Nephrology

Question 1

Respiratory acidosis causes

Answer 1

Hypoventilation

• opiates
• COPD
• Asthma
• OSA
• Muscle strength

Question 2

Respiratory alkalosis causes

Answer 2

• Pain
• Anxiety
• Hypoxemia

Question 3

Anion gap metabolic acidosis causes

Answer 3

MUDPILES

• Methanol
• Uremia
• DKA
• Propylene Glycol
• Iron and INH
• Lactic acidosis
• Ethylene Glycol
• Salicylates

Question 4

Non-gap metabolic acidosis management

Answer 4

Do Urine anion gap
+ is renal tubular acidosis
- is diarrhea

Question 5

What do you do when you find out a patient has metabolic alkalosis?

Answer 5

Urine Cl-

Question 6

What does a urine Cl->10 in the setting of metabolic alkalosis indicate? What is management?

Answer 6

Not volume responsive, likely HTN. If HTN and Ucl >10, is hyper-aldosterone.  Causes:
-renal artery stenosis
-Conn's Syndrome
If no HTN, genetic, could be
-Barter
-Gitelman

Question 7

What does a urine Cl-

Answer 7

Indicates volume responsiveness.

Could be from diarrhea, dehydration, emesis, or NG suction. Give fluids.

Question 8

The only thing that causes metabolic alkalosis is ______

Answer 8

high aldosterone

Question 9

Anion gap equation

Answer 9

Na-Cl-bicarb, must be 12 for normal

Question 10

DKA (MUDPILES)

Answer 10

Diabetic who is acidotic. Look for ketones. Treat with insulin, fluids, and replete potassium

Question 11

Methanol

Answer 11

Homemade liquor (moonshine), causes blindness. No cure

Question 12

Ethylene Glycol, what is it? What does it do? What do you give for it?

Answer 12

Crystals in the urine, urine turns colors under Wood’s lamp. Give either ethanol or fomepizole

Question 13

Lactic acidosis

Answer 13

Either metformin + AKI or … patient in shock (fix the shock)

Question 14

Urine anion gap equation

Answer 14

Na + K - Cl

Question 15

How do you fix hypernatremia?

Answer 15

PO water mild
IV NS moderate
IV D5W severe

Question 16

What do you give a patient in a severe state of hyponatremia (seizure, coma)?

Answer 16

Hypertonic saline (3%)

Question 17

How do you correct moderate hyponatremia?

Answer 17

IV NS

Question 18

When a patient is volume down, what do you do?

Answer 18

Urine sodium. Fluids if extra renal

Question 19

What does high potassium cause?

Answer 19

Areflexia, spastic paralysis, paresthesia, ECG changes (long QRS, peaked T)

Question 20

What is the first thing you do when there is hyperkalemia?

Answer 20

Recheck potassium

Question 21

What do you do if you have 2 readings indicating hyperkalemia?

Answer 21

ECG

Question 22

What do you do if ECG confirms cardiac changes in the setting of hyperkalemia?

Answer 22

-IV calcium: stabilizes myocardium
-Insulin+Glucose: Shifts K into cells
-Bicarb: Shifts K into cells
Kayaexalate- Decreases total body potassium
-Dialysis: Decreases K

Question 23

What do you do if Hyperkalemia is confirmed but there are no ECG changes?

Answer 23

Patient is stable, treat with Kayaxelate

Question 24

What usually causes hypokalemia?

Answer 24

GI (diarrhea, laxatives, vomiting) or renal losses (hyperaldo states, thiazide, loop diuretics)

Question 25

Hypokalemia management

Answer 25

Recheck K, ECG, replace K with PO>IV

Question 26

Treatment for hypercalcemia

Answer 26

IVF, bisphosphonates, furosemide

Question 27

What treatment gets you through a hypercalcemia crisis?

Answer 27

Calcitonin

Question 28

When is furosemide given for hypercalcemia?

Answer 28

After volume status is corrected

Question 29

What test can be used to figure out which parathyroid gland is overactive?

Answer 29

radionucleotide scan

Question 30

used for hypertensive emergencies, nitroprusside can cause _____

Answer 30

cyanide toxcitiy (lactic acidosis is a symptom)