Nephrology Flashcards
Respiratory acidosis causes
Hypoventilation
- opiates
- COPD
- Asthma
- OSA
- Muscle strength
Respiratory alkalosis causes
- Pain
- Anxiety
- Hypoxemia
Anion gap metabolic acidosis causes
MUDPILES
- Methanol
- Uremia
- DKA
- Propylene Glycol
- Iron and INH
- Lactic acidosis
- Ethylene Glycol
- Salicylates
Non-gap metabolic acidosis management
Do Urine anion gap
+ is renal tubular acidosis
- is diarrhea
What do you do when you find out a patient has metabolic alkalosis?
Urine Cl-
What does a urine Cl->10 in the setting of metabolic alkalosis indicate? What is management?
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
What does a urine Cl-
Indicates volume responsiveness.
Could be from diarrhea, dehydration, emesis, or NG suction. Give fluids.
The only thing that causes metabolic alkalosis is ______
high aldosterone
Anion gap equation
Na-Cl-bicarb, must be 12 for normal
DKA (MUDPILES)
Diabetic who is acidotic. Look for ketones. Treat with insulin, fluids, and replete potassium
Methanol
Homemade liquor (moonshine), causes blindness. No cure
Ethylene Glycol, what is it? What does it do? What do you give for it?
Crystals in the urine, urine turns colors under Wood’s lamp. Give either ethanol or fomepizole
Lactic acidosis
Either metformin + AKI or … patient in shock (fix the shock)
Urine anion gap equation
Na + K - Cl
How do you fix hypernatremia?
PO water mild
IV NS moderate
IV D5W severe
What do you give a patient in a severe state of hyponatremia (seizure, coma)?
Hypertonic saline (3%)
How do you correct moderate hyponatremia?
IV NS
When a patient is volume down, what do you do?
Urine sodium. Fluids if extra renal
What does high potassium cause?
Areflexia, spastic paralysis, paresthesia, ECG changes (long QRS, peaked T)
What is the first thing you do when there is hyperkalemia?
Recheck potassium
What do you do if you have 2 readings indicating hyperkalemia?
ECG
What do you do if ECG confirms cardiac changes in the setting of hyperkalemia?
-IV calcium: stabilizes myocardium
-Insulin+Glucose: Shifts K into cells
-Bicarb: Shifts K into cells
Kayaexalate- Decreases total body potassium
-Dialysis: Decreases K
What do you do if Hyperkalemia is confirmed but there are no ECG changes?
Patient is stable, treat with Kayaxelate
What usually causes hypokalemia?
GI (diarrhea, laxatives, vomiting) or renal losses (hyperaldo states, thiazide, loop diuretics)
Hypokalemia management
Recheck K, ECG, replace K with PO>IV
Treatment for hypercalcemia
IVF, bisphosphonates, furosemide
What treatment gets you through a hypercalcemia crisis?
Calcitonin
When is furosemide given for hypercalcemia?
After volume status is corrected
What test can be used to figure out which parathyroid gland is overactive?
radionucleotide scan
used for hypertensive emergencies, nitroprusside can cause _____
cyanide toxcitiy (lactic acidosis is a symptom)
