Renal Assessment- Part 1: Electrolytes Flashcards by TWU .

TBW =

Body wt x 0.6

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Which body fluid is more immediately altered by kidneys?

ECF

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Osmolar homeostasis is mainly mediated by sensors located in the ___________

Anterior hypothalamus

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What do the osmolality sensors stimulate? (3)

Thirst
Pituitary release of vasopressin (ADH)
Cardiac atria release of ANP

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Volume homeostasis is mediated by ________

Juxtaglomerular apparatus

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What happens if you decrease volume at the Juxtaglomerular apparatus?

triggers RAAS –> increases Na/H2O reabsorption

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What is ECF?

Plasma & ISF

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Plasma is ____ of ECF and ISF is _____ of ECF

1/4 or 25%

3/4 or 75%

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ECF is about ______ of TBW

less than half

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What is the normal Na range?

135 - 145 mEq/L

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What value of Na do we want to correct beore elective Sx?

<125 or >155

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What are causes of hyponatremia with: hypovolemia; euvolemia; hypervolemia?

Hypo: diuretics, G.I. loss, burns, trauma

Euvo: salt restrictions, endocrine related (hypothyroid, SIADH)

Hyper: ARF/CKD, HF, Increased endogenous vasopressin (ADH), over fluid-resuscitation

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You will see ______ changes with hyponatremia. Describe them.

Neurological

Na 130–135: could be assymptomiatic; HA; N/V

120-130: Malaise; unsteadiness; HA; N/V; confusion; muscle cramps; fatigue

<120: seizures; respiratory arrest; death; brings them herniation;

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Are numbers or trends more important?

Trends

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How do you treat hyponatremia?

Treat the underlying cause & volume status
- electrolyte drinks, NS, diuretics
-Hypertonic Saline

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How do you give Hypertonic 3% NaCl?

80ml/hr or 15 hrs

Correction should not exceed 1.5 mEq/L/hr

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What happens if you give Hypertonic 3% NaCl too fast? What is the exception?

if given greater than 6 mEq/L in 24 hrs –> Osmotic Demylination Syndrome –> permanent Neuro damage

Exception: seizures
Give 3-5 ml/kg over 20 min until seizures stop

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we check Na every ____ while replacing

4 hr

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what causes hypernatremia with: hypovolemia; euvolemia; hypervolemia?

hypo: Renal/GI loss

Euvo: DI; excessive evaporation

Hyper: excessive sodium/bicarb; hyperaldosteronium, cushings

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What are symptoms of hypernatremia?

Neuro

Orthostasis
Restlessness
Lethargy
Tremor/muscle twitching
Seizures
Death

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What is the treatment for hypernatremia?

Root cause/Volume status

Hypovolemic: NS
Euvo: Water PO or D5W
Hyper: diuretics

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With hypernatremia, how fast can you lower the Na? why?

<5 mmol/L/hr AND <10 mmol/L/day

Avoid cerebral edema, seizures, and neuro damage

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_____ of K+ is in the ECF. Where is the majority of it?

<1.5%

ICF

What does serum K+ reflect?

Transmembrane K+ regulation

What is the normal range for K+?

3.5 - 5.5 mmol/L

________ causes the distal nephron to secrete K+

aldosterone

In renal failure, where does K excretion shift to?

It declines and shifts to the **GI system**

What are your most common causes of hypokalemia?

Renal: diuretics; hyperaldosteronism GI: N/V/D; malabsorption Intracellular shifts: alkalosis, Beta-agonists, insulin DKA Thiazide diuretics Hyperventilation Excessive licorice

what candy causes hypokalemia?

Excessive licorice

What are symptoms of hypokalemia?

Cardiac: dysrhythmia U-wave Neuromuscular: muscle weakness/cramps -ileus

What is the treatment for hypokalemia?

Underlying cause K+ PO > IV 10-20mEq/L/hr IV

Each 10 meq of IV K+ raises serum K+ by _______

0.1 mmol/L

What causes hyperkalemia?

-renal failure -hypoaldosteronism -drugs that inhibit RAAS -drugs that inhibit K excretion -Depolarizing NMB (Succs) -acidosis -cell death -massive blood transfusion

What are symptoms of hyperkalemia?

Chronic: minimal -malaise; GI upset Acute: skeletal muscle paralysis; decreased fine motor; cardiac dysrhythmias

what EKG changes would you see with hyperkalemia?

Peak T wave Disappearance of P wave Prolonged QRS Sine waves Asystole

How much does Succ increase serum K by?

0.5 - 1.0 meq/L

What is the initial Tx for hyperkalemia? What are other Tx?

Initial: Ca++ --> stabilizes membrane Dialyze w/i 24h prior to Sx Hyperventilate Insulin and glucose Bicarb Loop diuretics Kayexalate

With hyperventilation increasing pH by 0.1 --> ____ K by _________

decrease 0.4 - 1.5 mmol/L

With hyperkalemia, how much insulin and glucose do we get for treatment? How long does it take to work?

10u of insulin 25g of D50 10 - 20 mins

___% of Ca is in ECF and the rest is stored in ______

1% bones

_____% of plasma Ca is protein bound to ______. Is it active or inactive?

60% albumin inactive

What type of Ca is physiologically active?

Ionized Ca

What is the range of ionized Ca?

1.2 - 1.38 mmol/L

How is ionized Ca levels affected by pH and albumin?

Increased pH/albumin = decreased ionized Ca

What hormones regulate Ca? (3)

Parathyroid hormone: GI/renal absorption; regulates bone/blood levels Vitamin D: intestinal absorption Calcitonin: promote storage in bone

What causes hypocalcemia?

-decrease parathyroid hormone (PTH) secretion -magnesium deficiency (required for PTH production) -low vitamin D -renal failure -massive blood transfusion

Vitamin D is required for _______ production

Parathyroid hormone (PTH)

Hypocalcemia from decreases in PTH can lead to ________. Why is this important? What consideration should we have with this?

Laryngospasm Life-threatening complication Be cautious when extubating and always have a plan

What are the main causes of hypercalcemia? What are the values for this? What are the less common causes?

Main causes: Hyper-parathyroid >11 Cancer > 13 Less common: Vitamin D intoxication Milk – alkali syndrome Granulomatous disease (sarcoidosis)

What are the symptoms of hypercalcemia?

Confusion Lethargy Decrease deep tendon reflexes Hypotonia N/V Short QT interval Chronic: Nephrolithiasis; hypercalciuria

What are the symptoms of hypocalcemia?

Paresthesias Irritability Hypotension Seizures Myocardial depression Prolonged QT interval **Laryngospams** <---- life threatening**

What are the causes and symptoms of hypomagnesium?

Causes: diet/absorption Renal wasting Symptoms: muscle weakness/excitation Seizures Ventricular dysrhythmias (VTach/ torsades)

What is the Tx of hypomagnesium?

Depends on severity Slow mag infusion Torsades/seizure --> 2g mag sulfate

What are the causes of hypermagnesium?

Over treatment from preeclampsia/eclampsia or Pheochromocytoma

what are the symptoms of hypermagnesium?

4-5: lethargy; N/V; flushing >6: hypotension; decrease deep tendon reflexes >10: paralysis; apnea; HB; cardiac arrest

What is the Tx for hypermagnesium?

Diuresis IV Calcium Dialysis

What considerations should we have if pt on gtt mag?

need to check levels every 4 hrs

Renal Assessment- Part 1: Electrolytes Flashcards

Test 3