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Medical Emergencies > renal and acid base emergencies > Flashcards

renal and acid base emergencies Flashcards

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USMLE® Step 1 flashcards
1
Q

introduction

A
  • both medical and traumatic problems heavily depend on renal function to maintain homeostasis
  • role of kidneys:
  • fluid and electrolyte balance
  • blood pressure regulation
  • red blood cell synthesis
  • metabolic waste removal
  • medication metabolism
  • acid base balance
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2
Q

kidney blockage

A
  • affects the whole body
  • backup of fluids will affect pulmonary and cardiac systems
  • fluid buildup -> edema
  • fluid in lungs
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3
Q

renal anatomy

A
  • in retroperitoneal space at level of costovertebral angle (T12-L3)
  • perfusion:
  • renal arteries
  • receives about 25% of cardiac output
  • 1,200 ml of blood/min
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4
Q

anatomic structures

A
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5
Q

nephron

A
  • functional unit of kidney
  • responsible for filtrating reabsorbing, and secreting fluids, electrolytes, and waste products by forming urine
  • lack of filtration -> sepsis (ex. uti)
  • each contains:
  • bowman’s capsule
  • glomerulus
  • proximal tube
  • loop of Henle
  • distal tubule
  • collecting duct
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6
Q

secretion

A
  • filtrate not reabsorbed by nephron travels to disetal collecting tubule
  • secreted as urine
  • normal urine: 95% water and 5% solute
  • kidney can concentrate urine based on physiologic requirements
  • normal urine output >500 ml/day
  • <500 ml/day -> oliguria
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7
Q

renal failure

A
  • inability of kidneys to cleanse blood
  • resultant buildup of waste products
  • classifications of acute renal failure: (dont know symptoms of each)
  • prerenal
  • intrarenal
  • postrenal
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8
Q

prerenal renal failure

A
  • decreased renal perfusion results in decreased glomerular filtration rate (GFR) and decreased urine output
  • secondary to:
  • hypovolemia
  • cardiac failure
  • decreased CO
  • accumulation of metabolic waste products in blood
  • increased blood urea nitrate (BUN), creatinine **
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9
Q

prerenal renal failure: treatment

A
  • correction of underlying cause of hypoperfusion
  • hypovolemia
  • control active hemorrhage
  • IV crystalloids, blood and blood products
  • cardiac failure
  • diuretics
  • nitrates
  • inotropic agents
  • vasopressors
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10
Q

intrarenal renal failure

A
  • results from direct damage to kidney parenchyma

- secondary to trauma, infection, or disease

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11
Q

postrenal renal failure

A
  • renal failure secondary to obstruction of urine flow
  • urine backs up into kidney filtration cannot occur
  • causes of obstruction:
  • prostatic hypertrophy
  • renal calculi (kidney stones)- calcium build up
  • neoplasms
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12
Q

renal calculi

A
  • kidney stones
  • severe back pain
  • build up of calcium
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13
Q

postrenal renal failure: treatment

A
  • correction of obstruction
  • urine clearance
  • foley catheter- tube inserted directly into bladder to allow passage of urine
  • suprapubic urinary catheter
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14
Q

dialysis

A
  • filter blood
  • for people with non functioning kidneys
  • method of removing toxins from blood when kidneys cannot
  • blood circulated through filters
  • used in patients with:
  • kidney failure
  • acute poisoning
  • patients have a fistula implanted under the skin forearm into the bicep -> dialysis into renal system
  • do not do blood pressure on the fistula arm!
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15
Q

acute emergencies in chronic renal failure (CRF)

A

-regular dialysis needed for CRF patients

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16
Q

complications of dialysis

A
  • hypotension- when you take the blood out you arnt getting the same amount of blood flow
  • muscle cramps
  • nausea and vomiting
  • headache
  • chest and back pain- electrolyte abnormalities
  • febrile reactions
  • first use syndromes
  • pruritis
  • uncommon but serious complications:
  • disequilibrium syndrome
  • dialyzer reactions
  • arrhythmias
  • cardiac tamponade
  • intracranial bleeding
  • seizures
  • hemolysis
  • air embolism
  • dialysis associated neutropenia and complement activation
  • hypoxemia
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17
Q

BUN

A
  • diagnostic tool
  • urea formed by liver, excreted by kidneys
  • urea accumulates in blood if renal dysfunction occurs
  • urea builds up in renal failure patients
  • waste build up but everyone has it -> normal range is 5-20 mg/dl
  • increases with renal failure
  • can be affected by hydration status `
18
Q

creatinine

A
  • waste product of creatine phosphate, a high energy molecule found in skeletal muscle tissue, released into blood
  • normal value: .5-1.2 mg/dl
  • best indicator of renal function
  • increases with renal failure
  • creatinine of 3-4 mg/dl indicates decreased of GFR by 50%
19
Q

other lab values used to evaluate renal failure

A
  • urinalysis
  • proteinuria indicates intrarenal or postrenal renal failure
  • ketonuria, glycosuria, elevated specific gravity (hydration status) indicates prerenal origin of renal failure
  • serum protein
  • serum albumin
  • complete blood count
20
Q

chronic renal failure

A
  • permanent loss of renal function
  • 80% of nephrons in the kidneys destroyed
  • S/S include changes in urinary habits, nausea, vomiting, dyspnea, or acute coronary syndrome
  • treatment:
  • fluid administration
  • administration of diuretics (long-term solution)
  • pain medication
  • dialysis - 2-3 times a week
  • kidney transplant
21
Q

if you miss dialysis (chronic renal failure symptoms)

A
  • difficulty breathing
  • pitting edema- push in on skin and indentation stays*
  • dry flakey skin
  • fluid build up
  • weakness/fatigue
  • increased BP- due to high build up fluid (u cant urinate)
  • cardiovascular and pulmonary signs *
  • make sure fistula isnt infected
  • diabetes is the biggest cause
  • high BP can cause CRF
22
Q

renal failure: hyperkalemia

A
  • high potassium
  • cardiac abnormalities- tented T waves, abnormal EKGs**
  • 3.5-5 is normal
  • serum potassium greater than 5.5 mEg/L
  • electrolyte disorder caused ingestion of potassium supplements, acute or chronic renal failure, blood transfusions, sepsis, addisons disease, acidosis, and crush syndrome
  • S/S include weakness, muscle cramps, tetany, paralysis, palpitations, or arrhythmias
  • diagnosed by ECG (peaked T waves) and lab values
23
Q

acid base physiology

A
  • body can adjust for pH fluctuations
  • buffering systems used for short term pH control
  • ties up H+
  • respiratory and renal systems used for long term acid base balance
  • removes H+ from body
  • manipulate pH with CO2, HCO3-, and H+ secretion/retention
  • combination of buffer, respiratory, and renal systems maintain pH within normal 7.35-7.45 range
24
Q

what happens when patient has pH imbalance

A
  • pH- <7.35 -> acidosis
  • metabolic acidosis -> respiratory compensation -> increase respiratory rate to balance pH imbalance
  • respiratory acidosis -> renal compensation
  • metabolic alkalosis -> respiratory compensation
  • respiratory alkalosis -> renal compensation
  • LOOK AT CHART
25
Q

renal system

A
  • slowest of three systems (buffers and respiratory)

- may take 25-48 hours to react to pH changes

26
Q

imbalances categorized according to origin: metabolic alkalosis

A
  • metabolic alkalosis
  • pH > 7.45
  • result of:
  • increased HCO3- intake
  • increased H+ loss
  • can occur secondary to:
  • excessive bicarbonate ingestion
  • blood transfusion
  • vomiting nasogastric suctioning
  • drug therapy/ abuse
27
Q

imbalances categorized according to origin: metabolic acidosis

A
  • metabolic acidosis
  • pH < 7.35
  • result of :
  • increased H+ reabsorption
  • decreased HCO3- production
  • decreased HCO3- intake
  • impaired HCO3- reabsorption
  • can occur secondary to :
  • hypermetabolic state- hyperthyroidism
  • anaerobic metabolism
  • ketoacidosis
  • acute or chronic renal, hepatic, and pancreatic failure
  • diarrhea
  • diabetes
28
Q

kidney stones

A
  • renal lithiasis
  • nephrolithiasis
  • small mineral deposits that form inside kidneys (mineral and acid salts)
  • form when urine becomes concentrated, and minerals crystalize and stick together
  • calcium oxalate and uric acid
  • may not cause pain until it moves around in kidney or passes into ureter
29
Q

risk factors for kidney stones

A
  • family or personal history
  • being obese: high BMI
  • dehydration
  • certain diets: high in protein, sodium and sugar
  • digestive diseases and surgery; gastric bypass surgery, inflammatory bowel disease or chronic diarrhea
  • other medical conditions: renal tubular acidosis, cystinuria, hyperparathyroidism, certain medications and some urinary tract infections
30
Q

symptoms of kidney stones

A
  • severe pain in the side, back, below ribs
  • pain that spread to the lower abdomen and groin
  • pain that comes in waves and fluctuates in intensity
  • pain on urination (dysuria)
  • pink, red, or brown urine (hematuria)
  • cloudy or foul smelling urine
  • nausea and vomiting
  • persistent need to urinate (usually small amounts)
  • fever and chills if an infection is present
31
Q

tests/diagnosis of kidneys stones

A
  • blood testing: too much calcium or uric acid in your blood
  • urine testing: the 24-hour urine collection test may show that your excreting too many stone forming minerals or too few stone preventing substances
  • imaging: imaging tests may show kidney stones in your urinary tract (x-rays or CT)
  • analysis of passed stones: urinate through a strainer to catch stones and lab analysis will reveal the makeup of stones
32
Q

treatment for kidney stones

A
  • small stones/minor symptoms:
  • drinking water- 2-3 quarts/day
  • pain relievers: ibuprofen, acetaminophen
  • medical therapy: alpha blockers to relax muscles in ureter
  • larger stones:
  • lithotripsy- sound waves to break up stones
  • surgery
  • scope through urethra, bladder, ureters
  • parathyroid gland removal
33
Q

urinary tract infection

A
  • fever

- suprapubic pain

34
Q

pyelonephritis

A
  • fever
  • suprapubic pain that radiates through the back to the lower back
  • back pain on percussion**
  • can be life threatening if sepsis or complications develop
  • may present with few symptoms to severe symptoms
  • may or may not have associated dysuria
  • may have no fever to a fever greater than 103
  • costovertebral tenderness is common presentation over the affected kidney
35
Q

sepsis

A
  • fever
  • malaise
  • may have pyelonephritis and sepsis as well
36
Q

vaginal/uterine infection, PID (pelvic inflammatory disease)

A
37
Q

STD

A

suprapubic pain and fever

38
Q

ongoing management of pyelonephritis

A
  • IV access- NS bolus 250 ml
  • cardiac monitoring
  • antipyretics
  • pain medications as needed
  • antibiotics- readily respond to antibiotic therapy
  • sepsis protocol if needed
39
Q

summary

A
  • the renal system helps maintain a homeostatic state of balance
  • disease process or toxic events, accidental or intentional, may put that balance at risk
  • the provider has a responsibility to:
  • maintain and optimize cardiopulmonary performance to maintain end organ perfusion
  • treat symptoms of metabolic derangement until definitive treatment can be administered
40
Q

conclusions

A
  • renal failure is a serious emergency
  • what lab tests help to diagnose this emergency?
  • what is the primary treatment for chronic renal failure and what are complications that can develop as a result
  • how does hyperkalemia factor into renal failure
  • how does acid base physiology factor into the renal buffer system and how does this buffer system counteract this physiology
  • what are the various treatments for patients with kidney stones

Medical Emergencies (16 decks)

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