Renal History and Hypernatraemia Flashcards
what are common presenting complaints in a renal history?
- dyspnoea
- leg swelling
- nausea and vomiting
- upper airway symptoms
- constitutional symptoms
- LUTS
- flank pain
what is important to explore in a patient presenting with dyspnoea?
- exercise tolerance
- triggers
- relieving/aggravating factors
- orthopnoea/PND
- associated symptoms
what is important to explore in a patient presenting with leg swelling?
- site, severity
- time of onset
- amount of fluid intake
- DHx and THx
what is important to explore in a patient presenting with nausea and vomiting?
- triggers
- aggravating/ relieving factors
- are they able to keep down food?
- bowel frequency
- associated symptoms
what is important to explore in a patient presenting with upper airway symptoms?
- symptoms (nasal secretions, sinusitis, epistaxis, haemoptysis, sore throat)
- visual disturbances
- hearing loss
what is important to explore in a patient presenting with constitutional symptoms?
- fever
- joint pains
- muscle aches
- weight changes
- lethargy
- night sweats
- pruritis
what is important to explore in a patient presenting with LUTS?
dysuria, frequency, quantity of urine, colour of urine, frothiness, haematuria
what is important to explore in a patient presenting with flank pain?
SOCRATES/SQUITARS
what is important in a past medical history when taking a renal history?
- AKI/ CKD (causes and any hospital admissions)
- CVS risk factors (DM, HTN, hypercholesterolaemia)
- recent UTIs
- childhood infections
- cancers
- previous surgeries
what is important in a family history when taking a renal history?
- renal disease
- CVS disease
- diabetes
- hypertension
what are the results that put a patient in metabolic alkalosis?
- pH = high
- bicarbonate = high
- pCO2 = normal
what are the results that put a patient in metabolic acidosis?
- pH = low
- bicarbonate = low
- pCO2 = normal/ low
what is the anion gap and what is it’s normal range?
a calculation that helps work out what could be the cause of a patient’s acidosis state
normal range = 8-12
how do you calculate the anion gap?
[Na+] - [Cl-] + [HCO3-]
if the anion gap is high, what tends to be the cause of the acidosis?
acidosis due to increased acid (e.g. lactic acidosis, ketoacidosis, toxins, or renal failure)
if the anion gap is normal, what tends to be the cause of the acidosis?
acidosis due to reduced alkali (e.g. GI or renal losses of HCO3-, or toxins)
true or false: diabetes is the only way someone can get ketoacidosis
false.
ketoacidosis can also occur if there is alcohol abuse or starvation
what causes renal losses of HCO3-?
- renal tubular acidosis
- mineralcorticoid deficiency (Addison’s)
what is the most common cause of hypernatraemia?
dehydration
what are the consequences of hypernatraemia on a cellular level?
- causes cellular dehydration (water moving out of the cells)
- creates vascular shear stress (bleeding and thrombosis)
what are the common symptoms of hypernatraemia?
thirst, irritability, weakness, confusion, reduced GCS, seizures, hyper-reflexia, spasticity, and coma
what are the causes of hypovolaemic hypernatraemia?
- renal free water losses (NG feed tube, loop diuretics, intrinsic renal disease)
- non-renal free water losses (sweating, burns, diarrhoea, fistulas)
what are the causes of euvolaemic hypernatraemia?
- renal losses (diabetes insipidus, hypodipsia)
- extra-renal losses (respiratory losses)
what are the causes of hypervolaemic hypernatraemia (excess Na)?
- primary hyperaldosteronism
- Cushing’s syndrome
- hypertonic dialysis
- hypertonic NaCO3
- exogenous sodium
