Renal Recap Flashcards
Why is hyperkalemia more common in diabetic patients?
Due to renal tubular acidosis type 4
How many g of protein does a renal exchange contain?
6-8g
What % of dextrose if absorbed in CAPD and CCPD?
CAPD: 60-70%
CCPD: 40-50%
Which vitamin/mineral supplement do we recommend?
Replavite
Who could required IDPN?
HD patients
Explain the calcium and phosphorus metabolism in ESRD and RO/metastatic calcification.
low levels of Ca = high levels of PO4
causes calcium deposition on the bones
Calcification of blood vessels and soft tissues = metastatic calcification
How much PO4 (in g) is taken out per session?
800mg
How do you chose the dialysate K2 or K3?
K2 if they need more K taken out (high levels of K)
K3 if they need less K taken out (lower levels of K)
What are the 5 phosphate binders?
- calcium carbonate
- tums
- renagel
- renvela
- fosrenol
What are the 4 possible causes of constipation?
- inadequate fluid intake
- low physical activity
- low fiber intake
- use of PO4 binders
What are the treatments for constipation in ESDR?
- stool softeners (ducosate sodium/calcium)
- stimulants (senna, bisacodyl)
- osmotic laxatives (lactulose)
- bulking agents (unifiber, benefiber, metamucil)
- suppositories (glycerine)
- enemas
When is CRRT done?
In ICU settings
How can you tell if someone lost weight even though they have the same weight (due to fluid accumulation)?
By checking BP. If high BP -> more fluid so lost weight
What % dextrose solution would you chose for extra fluid removal?
A higher % one
What if a patient is diabetic but has a lot of fluid to be removed?
There are solutions based on a.a and not dextrose, they offer half the calories and does the same job
What is PET and what frequency should it be done at?
PET: peritoneal equilibration test -> tests the permeability of the peritoneal membrane and helps to determine the % dextrose absorbed, which helps choosing the proper formula/solution
Should be done every 6 months
Why do we give them phosphate binders?
Because since they have increased protein needs, when they eat more protein they also increase PO4 levels, which we want to avoid
Should we look at blood tests before or after doing HD and PD?
HD: BEFORE (to see how they are managing diet at home), after dialysis everything should be normal
PD: does not matter - patient is on dialysis everyday
Why are most patients on blood thinners while doing dialysis?
Because we don’t want the system to clogg
What is the normal serum potassium level? What is it during HD? During PD?
Normal: 3.5-6 mmol/L
HD: 2-3 g/d
PD: no restriction
What drugs may raise potassium?
ACEi, ARB, selective aldosterone receptor antagonists, NSAIDS, B-Blockers
What are some high K foods?
- fruits (dried, banana, juice, avocado)
- vegetables
- bran, chocolate, milk, molasses, nuts, seeds
What are some low K foods?
- fruits: apples, berries, grapes, pineapples
- vegetables
- rice, noodles, pasta, coffee, tea
What are the fluid needs if output<1L/d? If output > 1L/d? What are the fluid needs for PD?
Less 1L/d: 1-1.5 L/d and 2g of Na
Over 1L/d: 2L/d and 2-4g of Na
PD: 1-3L and 2-3g of Na
