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Laughing Pedi > FEN, Acid Base, Renal > Flashcards

FEN, Acid Base, Renal Flashcards

0
Q

easy maintenance fluid req for wt >20kg

A

60cc/hr + 1cc/kg/hr

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1
Q

Maintenance electrolyte requirements, Na, K, Chloride

A

PSC: 1, 2, 3
Potassium: 1 meq/kg/day
Sodium: 2 meq/kg/day
Chloride: 3 meq/kg/day

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2
Q

Calculating % of dehydration by skin turgor and mucus membranes

  • normal/slightly decreased skin turgor
  • decreased
  • markedly decreased
  • cold/dry
A

normal skin, slightly dry mucus membranes: 3-5%
decreased skin, dry mm 6-10%
markedly decr skin, parched cotton mouth 10-15%
Cold/cry, parched >15%

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3
Q

When does pulse go up and resp go up with % dehydration, and when does orthostatus start

A

6-10% BP still normal

10-15%: orthostatic

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4
Q

cause of late seizure in child with hypernatremic dehydration?

A

hypocalcemia

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5
Q

how to correct hypernatremic dehyration?

A 
Calculate 48 hour water req, and give slowly over this time
use hypotonic (0.2%NS)
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6
Q

volume of distribution of Na? Calculation

A

0.6 x body weight

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7
Q

Quick and easy way to look at urine lytes and determine if dehyrated?

A

UNa < 10!

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8
Q

FeNa to determine dehydration vs renal failure

A

1% renal failure

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9
Q

Syndrome w/ Incr risk of renal artery stenosis due to renovascular disease?

A

Williams

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10
Q

possible causes of htn in NF? (4)

A
  1. pheo
  2. CoA
  3. RAS
  4. tumor
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11
Q

Clue to renal artery stenosis (4)

A
  1. renal asymmery
  2. acute incr BP
  3. ARF w/ ACEi
  4. refractory htn
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12
Q

causes of Renal artery stenosis? (4 etiology)

A
  1. fibromuscular dysplasia: string of beads
  2. syndrome: Williams
  3. athero
  4. idiopathic
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13
Q

4 syndromes assoc w/ pheo

A
  1. NF
  2. Von hippel landau
  3. sturge weber
  4. MEN2
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14
Q

In child w/ endo syndrome with htn/pheo what are the other things to look for? what is dx?

A

MEN2

higher risk for thyroid and hperparathyroid Ca

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15
Q

dx in child with HTN, wt loss, hyperglycemia, dilated cardiomyopathy

A

pheo

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16
Q

Dx steps for pheo

A

24 urine metanephrines, plasma metanephrines more sens in kids.
If high, check abd MRI/CT and MIBG/octreoscan

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17
Q

nephrotic syndrome mortality?

A

5%

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18
Q

three top bugs in nephrotic syndrome peritonitis?

A
  1. Strep pneumo**
  2. E. coli
  3. aseptic
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19
Q

hx of large placenta and massive anasarca
finnish autosomal recessive
dx and cause of death?

A

congenital nephrotic syndrome

Ecoli sepsis

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20
Q

define microscopic hematuria

A

> /= 3 RBC/hpf x 2 fresh voided urines

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21
Q

urine pos for blood could mean what? next step?

A

+ hemoglobin, myoglobin, porphyrins.

Obtain a UA!! (dip can’t tell, UA can)…

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22
Q

UA findings for myoglobinuria, hemoglobinuria

A

myoglobinuria 1-2 cells and dark urine

hemoglobinuria will have jaundice and anemia, but no hematuria / RBC in urine

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23
Q

5 things to know if you get microscopic hematuria to guide work up? If none present, next step?

A 
Just repeat UA in 2 wks unless:
Proteinuria
HTN
Abd pain
Dysuria
FH Kidney dz
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24
Q

If Microscopic hematuria repeatedly (persistent hematuria), management should be what next and why?
What else to look for?

A

Check for hypercalciuria in random urine sample
.look for Urine Ca/Cr > 0.25
-may also see crystals in urine and have abd pain/dysuria even w/o frank stones

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25
Q

Urine Calcium / Creatinine ratio < 0.2-0.25 should prompt what work up / management in microscopic hematuria?

A

24 urine collection, in which value >4mg/day of total calcium would indicate hypercalciuria, therefore need for renal US to look for stone

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26
Q

Urine Calcium / Cr ratio < 0.2 in eval for microscopic hematuria

A

should check for UPJ obstruction with renal ultrasound to look for structural abnormalities

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27
Q

Relationship between sickle cell and renal disease?

A

trait and disease can cause hematuria

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28
Q

consider dx in child w/ microscopic hematuria after injury/trauma

A

UPJ obstruction (very large kidney)

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29
Q

confirmatory test for suspected UPJ

A

after hydronephrosis found, get renal scan to show delayed excretion from that kidney, and consider VCUG in opposite kidney b/c risk of VUR

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30
Q

how to dx orthostatic proteinuria

A

first AM urine should be negative, and subsequent daytime one would be positive

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31
Q

protein / creatinine ratio suggestive of renal disease

A

Protein / Creatinine > 0.2

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32
Q

scenarios in which proteinuria can be benign (2)

A
  1. concentrated urine (high spec grav)

2. alkaline urine

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33
Q

If 24 hr urine protein collection is done, what would lead to renal biopsy

A

> 8mg/kg/day (halfway to 16 which is nephrotic…)

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34
Q

What is alport syndrome?

A

X linked dominant d/o w/ b/l sensorineural hearing loss, ocular defects, and renal failure in males
(two kidney planes landing on eyes that you can’t hear)

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35
Q

unilateral flank mass should lead to what, and what should you consider

A

Multicystic dysplastic kidney disease:
dysplastic kidney, may have oligo prenatally. usu unilateral, 50% with other GU anomalies like UPJ obstrx, VUR, posterior valves, megaureter/duplication *think of this as causing the mass. And need VCUG

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36
Q

multicystic dysplastic kidney disease is associated with what?

A

hepatic fibrosis / portal htn (autosomal recessive polycystic kidney dz)

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37
Q

two presentations of autosomal recessive polycystic kidney dz (AR)

A
  1. neonate w/ bilateral flank masses, oligo

2. older child w/ liver issue and kidney masses, TCP/splenomegaly

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38
Q

which polycystic kidney disease is associated w/ brain thing

-what is it and whats the trm

A

cerebral aneurysm in adult onset PCKD (autosomal dom)

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39
Q

What is nephronophthisis and what do you need to look for (3 things)

A

juvenile medullary cystic disease (Aut Rec), polyuria, enuresis, polydipsia, hyposthenuria (can’t concentrate urine)
-assoc w/ short stature, eye problems/retinal disease**, anemia

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40
Q

mass from urethral meatus or round filling defect on IVP causing urinary obstruction and urinary retention?

A

ureteroceles

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41
Q

Grades of VUR and management?

A

VUR 1 and 2: periodic cultures, most self resolve
VUR 3: Abx and f/u VCUG, 1/2 resolve
VUR 4-5: surgery needed (moderate dilation of ureter and renal pelvis)
Females: Abx

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42
Q

Normal bladder size (wt)

A

age (yrs) + 2 (ounces)

43
Q

newborn with palpable bladder and weak urinary stream.

Treatment and prognosis?

A

posterior urethral valves, prob: even w/ surgery they can get ESRD w/n 5 yrs!

44
Q

UTI culture result dx

bugs? (3)

A

100,000 colonies or >10,000 on cath

three most common bugs: Ecoli, Klebsiella, Enterococcus

45
Q

prune belly triad (Eagle Barrett syndrome)

A
  1. lack of abd muscles
  2. undesc testes
  3. GU abnormalities w/ obstrx mostly
46
Q

lipid issue in nephrotic syndrome

A

LDL / HDL is high, very high cholesterol

47
Q

nephrotic syndrome and calcium issue?

A

low albumin, decreases bound AND AVAILABLE calcium, so you get low Ca

48
Q

nephrotic syndrome and thyroid?

A

loss of thyroxine binding globulin, so functional hypothyroidism.

49
Q

RBC casts suggests what

A

glomerular disease

50
Q

3 causes of low complement (C3)

A
  1. SLE
  2. Post-strep
  3. Membranoproliferative glomerulonephritis
    (PMS: not in the mood to complement)
51
Q

typically black teen male w/ progressive renal failure, not responding to steroids
Tx

A

focal and segmental glomerulosclerosis.. this sucks

Steroids don’t work, use cyclophos or try ACEi or ARB

52
Q

If you suspect Minimal change disease, but no response to steroids, consider what?

A

Then its likely focal segmental glomerulosclerosis

53
Q

what kidney disease should NOT get steroids, and how do you know not to give… 1st step in management?

A

membranoproliferative GN b/c they may get severe htn, you don’t give them if they have low C3 (also often an older female). Get Renal Bx instead.

54
Q

peritonitis complication in minimal change nephrotic syndrome caused by what bugs? (3), mortality?

A

strep pneumo, ecoli, aseptic (5% mortality)

55
Q

top three nephrotic syndrome?

A
  1. Minimal change
  2. focal segmental (increasing)
  3. membranoproliferative
56
Q

massive anasarca in newborn, large placenta, death by 1 yr from ecoli sepsis, what is dx?

A

autosomal recessive congenital nephrotic syndrome

57
Q

tea colored, cola colored, rusty, smoky urine
hypertension
edema

Dx?

A

post strep GN

58
Q

Berger dz?

A

IgA nephropathy

59
Q

IgA nephropathy causes what sx?

indicator of poor prognosis

A

hematuria, often after URI

bad prognosis if persistent proteinuria

60
Q

acid/base d/o in chronic renal failure and type of ca/phos issue?

A
  1. metabolic acidosis (decr bicarb production by tubule so acid not excreted)
  2. secondary hyperparathyroid (high because kidney is bad at getting rid of phosphorous and does get rid of calcium –> high PTH) –> decreased calcitriol leads to decr Ca absorption / incr ca loss)
61
Q

Tx of common HUS in kids?

A

SYNSORB pk binds verotoxin in Ecoli o157 strain

62
Q

define htn in kids?

A

> 95% x 3!
STage 1: 95% - 99%+5
Stage 2: >99% + 5

63
Q

treatment of hypercalciuria

A

thiazide and fluids (thiazide decreases urinary excretion of calcium (remember hyper-GLUC)

64
Q

% of IgA nephropathy that get chronic renal disease?

A

15%

65
Q

htn + prematurity

A

umbilical cath causing renal injury

66
Q

htn + joint pain/swelling

A

SLE / connective tissue d/o

67
Q

htn + flushing, palp, fever, wt loss

A

pheo

68
Q

htn with weakness and muscle cramps

A

hypo K - hyperaldo problem!

69
Q

htn + sexual development onset

A

enzyme def (CAH)

70
Q

htn with pale color and edema

A

think renal dz (pallor from poor epo / anemia)

71
Q

HTN w/ low BP in legs vs arms, decr femoral pulse

A

Coarct Ao

72
Q

tx before surgery for pheo

A

alpha blockade before beta blockade (no unopposed alpha or htn crisis)

73
Q

2 wk infant normal electrolyte lab values

A

creat -0.2-0.4, high phosphate, relative acidosis, increased FENA

74
Q

don’t use ACE i in what htn disease?

A

RAS b/l!!

75
Q

diagnosing RAS? (3)

A

can do a random renin level (best after captopril premed)
can check MRA/CTA
US/Doppler - technique dep

76
Q

water requirement rule for maintenance / day and /hr/

A

hour: 4-2-1
day: 100-50-20

77
Q

fluid/electrolyte fluid for 10kg infant? 40kg child?

A

0.2% NS + 10 meq KCL x 24h
(1/4NS)

child: D5 1/4NS + 20mEQ KCL

78
Q

1kg = how many ccs of fluid when calculating % loss (deficit) of fluid

A

1kg = 1000cc

79
Q

Calculate fluid deficit of 10kg baby 10% dehydrated

A

0.10 x 10 x 1000 = 1kg = 1000cc

80
Q

calculation for serum osmolality and what is normal

A

2 (Na) + 10 + [BUN/3 + Gluc/18]
Estimate with 2(Na) + 10
Normal 290

81
Q

electrolyte abnormality causing seizure after hypernatremic dehydration

A

hypocalcemia

82
Q

calculate free water deficit / excess

A

Wt x 0.6 = volume of distribution
(Na level x Vc ) / 140 (nl sodium) = new volume distr
New Vd - normal Vd = excess/deficit

83
Q

Formula for FeNa

A

UNa x P Cr / UCr x PNa x 100

84
Q

3 causes of nongap acidosis?

A
  1. Renal loss of bicarb (RTA, carbonic anhydrase inhib)
  2. GI loss of bicarb (diarrhea)
  3. acid administration (HCl, parenteral nutrition)
85
Q

anion gap formula, normal?

A

Na - (HCO3 + Cl)

normal 8-16

86
Q

RTA type 1 features

A

Cannot excrete acid load so never w/ urine pH < 6!

renal stones, can get low K w/ Na salts

87
Q

prob w/ bicarb admin in acidosis

A

blood will quickly equilibrate with increased bicarb and incr pCO2, but CSF will not catch up right away and will incr pCO2 w/o concomitant bicarb right away;, causing a low pH in CSF…

88
Q

if urine pH <6, the diagnosis is NOT what?

A

RTA 1 (can’t excrete acid)

89
Q

where is defect in RTA 1

A

distal tubule where you excrete acid from NH4 production

90
Q

UNa for prerenal

A

<20 is the clue for prerenal azotemia

91
Q

clue for renal azotemia in urine sodium

A

UNa >30

184
Q

RTA 1 vs 4

A

both can acidify urine, but four can have hyperkalemia

185
Q

two drugs potential use in siadh if fluid rstrx fails

A

demeclocycline

fludrocortisone

186
Q

two chemo agents that can cause hyponatremia and how

A

cylcophos decreases water excretion

vincristine causes siadh

187
Q

diabetes drug that can cause hyponatremia

A

chlorpropamide

188
Q

what is the total body sodium in water tox?

what is the urine concentration of na

A

normal

high urine Na

189
Q

what is the total body sodium in pseudohyponatremia (like in high TG)

A

total body na high (water is high, but volume is low so total na looks low)

190
Q

low calcium effect on ekg

A

long qt

191
Q

low magnesium effect on ekg

A

long pr or qt

192
Q

hypokalemia ekg changes

A

flat T, st depr, pvcs

193
Q

hyperkalemia ekg changes

A

peak t, no p, wide qrs, EMD

194
Q

best replacement fluid for toddlers oral

A

glucose 2-2.5%
na 60-90 meq

(teens water)

195
Q

appropriate correction of hypernatremia

A

slow: no more than 10-12 in 24 hours

196
Q

for every 1L of maintenance fluid, how much Na, CL, K do you need?
How do you figure out deficit Na?

A

30mEq Na
20meq K
20 meq Cl

Can figure out deficit electrolytes too by multiplying ECF deficit (60% deficit) x 140meq. (This is the 0.6 volume of distribution for Na!)

Laughing Pedi (24 decks)

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