deck 2 Flashcards
hyponatremic hypovolemia
diarrhea emesis burns third spacing urine na - low (cause you are concentrating)
hypervolemia hyponatremia
CHF nephrotic syndrome renal failure sepsis if leaky decreased albumin from protein losing enteropathy cirrhoses
euvolemic hyponatremia
SIADH water intoxication - psychogenic or dilute formula glucose hypothyroidism glucocorticoid deficiency
8 month old baby with gastroenteritis. Na 160, Cl elevated, Bicarb 14, HR 220, BP 60/30. What is your initial management. Once stable what is your ongoing fluid management?
ABCs 20 cc/kg NS then ongoing fluid management once stable determine how long to correct Na over - initial Na 145-157 correct over 24 hours 158-170 over 48 hours 171 -183 72 hours 184-196 over 96 hours
correction rate 10-12 mmol/day
typically fluid D5 1/2 normal saline with 20 KCl
1.25-1.5 maintenance (because they are dehydrated)
check your sodium often
Change in Serum Sodium
= (Fluid Sodium - Serum Sodium) / (Total Body Water + 1)
Total Body Water = (Wt in kg * % Water)
noctural enuresis
2 parents with enuresis, 75% chance of enuresis
causes for nocturnal enuresis:
delayed maturation in cortical mechanism
sleep disorders
OSA
severe constipation
Don’t make as much ADH at night
Motivational therapy – limited evidence, try it
Fluid restrict, void before bed, caffeine
If doesn’t work, conditioning therapy – 30-60%, curative
Alarm system, usually better in kids > 6-7
meds - symptomatic
1st line DDAVP
2nd oxybutinin
3rd imipramine
Struvite stone, which organism
proteus
foreign body
urinary stasis
protein in a teenage girl
1st test - 1st AM urine x 2 then move on to other tests
in general if 3+ on dipstick more likely to be a fixed proteinuria, more likely to be a glomerular or tubular issue
when do sperm die in torsion
4-6 hours
painless testicular masses
varicocele hydrocele spermatocele inguinal hernia idiopathic
painful scrotal masses
epididymitis
testicular torsion/appendicular torsion
orchitis
trauma
most common flank mass
hydronephrosis
most common abdo mass
multicystic dysplastic kidney
types of rhabdo
- exertional
- non trauma exertional - hyperthermia, metabolic
- non trauma non exertional - drugs, toxins, , infections
What is DMSA
functional and anatomical information
better visualizes focal renal parenchymal abnormalities
also can compare kidney function between the two
look for scarring and pyelo
What is MAG3
look at obstructive and non obstructive hydronephrosis, as well as different function between the two kidneys
3 things VCUG can tell you
- reflux
- PUV
- bladder shape and function
Alport’s disease
X linked dominant in 85% the rest are different types
start on high frequency loss
eye stuff - anti - lento conus (eye stuff), macular flex, corneal erosion, anterior lenticonus is pathognomic for Alport’s
renal disease - hypertension
type 4 collagen
prognosis for boys: 15% by 15 years old, 75% by age 30, hearing loss is gradual
for ladies - mild in general, some can have findings later in life (milder)
Prognostic factors in Alport’s
- gross hematuria
- nephrotic syndrome
- on biopsy have prominent glomerular basement membrane thickening
What percentage of patients with nocturnal enuresis will spontaneously improve each year?
15% per year
Do acute hydroceles hurt?
might have discomfort, but should be okay and tolerate feedings
Causes of HUS
Infectious causes of HUS: - E. coli, S. pneumo, Shigella , HIV Medications - chemo (cyclosporine and tacrolimus) Genetic HUS Any disease with microvascular disease - lupus, HELLP, antiphospholid
Places you can get organism
uncooked meat well water contaminate vegetables unpasteurized milk/apple cider petting farms (usually E. coli, sometimes shigella)
What is the incidence of CNS involvement in HUS?
the majority have CNS involvement, most are mild - lethargy, irritability, non specific encephalopathic features, seizures, stroke
microvascular thrombosis
What’s the prognosis for HUS?
<5% mortality but 50% of children need dialysis during the acute phase
70% fully recover, 30% have chronic renal insufficiency
single umbilical artery
if no other abnormality then likely not a problem
associated abnormalities with renal abnormalities:
- ear abnormalities, GU, pulmonary hypoplasia, imperforate anus, scoliosis
Definition of hypertension urgency
> 99th percentile BP
headache or vomiting but no signs of end organ damage
tx: IV or PO
hypertension emergency
> 99th percentile BP with encephalopathy, seizures or renal dysfunction
fragile vessels and the blood pounding them, lots of pressure
wrecks your organs like a typhoon.
tx: must be IV
How fast should you decrease the BP?
don’t go too fast because you don’t want to reduce the perfusion to the organ
goal of 25% decrease over the 1st 8 hours
normalization over the next 48 hours
regardless of whether they are still symptomatic
Aside from nifedipine, 3 other meds for acute BP
nitro
labetalol
hydralazine
Most common cause of nephrotic syndrome in children
minimal change disease
What is the treatment for minimal change disease
steroids
In a child with nephrotic syndrome, when to biopsy
if steroids fail, or if older age
BP in nephrotic syndrome
should be nomal (although can be elevated in 25%, but shouldn’t be in typical minimal change disease (baby nelson)
Treatment of rhabdo
either dialysis or mannitol (to help with osmotic diuresis)
because doesn’t act on the kidneys
(vs lasix actually acts on stuff)
benefit of mannitol is not established
Why do you get polyuria with ATN?
3 phases
- acute decrease in GFR with sudden increase in BUN/Cr
- maintenance - severe sustained reduction in GFR
- recovery - tubular function restored - increase in u/o volume at that point
Abdominal compartment syndrome
abdominal compartment
- low u/o
- hypotension
- resp distress because of increased abdominal pressure
How to measure abdominal compartment pressure?
bladder probe - manometer - on the end of a foley
increased anion gap
mudpiles
i is isoniazzid and iron
non anion gap: is RTA and diarrhea
Bartters syndrome
loop of henle problem
autosomal recessive
metabolic alkalosis - present with persistent vomiting, polyuria and polydipsia
kid not peeing and hyponatremic
urine SP gravity 1.020 (concentrated)
fluid restrict 1L/m2/24 hours
4 year old with hematuria on two urine dips, has a grandfather with renal stones
urine calcium/creatinine ratio
>0.2 think of stones
random microscopic hematuria
check BP, repeat the urine (2 more times), check for protein
proteinuria - false positive
antiseptic agent
if urine is alkaline
if the dipstick stays there too long
most common cause of persistent proteinuria
orthostatic proteinuria
test for this diagnosis: first morning urine x 2/3
urine protein/Cr ratio <0.2 then confirms diagnosis
when to refer to paediatric surgeon for undescended testicle
should refer by 6 months (most descent by 4 months?, somewhere else says 9 months)
2 complications:
- infertility
- undetected cancer/cancer
5 month old with UTI, 2 indications for prophylaxis
- high grade reflux
- obstruction - ie PUV
reasons for urology
1. hypertension 2. impaired renal function3. renal abnormalities
reducible hernia, when to refer?
does not resolve spontaneously, early repair reduces the chance of incarceration, should do within 6-12 months of life
70% of incarcerated occur in the first year of life
can get testicular atrophy from inguinal hernia
for the routine hernia, operation should be done shortly after diagnosis
