Day 9 - GU2 ARF, Acid-Base, Lytes

Question 1

Tx CKD

Answer 1

Stop smoking; Aggressive control of bp

Question 2

DDx metabolic acidosis w/ normal anion gap - How serum K+ be useful in narrowing?

Answer 2

Low serum K+ - seen w/ diuretic use, RTA type 1 & 2, diarrhea, Fanconi syndrome; High serum K+ - Addison’s disease, RTA type 4, Potassium-sparing diuretics, Hyperalimentation (i.e., TPN)

Question 3

Pseudohyponatremia

Answer 3

Serum volume expanded by substance like lipid or protein, amount of sodium per volume decreased although sodium per water appropriate; Different from hypoosmolarity (pulls water out of cells, diluting serum Na)

Question 4

Vol status in pt w/ hyponatremia due to: Thiazide diuretics

Answer 4

Dehydrated (hypovolemic) or euvolemic

Question 5

Vol status in pt w/ hyponatremia due to: SIAD

Answer 5

Euvolemic

Question 6

Vol status in pt w/ hyponatremia due to: hepatic cirrhosis

Answer 6

Hypervolemia

Question 7

Vol status in pt w/ hyponatremia due to: Addison’s disease

Answer 7

Hypovolemia

Question 8

Vol status in pt w/ hyponatremia due to: Hypothyroidism

Answer 8

Euvolemia

Question 9

Vol status in pt w/ hyponatremia due to: Renal failure

Answer 9

Hypovolemia

Question 10

Vol status in pt w/ hyponatremia due to: psychogenic polydipsia

Answer 10

Euvolemic

Question 11

Urine & serum osmolality in following cause of euvolemic hyponatremia: SIADH

Answer 11

Urine Na > 20 or FENA > 1%; Urine osmolality > 100

Question 12

Urine & serum osmolality in following cause of euvolemic hyponatremia: Psychogenic polydipsia

Answer 12

Urine Na

Question 13

Urine & serum osmolality in following cause of euvolemic hyponatremia: Thiazides

Answer 13

Recall: hypovolemia or euvolemia; Urine Na > 20; Urine osmolality > 100

Question 14

Urine & serum osmolality in following cause of euvolemic hyponatremia: Alcoholism

Answer 14

Urine Na

Question 15

Urine & serum osmolality in following cause of euvolemic hyponatremia: Hypothyroidism

Answer 15

Urine Na

Question 16

DDx hypovolemic hyponatremia based on urine Na levels

Answer 16

Urine Na 20: Renal losses - Thiazides, salt-wasting renal diseases, partial urinary tract obstrx, adrenal insufficiency (including inadequate mineralocorticoid or Addison’s)

Question 17

DDx hypervolemic hyponatremia based on Na levels

Answer 17

Urine Na 20: Renal failure

Question 18

Rapid correction of hyponatremia - Complication & it p/w

Answer 18

Central pontine myelinolysis (osmotic demyelination) p/w (within 48 hrs; imaging changes not seen for 4 weeks after event) dysarthria, paraparesis, quadriparesis, behavioral disturbances, lethargy, coma; correction greater than 12 meq/L over 24 hrs (same rate for hypo & hyper natremia): over 20 meq/L, almost always get CPM OR correct hyponatremia to over 140

Question 19

Etiologies of SIADH

Answer 19

CNS disease, pulm disease (esp. SCLC), Drugs (NSAIDs, antidepressants, antipsychotics, carbamazepine, ecstacy, vasopressin/DDAVP), HIV/AIDS, major abdominal/thoracic surgery

Question 20

Tx emergency hyperkalemia

Answer 20

Stat EKG, repeat K+, D50, Insulin (lasts 4-6 hrs), CALCIUM GLUCONATE OR CHLORIDE (first thing if EKG changes), NaHCO3, Albuterol neb, Kayexalate; Furosemide or Lasix, Replace Mg if