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Renal- PA Sp23 > Fluid and Electrolyte Disorders > Flashcards

Fluid and Electrolyte Disorders Flashcards

1
Q

What does a BMP include?

A

glucose
Ca
Na
Cl
K
Co2
BUN
Cr

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2
Q

What does a CMP include?

A

BMP +
ALP
AST
ALT
Bili
Total Protein
Albumin
Globulin

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3
Q

Normal Ca levels

A

8.4- 10.2

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4
Q

Decreased ____ levels of Ca produce ____.
- commonly seen are Trousseau’s sign and _____ sign.

A

ionized
tetany
Chvotek’s

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5
Q

What is associated with hypoalbuminemia?

A

HYPOcalcemia

  • normal ionized Ca— PTH normal so no tetany
  • need to correct for decreased albumin
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6
Q

Alkalotic hypercalcemia presents with ____. ____ bound serum Ca, ____ ionized Ca, and ____ PTH.

A

Tetany
Increased
decreased
increased

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7
Q

Causes of hypercalcemia include:

A
  • primary hyperparathyroidism (MCC -outpt)
  • Malginancy-induced (MCC- inpt)
  • Thiazide diuretics
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8
Q

How does hyperparathryoidism present?

A

HIGH Ca
LOW Phosphate
HIGH Cl
HIGH PTH

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9
Q

Causes of hypocalcemia include:

A

-Hypoalbuminemia (MCC)
-HypoMg (MCC- inpt)
-LOW Vit D– renal disease (MC)
- HYPOparathyroidism
- acute pancreatitis
- Pseudohypoparathyroidism

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10
Q

If you decrease Ca, you also will have decrease in….

A

Mg and PTH, Vit D, albumin

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11
Q

Causes of hypomagnesemia include:

A

Alcohol excess
diarrhea
drugs (aminoglycosides, cisplatin, and diuretics)

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12
Q

How does HYPOparathyroidism present?

A

Thyroid surgery (MCC)
AI destruction
DiGeorge Syndrome

LOW Ca
HIGH PO4
LOW PTH

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13
Q

How does pseudohypoparathryoidism present?

A
  • End organ resistance to PTH
  • XLD disease

LOW Ca
HIGH PO4
HIGH PTH (makes PTH but no R to bind it)

“knuckle, knuckle, dimple, knuckle”

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14
Q

Lack of phosphate even in the presence of Ca leads to ________ in adults and _____ in children.

A

osteomalacia
rickets

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15
Q

Normal Phosphorus:
Adults=
Children=

A

Adults= 3.0-4.5
Children= 3.6-5.6

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16
Q

How does HYPERphosphatemia present?

A

-renal failure (MCC)
-pseudohypoparathyroidism
-undiluted cow’s milk (esp. before 1 y/o)
- rhabdo
-tumor lysis syndrome

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17
Q

How does HYPOphosphatemia present?

A
  • resp alkalosis (MCC)
  • malabsorption
  • primary hyperparathyroidism
  • PT dysfunction
  • LOW Vit D
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18
Q

Why is hypoPO4 dangerous?

A

resp failure from LOW ATP

transcellular shift with insulin and
IV infusion in alcoholics

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19
Q

Normal glucose

A

70-110

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20
Q

HYPERglycemia

A
  • DM (MCC)
  • Cushing’s
  • acute MI or CVA
  • infections
  • metabolic acidosis
  • relative HYPONa
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21
Q

HYPOglycemia

A
  • too much insulin (MCC- LOW c-peptide)
  • Insulinoma (HIGH c-peptide)
  • Alcoholism (LOW gluconeogensis)
  • impaired glucose tolerance
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22
Q

Normal BUN

A

7-18

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23
Q

Reabsorption of ___ in the kidneys is ____ dependent.

A

urea
flow

HIGH GFR increases reabsorption of urea in the PCT

LOW GFR decreases urea reabsorption

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24
Q

Increase in BUN:Cr is seen in…

A

pre-renal azotemia, post-renal azotemia (variable), increased protein intake, and GI bleeding

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25
Q

Decrease in BUN: Cr is seen in….

A

Renal azotemia
SIADH
normal pregnancy

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26
Q

Pre-renal azotemia is caused by ___ (MCC) and ____ shock. It is the _____ CO causing decreased _____ in the presence of normal renal function.

A

CHF
hypovolemic
decreased
GFR

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27
Q

Renal azotemia is caused by ____ azotemia, ATN, and CKD. It is the _____ in GFR with ______ ________.

A

prerenal
decrease
renal dysfunction

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28
Q

Postrenal azotemia is caused by _______, UTI, etc. If left untreated, it will progress to ______ ______.

A

Obstruction
renal azotemia

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29
Q

Creatinine is dependent on _____ mass.

30
Q

Is Cr filtered by any other organ besides kidneys?

31
Q

HIGH Cr caused by….

A
  • renal failure (MCC)
  • prerenal azotemia
  • Athletes taking creatine supp
32
Q

LOW Cr caused by…

A

muscle wasting
normal pregnancy

33
Q

Prerenal, renal, and postrenal all have _____ GFR and _____.

A

decreased
Oliguria

34
Q

BUN:Cr >15:1

A

Pre and post renal

urea reabsorbed but Cr not

35
Q

BUN:Cr <15:1

A

urea and creatinine both effected

kidneys not working

36
Q

Serum sodium concentration is ________ to ____/_____.

A

proportional
TBNa
TBW

37
Q

TBNa is determined by ____ ____.

A

PE

it is limited to ECF

38
Q

LOW TBNa shows signs of _____ (skin tenting).

A

volume depletion

39
Q

HIGH TBNa shows signs of ____ (pitting edema)

A

volume overload

40
Q

Normal TBNa= ___

41
Q

Isotonic gain is _____ TBNa/ TBW. It does not alter serum Na.

A

increased

non-pitting edema

42
Q

Isotonic loss is _____ TBNa/ TBW. It does not alter serum Na.

A

decreased

volume depletion

43
Q

If pt gains weight in an inpatient setting is it usually due to ____ TBNa.

44
Q

What type of volume disorder is SIADH?

A

Euvolemic hyponatremia

45
Q

_____ CO activates _____ (retention of Na), ____ GFR increases Na reabsorption, and ____ increases.

A

Decreased
RAAS
Decreased
thirst

46
Q

HYPERnatremia

47
Q

HYPOnatremia

48
Q

HYPER vs HYPO natremia

49
Q

Normal K

50
Q

Potassium is affected by changes in ____!!

51
Q

What is acidosis?

A

Excess H enteres RBCs
K leaves RBCs to offset the gain of H–> hyperkalemia

52
Q

What is alkalosis?

A

H leaves RBCs
K enters RBCs to offset the loss of H–> hypokalemia

53
Q

Diarrhea ____ transcellular effect causing lose of bicarb and resulting in ____ ____.

A

overrides
metabolic acidosis

54
Q

What A-B disorders override loss of K in urine?

A

proximal and distal rental tubular acidosis

55
Q

What EKG findings will you see with HYPOnatremia?

56
Q

What EKG findings will you see with HYPERkalemia?

A

peaked T- waves

57
Q

HYPERkalemia

58
Q

HYPOkalemia

59
Q

HYPER vs HYPO kalemia

60
Q

Normal anion gap

61
Q

HYPERchloridemia:

______ anion gap metabolic acidosis. Presents with ___ overload, ______ excess.

Compensation= respiratory ______

A

normal
salt
mineralocorticoid
alkalosis

62
Q

HYPOchloridemia:

Presents with ____ (loss of stomach acid) and ____ sodium.

Compensation= respiratory _____.

A

vomiting
LOW
acidosis

63
Q

Normal Bicarbonate

64
Q

HIGH bicarb

A

METABOLIC ALKALOSIS

LOOPs and thiazides MCC

Others: vomiting (Cl responsive), contraction alkalosis, primary aldosteronism (Cl resistant)

65
Q

LOW bicarb

A

METABOLIC ACIDOSIS

increased AG or normal AG

66
Q

Increased AG is d/t ____ being added to the blood. Bicarb will then buffer this, thereby “using up” the bicarb and decreasing serum concentration

A

acid

**LOW bicarb
**HIGH AG

67
Q

Causes of increased AG Metabolic Acidosis:

A

MUDPILES

Methanol (blindness)
Uremia
DKA
Propylene glycol
Iron or Isoniazid
Lactic acidosis (MCC)- liver, ETOH
Ethylene glycol (Ca Ox crystals)
Salicylates

68
Q

Causes of normal AG metabolic acidosis:

A

HARDASS

Hyperalimentation
Addison’s disease
Renal tubular acidosis (P or D)
Diarrhea (MCC)
Acetazolamide
Spironolactone
Saline infusion

69
Q

Normal AG metabolic acidosis:

d/t loss of ___ from __ or ___ tracts or inability to regenerate bicarb in the kidneys. ___ reabsorbed to offset loss of bicarb. Every bicarb lost is replaced by ___. Therefore, AG remains unchanged.

A

bicarb
GI
GU
Cl
Cl

**HIGH serum Cl
** LOW serum HCO3

70
Q

Diarrhea is ____ in adults (normal Na) and ____ in children (hypernatremia)

A

isotonic
hypotonic

71
Q

When HCO3 is decreased…

If Cl is INCREASED, a ____ ___ is present.

72
Q

when HCO3 decreased

Renal- PA Sp23 (4 decks)

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