 6

Issa no from me dawg. it has a metabolite (normeperidine which is neurotoxic and can lead to convusions when used in renal failure pts)