Renal Flashcards
What level urine sodium is associated with ATN?
More than 20
What is the calculation for FENa
(UNa/PNa divided by UCr/PCr) X 100
Cutoff 1%. Only useful in setting of oliguria
Does NAC help with contrast nephropathy?
No. Debate whether contrast nephropathy even exists
What is the other way to determine if there’s a concomitant AB disorder other than delta gap?
Take AG and add to bicarb= this is the bicarb before the metabolic acidosis
How do you calculate free water deficit?
%body water x kg x (current Na-ideal Na/ideal Na)
%body water is 60% in men 50% in women
What are common causes of euglycemic DKA?
SGLUT2i, ETOH, cirrhosis, pregnancy, anorexia/fasting state
In thyroid storm, how long do you wait after giving PTU/MMI before giving iodine?
1 hr
How is pituitary apoplexy treated?
SDS, watch for DI, NSGY consult for potential decompression
Thyroid replacement eventually
Are there any differences in outcomes for trickle feed vs full feeds?
No except trickle feeds have less GI intolerance episodes
No worse or better outcomes
Mya have benefit to underfeeding patients with baseline low prealbumin
What do studies say about enteral vs parenteral nutrition?
Only difference is more infections with parenteral
What does activated charcoal NOT absorb?
iron, lithium, alcohols, hydrocarbons, acids, alkalis
Which toxic alcohols have an increased osmol gap and how do you differentiate between them?
Ethylene gycol: oxalate crystals
Methanol: optic neuropathy, intracranial bleed/infarct
Tx ethanol or fomepizole. HD if level above 25, osmolar gap above 25
What are the features of cyanide poisoning?
Setting: metal extraction, electroplating, smoke exposure, mitroprusside
Lactic acidosis, seizures, coma, shock
Give sodium nitrite (can cause methemoglobinemia) then sodium thiosulfate to excrete
VitB12 (hydroxocobalamin)
What common drugs cause bradycardia?
Barbituates, clonidine, cholinergic drugs (pyridostigmine), GHB, organophosphates
What treatments are used for refractory BBer/CCBer overdose?
High dose insulin, pressors, pacing, lipid emulsion, ECMO
How are sulfonylurea overdose treated?
Octreotide, supportive care
What are the characteristics for cholinergic sydrome?
Hypersecretory, brady, weakness.
Give atropine
Give pralidoxime for weakness
Avoid succinylcholine
What are the features of proprofol infusion syndrome?
Refractory bradycardia in the presence of metabolic acidosis/rhabdo/HLD/hepatomegaly. usually >4mg/kg/hr for more than 48hrs
What are symptoms of hypocalcemia
Parasthesias, arrhythmias, bronchospasm
How does tylenol cause metabolic acidosis?
Accumulation of 5-oxoproline
More prone in sepsis, chronic ETOH, chronic liver disease, malnutrition, old age, pregnancy due to glutathione depletion
How can one distinguish type B lactic acidosis?
lactate:pyruvate ratios are normal as anaerobic metabolism isn’t driving it
Which med should be used in thyroid storm in first trimester of pregnancy?
PTU
When do you give steroids for hypercalcemia?
Mild-moderate due to vitamin D as steroids lower 1,25 vit D
What are the symptoms of lithium toxicity?
Levels more than 5, AMS, bradycardia, AKI, shock
HD removes it
