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Chemical Pathology > Hyperkalemia And Acute Kidney Injury > Flashcards

Hyperkalemia And Acute Kidney Injury Flashcards

1
Q

What is Dilutional Hyponatremia?

A

A condition characterized by renal dysfunction with increased intake of hypotonic fluids, excessive sweating, and impaired renal excretion of water.

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2
Q

List some causes of Dilutional Hyponatremia.

A
  • Syndrome of Inappropriate ADH (SIADH)
  • Oliguric renal failure
  • Severe congestive heart failure
  • Cirrhosis
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3
Q

What is Hyperkalaemia?

A

A condition where serum potassium (K+) levels exceed 5.5 mEq/L.

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4
Q

What are the early clinical manifestations of Hyperkalemia?

A
  • Hyperactive muscles
  • Paraesthesia
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5
Q

What are the late clinical manifestations of Hyperkalemia?

A
  • Muscle weakness
  • Flaccid paralysis
  • Change in ECG pattern
  • Dysrhythmias
  • Bradycardia
  • Cardiac arrest
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6
Q

What is the initial treatment for Hyperkalemia?

A
  • Find cause & treat
  • Calcium gluconate IV
  • Soluble insulin with 50% glucose IV
  • Ion exchange resin
  • Bicarbonate IV
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7
Q

What is the long-term treatment for Hyperkalemia?

A

Dialysis.

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8
Q

What are the clinical manifestations of Hypokalaemia?

A
  • Weakness
  • Flaccid paralysis
  • Respiratory arrest
  • Constipation
  • Dysrhythmias
  • Postural hypotension
  • Cardiac arrest
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9
Q

What is the treatment for Hypokalaemia?

A

Increase K+ intake, preferably by foods, but slowly.

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10
Q

What is the etiology of Hyperkalemia?

A
  • Renal disease
  • Massive cellular trauma
  • Insulin deficiency
  • Addison’s disease
  • Potassium-sparing diuretics
  • Decreased blood pH
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11
Q

True or False: Peritoneal dialysis is as effective as hemodialysis for treating Hyperkalemia.

A

False.

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12
Q

What are some causes of Hypernatremia?

A
  • Hypertonic IV solution
  • Oversecretion of aldosterone
  • Loss of pure water
  • Long-term sweating with chronic fever
  • Respiratory infection
  • Diabetes
  • Insufficient intake of water
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13
Q

What is the treatment for Hyponatremia?

A
  • Water restriction
  • Sodium chloride administration
  • Hypertonic saline for severe cases
  • Vaptan
  • Treat underlying aetiology
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14
Q

What are the clinical manifestations of Hyponatremia?

A
  • Neurological symptoms: lethargy, headache, confusion, seizures
  • Muscle symptoms: cramps, weakness
  • Gastrointestinal symptoms: nausea, vomiting, abdominal cramps
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15
Q

What is the treatment for Hypernatremia?

A
  • Desmopressin for DI
  • Volume status assessment
  • Salt restriction
  • Loop diuretics with water
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16
Q

What are the aetiologies of calcium imbalance?

A
  • Hypocalcemia: post thyroid surgery, renal failure, hyperphosphatemia
  • Hypercalcemia: renal dysfunction, malignant disease, nutritional disorders
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17
Q

What are the clinical features of Hypocalcaemia?

A
  • Tetany
  • Depression
  • Perioral paraesthesiae
  • Carpopedal spasm
  • Neuromuscular excitability
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18
Q

What is the treatment for Hypercalcemia?

A
  • Treat the etiology
  • Saline diuresis with furosemide
  • Inhibit bone resorption
  • Hemodialysis
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19
Q

What is the normal serum level of potassium?

A

3.5-5.0 mmol/L.

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20
Q

What is the primary intracellular ion?

A

Potassium.

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21
Q

Fill in the blank: An electrolyte is a substance whose components dissociate in solution into positively charged _______ and negatively charged _______.

A

[cations], [anions]

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22
Q

What regulates sodium balance in the body?

A

ADH.

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23
Q

What is the RDA for sodium?

A

2400 mg (1-2 mEq/kg/day).

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24
Q

What is the RDA for potassium?

A

4700 mg (0.6-0.8 mEq/kg/day).

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25
Q

What is the significance of serum osmolality?

A

It helps assess the concentration of solutes in the serum.

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26
Q

Reference interval for hyperkalemia

A

3.5-5.0mmol/l

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27
Q

The most important intracellular cation Is?

A

Potassium

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28
Q

Which of the concentration of potassium (extracellular or intracellular ) is of clinical significance

A

Extracellular concentration

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29
Q

When does potassium arrest the heart

A

Diastole

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30
Q

When does calcium cause cardiac arrrest

A

In systole

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31
Q

What does AKI stand for?

A

Acute Kidney Injury

32
Q

What is the primary clinical measurement used to diagnose AKI?

A

A rise in serum creatinine and a decrease in urinary output

33
Q

According to KDIGO guidelines, what is one criterion for diagnosing AKI?

A

A rise from baseline of at least 0.3 mg/dL (26µmol/L) within 48 h

34
Q

What is the KDIGO definition for a reduction in urine output indicative of AKI?

A

A reduction in urine output to <0.5 mL/kg per hour for >6 consecutive hours

35
Q

What are common findings associated with AKI?

A
  • Increased plasma urea
  • Hyperkalemia
  • Increased anion gap
36
Q

What is the role of intravenous crystalloid solutions in AKI?

A

They may prevent further deterioration of AKI in many cases

37
Q

What percentage of hospital patients experience AKI?

A

About 18%

38
Q

What are some risk factors for developing AKI?

A
  • Older age
  • Pre-existing CKD
  • Male gender
  • Co-morbidities (e.g., diabetes, heart disease)
39
Q

What are the three categories of AKI precipitating factors?

A
  • Pre-renal
  • Renal
  • Post-renal
40
Q

What is the most common cause of AKI?

A

Pre-renal AKI

41
Q

What characterizes pre-renal azotemia?

A

Diminished renal function due to poor renal perfusion

42
Q

What urine sodium concentration is typically seen in pre-renal azotemia?

A

Typically <20 mmol/L

43
Q

What is the first urgent requirement in treating pre-renal AKI?

A

Restoration of extracellular volume

44
Q

What is intrinsic AKI caused by?

A

Primary vascular, glomerular, or interstitial disorders

45
Q

What is the most common kidney lesion seen in intrinsic AKI?

A

Acute tubular necrosis (ATN)

46
Q

What are some nephrotoxins that can cause intrinsic AKI?

A
  • Contrast agents
  • Aminoglycoside antibiotics
  • Hemoglobin
  • Myoglobin
47
Q

What is a common finding in urine for intrinsic renal azotemia?

A

Isosthenuric urine

48
Q

What does the fractional excretion of sodium (FeNa) indicate?

A

The kidney’s ability to reabsorb sodium

49
Q

What is a typical serum urea to creatinine ratio in prerenal azotemia?

A

Above 40:1

50
Q

What type of AKI occurs when urine flow is obstructed?

A

Post-renal AKI

51
Q

What is one common urinalysis finding in prerenal azotemia?

A

Unremarkable or hyaline casts

52
Q

What tests are crucial in the investigation of AKI?

A
  • Blood tests
  • Urinalysis
  • Imaging (ultrasound)
53
Q

What is the typical duration for renal tubular epithelial cell regeneration after injury?

A

3–4 weeks

54
Q

What is a key feature of urine in intrinsic renal disease?

A

Urine sodium concentration >20 mmol/L

55
Q

True or False: AKI is a disease entity.

A

False

56
Q

What is the NEWS score derived from?

A

Seven physiological variables or vital signs

57
Q

What can increased urinary output indicate in the context of AKI?

A

A normal kidney function

58
Q

What type of obstruction may lead to post-renal azotemia?

A

Functional or structural obstruction

59
Q

What is the significance of urinalysis in patients with AKI?

A

To test for infection, hematuria, and proteinuria

60
Q

What is the primary characteristic of acute kidney injury (AKI) due to intrinsic renal pathology?

A

Typical features of AKI due to intrinsic renal pathology.

61
Q

What laboratory finding indicates a patient has hyperkalemia?

A

Potassium level above 5.0 mmol/L.

62
Q

What is the significance of a urea:creatinine ratio less than 40:1 in renal dysfunction?

A

It favors the diagnosis of intrinsic renal disease.

63
Q

What are the four key components defining nephrotic syndrome?

A
  • Massive proteinuria
  • Hypoalbuminemia
  • Peripheral edema
  • Hyperlipidemia
64
Q

Fill in the blank: Nephrosis is a clinical disorder defined by massive _______.

A

[proteinuria]

65
Q

What laboratory tests are performed in nephrotic patients?

A
  • Establish the clinical syndrome
  • Evaluate renal function
  • Define the underlying etiological process
  • Monitor the effects of therapy
66
Q

What is the typical urine sodium level in pre-renal AKI?

A

Less than 1%.

67
Q

What is the most likely diagnosis for a patient with azotemia and a short duration of illness?

A

Acute kidney injury (pre-renal).

68
Q

True or False: The fractional excretion of sodium is typically above 1% in intrinsic acute kidney injury.

A

True.

69
Q

What are the laboratory findings of a patient with severe dyspnea and acute renal failure after drug withdrawal?

A
  • Hypertension
  • Elevated creatinine
  • Elevated urea
  • Altered sodium and potassium levels
70
Q

What does a urine osmolality of 298 mosm/Kg suggest in the context of renal disease?

A

It is typical of intrinsic renal disease.

71
Q

What is the expected change in urine output for a patient recovering from acute tubular necrosis (ATN)?

A

Urine output increases to >1500 mL/day.

72
Q

What can happen if a patient’s serum potassium falls to 3.1 mmol/L?

A

Oral potassium supplementation may be initiated.

73
Q

What is the reference interval for plasma sodium levels?

A

132-144 mmol/L.

74
Q

What laboratory value indicates metabolic acidosis in a patient?

A

Bicarbonate levels below the reference interval.

75
Q

Fill in the blank: A plasma creatinine level of _______ mg/dL indicates severe renal impairment.

A

[greater than 5.0]

76
Q

What are the typical laboratory findings for a patient undergoing acute renal failure?

A
  • Elevated creatinine
  • Elevated urea
  • Variable sodium and potassium levels
77
Q

What does a urine osmolality of 325 mosm/Kg indicate?

A

It suggests concentrated urine, possibly due to dehydration.

Chemical Pathology (2 decks)

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