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Year2 Renal > Exam 3 -electrolyte disorders- Darrow > Flashcards

Exam 3 -electrolyte disorders- Darrow Flashcards

1
Q

tonicity is calculated how

A

serum osmolality

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2
Q

how do you get hypotonic with hyponatremia

A

taking in water

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3
Q

in a hypotonic, hypovolemic patient, what is Urinary Na

A

less than 10 because trying to hold onto it

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4
Q

how does hypovolemia lead to increased Na reabsorption

A

decreased volume produces bator stretch with increased SAN to activate RAAS
decreased CO also will cause dec RBF and GFR which inc NA reabsorption

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5
Q

Why is serum Na so low in a dehydrated patient who is hypo everything

A

ADH overiding everything

retaining water which is diluting the Na

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6
Q

What is the exception of hyponatremia that is not attributed to increase in ADH

A

pyschogenic polydipsia

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7
Q

What is normal tonicity

A

280-295

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8
Q

what is low tonicity

A

<280

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9
Q

what is high tonicity

A

> 295

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10
Q

what can cause isotonic hyponatremia

A

artifactual pseudohyponatremia from extra fat and protein
hyperproteinemia (myeloma)
hyperlipidemia (chylomicrons, TG)

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11
Q

what can cause hypertonic hyponatremia

A 
extra carbs
hyperglycemia
mannitol, sorbitol, glycerol maltose
radiocontrast agents
ethylene glycol methanol
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12
Q

what must you look into when have hypotonic hyponatremia

A

volume stat

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13
Q

What could cause a hypotonic, euvolemic hyponatremia

A 
SIADH
pyschogenic polydipsia
hypothyroidism
stress
HIV
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14
Q

What is the Urinary Na excretion in hypotonic euvolemic hyponatremia

A

> 20

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15
Q

what are 2 groups of hypotonic hypovolemic hyponatremia and correlating Urinary Na

A

extra renal salt loss 20 Urinary Na

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16
Q

what are types of extra renal salt loss

A

dehydration, vomiting, diarrhea, 3rd spacing (burns)

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17
Q

what are types of renal salt loss

A

diuretics, ACEI, nephropathies, Addisons, type IV RTA

18
Q

what can cause hypotonic hypervolemic hyponatremia

and Urinary Na?

A

edematous states: UNa20)

19
Q

What are the effects of NSAIDs on ADH

A

increase because inhibit PG

20
Q

what are the effects of increased serotonin on ADH

A

increase ADH

21
Q

why do hyponatremic patients present with hypokalemic alkalosis

A

Na reabsorption in Collecting duct in exchange for one K and one H

22
Q

what does hypokalemia look like on EKG

A

flattened to inverted T waves with U waves

23
Q

what is contraction alkaosis

A

increase HCO3 because losing so much K and H

24
Q

Why do you see hyperuremia (increased BUN) in hyponatremia

A

lost Na in tubule because reabsorbing so much so Urea flows down concentration gradient

25
Q

What is a normal BUN/Cr

A

10:1

26
Q

if BUN/Cr is >10:1 what does this mean

A

pre or post renal problem

27
Q

What are causes of pre renal diseases that have elevated BUN/Cr

A

dehydraiont, CHF, shock, glomerulonephritis

28
Q

what post renal diseases can lead to elevated BUN.Cr

A

prostatic obstruction

ureteral obstruction

29
Q

what does BUN/Cr 10/1 mean

A

normal or intrinsic renal disease if Cr is >1

30
Q

If BUN:Cr is less than 10:1 what could it be

A

liver failure, malnutrition, overhydration, pregnancy, SIADH

31
Q

patient has pancreatitis with muddy brown granular casts

Dx?

A

ATN

32
Q

epithelial casts are a marker for what

A

tubular necrosis

33
Q

what exogenous toxins cause acute tubular necrosis

A

aminoglycosides
vancomycin
clyclosporin
radiographic contrast media

34
Q

what endogenous toxins cause ATN

A

myoglobinuria
Hb
hyperuricemia
bence jones

35
Q

what are locations of ADH release

A

brain and lung

36
Q

prolonged PR interval and peaked T waves on EKG is indicative of what

A

hyperkalemia

37
Q

What is alcohols impact on phosphate

A

decreases

38
Q

What does myoglobin cause in tubules

A

acute tubular necrosis

39
Q

What is biggest concern to correct hypophosphate in renal ATN from rhabdomyolysis

A

replace it slowly to avoid hypocalcemia

40
Q

What is clinical presentation of classic crush injury rhabdomyolysis

A

massive release of phosphate, uric acid and potassium with decreased Ca from Ca PO4 precipitation in tissues

41
Q

What ion do you NOT correct in classic crush injury rhabdomyolysis

A

Ca because with improvement it will be released from tissues

Year2 Renal (20 decks)

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