Kidney I Flashcards
Normal SCr
0.5-1.2 mg/dL
Normal Cystatin C
0.5-1.2 mg/dL
BUN/SCr for decreased kidney perfusion
> 20:1
oliguria
UOP < 400 mL
anuria
UOP <50 mL
Normal albumin
< 30 mg/day
microalbuminuria
30-299 mg/day
macroalbuminura
> = 300 mg/day
What does the kidney do in hypovolemia?
What does urine volume, sodium and specific gravity look like?
preserve salt and water
«_space;urine volume, < urine sodium, > urine specific gravity (concentrated)
What does the kidney do in hypervolemia?
What does urine volume, sodium and specific gravity look like?
eliminates salt and water
» urine volume, > urine sodium, < urine specific gravity (diluted)
insensible, sweat, urine, loop diuretic urine
hypotonic fluid loss
loop diuretic urine, blood, vomiting diarrhea
isotonic fluid loss
clinical presentation of hypovolemia
tachycardia, hypotension, poor skin turgor, slow capillary refill, dry mucus membranes, orthostasis, cool extremities, low jugular venous pressure
clinical presentation of hypervolemia
hypertension, edema, weight gain, +JVD
D5W
hypotonic
0.45% NaCl
hypotonic
0.9% NaCl
isotonic
3% NaCl
hypertonic
Lactated ringers
isotonic
5% albumin
isotonic
NS D5W
isotonic
NS D5W w/ 20 mEq KCl
hypertonic
1/2 NS D5W
hypotonic
1/2 NS D5W w/ 20 mEq KCl
hypotonic
1/2 NS D5W w/ 40 mEq KCl
hypotonic
What are the bolus isotonic crystalloids and what are they used for?
Lactated ringers, plasma-lyte A, and NS
hemodynamic instability
Maintenance fluids infusion rate
30-35 mL/kg per day
give less than maintenance fluids
CKD, chronic liver disease, HF, liver disease
give more than maintenance fluids
dehydrated, hemodynamic shock
hyponatremia is defined as
Na < 135 mEq/L
drugs that cause hyponatremia
SSRIs, carbamazepine, opiates
symptoms of hyponatremia
HA > confusion > lethargy > coma
hypertonic hyponatremia is due to
hyperglycemia- sugar diluting Na
hyponatremia where TBW is increased
isovolemic hypotonic hyponatremia
v2 antagonist used for isovolemic hypotonic hyponatremia due to HF, cirrhosis, or SIADH
tolvaptan (samsca)
side effects of tolvaptan
thirst, polyuria, constipation
BBW tolvaptan
hepatotoxicity
V1/V2 antagonist given IV for acute isovolemic hypotonic hyponatremia
conivaptan
hyponatremia with high Na and very high TBW
hypervolemic hypotonic hyponatremia
hyponatremia with very low NA and low TBW
hypovolemic hypotonic hyponatremia
HYPO x3 (hyponatremia) is treated with
0.9% NS
maximum correction rate for hypo x3
6-8 mEq/L/day, up to 12 if acute
0.25-0.5 mEq/L/hr
Goal Na for hyponatremia
135-145 mEq/L
hypernatremia with lots of of TBW loss relative to Na
hypovolemia hypernatremia
hypernatremia with TBW loss while Na is the same
euvolemic hypernatremia
hypernatremia with very high Na with high TBW
hypervolemic hypernatremia
furosemide name brand
lasix
bumetanide name brand
bumex
torsemide name brand
demadex
ethacrynic acid name brand
edecrin
loop diuretics
furosemide, bumetanide, torsemide, ethacrynic acid
furosemide IV and PO dose
DOA
IV 20
PO 40
6hr
bumetanide IV and PO dose
DOA
IV 1
PO 1
4-8hr
torsemide IV and PO dose
DOA
IV 20
PO 20
6-12 hr
ethacrynic acid IV and PO dose
DOA
clinical pearl
IV 50
PO 50
6-8 hr
No sulfa
side effects of loops
hypokalemia, metabolic alkalosis, renal injury, ototoxicity, sulfa reaction
goal for acute diuretic dosing
UOP >= 500 mL in 6 hours
thiazide diuretics
HCTZ, chlorothiazide, chlorthalidone, metolazone, indapamide
side effects of thiazides
hyperuricemia, hypercalcemia, hypokalemia
K sparing diuretics
spironolactone, eplerenone, amiloride, triamterene
side effects of K sparing
hyperkalemia, metabolic acidosis
carbonic anhydrase inhibitor
acetazolamide
side effect of acetazolamide
metabolic acidosism
mild hypokalemia
3-3.5 mEq/L
moderate hypokalemia
2.5-3 mEq/L
Severe hypokalemia
< 2.5 mEq/L
causes of hypokalemia
GI losses, diuretics, hypomagnesemia
drugs causing hypokalemia
diuretics, steroids, insulin, glucose, B agonists…
presentation of hypokalemia
cramping, weakness, fatigue, arrhythmias, ECG abnormalities
side effects of KCL supplement
IV- thrombophlebitis, hyperkalemia, pain/burning
PO- GI irritation & erosion
peripheral KCl infusion rate
10-20 mEq/100mL over 1 hour
central KCl infusion rate
40 mEq/100 mL over 1 hour
hyperkalemia is characterized by
K > 5.5 mEq/L
causes of hyperkalemia
increased dietary K, decreased renal K excretion, renal tubule unresponsive to aldosterone, etc.
drugs that cause hyperkalemia
ACE, ARB, RIs, B-blockers, aldosterone antagonists, K sparing diuretics, etc.
clinical presentation of hyperkalemia
palpitations and ECG changes (arrhythmias)
sodium polystyrene sulfonate (SPS)
use and dose
chronic treatment of hyperkalemia, also in emergent hyperkalemia
15-30 mg PO QW to TID
side effects of SPS
GI upset, intestinal necrosis
patiromer (veltassa)
use and dose
chronic treatment of hyperkalemia
8.4 g QD titrated to 25.2 g QD
side effects of patiromer
GI, hypomagnesemia
administer 3 hrs away from other meds
sodium zirconium cyclosilicate (lokelma)
use and dose
chronic treatment of hyperkalemia
10 g PO TID x48hrs then 10 g QD
side effects of lokelma
edema
administer 2 hrs away from other meds
emergent hyperkalemia is characterized by
K > 7 mEq/L OR
K 5.5-6.9 mEq/L with ECG changes
treatment for ECG change in emergent hyperkalemia
1g IV calcium gluconate
therapy to shift K into cells in emergent hyperkalemia
regular insulin 10U IV + 25g dextrose if euglycemic
50-100 mEq IV Na Bicarb if acidotic
albuterol nebulizer if cannot get IV access
treatment removing excess K in emergent hyperkalemia
sodium polystyrene sulfonate 15-30 mg PO
IV loop
emergent hemodialysis
