Nephrology

Question 1

Potassium

Answer 1

Normal 3.5-5.0

Question 2

Hyperkalemia

Answer 2

Renal failure, hypoaldosteronism, potassium, ACEi/ARB, heparin, NSAIDS, K sparing diuretics, digoxin

Question 3

Hypokalemia

Answer 3

loop diuretics, thiazide diuretics, osotic diuretics, hyperaldosteronism, mineralocorticoids, fluid loss

Question 4

Factors that indicate emergent tx of hyperkalemia

Answer 4

EKG changes 
(tall, peaked T wave, loss of p wave, widened QRS and tall T wave)
-rapid rise if serum K, (>6)
-dec renal fx
-presence of significant acidosis

Question 5

Hyperkalemia presentation

Answer 5

• usually asymptomatic
• nonspecific - weakness, fatigue, GI hypermotility
• serious arrhythmias, neuro s/e, hemodynamic changes

Question 6

Hyperkalemia and IV Ca

Answer 6

• lowers threshold potential of myocardium, no effect on serum Na
• caution with digoxin (could use Mg as alternative)
• should improve in 2-3 min
• gluconate preferred, chloride ok if central

Question 7

Hyperkalemia and D50

Answer 7

10 units regular insulin IV
50 ml of D50 (BG <250)
repeat doses if K remains high

Question 8

Hyperkalemia and inhaled beta 2 agonists

Answer 8

• 10-20 mg
• effects are additive to insulin admin
• rapid onset of action - for non-acute scenarios

Question 9

Hyperkalemia and Sodium Bicarb

Answer 9

• no longer recommended
• still useful for severe metabol acidosis
• may take several hours

Question 10

Hyperkalemia and GI elim

Answer 10

• sodium polysterene sulfonate (Kayexalate)

- exxhange sodium can result in volume overload, admin with furosemide

Question 11

Dialysis for hyperkalemia…

Answer 11

last resort

Question 12

Patiromer (Veltassa)

Answer 12

• oral GI binder to increase fecal excretion
• not emergent
• ideal for CKD or DM requiring RAAS med
• separate admin from other meds

Question 13

Sodium Zirconium Cyclosilicate (Lokelma)

Answer 13

• better suited for acute tx
• oral GI binder
• onset 1 hr

Question 14

Sodium

Answer 14

Normal 135-145

Question 15

Hypernatremia

Answer 15

increased intake, pure water loss (DI), ADH abnom, osmotic diuretics

Question 16

Hypernatremia

Answer 16

loss of body fluid, thiazides, loops, CHF, carbamazepine, lithium, liver disease

Question 17

Sodium disorder presentation

Answer 17

neuro depression, seizures, resp depression, coma

Question 18

Sodium correction rates

Answer 18

severe: 6-12 mEq/L in first 24 h and 18 mEq/L or less in 48 h
chronic: 0.5 mEq/L/hr with max change of 8-10 in 24 hr

Question 19

Calcium

Answer 19

8.5-10.5

dependent on albumin

Question 20

Hypercalcemia

Answer 20

hyperparathyroidism, cancer, thiazides, vit D definciency

Question 21

Hypocalcemia

Answer 21

hypoparathyroidism, renal disease, loops

Question 22

Hypercalcemia: Renal

Answer 22

nephrolithiasis, nephrogenic, DI, dehydration

Question 23

Hypercalcemia: Skeleton

Answer 23

bone pain, osteoporosis

Question 24

Hypercalcemia: GI, nuero, CV

Answer 24

N&V, confusion, coma, HTN, shortened QT

Question 25

Glomerulus with Bowman's Capsule

Answer 25

filtration 25% of plasma passing through becomes filtrate OSMOTIC DIURETICS

Question 26

Proximal Tubule

Answer 26

Reabsorption - NaCl mostly, but also glucose, K, amino acids, bicard, etc. Secretion - hydrogen isotonic CARBONIC ANHYDFRASE INHIBITORS

Question 27

Loops of Henle

Answer 27

descending - water reabsorption, NaCl diffuses in ascending - sodium actively reabsorbed, water stays in LOOP DIURETICS

Question 28

Distal Tubule

Answer 28

Reabsorption - NaCl, water (ADH required), bicard secretion- K, urea, hydrogen THIAZIDES

Question 29

Collecting Duct

Answer 29

Reabsorption - water (ADH required), NaCl final concentration K SPARING DIURETICS

Question 30

Hypercalcemia Tx

Answer 30

NS, Pamidronate, Calcitonin, corticosteroids

Question 31

High Alert Meds

Answer 31

significant risk of causing a devastating event to the pt if used in error all anesthetics, NMB, epidural meds