Shared Flashcard Set

Details

CCRN Renal System
Renal System Review
75
Nursing
Undergraduate 4
11/13/2015

Additional Nursing Flashcards

 


 

Cards

Term
Exam Blueprint - Renal
Definition

 

CCRN (~6%)

 

Acute kidney injury

 

Acute renal failure

 

Acute tubular necrosis

 

(ATN)

 

Chronic kidney disease

 

Incontinence

 

Infections

 

Life threatening electrolyte

 

imbalances

 

7 – 9 questions

 

Term

CCRN Testable Nursing Actions

 

Definition

 

Recognize normal & abnormal physical assessment findings

 

Identify & monitor normal & abnormal diagnostic test results

 

Manage patients receiving renal medications & monitor

 

response

 

Recognize indications for & manage patients requiring renal

 

therapeutic intervention (e.g., CRRT, peritoneal dialysis)

 

Monitor patients & follow protocols for:

 

  • renal surgery
  • pre-, intra-, and post-procedure (e.g., renal biopsy,
  • ultrasound)

 

Recognize signs & symptoms of renal emergencies, initiate

 

interventions, & seek assistance as needed

 

 

 

Term

Review of the renal system

 

Definition

 

Approximately

 

20%

 

of cardiac output

 

goes to the kidneys

 

Renal arteries

 

branch

 

directly off aorta

 

 

The kidney functions

 

to cleanse & detoxify

 

blood

 

Term

The Kidneys

 

Definition

Main functions:

Filtration

Reabsorption

Secretion

Acid/base balance

BP regulation

Erythropoietin

Term

The Nephron

 

Definition

Glomerulus

 

Network of capillaries

 

Filters blood

 

Proximal Convoluted Tubule

 

Reabsorbs H2O, sodium, amino

 

 

acids & glucose

Loop of Henle

 

Reabsorbs Na, water &

 

 

concentrates urine

Distal Convoluted Tubule

 

Regulates pH, K+, Na+ & Ca

 

Collecting Duct

 

Collects urine from the nephrons

 

Term
Nephron
Definition
Term
Nephron
Definition
[image]
Term

Fluid balance is regulated by:

 

Definition

 

Thirst

 

ADH

 

Aldosterone**

 

  • Elevated K+ triggers release of aldosterone

 

ANP

 

  • Overstretch of the atria

 

Renin Angiotensin

 

Aldosterone System

 

(RAAS)

 

Term

Urine

 

Definition

 

Normal UOP

 

1500 mL/day or 0.5 mL/kg/hr

 

Anuria

 

0 – 100 mL/day

 

Oliguria

 

100 – 400 mL/day

 

Polyuria

 

> 2500 mL/day

 

Term

Are we measuring the same?

 

 

 

Typical order – Call < 30 cc/hr

 

Definition

0.5 ml/kg/hr

 

Term

Acute Kidney Injury (AKI)

< 400 mL/day

Definition

 

a.k.a. Acute renal failure (ARF)

 

Incidence: ~18% in hospitalized patients

 

Abrupt decline in glomerular filtration rate (GFR)

 

Results in retention of metabolic waste

 

  • Protein catabolism (azotemia)
  • Electrolyte & acid-base imbalance
  • Volume imbalance

 

Causes:

 

Low perfusion, medications, parenchymal disease

 

Reversible if prompt treatment is received

 

Term

Risk factors for developing AKI

 

Definition

 

Elderly

 

Female > male

 

Heart failure

 

Baseline renal function

 

Elevated BMI (>32)

 

COPD

 

Liver disease

 

Sepsis

 

GI Bleeding

 

Burns

 

 

Multi-System Organ

 

Failure

 

Hypotension

 

Trauma injury

 

Rhabdomyolysis

 

Contrast

 

 

 

Term

RIFLE Criteria/Classification

 

Definition
Term
RIFLE Criteria/Classification
Definition
[image]
Term
AKI LABS
Definition

 

BUN & creatinine

 

  • Up to 12 hr lag time

 

Normal BUN/Creat

 

ratio – 10:1

 

GFR*

 

Proteinuria

 

Casts

 

  • Tubular cell death

 

Urine lytes

 

Urine glucose

 

What does the future

 

hold?

 

Biomarkers?

 

Insulin-like growth

 

factor-binding protein

 

TIMP-2

 

  • Tissue inhibitor of metalloproteinases-2

 

Term

Glomerular Filtration Rate

 

Definition

 

Estimated by creatinine clearance

 

The measurement of how much filtrate is made by the

 

kidney (ml/min)

 

~ 80 – 120 ml/min

 

Males slightly higher

 

Isolated plasma creatinine is not a sensitive marker for

 

GFR in early stages of kidney injury

 

Estimating Equations

 

A. Cockcroft-Gault

 

GFR = (140 - age) x (weight) / (sCr x 72) (x 0.85 for )

 

B. MDRD

 

GFR = 186 x (serum creatinine in mg/dL)-1.154 x (Age in years)-0.203

 

(x0.742 if female) (x1.210 if African-American)

 

Term

3 Categories of AKI (location of cause)

 

Definition

 

Postrenal

 

  • Injury caused by disruption
  • of urine flow
  • Think obstruction!
  • Examples: urethral obstruction, prostatic disease, infection,
  • neurogenic problems
  • BUN/creat 10:1

 

Term

3 Categories of AKI (location of cause)

 

Definition

 

Prerenal

 

Injury occurs before

 

blood reaches the kidney

 

Results in hypoperfusion

 

Kidney structure & function is

 

preserved

 

Examples: Sepsis, heart

 

failure, trauma, severe

 

hypovolemia

 

BUN/Creat 25:1

 

Urine Na < 10 mEq/L

 

Term

3 Categories of AKI (location of cause)

 

Definition

 

Acute Tubular Necrosis

 

(ATN)

 

May also be referred to as

 

“intrinsic”, “infra-renal”

 

kidney injury

 

Injury occurs at the nephrons

 

Renal failure requiring renal

 

replacement therapy

 

Examples: Hypotension,

 

glomerulonephritis, DM,

 

rhabdomyolysis, nephrotoxic

 

meds, shock

 

BUN/Creat 10:1

 

Urine Na > 40 meq/L

 

Term
Acute Tubular Necrosis
Definition

 

Ischemic ATN

 

Irregular damage along tubular membranes

 

Tubular cell damage & cast formation

 

Poor – no perfusion to kidneys

 

Recovery long (> 8 days)

 

Toxic ATN

 

Caused by drugs or bacteria

 

  • Aminoglycosides, antivirals

 

Uniform, wide spread damage

 

Recovery more rapid (< 8 days)

 

***Reversible!

 

Term

Phases of ATN

 

Definition

 

Initiation/Onset Phase

 

Insult to injury

 

Lasts hours to days

 

GFR is decreased d/t

 

decreased flow

 

50% are oliguric, 50% are

 

non-oliguric with UOP > 600

 

mL/8 hrs

 

Oliguric Phase

 

Lasts 7 – 16 days

 

Inability to excrete fluids &

 

metabolic wastes

 

Often requires total renal

 

support

 

Mortality: 25% with nonoliguria,

 

66% with oliguria

 

 

Diuretic Phase

 

Lasts 7 – 14 days

 

Increase in GFR & polyuria

 

2 – 4 L/day

 

HD may cover polyuria

 

Kidneys can often clear volume,

 

but not solute

 

Recovery Phase

 

GFR returns to < 80% of within

 

1 – 2 years

 

 

 

Term
Characteristics of each location of failure
Definition
Term
Characteristics of each location of failure
Definition
[image]
Term

Contrast induced nephropathy

 

Definition

 

At risk:

 

  • Diabetics, HTN
  • Pre-existing renal insufficiency
  • Dehydrated
  • 10% of all hospital acquired renal insufficiency

 

***HYDRATION!!!***

 

Sodium bicarbonate – IV 1 hour before & 6 hours after

 

N-Acetylcysteine for prevention

 

  • 600 mg PO day before & day of (4 doses)
  • Prevents toxicity to renal tubules

 

Term

Overall Recovery of ATN

 

Definition

 

Of those who survive,

 

~ 62% will recover renal function

 

33% will have renal insufficiency

 

5% will require long term dialysis

 

Term

 

Indications for Dialysis

 

Definition

 

A: Acid/base imbalance

 

E: Electrolyte imbalance (hyperkalemia)

 

I: Intoxications (ODs/toxins)

 

O: Overload (fluid)

 

U: Uremic symptoms

 

Term

Laboratory Findings

 

Definition

 

BUN > 100

 

Creatinine > 10

 

Cr climbing ≥ 1

 

point/day

 

Metabolic acidosis

 

Anemia

 

Electrolyte imbalances

 

Increased K+/Phos

 

Decreased Ca, HCO3

 

Abnormal urine lytes

 

Term

Uremic Syndrome

 

Definition

 

Neurologic

 

Lethargy, fatigue, seizures,

 

coma

 

Cardiovascular

 

ECG changes

 

(d/t hyperkalemia)

 

Signs of fluid overload;

 

tachycardia, S3

 

Hematologic

 

Anemia

 

 

Pulmonary

 

Crackles, pulmonary

 

edema

 

Edema/SOB/effusions

 

Pleuritis from uremia

 

GI

 

Decreased appetite

 

N/V

 

Ascites – fluid overload

 

 

 

Term

General Treatment Goals for AKI

 

Definition

 

Hemodynamic stability

 

Improve renal perfusion

 

Correct chemistry

 

(Lytes/BUN/Creat)

 

abnormalities

 

Electrolyte imbalances

 

  • During therapy
  • After therapy

 

Adequate

 

hydration/careful use of

 

diuretics

 

  • Accurate, meticulous daily weights

 

Aggressive dialysis

 

Monitor drug levels

 

Monitor coags

 

*Alter medication

 

schedules if needed

 

Minimize exposure to

 

nephrotoxins

 

Prevent infection

 

Maintain nutritional state

 

Term

 

 

 

 

Chronic Renal Failure

 

 

Definition

 

CRF is a slow, progressive deterioration of renal

 

function

 

Diminished renal reserve puts patients at a higher

 

risk for development

 

Lab findings:

 

Anemia*

 

BUN/creat/PO4

 

Ca, HCO3, Protein

 

Term

 

Risk Factors for CRF

 

Definition

 

Diabetes*

 

Hypertension*

 

Autoimmune diseases

 

Systemic infection

 

Urinary stones or

 

lower urinary tract

 

obstructions

 

Prolong exposure to

 

nephrotoxic drugs

 

*Responsible for 70% of CRF cases

 

Increasing in age

 

Race or ethnic

 

background

 

Exposure to chemicals

 

or environmental toxins

 

Family history

 

Term

Classification of Function

 

Definition

 

Diminished renal reserve

 

  • 50% nephron loss
  • Creatinine levels elevated
  • Otherwise symptom free

 

Renal insufficiency

 

  • 75% nephron loss
  • Clinical evidence of impairment
  • Requires medication

 

ESRD – 90% nephron loss

Term
Stages of Chronic Kidney Disease
Definition

 

Stage 1: Damage w/increased GFR

 

(> 90 ml/min/1.73 m2)

 

Stage 2: Mild reduction GFR

 

(60 – 89 ml/min/1.73 m2)

 

Stage 3: Moderate reduction in GFR

 

(30 – 59 ml/min/1.73 m2)

 

Stage 4: Severe reduction in GFR

 

(15 – 29 ml/min/1.73 m2)

 

Stage 5: Kidney Failure

 

(< 15 ml/min/1.73 m2)

 

Term

Dialysis Modes

 

Definition

 

Hemodialysis

 

  • Intermittent
  • Slow Low Efficiency

 

Dialysis (SLED)

 

Continuous Renal

 

Replacement Therapy

 

Slow, continuous

 

Used in patients with

 

hemodynamic instability

 

 

 

CRRT

 

  • Slow Continuous Ultrafiltration (SCUF)
  • Continuous Venovenous hemofiltration (CVVH)
  • with hemodialysis (CVVHD)
  • with hemodiafiltration (CVVHDF)
  • Continuous arteriovenous (CAVH/CAVHD/F)

 

Term

Principles of Dialysis

 

Definition

 

Two compartments (blood & filtrate) separated by

 

a semi-permeable membrane

 

Pressure gradients are created

 

Water, toxins, electrolytes & drugs can cross the

 

membrane

 

Goal is to reach equilibrium on each side of the

 

membrane

 

Term

Peritoneal Dialysis

 

Definition

 

Soft catheter inserted percutaneously into

 

abdominal cavity

 

Abdominal mesenteric capillary bed is utilized as

 

the SPM

 

Glucose based dialysate is used

 

(1.5%, 2.5%, 4.25%)

 

Usually 2 Liter exchanges q 3 - 4 hrs.

 

glucose conc = fluid removal (via diffusion

 

gradient)

 

Advantages: patient can do, cost effective, no need for

 

anticoagulation or vascular access

 

Soft catheter inserted percutaneously into

 

abdominal cavity

 

Abdominal mesenteric capillary bed is utilized as

 

the SPM

 

Glucose based dialysate is used

 

(1.5%, 2.5%, 4.25%)

 

Usually 2 Liter exchanges q 3 - 4 hrs.

 

glucose conc = fluid removal (via diffusion

 

gradient)

 

Advantages: patient can do, cost effective, no need for

 

anticoagulation or vascular access

 

Term

Complications of PD

 

Definition

 

Peritonitis

 

Hyperglycemia

 

Diaphragmatic pressure/resp. compromise

 

Pleural effusion

 

Visceral herniation or perforation

 

Contraindications: Recent abdominal surgery,

 

abdominal adhesions, need for emergent dialysis

 

Term

Hemodialysis

 

Definition

 

Artificial kidney (hemofilter) with a synthetic

 

membrane

 

Dialysate is bicarbonate & sodium based with

 

electrolytes

 

Short term access

 

  • Double lumen catheter

 

Long term access

 

  • AV fistula/shunt

 

Term

Hemodialysis Complications

 

Definition

 

Hypotension

 

Angina

 

Dysrhythmias

 

Fever / pyrogenic reaction

 

Coagulopathy/Thrombocytopenia

 

Disequilibrium Syndrome (post-treatment cerebral

 

edema)

 

Exsanguination

 

Air embolus

 

 

 

Term

Air Embolus

 

 

 

 

 

Definition

 

Venous signs:

 

Shortness of breath

 

Chest pain

 

Acute right heart failure

 

(if obstructs flow from right

 

heart to the lungs)

 

Treatment:

 

Lay on left side,

 

Trendelenburg position

 

Hyperbaric with 100% FiO2

 

(accelerates the removal of

 

nitrogen)

 

Arterial signs:

 

Change in LOC

 

Decreased arterial

 

flow/perfusion

 

2 ml fatal in artery

 

0.5 ml fatal in coronary

 

artery

 

Term

CRRT

 

Definition

 

Must have sufficient MAP or AV gradient

 

AV Gradient: MAP – CVP (> 60 mmHg)

 

Indications: fluid removal refractory to diuretics

 

Complications:

 

  • Hypotension

  • Bleeding (anticoagulation)

  • Hypothermia

  • Filter/circuit clotting

  • Membrane rupture

 

Term

Renal Terms

 

Definition

 

Azotemia

 

  • Acute rise in blood urea nitrogen (BUN)

 

Anuria

 

  • Complete suppression of urine output

 

Oliguria

 

  • Urine output < 400 mL/day

 

Glomerular filtration rate (GFR)

 

  • The amount of glomerular filtrate formed in the kidneys each minute

  • It is used to evaluate the kidneys’ ability to remove waste products from

 

the body

 

Urine casts

 

  • Cylindrical structures formed by the kidneys in certain disease states

  • Released from the distal tubule & collecting ducts

  • Detected on urinalysis

 

Term

Laboratory norms

 

Definition
Term

Laboratory norms

 

Definition
Term

Laboratory norms

 

Definition
Term

Renal Laboratory norms

 

Definition
[image]
Term

Name that renal injury…

 

Definition

 

Name that renal injury…

 

(ie. Prerenal, ATN (infranrenal), or postrenal:

 

Creatinine of 5.6 caused from a UTI in a patient with an

 

enlarged prostate

 

  • Postrenal

 

BUN 80/Creatinine10, Urine Na 56, one week after a

 

prolonged cardiac arrest

 

  • ATN - Infrarenal (intrinsic)

 

BUN 50/Creatinine 2.2, Urine Na 9, 12 hours after a 4 hour

 

period of hypotension

 

  • Prerenal

 

Term

Name that renal injury…

 

Definition

 

3 weeks after hypotension post surgery, urine output of 1

 

L/day with casts present, urine specific gravity of 1.010 &

 

urine Na of 60

 

  • ATN - Infrarenal (intrinsic) renal failure

 

58 yo with prostate enlargement and unable to urinate for 2

 

days. Blood is present, urine Na is 25, BUN 30, creat 3.0.

 

Urinary catheter inserted for a return of 2 liters of urine.

 

  • Postrenal

 

46 yo with cardiogenic shock after an acute anterior wall MI.

 

On Dopamine & Dobutamine infusions with low cardiac output.

 

Urine output averages 5 – 10 ml/hr, urine specific gravity is

 

1.025, Urine Na is 6. Bun 125/creatinine 5

 

  • Prerenal

 

Term

Hypernatremia Na+ > 145 mEQ/L

 

Definition

 

Dehydration

 

Increased Hct

 

Increased Cl

 

  • > 106 mEQ/L

 

Urine specific gravity

 

  • > 1.025

 

Decreased urine Na

 

Increased osmo

 

Treat Cause

 

  • Excess administration of NaCl or NaHCO3

  • Hypertonic enteral feedings

  • Comatose patient

  • DKA

  • Burn injury

 

Treatment:

 

  • Free H2O

  • Diuretics

 

Term

Hyponatremia – Na+ <130, Cl < 98

 

 

 

Excess H2O or Na+ depletion

 

Definition

Water retention


  • Neuro changes,

  • headache, confusion,

  • coma, death


Dehydration


  • Anxiety, weakness,

  • abdominal cramping,

  • seizures, hypotension,

  • tachycardia, shock


Causes:


  • NG tube suction

  • SIADH

  • Diarrhea

  • Intestinal surgery


Treatment:


  • Slow correction!!!

  • Na+ Phos:

    • 1 – 2 mmol/hr for 1st 3 –

    • 4 hrs

  • Hypertonic saline

  • Na tabs


Term

Potassium 3.5 - 5.0 mEq/L

 

Definition

 

90% intracellular, 10% in serum

 

  • Na/K+ pump = maintains normal cell volume and
  • electro-neutrality of the cell membrane

 

Functions:

 

Transmission of nerve impulses

 

Intracellular osmolality

 

Enzymatic reactions

 

Acid-base balance

 

Myocardial, skeletal & smooth

 

muscle contractility

 

 

 

Term

Potassium Regulation

 

Definition

 

Kidneys - Primary excretory source

 

Intestines (excretion)

 

So efficient rarely have hyper states in normal RF

 

In the presence of aldosterone, K+ is excreted by

 

the renal tubules

 

K+ and Na+ constantly in

 

competition

 

Term

Hypokalemia: < 3.5 mEq/L

 

Definition

 

Increased loss

 

  • GI: Vomiting, NGT suctioning (aggravated by Met Alkalosis)

  • Diarrhea, fistula, ileostomy ( LGI K+ 30 mEq/L)

 

Excessive urinary loss

 

  • Hyperaldosterone states, Thiazide Diuretics, Ampho, Gent,

  • cisplatin

 

Inadequate intake

 

  • Anorexia, ETOH, IV (K free)

  • Magnesium depletion

 

Intracellular shift

 

  • Alka-LO-sis 0.1 unit in pH K 0.4 mEq/L

  • Insulin

 

Term

Hypokalemia

 

Definition

 

Clinical presentation – symptoms < 3.0


 Cardiovascular

    • Ventricular irritability (PVCs) < 2.8

    • Ventricular fibrillation

    • Depressed ST segment

    • U-wave

    • Prolonged QT interval

    • Potentates Digoxin activity

 

Term

Hypokalemia: Treatment

 

Definition

 

1. Replace K+

 

  • Oral supplements or increased dietary intake when

  • possible

  • IV

    • Standard dose 10-20 mEq over 1 hours

    • Central line administration is best

    • Monitor IV site – irritant

 

2. Eliminate or treat conditions that promote K+

 

shifts (ie. alkalosis)

 

  • Ensure adequate renal function

 

Term

Hyperkalemia K+ >5.5 mEq

 

Definition

 

Causes of hyperkalemia:

 

Renal failure (~75% of all cases)

 

  • Inability of renal tubules to excrete K+

 

Acidosis

 

Decreased cardiac output

 

Elderly taking K+ sparing diuretics

 

Severe trauma

 

Severe burns

 

Infection

 

Addison’s Disease

 

Consumption of table salt or antacids

 

Term

Hyperkalemia Symptoms

 

Definition

 

N/V

 

Diarrhea

 

Tingling skin

 

Numbness in hands & feet

 

Flaccid paralysis

 

Cardiac signs

 

Apathy

 

Confusion

 

 

 

Term
Hyperkalemia: Cardiac changes
Definition

 

Cardiovascular

 

Tall tented symmetrical T

 

waves

 

(K+ >6.5)

 

Widened QRS, prolonged

 

PR, widened P wave (K+

 

>8.0)

 

Decreased

 

automaticity

 

(K+ 10-11.0)

 

P waves disappear

 

QRS merges with T to

 

form sine wave

 

Asystole or ventricular

 

fibrillation

 

Decreased strength of

 

contraction

 

Term

Hyperkalemia Treatment

 

Definition

 

Emergency: (Move potassium)

 

Regular Insulin

 

  • Dextrose if normal or low glucose

  • Calcium Chloride (cardio protectant; no effect on K+ levels)

  • NaHCO3

 

Nebulized albuterol

 

  • onset ~15 min., duration ~ 15 - 90 min.

 

Dialysis* (Remove potassium)

 

Loop diuretics

 

Sodium polystyrene sulfonate (Kayexalate)

 

  • Dose 15 Grams 1- 4 doses/day, 24 hrs to correct

 

Term

Magnesium 1.5 – 2.5 mEq/L

 

Definition

 

Functions:

 

Neuromuscular transmission

 

Cardiac contraction

 

Activation of enzymes for cellular metabolism

 

Active transport at the cellular level

 

Transmission of hereditary info.

 

Term

 

Hypomagnesemia <1.3 mEq/L

 

Definition

 

Increased excretion

 

  • NG suctioning, diarrhea, fistulas

  • Diuretic: blocks Na reabsorption

  • Osmotic diuresis

  • Antibiotics & antineoplastics

  • Hypercalcemia

 

Decreased intake

 

Chronic alcoholism

 

Malabsorption

 

Acute pancreatitis

 

Term

Hypomagnesemia symptoms:

 

Definition

 

CV: Tachycardia, depressed ST segment, prolonged QT

 

PACs & PVCs

 

  • Increased risk for digoxin toxicity

  • Hypotension

  • Coronary artery spasm

 

Neuromuscular

 

  • twitching, paresthesias, cramps, muscle tremors

 

CNS: mentation changes, seizures

 

Hypokalemia

 

Term

Hypomagnesemia

 

Definition

 

Management:

 

  • Assess renal function

  • Increase intake

    • Dietary: diet or PO supplementation

    • IV 1-2 G MgSO4 over 60 minutes, emergency 1 – 2 minutes

    • Add to IV or TPN

 

Monitor BP & airway

 

Monitor neurological status

 

Monitor K+ and Ca+

 

Serial Magnesium levels

 

 

 

Term

Hypermagnesemia >2.5 mEq/L

 

Definition

 

Extremely rare!

 

Etiology

 

  • Decreased excretion – renal failure - most common

  • Acidosis, DKA

 

Clinical presentation

 

  • 3-5 mEq/L Peripheral dilation, facial flushing, hypotension

  • 4-7 mEq/L Drowsiness, lethargy

  • Treat

    • Increase excretion

    • Fluids & diuretics

 

Term

Hypocalcemia – Ca++ <8.5

 

Definition

 

Hypercalcemia: rare (Treatment: IV fluids)

 

Hypocalcemia: more common

 

  • Follow ionized (active) Ca++

  • Normal: 1.1 - 1.35 mmol/L

  • Symptoms:

    • Diarrhea

    • Diuretics

    • Malabsorption

    • Chronic renal failure

    • Alkalosis – Ca++ bound to albumin & is inactive

  •  Increased PO4 = Decreased Ca++

  • Alkalosis – Decreased iCa

  • Acidosis – Increased iCa

 

Term

Hypocalcemia signs

 

Definition
Trousseau's sign (arm flexes upon bp cuff inflation) Chvostek's sign (Cheek twitches when touched)
Term

Hypocalcemia

 

Definition

 

Clinical presentation

 

  • Cardiovascular

    • prolonged QTc, ↓BP, ↓CO, ventricular ectopy, ventricular fibrillation

  • Neuromuscular

    • Tingling, spasms, tetany, seizures

  • Respiratory

    • bronchospasm; labored shallow breathing

  • Gastrointestinal – smooth muscle hyperactivity

  • Bleeding – Ca++ needed to clot

 

Safety – confusion & seizures

 

Muscle cramps can precede tetany

 

Monitor airway – bronchospasm

 

Term

Hypophosphatemia < 2.5 mg/dL

 

Definition

 

Etiology

 

  • Decreased intake

    • ETOH, Small bowel disease

  • Increased elimination

    • Vomiting and diarrhea

    • Use of phosphate binding antacids

    • Increased urinary losses: osmotic diuresis, thiazide diuretics

  • Increased utilization

    • Necessary for cellular energy

    • Tissue catabolism: increase use in tissue repair

  • Intracellular shifts

    • Alkalosis (respiratory)

    • Refeeding syndrome

 

Term

 

Etiology

 

  • Decreased intake

    • ETOH, Small bowel disease

  • Increased elimination

    • Vomiting and diarrhea

    • Use of phosphate binding antacids

    • Increased urinary losses: osmotic diuresis, thiazide diuretics

  • Increased utilization

    • Necessary for cellular energy

    • Tissue catabolism: increase use in tissue repair

  • Intracellular shifts

    • Alkalosis (respiratory)

    • Refeeding syndrome

 

Definition

 

Clinical Manifestation: symptoms are secondary to

 

decreases in ATP and 2,3 DPG

 

  • Acute: Confusion, seizures, coma, chest pain due to poor oxygenation of the myocardium, numbness and tingling of the fingers, circumoral region, and incoordination, speech difficulty, weakness of respiratory muscle,

  • Chronic: Memory loss, lethargy, bone pain, hypomagnesemia

 

Term

Hypophosphatemia < 2.5 mg/dL

 

Definition

 

Management

 

  • Identification and elimination of the cause

  • Increase dietary intake of phosphate

  • Oral phosphate supplements – K+ Phos. tabs, neutraphos. capsules

  • IV : potassium phosphate

    • sodium phosphate

 

Term
Hyperphosphatemia > 4.5 mg/dL
Definition

 

Etiology

 

  • Increased intake

    • phosphate containing antacids

  • Decreased excretion

    • Renal failure

  • Transcellular shifts

    • Respiratory acidosis

    • Intracellular release

    • Cell lysis of RBC, skeletal muscle or tumor cells

 

Term

Hyperphosphatemia > 4.5 mg/dL

 

Definition

 

Clinical Manifestation

 

  • Rebound hypocalcemia – phosphate binds with free

  • calcium and ionized serum calcium falls

  • Ectopic disposition of Ca-PO4

  • Anorexia, nausea, vomiting

  • Muscle weakness, hyperreflexia, tetany,

  • Tachycardia

  • Increased PO4 = Decreased Ca++

 

Term
Hyperphosphatemia > 4.5 mg/dL
Definition

 

Management

 

  • Identification and elimination of cause

  • Use of aluminum, magnesium or calcium gels or

  • antacids: binds phosphorus in the gut

  • Diet low in phosphorus

    • avoid meats, fish, poultry, milk, whole grains, seeds, nuts, eggs, dried beans

  • Dialysis therapy

  • Acetazolamide stimulated urinary PO4 excretion

 

Term
Chloride 98 – 106 mg/dL
Definition

 

Metabolic alkalosis

 

  • Always associated with hypochloremia

    • Excess serum HCO3 displaces Cl in ECF resulting in

    • hypochloremia

    • Decreased Cl delivery to nephron

    • Volume sensing cells in distal tubules are chloride dependent

    • Interpret hypochloremia as volume depleted

    • RAA system activated = Na and HCO3 reabsorbed

    • Acidosis – Cl excreted

    • Alkalosis – Cl reabsorbed

 

Term

Venous measure CO2

 

Definition

 

Most acid/base disturbances can be detected by

 

evaluating venous CO2 i.e. HCO3

 

  • Laboratories typically measure HCO3 indirectly using

  • CO2

  • This measured CO2 approximates HCO3 in the serum

 

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