Renal

Question 1

nl for serum K+

Answer 1

3.5 - 5.0

Question 2

sources of increased intake of K+ (2)

Answer 2

supplements

IV

Question 3

mechanical trauma from venipuncture can cause __,

in which case you will see __

Answer 3

pseudohyperkalemia

red serum

Question 4

hyperkalemia with red serum related to __ is more common than pseudohyperkalemia

Answer 4

true severe intravascular hemolysis

Question 5

5 causes of hyperkalemia

Answer 5

venipuncture

exercise

cooling of sample/deterioration of sample

thrombocytosis

severe leukocytosis

Question 6

3 causes of intracellular to extracellular K+ shifts

Answer 6

breakdown of cells

acidosis

insulin deficiency or resistance

Question 7

how does insulin affect K+

Answer 7

causes K+ entry into cells

Question 8

meds that cause hyperkalemia

Answer 8

ACEIs

ARBs

NSAIDs

spironolactone

bb

digitalis

succinylcholine

bactrim

amiloride

K+ supplements

Question 9

how does hyperkalemia affect the heart

Answer 9

membrane excitability → elevated depolarization threshold → depressed cardiac fxn

Question 10

sx of hyperkalemia

Answer 10

n/v

palpitations

lethargy

confusion

paresthesias

muscle weakness

paralysis

arrhythmias/death

Question 11

2 most important labs for eval of hyperkalemia

Answer 11

BMP

EKG

+/- ABG

Question 12

EKG changes of hyperkalemia in order of early to late

Answer 12

1. peaked T waves
2. flattened P wave
3. wide QRS
4. sine wave

Question 13

3 most serious sx of hyperkalemia

Answer 13

muscle weakness

paralysis

arrhythmias

Question 14

tx for hyperkalemia + EKG changes

Answer 14

IV calcium gluconate

continuous cardiac monitoring

drive K+ back into cell/remove K+ from body

Question 15

3 temporary options to drive K+ back into the cell

Answer 15

insulin + glucose

SABA → albuterol

IV sodium bicarbonate

Question 16

all pt w. hyperkalemia should get

Answer 16

insulin + glucose

Question 17

3 options to remove K+ from the body

Answer 17

GI cation exchanger

diuretics + saline

hemodialysis

Question 18

med that binds K+ in the GI tract in exchange for other cations so that it is excreted in feces

Answer 18

GI cation exchanger

Question 19

2 ex of GI cation exchangers

Answer 19

Kayexelate

Patiromer (Valtassa)

Question 20

what diuretic is first line for hyperkalemia

Answer 20

loop → Lasix

Question 21

tx for hyperkalemic pt w. severe renal impairment

Answer 21

hemodialysis

Question 22

CKD is defined as declining kidney fxn for __ or more months

Answer 22

3

Question 23

2 mc causes of CKD

Answer 23

DM

HTN

Question 24

gs for GFR measurement

Answer 24

inulin clearance

Question 25

2 equations used for GFR calculation

Answer 25

MDRD

Cockroft-Gault

Question 26

__ equation shouldn’t be used in AKI

Answer 26

MDRD

Question 27

for GFR equations, __ should be used for obese or fluid overloaded pt’s

Answer 27

IBW

Question 28

CKD staging includes (2)

Answer 28

GFR

albuminuria

Question 29

normal kidney size on US

Answer 29

10 cm

Question 30

__ kidney indicates CKD

Answer 30

shrunken

Question 31

what can help differentiate CKD vs AKI

Answer 31

US → shrunken kidney = CKD

Question 32

meds that need renal dosing

Answer 32

NSAIDs

contrast

Mg (laxatives)

phosphorus (Fleet’s enemas)

aluminum (Maalox/Rolaids)

antimicrobials

DM meds

decongestants

antihypertensives

opioids/gabapentin

Question 33

indications for dialysis

Answer 33

GFR 10-15

unable to control volume status

hyperkalemia

Question 34

types of dialysis

Answer 34

HD

PD

Question 35

HD is given __ x/week

Answer 35

3

Question 36

how often is PD administered

Answer 36

4-5x/day vs when pt is sleeping

continuous ambulatory vs continuous cyclic

Question 37

stages of CKD

Answer 37