Renal Electrolytes- schoenwald (Exam 4) Flashcards
The normal range of sodium
135-145
The primary circulating cation
a. chlorine
b. sodium
c. potassium
b. sodium
Osmolality is the measure of what?
dissolved particles in the blood
Normal serum Osmolality
a. 280-295
b. 200-250
c. 250-300
a. 280-295
osmolality will _____with overhydration and _____with dehydration
a. increase, decrease
b. decrease, increase
c. increase, stay the same
b. decrease with overhydration and increase with dehydration
Hypernatremia, hyperglycemia, ketosis, dehydration, diabetes insipidus will have what effect on osmolality
increase
SIADH with have what effect on osmolality
decrease
SIADH cause a ______ of serum sodium and a ______ in urine sodium
Decrease in serum and an increase in urine sodium.
You lose all of the sodium through urine.
**hyponatremia
Diabetes Insipidus causes hypo or hypernatremia?
Hypernatremia.
You have a patient that has an increased thrist as well as urinated ALOT of dilute urine. You draw their blood and they are hypernatremic. ______ is likely the cause
a. Diabetes insipidus
b. SIADH
c. overhydration
a. diabetes insipidus
_____ _____ is a good way to test the ability of the kidney to concentrate urine
urine osmolality
Urine osmolality normal range
50-1200
match the disease with the correct effect on urine osmolality (Increase or decrease)
SIADH
Diabetes insipidus
SIADH–> increase urine osmolality (decrease serum osmolality)
Diabetes insipidus –> decrease urine osmolality (increased serum osmolality)
CHF will cause a _______ urine osmolality
increased
Two types of hyponatremia
sodium depletion - free water loss
dilutional - water intake greater than water output - renal failure
What can casue hypernatremia?
impaired thrist mechanism
water loss without sodium loss - burns, fever
what kind of urine test can help determine between renal and non renal causes of hyponatremia
urine sodium, spot or 24 hour
The primary intracellular ion
a. sodium
b. chlorine
c. potassium
c. potassium
as sodium is ______. potassium is _____
rebsorbed, lost
normal range of potassium
3.5-5.5
glucose administration can cause ______ .
Hypokalemia
Aldosterone _______ potassium excretion
enhances
ACEI can cause ________. (do not forget!)
hyperkalemia
A possible finding on EKG of hyperkalemia
peaked t-waves
Normal range for chloride
96-106
in the renal proximal tubules chloride is exchanged for ______.
Bicarb ions
Two causes of increased chloride
dehydration, metabolic acidosis
Three causes of decreased chloride
overhydration, SIADH, Vomitting
You have a patient that presents with altered mental status and a history of vomitting for three days. You notice marked edema. What might you suspect?
Acute renal failure
causes of pre renal ARF (AKI)
Hypovolemia
Hypotension
CHF
Renal artery stenosis
acute increase of ______ or more than 50% over baseline levels of Creatinine is AKI
> = .5
intrinsic renal failure will have a ______ BUN/cr
decreased
prerenal failure will have ______ BUN/cr
increased
Urine sodium of
Prerenal vs intrinsic
Prerenal: <20
Intrinsic >40
Fractional excretion of Na in
Prerenal vs
intrinsic
Prerenal : <1%
Intrinsic : >1-2%
urine osmolality in
Prerenal vs intrinsic
Prerenal 500
Intrinsic 250-300
CKD stages (GFR)
stage 1: >90 Stage 2: 60-89 Stage 3: 30-59 Stage 4: 15-29 Stage 5: <15
_____kalemia will be present in AKI
hyper
MUDPILES of metabolic acidosis
M- methanol U- uremia D- DKA P- Paraldehyde I- iron L- lactic acidosis E- Ethylene glycol S- salicylates
