Kidney I Flashcards by Sara Bojarski

Normal SCr

0.5-1.2 mg/dL

How well did you know this?

Not at all

Perfectly

Normal Cystatin C

0.5-1.2 mg/dL

How well did you know this?

Not at all

Perfectly

BUN/SCr for decreased kidney perfusion

> 20:1

How well did you know this?

Not at all

Perfectly

oliguria

UOP < 400 mL

How well did you know this?

Not at all

Perfectly

anuria

UOP <50 mL

How well did you know this?

Not at all

Perfectly

Normal albumin

< 30 mg/day

How well did you know this?

Not at all

Perfectly

microalbuminuria

30-299 mg/day

How well did you know this?

Not at all

Perfectly

macroalbuminura

> = 300 mg/day

How well did you know this?

Not at all

Perfectly

What does the kidney do in hypovolemia?
What does urine volume, sodium and specific gravity look like?

preserve salt and water
&laquo_space;urine volume, < urine sodium, > urine specific gravity (concentrated)

How well did you know this?

Not at all

Perfectly

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)

How well did you know this?

Not at all

Perfectly

insensible, sweat, urine, loop diuretic urine

hypotonic fluid loss

How well did you know this?

Not at all

Perfectly

loop diuretic urine, blood, vomiting diarrhea

isotonic fluid loss

How well did you know this?

Not at all

Perfectly

clinical presentation of hypovolemia

tachycardia, hypotension, poor skin turgor, slow capillary refill, dry mucus membranes, orthostasis, cool extremities, low jugular venous pressure

How well did you know this?

Not at all

Perfectly

clinical presentation of hypervolemia

hypertension, edema, weight gain, +JVD

How well did you know this?

Not at all

Perfectly

D5W

hypotonic

How well did you know this?

Not at all

Perfectly

0.45% NaCl

hypotonic

How well did you know this?

Not at all

Perfectly

0.9% NaCl

isotonic

How well did you know this?

Not at all

Perfectly

3% NaCl

hypertonic

How well did you know this?

Not at all

Perfectly

Lactated ringers

isotonic

How well did you know this?

Not at all

Perfectly

5% albumin

isotonic

How well did you know this?

Not at all

Perfectly

NS D5W

isotonic

How well did you know this?

Not at all

Perfectly

NS D5W w/ 20 mEq KCl

hypertonic

How well did you know this?

Not at all

Perfectly

1/2 NS D5W

hypotonic

How well did you know this?

Not at all

Perfectly

1/2 NS D5W w/ 20 mEq KCl

hypotonic

How well did you know this?

Not at all

Perfectly

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