Renal Exam 2 (Carstons)

Where does water move to?

High osmolar concentration

The following describes what?

• mOsm/kg

• tells us where water goes

• only accounts for water

OsmolaLity

The following describes what?

• mOsm/L

• tells us if the fluid is compatible with body fluids

• accounts for total volume

OsmolaRity

T/F: tonicity is the concentration of non-permeable solute molecules in a solution

True

Solute concentration is higher outside of the cell, so water moves outside the cell

HypERtonic

Solute concentration is lower outside the cell, so water moves into the cell

HypOtonic

Best fluid for septic patients

Lactated ringers

Which fluid should be given if a patient has high Cl- levels?

Lactated ringers

• Normal saline

• Lactated ringers

• Plasma-lyte

Crystalloids

• Blood

• Albumin

• Hetastarch

• Dextran

Colloids

T/F: both whole blood and albumin require blood typing and may have a small risk of disease transmission

False, albumin does not require typing

If a patient is hypERnatremic, which should be corrected first?

Hypovolemia → give fluids

Normally, sodium should be corrected slowly. When is is appropriate to correct quickly with 3% saline?

If sodium was normal within the previous 48hr and rapidly dropped, and patient is likely symptomatic

HypOvolemic hypOnatremia treatment

Normal saline (replace lost volume will correct sodium)

HypERkalemia + EKG changes treatment

Calcium, regular insulin + glucose/dextrose, sodium bicarb and beta agonists

T/F: giving calcium for hypERkalemia will help reduce potassium

False, it will only help stabilize cardiac cells

HypERkalemia only treatment

Regular insulin + glucose/dextrose, sodium bicarb and beta agonists

Osmolar gap

difference between measured serum osmols and calculated osmols

All of the following are examples of…

• Alcohols

• Sugars

• Lipids

osmotically active

pH<7.35

pCO2>45

Respiratory acidosis

pH>7.45

pCO2<38

Respiratory alkalosis

pH<7.35

HCO3<22

Metabolic acidosis

pH>7.45

HCO3>26

Metabolic alkalosis

How is respiratory acidosis compensated for?

Increasing HCO3

How is respiratory alkalosis compensated for?

Decreasing HCO3

How is metabolic acidosis compensated for?

Decreasing CO2

How is metabolic alkalosis compensated for?

Increasing CO2

Exhaling more CO2 does what to pH?

Increases pH

The following medications can cause respiratory suppression which can lead to what?

• Opioids

• Benzodiazepines

• Ethanol

Respiratory acidosis

Breathing rate with rapid, deep breaths and excessive loss of CO2

Hyperventilation

Excessive breathing rate with shallow breathing

Tachypnea

Hyperventilation can cause what?

Respiratory alkalosis

Pulmonary embolism can lead to what?

Hypoxic respiratory alkalosis

T/F: hypoxic respiratory alkalosis (e.g. due to pulmonary embolism) can be corrected with oxygen

True

Chloride responsive metabolic alkalosis can be treated with normal saline and is caused by what?

Gastric acid loss, diarrhea, excessive bicarbonate therapy (including lactate, acetate and citrate), loop diuretic therapy

Because loop diuretics increase K+, Na+, and Cl- excretion and in turn reabsorbs more HCO3, they can lead to contraction _____

Metabolic alkalosis

Treatment for loop diuretic contraction metabolic alkalosis

Carbonic anhydrase inhibitor + fluids

Chloride resistant metabolic alkalosis can be treated with potassium and is caused by what?

Excessive aldosterone or corticosteroid therapy, decreased Mg2+, excessive black licorice intake

In which kind of metabolic acidosis is excess chloride retained to keep electrical neutrality when HCO3 is lost?

Non-anion gap

The following are causes of what?

• Lactic acidosis

• Ketoacidosis

• Methanol

• Ethylene glycol

• Salicylates

High anion gap (greater than 12)

The following are causes of what?

• HypOalbuminermia

• Increased in unmeasured cations such as Mg or Ca

Low anion gap (less than 8)

Which value in the anion gap formula is (mainly) driving the equation to increase?

Loss of bicarbonate WITHOUT Cl- compensation

In which kind of metabolic acidosis are unmeasured anions retained to keep electrical neutrality when HCO3 is lost?

Anion gap

Diabetic ketoacidosis treatment

Regular insulin and fluids

Which binds more tightly to alcohol dehydrogenase?

Fomepizole

Methanol toxicity adjunctive treatment

Folic acid 50 mg IV Q4hr

Ethylene glycol toxicity adjunctive treatment

Thiamine 100 mg IV QD or pyridoxine 50 mg IV Q6hr

Salicylate toxicity progression

Respiratory alkalosis → metabolic lactic acidosis

Salicylate toxicity: Sodium bicarbonate is used for what purpose?

To alkalinize the urine to pull the salicylates into the urine to be excreted

T/F: sodium bicarbonate is an appropriate treatment for metabolic acidosis

False, there is no benefit and IV fluids are better