LYTES NTR

Question 1

SIADH

Answer 1

SIADH causes persistent sodium retention in the kidney leading to electrolyte abnormalities and concentrated urine. Patients with SIADH will remain normovolemic.
Patients with similar findings who are hypovolemic more likely have cerebral salt wasting disease.
Bottom Line: SIADH is associated with normovolemia.

Question 2

Fat malabsorption secondary to bile acid deficiency in patients with extensive ileal resection is associated with an increased risk

Answer 2

of oxalate kidney stones if the colon is preserved.

Mech:
long-chain FATTY acids (from steatorrhea) compete with oxalate for available luminal calcium.

larger amount of free oxalate is make it to the colon, where it is absorbed by the colon and ultimately excreted by the kidney.

Therefore, patients with short bowel syndrome who do not have a colon in continuity are not at increased risk.

Question 3

Treatment of hyperoxaluria consists of

Answer 3

restriction of oxalate

If hyperoxaluria persists,
oral administration of calcium citrate

the extra calcium precipitates dietary oxalate, and the citrate prevents stone growth in the urine.

Question 4

lyte abnormalities and EKG changes

Answer 4

Hypocalcemia- Prolonged ST and QT intervals

Hypercalcemia- shortened ST segment
- widened T wave

Hypokalemia- ST depression

• shallow, flat, inverted T wave
• Prominent U wave

Hyperkalemia- Tall, peaked T waves

• Flat P waves
• widened QRS complex
• Prolonged PR interval

Hypomagnesemia- Tall T waves
- Depressed ST segment

Hypermagnesemia- Prolonged PR interval
- widened QRS complexes

Question 5

lyte abnormalities and EKG changes mneumonic

Answer 5

think how it starts and end…so it starts with p followed by q r s t

so let’s start from where it begins…

p flat hyperkalemia

pr prolonged hyperkalemia hypermagnesemia
qrs widened hyperkalemia hypermagnesemia

qt prolonged hypocalcemia
st prolonged hypocacemia

st shortened hypercalcemia

st depressed hypokalemia hypomagnesemia

t widened hypercalcemia

t tall hyperkalemia hypomagnesemia

t inverted hypokalemia
shallow, flat

u prominent hypokalemia

Question 6

most abundant amino acid in the human body

Answer 6

Glutamine

In healthy individuals, glutamine is considered a nonessential amino acid, because it is synthesized within the skeletal muscles and the lungs.

Glutamine is a necessary substrate for nucleotide synthesis in most dividing cells and hence provides a major fuel source for enterocytes.

It also serves as an important fuel source for immunocytes and is a precursor for glutathione, a major intracellular antioxidant.

During stress states such as sepsis, or in tumor-bearing hosts, peripheralglutamine stores are rapidly depleted, and the amino acid is preferentially shunted as a fuel source toward the visceral organs and tumors, respectively.

Of all amino acids, glutamine appears to be a unique, major source of energy for enterocytes.

Active glutamine uptake into enterocytes occurs through both apical and basolateral transport mechanisms.

Bottom Line: The primary fuel source of the enterocyte in the small bowel is glutamine during times of stress.

Surgery Board Insight: Know the fuel sources for the small bowel enterocyte (glutamine) and colon (short chain fatty acids).