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nephrology Flashcards

1
Q

acidosis and acidemia

A 
acidosis= low serum bicarb
acidemia= serum pH<7.35
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2
Q

alkalosis and alkalemia

A

alkalosis= high serum bicarb

alkalemia=serum pH >7.45

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3
Q

effects of acidosis

A

decrease in force of cardiac contractions
decrease in vascular response to catecholamines
diminished response to the effects and actions of certain meds

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4
Q

effects of alkalosis

A

interferes w/ tissue oxygenation

interferes w/ normal neurological and muscular functioning

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5
Q

what causes oxy curve to shift to right

A

increased H ions (decrease in pH), increased CO2, increase in temp

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6
Q

mudpiles

A 
methanol
uremia
DKA
paraldehyde
INH, IRON
Lactic acidosis
ethylene glycol
salicylates
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7
Q

used CAR (non anion gap)

A 
ureteral sigmoid diversions
saline admin
endocrinopathies (addisons, spironlacone, hyper   PTH)
diarrhea
carbonic anhydrase inhibitors
hyperalimentation
RTA
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8
Q

when are urine Anion gaps seen

A

urine anion gap>20 is seen in metabolic acidosis

If urine anion gap is 0 or negative but serum Anion gap is positive the source is most liley GI (diarrhea or vomitting)

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9
Q

when to use winters and summers formula

A

in metabolic acid base disorders…used to calculate respiratory compensation
Winters= metabolic acidosis (when projected CO2 is higher than actual there is respiratory alkalosis….when projected co2 is lower than actual there is concommittent respiratory acidosis)
summers= metabolic alkalosis (when projected CO2 is higher than actual there is respiratory alkalosis…when projected CO2 is lower than actual there is concommittent respiratory acidosis)

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10
Q

triple ripple

A

calculate the delta anion gap

tells if 3rd derangement

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11
Q

metabolic alkalosis

A

GI hydrogen loss

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12
Q

contraction alkalosis

A

basically is DEHYDRATION
loss of large volume of fluid and leave HCO3 in body then its more concentrated and get alkalosis
caused by: loop diuretics, thiazides, prolonged vomiting (if giving diuretic need to monitor this), sweat loses in pts w/ cystic fibrosis (cause H and Cl are secreted together)

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13
Q

what do you need to do if have metabolic derangment

A

check for compensation by summers or winters

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14
Q

what do you need to do if have respiratory derangement

A

check for compensation by looking for change in bicarb

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15
Q

what do you want to do before you get an ABG

A

allens test

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16
Q

causes of metabolic alkalosis

A

vomiting or NG suction, increase aldosterone secretion, loop/thiazide diuretic, hypercalcemia, hypokalemia, contraction alkalosis (massive diuresis, sweat losses in Cystic fibrosis), posthypercapnic alkalosis ( usually by mechanical ventilation)

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17
Q

posthypercapnic alkalosis

A

overcorrect someone’s co2 (wrong ventilator setting)

18
Q

2 basic categories of diseases when kidney’s retain HCO3

A

differentiated by response to NaCl

  1. chloride responsive (10) (these problems are telling kidney to retain HCO3 so NaCl won’t help)
    a. excess mineralocorticoid (cushings syndrome, conn’s syndrome, exogenous steroid admin, bartter syndrome)
19
Q

tx of chloride responsive

A

replace volume w/ NaCl if depleted

correct hypokalemia if present

20
Q

tx of chloride resistant

A

treat underlying problem such as stop steroids, etc

21
Q

can get metabolic alkalosis from blood (8 or more units)

A

true (due to citrate in blood)

22
Q

waste products of metabolism

A

urea, creatine, uric acid

23
Q

BUN increased w/ creatinine normal (>20/1)

A 
prerenal azotemia
catabolic state w/ increased muscle breakdown
GI hemorrhage
High protein intake
drugs (tetracycline, steroid)
24
Q

BUN increased and creatinine increased (>20/1)

A

postrenal azotemia (obstructive uropathy)
prerenal azotemia superimposed on renal disease
basicaly post renal stuff

25
Q

decreased ratio w/ decreased BUN (<10/1)

A 
acute tubular necrosis
low protein diet/ starvation/ liver disease
repeated dialysis
SIADH
pregnancy
26
Q

decreased ratio w/ increased creatinine

A

rhabdomyolisis

muscular pts who get renal failure

27
Q

purpose of urinalysis

A

detect systemic disturbances (endocrine abnormalities and metabolic disturbances)
detect intrinsic kidney/urinary system disorders (kidney disease/uti)

28
Q

low specific gravity casues

A

diabetes insipidus
well hydrated
tubular damage and renal abnormalities

29
Q

high specific gravity

A 
diabestes
adrenal insuffieciency
hepatic disease
CHF
excessive water or other loss of water
30
Q

severity of Na levels

A

> 130= usually not treated
120-130= depends on symptoms and situations
120< panic level

31
Q

sxs of hyponatremia

A

fatigue and malaise are first sxs

32
Q

hypotonic hyponatremia

A

due to GI loses or renal loses
can result in sxs of neuronal cell expansion and cerebral edema
Nausea, HA, seizure, coma, death
tx- normal saline slow bolus (1000cc over 1 hours)

33
Q

hypervolemic hyponatremia

A

cirhosis, renal failure, CHF
tx- restrict fluids 1000-1200
restrict Na1000-1200
can use loop diuretic

34
Q

hypervolemic hypernatremia

A

Iatrogenic

Hyperaldosteronism

35
Q

hypovolemic hypernatremia

A 
renal loses (diuretics, renal disease)
extrarenal loses (sweating, diarrhea, fluid shifts (burns)
36
Q

Euvolemic hypernatremia

A

diabetes inspidus

hypodipsia

37
Q

hypervolemic hyponatremia

A

CHF
liver failure (cirrhosis)
nephrotic syndrome

38
Q

hypovolemic hyponatremia

A

renal loss

extra renal loss

39
Q

euvolemic hyponatremia

A

SIADH
hypothyroid
polydipsia
adrenal insuffieciency

40
Q

pseudohyponatremia

A

increase glucose
increase lipids
increase proteins
increase urea

41
Q

what causes hyperkalemia

A 
renal failure
volume depletion
adrenal insuffieciency 
ACE inhibitors
spironlactone
increase in K intake (oral or IV)
pseudohyperkalemia 
decrease insulin
trauma
beta blockers
acidosis
42
Q

what causes hypokalemia

A 
renal loss (diuretics, hyperaldosteronism)
GI loss (vommiting or diarrhea)
decrese K intake
increase insulin
beta agonists (increase catecholamines)
alkalosis

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