test results

Question 1

How are sodium levels regulated

Answer 1

urinary loss decreased - aldosterone
increased - natriuretic peptides

ADH release - reducing loss

thirst control

Question 2

where in the nephron accounts for 65-70% of Na loss

Answer 2

proximal tubule

Question 3

Ref Range - Na

Answer 3

135-145 mmol/l

Question 4

symptoms hypernatraemia

Answer 4

CNS dysfunction - lethargy, confusion, irritability, seizures, weakness
Dehydration - dry mouth, oliguria, tachycardia

Question 5

symptoms hyponatraemia

Answer 5

decreased ability to think, headaches, balance issues

Question 6

causes hyponatraemia

Answer 6

SIADH
excess sweating
liver failure (due to increased blood volume)
kidney disease

Question 7

causes hypernatraemia

Answer 7

dementia (thirst mechanism impaired)
diarrhoea and vomiting
diabetes

Question 8

Ref Range K

Answer 8

3.5-5.5mmol/l

Question 9

Symptoms hypokalaemia

Answer 9

vague - weakness, tiredness, cramping, N+V constipation, cramps
palpitations,hypotension
polyuria, thirst
depression, psychosis, delirium

Question 10

causes hypokalaemia

Answer 10

N+V+D, furosemide, laxative, Mg deficiency (Mg needed to absorb K)
DKA - potassium excreted with negatively charged ketones
poor diet, malnutrition, illness, alcohol abuse
Insulin use
B agonist use

Question 11

Drugs which increase K loss through kidney

Answer 11

Penicillin
diuretic
gentamicin
fludrocortisone

Question 12

Drugs which encourage K loss from cells

Answer 12

verapamil
theophylline
pseudoephedrine

Question 13

K level to stop heart beating

Answer 13

> 6.5mmol/l

Question 14

treatment of hyperkalaemia

Answer 14

cation residues bind and excrete
IV glucose
nebulised salbutamol
haemodialysis

Calcium gluconate may be given to prevent cardiac effects

Question 15

Drug causes hyperkalaemia

Answer 15

ACE
Trimethoprim
NSAIDS
K sparing diuretic
digoxin
non-specific B-Blockers

Question 16

other causes hyperkalaemia

Answer 16

trauma, burns
haemolysis
insulin deficiency
dietary intake

Question 17

Urea ref range

Answer 17

1.7-7.1mmol/l

Question 18

Urea levels in the plasma do not rise or fall with GFR because

Answer 18

50% of filtered urea is reabsorbed in proximal tubule

Question 19

What do we find out from urea levels

Answer 19

hydration status
liver function
kidney function

Question 20

causes of high urea

Answer 20

dehydration
kidney dysfunction
high protein diet
GI bleed

Question 21

causes of low urea

Answer 21

overhydration
hepatic impairment
pregnancy
low protein diet

Question 22

creatinine ref ranges

Answer 22

men 60-110 mmol/l

women 45-90 mmol/l

Question 23

causes raised creatinine

Answer 23

trimethoprim - blocks tubular secretion of creatinine
rhabdomyolysis
high protein diet
reduction in GFR

Question 24

when to use CrCl or GFR

Answer 24

eGFR used to stage kidney disease

CrCl for dosing adjustments in renal impairment

Question 25

how is CKD detected?

Answer 25

eGFR, ACR(diabetes) protein:creatinine (no diabetes) and renal ultrasound
persistent proteinuria required