Renal Flashcards
1
Q
Oliguria
A
UOP < 400 mL/day or < 0.5 mL/kg/hr for 6 hrs
2
Q
Risk Factors of Acute Renal Failure
A
- Co-existing renal disease
- Advanced age
- CHF
- Symptomatic CV disease
- Major operative procedure (CABG, Abdominal aortic aneurysm)
- Sepsis
- Multiple organ dysfunction
- Iatrogenic causes
- Inadequate fluid replacement
- Delayed tx of sepsis
- Nephrotoxic drugs or dyes
- Hypotension
3
Q
Management of Acute Renal Failure
A
- Check vital signs
- Determine of prerenal, infrarenal, post-renal
- Determine and treat underlying cause
a. Prerenal
- Look for signs of decreased CO, shock, hypovolemia (CVP, PAC, TEE, Fluid challenge)
b. Renal
- Check urine for blood or myoglobin
- Check electrolytes
- Check BUN/Cr
- Check FENa (prerenal <1, renal >1)
- Send blood and urine specimen for Na, osmolality, creatinine, urea)
- Discontinue nephrotoxic drugs
c. Post-Renal
- Renal U/S to check for obstruction
- Check foley
- Palpate bladder - Resuscitate patient (fluids, Inotropes)
- Mannitol/Dopamine/Furosemide
- Hemodialysis every 2-4 days as needed
4
Q
Indications for Dialysis
A
- Metabolic Acidosis
- Electrolyte Abnormalities (Hyperkalemia, Hypercalcemia, Hyperphosphatemia, Hypermagnesemia, Hyperuricemia)
- Intoxication/Drug overdose
- Fluid overload/Pulmonary Edema
- Uremia
5
Q
Complications of Hemodialysis
A
- Vascular Access promblems
- Infection, Bleeding, Thrombosis, Stenosis, Aneurysm
- Hypotension
- Decreased intravascular volume
- Hemorrhage
- Septicemia
- Dysrhythimia
- Electrolyte abnormality
a. Hypo/Hyperkalemia, Hypo/Hypercalcemia, Hypermagnesemia
- Hemorrhage w/ resultant cardiac s/s
- GI Bleed
- Neurologic Dysfunction
- Disequilibrium syndrome: HA, malaise, nausea, vomiting, muscle cramps
6
Q
Risk Factors for TURP Syndrome
A
- Prostate > 45 grams
- Prolonged resection time greater than 90 min
- High inflow irrigating fluid pressure
- Non-continuous irrigating fluid
- Pre-op Hyponatremia
- Smoking history
7
Q
Other Complication of a TURP
A
- Bladder perforation
- Bleeding
- Coagulopathy/DIC
- Transient bacteremia and septicemia
- Toxicity of irrigating fluid
- Glycine toxicity: Transient blindness, Hyperglycinemia, Hyperammonemia
- Sorbitol toxicity: Hyperglycemia
- Ammonia toxicity: neurologic sequelae, nausea, vomiting, convulsions, coma
- Hypothermia
8
Q
Ways to provide renal protection during Aortic Cross-clamping
A
- Maintain adequate intravascular volume and hemodynamic stability
- Intermittent cross-clamping of internal iliac prior to aortic cross-clamping (preconditioning)
- Mannitol
- increases renal cortical blood flow, free radical scavenger, increases renal prostaglandin synthesis, decreases renin secretion, reduces ischemia-induced cellular edema
- Loop diuretics, fenoldopam, dopamine
9
Q
What sensory level would you want blocked with Neuraxial anesthesia for TURP?
A
T10
- provides adequate analgesia for the procedure
- allows monitoring for s/s of bladder perforation (abdominal pain w/ diaphragmatic irritation (shoulder pain))
10
Q
What is the treatment for MH?
A
- Hyperventilate patient w/ 100% oxygen
- Administer Dantrolene (2.5 mg/kg)
- *Give 1 mg/kg every 6hrs for 24-48hrs
- Monitor UoP
- Monitor potassium, calcium, ABGs
a. Treat hyperkalemia (dextrose/insulin)
b. Treat acidosis (bicarb) - Order CK, LFTs, coags
- Treat rhabdomyolysis (mannitol)
- Treat dysrhythmias (lidocaine) if necessary
- Treat hyperthermia (d/c when temp drops to 38-38.5C)
a. infusion of cold IV fluids
b. place icepacks over major arteries (groin and axilla)
c. iced saline gastric, bladder, rectal and wound lavage
d. cold peritoneal dialysis
e. cardiopulmonary bypass
11
Q
What are the signs and symptoms of MH?
A
- Generalized rigidity
- Tachypnea
- Changes in blood pressure
- Arrhythmias
- Increased temperature
- Peripheral mottling and sweating
- Rhabdomyolysis
- Cyanosis
ABG shows respiratory and metabolic acidosis with low oxygen tension
