Renal/Hepatic Assessment EXTRAS Flashcards
Why should you be extra cautious extubating patient post-parathyroidectomy?
Hypocalcemia induced laryngospasm!
What are some s/s associated with hyponatremia?
-HA
-confusion
-fatigue
-muscle cramps
-malaise
What are some s/s associated with hypernatremia?
-restlessness
-lethargy
-tremor/muscle twitching
What are some s/s associated with hypokalemia?
-muscle weakness/cramps
-ileus
-dysrhythmias, U wave
What are some s/s associated with hyperkalemia?
-skeletal muscle paralysis, malaise, GI upset
What are some s/s associated with hypercalcemia?
-confusion
-hypotonia
-decreased DTR
-abd pain
What are some s/s associated with hypocalcemia?
- irritability
-seizures
-hypotension - post parathyroidectomy hypocalcemia induced laryngospasm
Which induction agents are excreted renally?
barbiturates
Which NMBA’s are excreted renally?
- pancuronium
- vecuronium
Which cardiovascular drugs are excreted renally?
- atropine
- digoxin
- glycopyrrolate
- hydralazine
- milrinone
Why is blood loss a particular concern for renal dx patients?
Blood loss activates baroreceptors –> increases SNS outflow –> increases afferent arteriole constriction –> DECREASES RBF
Why should morphine and demerol be avoided in renal dx patients? What are their active metabolites?
Morphine and Demerol are cleared by the kidneys. Morphine active metabolite is morphine-6-glucuronide, demerol active metabolite is normeperidine.
–> LIFE-THREATENING RESP DEPRESSION
What does uremia do to vWF?
vWF synthesis is affected by uremia. Pre-surgical DDAVP may be a consideration.
Could we possibly see hypoparathyroidism or hyperparathyroidism with AKI? Why?
Hyperparathyroidism. “Parathyroid in overdrive” in an attempt to stimulate Ca reabsorption in an injured kidney
Which is better for renal patients: NS or LR?
NS. No K in NS
Which pressor agent is superior in regards to renal protection? How so?
Vasopressin. Preferentially constricts the EFFERENT arteriole instead of afferent arteriole, preserving GFR.
What is GFR in stage 1 of CKD?
GFR > 90 mL/min/1.73m^2
What is GFR in stage 2 of CKD?
GFR 60-89 mL/min/1.73m^2
What is GFR in stage 3 of CKD?
30-59 mL/min/1.73m^2
What is GFR in stage 4 of CKD?
15-29 mL/min/1.73m^2
What is GFR in stage 5 of CKD?
<15 mL/min/1.73m^2
Which class of diuretics is 1st line treatment for HTN in CKD?
Thiazide diuretics
What are treatment options for hepatorenal syndrome?
Midodrine, octreotide, albumin
What are treatment options for portopulmonary HTN?
PDE-I’s, NO, prostacyclin analogs, endothelin receptor antagonists
Should you consider an elective surgery in a patient with a MELD score of >16?
No. Consider alternatives and transplant
What if you determine your patient has a MELD score of 10-15 during your pre-assessment?
In the presence of portal HTN: Consider TIPS before elective procedure
In the absence of portal HTN: proceed to OR, careful monitoring
Can you proceed with scheduled surgery if your patient has a MELD score of less than 10?
Yes
What two paralytic agents can you consider giving to patients with hepatic dysfunction d/t not being metabolized by the liver?
Succinylcholine and cisatracurium
Alcoholism _______ MAC of volatile anesthetics
increases
Up to __% of the liver can be resected in a normal, healthy patient.
75%
