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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
Decrease in BUN: Cr is seen in....
Renal azotemia SIADH normal pregnancy
26
Pre-renal azotemia is caused by ___ (MCC) and ____ shock. It is the _____ CO causing decreased _____ in the presence of normal renal function.
CHF hypovolemic decreased GFR
27
Renal azotemia is caused by ____ azotemia, ATN, and CKD. It is the _____ in GFR with ______ ________.
prerenal decrease renal dysfunction
28
Postrenal azotemia is caused by _______, UTI, etc. If left untreated, it will progress to ______ ______.
Obstruction renal azotemia
29
Creatinine is dependent on _____ mass.
muscle
30
Is Cr filtered by any other organ besides kidneys?
NO
31
HIGH Cr caused by....
- renal failure (MCC) - prerenal azotemia - Athletes taking creatine supp
32
LOW Cr caused by...
muscle wasting normal pregnancy
33
Prerenal, renal, and postrenal all have _____ GFR and _____.
decreased Oliguria
34
BUN:Cr >15:1
Pre and post renal urea reabsorbed but Cr not
35
BUN:Cr <15:1
urea and creatinine both effected kidneys not working
36
Serum sodium concentration is ________ to ____/_____.
proportional TBNa TBW
37
TBNa is determined by ____ ____.
PE it is limited to ECF
38
LOW TBNa shows signs of _____ (skin tenting).
volume depletion
39
HIGH TBNa shows signs of ____ (pitting edema)
volume overload
40
Normal TBNa= ___
normal PE
41
Isotonic gain is _____ TBNa/ TBW. It does not alter serum Na.
increased non-pitting edema
42
Isotonic loss is _____ TBNa/ TBW. It does not alter serum Na.
decreased volume depletion
43
If pt gains weight in an inpatient setting is it usually due to ____ TBNa.
increased
44
What type of volume disorder is SIADH?
Euvolemic hyponatremia
45
_____ CO activates _____ (retention of Na), ____ GFR increases Na reabsorption, and ____ increases.
Decreased RAAS Decreased thirst
46
HYPERnatremia
47
HYPOnatremia
48
HYPER vs HYPO natremia
49
Normal K
3.5- 5.0
50
Potassium is affected by changes in ____!!
pH
51
What is acidosis?
Excess H enteres RBCs K leaves RBCs to offset the gain of H--> hyperkalemia
52
What is alkalosis?
H leaves RBCs K enters RBCs to offset the loss of H--> hypokalemia
53
Diarrhea ____ transcellular effect causing lose of bicarb and resulting in ____ ____.
overrides metabolic acidosis
54
What A-B disorders override loss of K in urine?
proximal and distal rental tubular acidosis
55
What EKG findings will you see with HYPOnatremia?
U waves
56
What EKG findings will you see with HYPERkalemia?
peaked T- waves
57
HYPERkalemia
58
HYPOkalemia
59
HYPER vs HYPO kalemia
60
Normal anion gap
12 +/- 4
61
HYPERchloridemia: ______ anion gap metabolic acidosis. Presents with ___ overload, ______ excess. Compensation= respiratory ______
normal salt mineralocorticoid alkalosis
62
HYPOchloridemia: Presents with ____ (loss of stomach acid) and ____ sodium. Compensation= respiratory _____.
vomiting LOW acidosis
63
Normal Bicarbonate
22-28
64
HIGH bicarb
METABOLIC ALKALOSIS LOOPs and thiazides MCC Others: vomiting (Cl responsive), contraction alkalosis, primary aldosteronism (Cl resistant)
65
LOW bicarb
METABOLIC ACIDOSIS increased AG or normal AG
66
Increased AG is d/t ____ being added to the blood. Bicarb will then buffer this, thereby "using up" the bicarb and decreasing serum concentration
acid **LOW bicarb **HIGH AG
67
Causes of increased AG Metabolic Acidosis:
MUDPILES Methanol (blindness) Uremia DKA Propylene glycol Iron or Isoniazid Lactic acidosis (MCC)- liver, ETOH Ethylene glycol (Ca Ox crystals) Salicylates
68
Causes of normal AG metabolic acidosis:
HARDASS Hyperalimentation Addison's disease Renal tubular acidosis (P or D) Diarrhea (MCC) Acetazolamide Spironolactone Saline infusion
69
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.
bicarb GI GU Cl Cl ***HIGH serum Cl *** LOW serum HCO3
70
Diarrhea is ____ in adults (normal Na) and ____ in children (hypernatremia)
isotonic hypotonic
71
When HCO3 is decreased... If Cl is INCREASED, a ____ ___ is present.
normal AG
72
when HCO3 decreased

Renal- PA Sp23 (4 decks)

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