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High Yield Boards > Fluids, Electrolytes, Renal > Flashcards

Fluids, Electrolytes, Renal Flashcards

1
Q

Total body and water and extracellular fluid ______ with increasing gestational age

A

Decrease

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2
Q

At what age does intracellular fluid begin to make up a larger part of total body water

A

Around three months of age

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3
Q

What percent of body weight is total body water at 24 weeks and at term

A

90% at 24 weeks gestation and 80% at term delivery

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4
Q

How to correct freewater deficit

A

Administer four mL/kilo of free water for everyone mEq per liter increase in sodium over 145

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5
Q

When is ADH present in the fetus?

A

11 weeks gestation

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6
Q

Calculation of plasma osmolality

A

(2 x plasma sodium) + (glucose mg/dL/18) + (BUN/2.8)

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7
Q

Genetics of congenital nephrogenic diabetes insipidus

A

X-linked recessive for the vasopressin receptor defect, and autosomal for the Aquaporin defect

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8
Q

Management of nephrogenic diabetes insipidus

A

Hydrate, monitor electrolytes, thiazides to increase urine concentrating ability (potassium supplementation as needed.)

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9
Q

Correction of sodium for high glucose

A

Sodium is decreased by 1.6 mEq/L for each 100 increase in glucose (pseduohyponatremia)

So to calculate= Measured Na + (glucose -100) x 0.016

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10
Q

Calculation of sodium deficit

A

[Na desired- Na current] x 0.6 x weight (kg)

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11
Q

Where does most of bicarbonate reabsorption occur?

A

60 to 80% occurs in the proximal tubule

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12
Q

Net acid excretion in the urine equals

A

(Titratable acids + ammonium) - non-reabsorbed bicarbonate

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13
Q

Where does acidification of the urine occur?

A

Cortical and medullary collecting tubule cells

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14
Q

Calculation of anion gap

A

Na - (chloride + bicarb)

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15
Q

Calculation of bicarb replacement

A

0.3 x bicarb deficit x weight

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16
Q

Problem in type I RTA

A

Can’t secrete H+ in distal tubule

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17
Q

Problem in type II RTA

A

Decreased or absent proximal tubule bicarb reabsoprtion

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18
Q

Dehydration, failure to thrive, normal blood pressure, nephrocalcinosis, polyuria, normal serum calcium

A

Barrter syndrome

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19
Q

Management of Bartter syndrome

A

Potassium supplementation, +/- thiazide diuretics, +/-indomethacin

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20
Q

When are first nephrons formed

A

8 weeks gestation

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21
Q

When does urine production start

A

10-12 weeks gestation

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22
Q

The preterm infant has recused ability to contrite urine due to:

A
  1. Tubule insensitivity to vasopressin
  2. Short loop of henle
  3. Low osmolality of medullary interstitium (secondary to limited Na reabsorption in thick ascending loop)
  4. Low serum urea
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23
Q

Calculation of fractional excretion of sodium

A

(Urine sodium x plasma creatinine) / (urine creatinine x plasma sodium) x100

<1% normal; 1-2.5% pre-renal; >3% intrinsic renal failure

24
Q

Where is potassium reabsorbed/secreted?

A

Reabsorbed proximal tubule and ascending loop of Henle
Secreted in distal tubule and collecting ducts

25
Q

Where is sodium reabsorbed in kidney

A

2/3 in proximal tubule
20% in ascending loop of Henle
10% in distal tubule/collecting duct

26
Q

Where is reabsorption of Calcium in kidney

A

Proximal tubule and loop of Henle by passive movement, limited by sodium

Distal tubule and collecting ducts (active)

27
Q

Calculation of tubular reabsorption of phosphorus

A

1- [(urine phosphorus x plasma creatinine) / (urine creatinine x plasma phosphorus)]

28
Q

Where is phosphorus reabsorbed

A

80% in proximal tubule, 10% in distal tubule, remaining excreted

29
Q

Genetics and pathogenesis of pseudohypoaldosteronism

A

X-linked recessive
Unresponsiveness of renal tubule to aldosterone

30
Q

Lab findings in pseudohypoaldosteronism

A

Low sodium, high potassium, metabolic acidosis, increased aldosterone, increased renin

31
Q

Estimated GFR formula

A

(0.45 x height)/ plasma creatinine

32
Q

Creatinine clearance calculation

A

(Urine creatinine x volume) / plasma creatinine

33
Q

Where is most protein reabsorbed in kidney

A

Proximal tubule

34
Q

What is the injury if you see leukocytouria in the urine?

A

UTI, obstructive uropathy, or glomerulonephritis

35
Q

What is the injury if you see red blood cell casts in the urine?

A

Glomerular injury

36
Q

What is the injury if you see white blood cell casts in the urine?

A

Infection, renal interstitial/tubular injury

37
Q

What is the injury if you see epithelial/granular casts in the urine?

A

Dehydration or renal interstitial/tubular injury

38
Q

What is the injury if you see hyaline casts in the urine?

A

Severe proteinuria, dehydration

39
Q

Proteinuria, hypoproteinemia, hyperlipidemia, and edema

A

Congenital nephrotic syndrome

40
Q

Genetics of Finnish congenital nephrotic syndrome

A

Autosomal recessive on chromosome 19, 19q13.1, gene NPHS1, gene product is called nephrin

41
Q

Gene and chromosome in autosomal recessive PKD

A

Chromosome 6p21, PKHD1, which encodes fibrocystin/polyductin-expressed on cilia of renal cells and bile duct cells

42
Q

Gene and chromosome in autosomal dominant PKD

A

Chromosome 16 (a few on 4p)

43
Q

Fanconi syndrome

A

Proximal tubule dysfunction, leading to excess urinary losses of amino acids, glucose, phosphate, and bicarbonate

44
Q

Management of Fanconi syndrome

A

Supplement with sodium phosphate, sodium and potassium citrate, and vitamin D

45
Q

Genetics of Fanconi syndrome

A

Autosomal dominant but generally sporadic

46
Q

What is cystinosis?

A

Defective carrier-mediated transport of cysteine leading to excess cysteine in lysosomes of many cells

47
Q

Diagnosis and management of cystinosis

A

Diagnosed with cornea lamp exam demonstrating cystine crystals, and management is with cysteamine and renal transplant

48
Q

Genetics and pathogenesis of lowe syndrome

A

X-linked recessive, gene defect leads to an enzyme deficiency disrupting, the Golgi apparatus

49
Q

Cataracts, glaucoma, mental deficiency, muscular hypotonia, renal, tubular, dysfunction, proteinuria, cryptorchidism

A

Lowe syndrome

50
Q

The recessive form of type I RTA can be associated with what?

A

Hearing loss

51
Q

Calculation of free water deficit

A

4 mL x weight x (desired change in serum Na)

52
Q

Modalities of continuous renal replacement therapy, that incorporate hemofiltration use the principle of what to remove solutes

A

Convection

53
Q

Slow continuous ultra filtration is useful for what

A

To remove fluid in patients with volume overload, but it will not correct acidosis electrolyte, anomalies or uremia, because the low ultra filtration rate has minimal solvent drag they are for trivial amounts of solutes are removed from plasma

54
Q

In cvvhd how are solutes removed

A

By diffusion across the concentration gradient

55
Q

Is CVVHD or CVVH more likely to remove low molecular weight solutes

A

CVVHD

(But is less likely to remove high molecular weight solutes, and water)

56
Q

Primary brain energy substrate during periods of hypoglycemia

A

Lactate

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