Term
| severe AKI can be treated with? |
|
Definition
| renal replacmeent therapy RTT |
|
|
Term
| indicaitons for RTT/dialysis acronym and meansing |
|
Definition
AEIOU
A-acidosis
E-electrolye abnormality
i-ingestion of toxin
o-overload fludis
u-uremia >100 |
|
|
Term
| which type of RTT isnt really used in AKI? why? |
|
Definition
peritoneal dialysis
leff efficient |
|
|
Term
| which RTT releis on internal system of body? |
|
Definition
|
|
Term
this is where particles move from high conc to lower conc
this ofcuses on removed? |
|
Definition
difussion/dialysis
small molecules |
|
|
Term
this RTT is where particles move across semiperm membd due to blood pressure?
this focuses on getting rid of? |
|
Definition
convection/ultrfiltraiton
volume |
|
|
Term
intermitten hemodialysis is done -x a week for - hrs
what process is used? |
|
Definition
|
|
Term
slow low effiiecny dialyss is done _ hrs
what is the process used? |
|
Definition
|
|
Term
| continuous renal replacment is done 24 hrs; the two subtypes and their main rpocess?-3 |
|
Definition
continuous veno hemofiltraiton- convection
continous veno hemodialy- diffusion
contn. ven hemodialfiltration- both! |
|
|
Term
| if pt hemodynamic stable can use what RRT |
|
Definition
|
|
Term
| if pt hemodyn unstable can use what RTT-3 |
|
Definition
|
|
Term
| look at slide for review of RTTs |
|
Definition
|
|
Term
|
Definition
rapid
allows down time;
hypotension, more complex |
|
|
Term
|
Definition
cont removal, easy control fo blaance
slower cl of toxins, need anticoag |
|
|
Term
|
Definition
hemodyn stableilit
allow down time;
slower Cl, more complex |
|
|
Term
|
Definition
simple, no anticoag
hyperglycemia, no control of rate |
|
|
Term
| for intermitten or SLED what calc are used for goal? |
|
Definition
Kt/V at least 1.3
URR>65%
k=dialyzer Cl
t-duraiton of dialysis
v= Vd (.6)x wt in kg |
|
|
Term
|
Definition
| 100 x (pre BUN-post BUN/preBUN) |
|
|
Term
for cont RTT what is used to determine efficacy?
what is goal |
|
Definition
effluent volume (solutes and water removed)
20-25 ml/kg/hr |
|
|
Term
| which equaiton for Cl isnt good for AKI?-3 |
|
Definition
cockcroft-gault
MDRD
CKD-EPI |
|
|
Term
| ask someone if need to knwo the equaitons not good for AKI pts |
|
Definition
|
|
Term
| tho not totally perfect what may be ebst equation for dosing in AKI? |
|
Definition
|
|
Term
which equation may be useful for CKD staging?
what is this and another equaitn good for estimating? |
|
Definition
|
|
Term
| for pts with AKI and no RTT, what needs to happenw ith dosing? |
|
Definition
|
|
Term
factros that give higher drug Cl w/ RTT
Vd
protein binding
water solubility
molecular size |
|
Definition
low Vd <1-2 L/kg
low prot bind <80%
hydrophillic (high solubility)
small molecule <5000 |
|
|
Term
if RTT intermittent when should drugs be given?
if rapid cleared what need to be done? |
|
Definition
|
|
Term
| most drug dosing based on low effiacy RTT, so may increase 25% if on high eff. |
|
Definition
|
|
Term
| RTT continues, not a lot fo data tho drug conc ususally subtherapuetic bc more Cl |
|
Definition
|
|
Term
| drug dosing in AKI need to look at-4 |
|
Definition
medical hisotry
GFR
PK/PD
type of RTT |
|
|
Term
| for all RTT loading dose of gnetamycin: |
|
Definition
|
|
Term
intermitten hemodilaysis dose of gent
continuous? |
|
Definition
1.5 mg/kg every 72 hrs
1.5 mg/kg every 24 hrs (redose if Cp<3-5) |
|
|
Term
for gentamycin when do you draw pre dialysis conc?
psot dilayss? |
|
Definition
|
|
Term
|
Definition
|
|
Term
intermittent hemodial vanc dose
how do you adjust? |
|
Definition
5-10 mg/kg after each 2nd dilaysis
pre dilaysis conc
<10- 1000 mg dose
10-25, 500-750 mg
>25, holdd vanc |
|
|
Term
dose for vanc with continuous RTT
when do you draw for conc? |
|
Definition
10-15 mg/kg q 24 hrs
before 3rd dose |
|
|
Term
| which med doesnt need bolus dose in RTT> |
|
Definition
|
|
Term
| intermitten RTT zosyn dose |
|
Definition
|
|
Term
|
Definition
|
|
Term
| other things to consider for ABX in RTT-3 |
|
Definition
severity
locaiton
immune status |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| if PH abnormal and HCO3 decrease= |
|
Definition
|
|
Term
| if pH abnromal and PcO2 increase= |
|
Definition
|
|
Term
| the compensaiton fro acid/base disorder alwyasfollows the primary distrubance arrow |
|
Definition
|
|
Term
normal anion gap if use just Na
if add K to Na? |
|
Definition
|
|
Term
| start at slide 102 tmrw for cards |
|
Definition
|
|
Term
| metabolic acidosis is defined as a _ in bicarb |
|
Definition
|
|
Term
what is the state called where metabolic acidosis has a normal anion gap?
how is this done? |
|
Definition
hyperchloriemic metabolic acidosis
chloride offsets bicarb increase |
|
|
Term
| metabolic acidosis with elevated anion gap is due to-2 |
|
Definition
increase organic acids-> increase bicarb consuption
-leaves chloride alone |
|
|
Term
acronym of normal anion gap metabolic acidosis?
meaning? |
|
Definition
USEDCARP
u-urterosigmodis
s-saline hydration
e-endocrine (hyperparathyroid)
D- diarrhea
C-carbonic anhydrase inhibitor (azetazolomide)
A- acid ingestion
R- rneal tube acidosis
P-pancreatic fistula |
|
|
Term
| whjat 3 meds cause renal tube acidodis and so normal anion gap? |
|
Definition
K sparing diuretics (spironoalc)
Li
Ampho B |
|
|
Term
| acronym for increase anion gap and meanings |
|
Definition
MUDPILES
M-methanol
U-uremia
D-DKA
P-paraaldehyde
I-isoniazid /Iron
L-lactic acidosis
E-ehtylene glycol
s- salicylates, starvation |
|
|
Term
| symtpoms fo metabolic acidosis?-2 |
|
Definition
|
|
Term
Tx for metabolic acidosis:
1)
2) |
|
Definition
treat underlying cuase
sodium bicarb if needed |
|
|
Term
| when are meds indicated for treatment of metaoblic acidosis? |
|
Definition
|
|
Term
use Na bicarb :
oral for _ therapy
IV for _ therapy |
|
Definition
|
|
Term
| ** ask someone if need to know equaitno for Na bicarb loading dose |
|
Definition
|
|
Term
| for Na bicarb loading dose how do you admin? |
|
Definition
|
|
Term
|
Definition
volume over load, hyper Na (bc Na)
hypoxia , metabolic alkalosis |
|
|
Term
| metabolic alkalosis is defined as _ bicarb |
|
Definition
|
|
Term
|
Definition
diuretics
gastric acid loss ie vomit |
|
|
Term
| causes of metabolic alkalosis-2 |
|
Definition
|
|
Term
|
Definition
blood trnasfusion
too muhc mineralcorticoid |
|
|
Term
| a patient is repsonsve to saline if urine Cl is? |
|
Definition
|
|
Term
Tx for Cl<10 -2
-if persistant add? |
|
Definition
underlying cause
hydraiton
ammonium |
|
|
Term
|
Definition
|
|
Term
| hypoventilation is same as? |
|
Definition
|
|
Term
resp acidosis is _ Pco2
Tx? |
|
Definition
increased
underlying cause |
|
|
Term
| drugs that cause resp acidosis-3 |
|
Definition
sedatives
opioids
anesthetics |
|
|
Term
|
Definition
|
|
Term
| drugs that can cause resp alkolosis-2 |
|
Definition
|
|
Term
| Tx for respiratory metabolic disorder? |
|
Definition
|
|
Term
| look at slide 111 fro review of how to do a case for metaolbic disorder |
|
Definition
|
|
Term
| the biggest elecotlryte abnormailty to occur in AKi is |
|
Definition
|
|
Term
| if pt hyperNA what ABX can be causing it?-3 |
|
Definition
IV metronidazole
ampicillin
piperacillin |
|
|
Term
| if pt HyperNA what is treatment? |
|
Definition
|
|
Term
| drugs that cna cause HyperK-4 |
|
Definition
ACEI
trimethoprim
heparin
Potassium increasing diuretics |
|
|
Term
Na range-
K range
Phosphate-
Ca
Mg |
|
Definition
135-145
3.5-5
2.5-4.5
8.5-10.5
1.5-2.5 |
|
|
Term
| what are charactersitcs of pt having severe hyperK?-3 |
|
Definition
K>6.5
very symptoamtic
EKG changes |
|
|
Term
| what is used for only sevre hyper K (otherwise no Tx) |
|
Definition
calcium gluconate 1 gm (10mL) bolus
-less potent than chloride so less ADEs |
|
|
Term
what herapy can decrease K by 1.0?
what is the dose? |
|
Definition
|
|
Term
| when does dextrose ( and how muhc) needs to be given with insulin |
|
Definition
| 50 mL if not glucose >180 |
|
|
Term
| which meds send K from extracell to intracell-3 |
|
Definition
insulin
sodiium bicarb (not as effective)
beulized B2 agonists |
|
|
Term
how do nebulized Beta 2 agonits work?
what is dose |
|
Definition
stimulate KATPaase pump
10 mg/mL |
|
|
Term
these agents directly remove K from body?
which is better but onyl use if sevre or current acces)
which cant be used with abnormal bowels? |
|
Definition
ion-exhcnage resisns (Na polystrene)
RRT
na polystrene |
|
|
Term
|
Definition
| Iv or oral Vit D (increases Gi absoprtion of Phos) |
|
|
Term
TX for hyperphos-
1)
2)
3)
4) |
|
Definition
1- if Ca low give IV Ca
2- limit phos intake
3- treat cause
4- RTT if all fails |
|
|
Term
|
Definition
|
|
Term
|
Definition
thiazides
vitamin D
clacium acetate |
|
|
Term
|
Definition
| give loop diuretic-> coritcosteroid->calcitonin |
|
|
Term
| Hypo Ca cna be induced by hypo K caused by-5 |
|
Definition
ampho b and aminoglycoside
furosemude, cincalcet, ketoconazle |
|
|
Term
if hypoCa is not sympathic give?
if they are? |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
Vanc for IHD if conc:
<10?
10-25
>25? |
|
Definition
give 1000 mg dose
give 500 mg
disct! |
|
|
