FEN Flashcards

1
Q

Correction of free water deficit

A

Administer 4mL/kg for every 1meq/L increase over 145

Administer 3mL/kg for Na >170

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2
Q

Plasma osmolality

A

(2 x Na) + (glucose / 18) + (BUN / 2.8)

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3
Q

Extrarenal ADH effect

A

Arterial vasoconstriction stimulating renal mesangial cell contraction, decrease renin secretion, and increase ACTH secretion

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4
Q

Obstructive renal disorder can cause what with ADH

A

Nephrogenic DI because of the pressure which decreases aquaporin expression

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5
Q

SIADH management

A

Free water restriction
If Na <120, replace with NaCl
Consider furosemide

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6
Q

Diabetes insipidus management

A

Central - vasopressin/desmopressin

Nephrogenic - thiazides to increase urine concentrating ability

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7
Q

Na content in hypergylcemic state

A

Na decreased by 1.6meq/L for each 100 increase in glucose (mg/dL)

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8
Q

Hyponatremia bucket differential

A

Decreased weight - renal loss or extrarenal loss

Increased or normal weight

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9
Q

Hyponatremic renal losses differential

A

Na losing nephropathy
Diuretics
Adrenal insufficiency

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10
Q

Hyponatremic extrarenal losses

A

GI losses
Skin losses
Third spacing
Cystic fibrosis

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11
Q

Increased weight hyponatremia

A
Nephrotic syndrome
CHF
SIADH
Acute or chronic renal failure
Excess water infusion
Cirrhosis
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12
Q

Na deficit equation

A

deficit=(desired Na -current Na)x0.6xwt

The 0.6 is the percent body water which should be higher in preterm

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13
Q

Hypokalemia differential buckets

A

Decreased stores: with hypertension or with normal BP

Normal K stores

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14
Q

Decreased K stores hypokalemia and HTN

A

Renovascular disease, excess renin, excess mineralocorticoid, Cushing syndrome

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15
Q

Decreased K stores normal BP

A

Renal: RTA, fanconi syndrome, bartter syndrome, antibiotics, diuretics, ampho B
Extrarenal: skin loss, GI loss, high carb diet, enemas, malnutrition

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16
Q

NaHCO3 replacement equation

A

NaHCO3 replacement (mEq) = 0.3xHCO3 deficit xweight

17
Q

RTA workup

A

Serum electrolytes
Urine pH and electrolytes (calcium, citrate, potassium, oxalate)
RBUS
Urine blood partial pressure of CO2 (nl >20; type I RTA <20)
Tubular reabsorption of phosphate (TRP)

18
Q

Type I RTA

A
Distal
Cannot secrete H
Normal renal bicarbonate threshold 
Most primary causes are AD
Can have secondary causes
Urine pH >6.2
19
Q

Type II RTA

A

Proximal
Decreased or absent proximal tubular HCO3 reabsorption, reduced renal bicarbonate reabsorption threshold
Large urine losses of bicarbonate
Can have urine pH <5.3

20
Q

FENa calculation and percentages

A

FENa = (urine Na x plasma Cr) / (urine Cr x plasma Na)
<1% normal
1-2.5% prerenal
>3% intrinsic

But premature infants have difficulty holding on to Na so their FENa may be elevated even though they are intravascularly depleted. However also limited ability to excrete Na load secondary to lower GFR

21
Q

Tubular reabsorption of phosphorus (TRP) equation

A

TRP = 1 - [100 x (urine Ph x plasma Cr) / (urine Cr x plasma Ph)]

22
Q

Estimated GFR calculation

A

Estimated GFR = (0.45 x height (cm)) / (plasma cr (mg/dL))

23
Q

Creatinine clearance calculation

A

Creatinine clearance = (urine Cr x volume) / plasma cr

24
Q

Tubular dysfunction

A

Fanconi syndrome
Lowe syndrome (oculocerebrorenal syndrome)
Cystinosis

25
Q

Adverse effects of NaBicarb administration for metabolic acidosis

A

Increased PCO2
Decreased ionized calcium (because bicarb causes calcium to bind albumin)
Decreased K
Increased Na
Hypertonic so increased risk of IVH

26
Q

Renin secretion in response to

A

Decreased renal perfusion (hypotension, volume depletion), an increased sympathetic activity

27
Q

Effects of angiotensin II

A

Stimulates release of aldosterone, which acts on the kidney and increases sodium reabsorption, increases chloride, increases, potassium, secretion, increases hydrogen, secretion

Angiotensin II also increases sodium and water resorption, arteriolar, vasoconstriction, stimulates release of ADH, stimulates release of aldosterone, activates vitamin D via PTH, activates erythropoietin

28
Q

GFR calculation

A

0.45 x height (cm) / plasma creatinine (mg/dL)

Use 0.33 for preterm infants

29
Q

Creatinine clearance

A

(Urine creatinine x volume (ml/min)) / plasma creatinine

30
Q

Fanconi syndrome describe lab findings and management

A

Lab: decreased phosphate, decreased TRP, metabolic acidosis, hypokalemia, normal GFR
Management: supplement with sodium phosphate, sodium and potassium citrate, and Vit D

31
Q

Cystinosis pathogenesis, describe lab findings and management

A

Patho: defective carrier mediated transport of cystine leading to excess cystine in lysosomes of many cells
Lab: normal plasma cystine levels
Diagnosis by cornea slit lamp - crystals
Management: cysteamine, renal transplant

32
Q

Oculocerebrorenal syndrome patho, diagnosis, and management (lowes syndrome)

A

X linked
Enzyme deficiency disrupting the Golgi apparatus
Cataract, glaucoma, mental deficiency, hypotonia, tubular dysfunction
Increased amniotic fluid AFP
Management: symptom directed

33
Q

Disorders that cause nephrocalcinosis

A

Williams syndrome
Type 1 RTA
Neonatal primary hyperparathyroidism
Bartters syndrome