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Laughing Your Way > Nephrology > Flashcards

Nephrology Flashcards

1
Q

Serum osmolality equation

A

2Na + BUN/2.8 + Glucose/18

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2
Q

Leading cause of metabolic acidosis in children

A

Diarrhea

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3
Q

Electrolyte derangement in pyloric stenosis

A

Hypochloremia
Hypokalemia
Hyponatremia
Metabolic alkalosis

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4
Q

Anion gap

A

Na - (Cl + HCO3)

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5
Q

Most common cause of NAGMA in children

A

Diarrhea

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6
Q

Causes of NAGMA

A

Ureterostomy
Small bowel fistula
Extra chloride
Diarrhea
Chronic diuretic use
Adrenal insufficiency
RTA
Pancreatic fistula

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7
Q

Causes of HAGMA

A

Methanol
Uremia
DKA
Paraldehyde
Isoniazid (INH)
Lactic acid
Ethanol/ethylene glycol
Salicylates

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8
Q

Compensation for metabolic acidosis

A

PCO2 = 1.5 (HCO3) + 8

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9
Q

Compensation for metabolic alkalosis

A

PCO2 = 40 + 0.7 (change in HCO3)

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10
Q

Compensation for respiratory acidosis

A

Acute: 1 HCO3 for every 10 CO2

Chronic: 3.5 HCO3 for every 10 CO2

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11
Q

Compensation for respiratory alkalosis

A

Acute: 2 HCO3 for every 10 CO2

Chronic: 5 HCO3 for every 10 CO2

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12
Q

Delta/delta

A

Change in AG / change in HCO3

> 2 = HAGMA + metabolic alkalosis
< 1 = HAGMA + NAGMA
1-2 = HAGMA

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13
Q

Acid base disturbance with cirrhosis and progesterone (pregnancy, OCP)

A

Respiratory alkalosis

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14
Q

Metabolic alkalosis + Ur Cl < 15

A

Chloride responsive
Volume depleted
Cl and HCO3 absorbed by kidneys

Remote diuretics
Volume depletion
Vomiting
NGT aspiration
Exogenous alkali

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15
Q

Metabolic alkalosis + Ur Cl > 15

A

Chloride unresponsive
Volume expanded
H lost but HCO3 not lost
Cl lost and HCO3 absorbed by kidneys

Diuretics
Recent high BP.
Hyper aldosteronism.
Cushing’s syndrome.
Licorice ingestion
Liddle’s syndrome.

Low/Normal BP
-hypomagnesemia
–hypokalemia.
–Bartter syndrome.
–Gitelman syndrome.

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16
Q

Decreased transportation, defect in ascending loop of Henle
Hypokalemia.
Lowe BP
Ur Cl > 15
Metabolic alkalosis
Similar to furosemide

A

Bartter syndrome

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17
Q

Decreased transportation defect in distal tubule.
Hypokalemia
Low BP.
Ur Cl > 15
Metabolic alkalosis
Increase uric acid
Increase Ca
Similar to thiazides

A

GItelman syndrome

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18
Q

Increased (aldosterone independent) transport defect and distal tubule
Hypokalemia
High BP
Ur Cl > 15
Metabolic alkalosis
Similar to hyperaldosteronism and licorice ingestion

A

Liddle’s syndrome

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19
Q

HAGMA + rectangular shaped calcium oxalate crystals

A

Ethylene glycol
(Aka antifreeze)

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20
Q

Management for osmolar gap

A

< 20 = supportive
> 20 = fomepizole
> 50 = HD + fomepizole

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21
Q

Increased Ur Cl

A

Diarrhea.
Ureterosigmoidostomy

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22
Q

Decreased Ur Cl

A

RTA
Early kidney disease
End stage kidney disease

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23
Q

Urine anion gap

A

UrNa + UrK - UrCl

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24
Q

Positive UAG

A

RTA

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25
Q

Negative UAG

A

Diarrhea (GI losses)

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26
Q

Defect in reabsorption of HCO3
+/- stone
Hypokalemia
Fanconi
Acetazolamide 
Topiramate

A

Proximal (Type 2) RTA

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27
Q

Defect in H & K excretion
No stones
Hyperkalemia
Ur pH < 5.5
Hypoaldosteronism
DM

A

Type 4 (hypoaldosterone) RTA

28
Q

Defect in H excretion
+ stones (CaPO4)
Hypokalemia
Ur pH > 5.5
SLE
Sjogren
Amphotericin B

A

Classic distal (type 1) RTA

29
Q

Daily requirement for sodium

A

3 mEq/kg/day

30
Q

Causes of Hypernatremia

A

Sodium excess:
-improper mixing a formula (not enough water)
-Ingestion of sea saltwater
-Excessive sodium bicarb after resuscitation
-Breastmilk with excess of sodium
-Iatrogenic

Water deficit
-DI
-Diarrhea

31
Q

Dilute urine
Hypernatremia
X-linked
Fails to respond to exogenous vasopressin

A

Nephrogenic DI

32
Q

Causes of hyponatremia

A

Loss of sodium
Increased water
-polydipsia
-SIADH

33
Q

Causes of SIADH

A

Trauma
Brain infection
Pulmonary disorders
Endocrine disorders
Vincristine
Cyclophosphamide
Carbamazepine
Post-op

34
Q

Hyponatremia
Elevated BP
Decreased UOP
Elevated Urine Na (> 25 mEq/L)
Normal renal function

A

SIADH

35
Q

Management of SIADH

A

Fluid restriction

Lasix
Hypertonic saline (Na < 120)
Demeclocycline (blocks effects of ADH on kidneys. Only indicated in > 8 yo)
Lithium (blocks effects of ADH on kidneys)

36
Q

Normal Total body Na
Urine Na high

A

Dilutional hyponatremia

37
Q

Increased UOP
High Urine Na

A

Cerebral salt wasting

38
Q

Elevated TG and/or plasma protein
HypoNa

A

Pseudohyponatremia

39
Q

Hypernatremia
Low urine Na
Low urine Osm (SG)
No urine Osm change post H2O deprivation
High urine Osm post DDAVP

A

Central DI

40
Q

Hypernatremia
Low urine Na
Low urine Osm (SG)
No urine Osm change post H2O deprivation
No urine Osm change post DDAVP

A

Nephrogenic DI

41
Q

Hyponatremia
Low urine Na
Low urine Osm (SG)
High urine Osm post H2O deprivation
High urine Osm post DDAVP

A

Psychogenic/polydipsia

42
Q

Hyponatremia
High urine Na
High urine Osm (SG)

A

SIADH

43
Q

Hyponatremia
High urine Na
High urine Osm (SG)
High urine Osm post DDAVP

A

Cerebral salt wasting

44
Q

Cause Hypertonic Hyponatremia

A

Hyperglycemia

45
Q

Cause of hypotonic isovolemic hyponatremia

A

SIADH

46
Q

Cause of hypotonic hypovolemic hyponatrmia

A

Diarrhea (Ur Na < 20)

CSW (Ur Na > 20)

47
Q

Daily requirement for potassium

A

2 mEq/kg/day

48
Q

Causes of hypokalemia

A

Poor intake

Loss
-GI
-Renal

49
Q

EKG changes in hypokalemia

A

Flatten T waves
ST depression
PVC
U wave

50
Q

Replacing potassium

A

KCl 0.5-1 mEq/L/kg

51
Q

Muscle weakness + prolonged QT

A

Hypocalcemia

52
Q

Diarrhea
Prolonged PR or QT

A

Hypomagnesemia

53
Q

Muscle weakness
No EKG changes

A

Hypoglycemia
Hyponatremia

54
Q

Causes of Hyperkalemia

A

Excess intake
Renal failure
Hypoaldosteronism
Acidosis
Cell breakdown (pseudohyperkalemia)

55
Q

EKG changes in hyperkalemia

A

Peaked T waves
Absent P waves
Wide QRS complex
Prolonged PR interval
V fib and asystole (electromechanical dissociation)

56
Q

Treatment for hyperkalemia

A

Calcium gluconate/chloride
Bicarbonate/Beta-agonist
Insulin/glucose
Kayexalate
Diuretics/Dialysis

57
Q

Potassium-pH relationship

A

For every 0.1 pH drop, K increases 0.6

For every 0.1 pH rise, K drops 0.6

58
Q

Signs of mild (5%) dehydration

A

Tachycardia
Decreased tear production
Decreased UOP
Increased urine concentration

59
Q

Volume down in 5% dehydration

A

50 mL/kg

Add to maintenance fluids

60
Q

Signs of Moderate (10%) dehydration

A

Tachycardia
Sunken eyes
Poor skin turgor
Sunken fontanelle

61
Q

Volume down in 10% dehydration

A

100 mL/kg

Add to maintenance fluids
Or give 20 mL/kg over 1 hr

62
Q

Signs of severe (15%) dehydration

A

Shock
Delayed Cap refill

63
Q

Volume down in 15% dehydration

A

150 mL/kg

Add to maintenance fluids
Or continuous 20 mL/kg boluses until improvement

64
Q

Sodium replacement

A

(Desired Na - measured Na) x wt x 0.6

Add above to maintenance Na (3 mEq/kg/day)

Equals total Na replacement in 24 hr

65
Q

Electrolyte abnormality in cystic fibrosis

A

Hypochloremia
Hyponatremia
Metabolic alkalosis

Laughing Your Way (34 decks)

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