Nephrology Emergencies 2 5/1/14 Flashcards
True or false AKI children could be hypo, hyper or euvolemi
True
Treatment of AKI with hypervolemia-oliguria e.g. HTN edema
Fluid restriction ( to insensible losses
Trial of lasix 2-3 mg/kg
Hemodialysis - uncontrollable volume overload
Insensible losses - how do you calculate
about 1/3 - 1/4 of MIVF
AKI electrolyte issues
hyperphosphatemia /hypocalcemia
Treatment of hypercalcemia
IV cal gluconate - if seveer /symptomatic
1,25 OHD and oral calium therapy - \
Avoid correcting acid base
Hyperphosphatemia treatment
Oral phosphate binders
Cal carbonate /cal acetate
Sevalamer
Al hydroxide ( not for chronic use)
When you make someone alkalotic - what happens to Cal
More cal will bind albumin and ionized cal will drop
Hypertension management
Fluid retriction
Diuretics -
Avoid ARBs and ACEi - can affect renin angiotesin system - = increased K +
Cal channel blockers ( peripheral acting) e.g. amlodipine -
Beta blocker - care with hyperKalemia
Indications for acute dialysis
Hyperkalemia resistant to medical therapy
Hyperphosphatemia - if severe enough
Uremia ( uremic pericarditis) - lethargy and mental status changes
Fluid overload resistant to meds - and compromising cardiac/ Htn
Poisonings - ethanol/methanol/ lithium
Urea cycle disorders/ MCD hyperleucidemia - resulting in severe hyperammonemia
Acute dialysis mnemonic (AEIOU)
Aciosis Electrolyte Ingestions Overdose Uremia
Hemodialysis - contraindications
unsuitable for hemodynamically unstable
Hemodialysis - indications
Acute dialysis
RPGN treatment
Pulse streroid theraopy
Atypical HUS
plasmaphoresis - enfluzimab?
HUS - why do you ask about abx and antimotility
Antibiotics - break open toxin
Antimotily - keep it in
Both have been shown to make things worse with HUS
Management of HUS
if in shock - NS fluid bolus
When do you give Cal for hyperK
EKG changes
Lasix side effects
independently hypotensive effects ( give in volume overlad vs euvolemia )
Why do you not give kayexalate in HUS
Avoid in bowel disease - risk of bowel perf
HyperK in HUS
Insulin dex
Albuterol ( 1 round)
Bicarb if acidotic ( clinical context)
how much bicarb in 1 amp
50 meq
HUS - what is happening to platelets - what should you do
Being consumed - they tend not to bleed
Avoid replenishing platelets
HUS - anemia - when do you transfuse
below 7.5 or if symptomatic
HUS/AKI transfusion - risks
Severe HTN very quickly - best to give blood on dialysis
Acute interstitial nephritis
Joint pain, rash, sterile pyruria
What is an ominous sign on EKG with hyper K
widened QRS
Fluid overlad mx
1/3 MIVF + UOP + stool losses
Nifedipine side effects
rebound hypertension
AIN medications
NSAIDs
ABx ( sulfa)
True or false AIN is not dose related
true - ( you can have a vasoactive associated AIn in the setting of mild dose of NSAID
PUV - risk of catherization
catheter can loop in dilated urethra - ultrasounf before you blow up the baloon to prevent urethral disruption
