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Electrolytes, Renal, HTN, Nutrition
Terms in this set (12)
When correcting hyponatremia do not want to exceed ___meq over 24hrs.
How does respiratory alkalosis affect phosphorous levels?
Respiratory alkalosis can cause pH to increase with decrease in PO4 level. Alkalosis can cause incr intracellular phosphosfructokinase activity with intracellular shift of PO4. Drop PO4 can occur 30-45min after hyperventilation and resolve spontaneously w/in 2-3 hrs.
How does one treat hypophosphatemia in setting of refeeding syndrome or DKA?
PO4 lvl <1.5mg/dL, IV PO4 given over 6-12hrs
POR >1.5 <2.3 (mild) give oral PO4 (Sodium Phosphate) 30-45mg/kg/day (loose stools may limit therapy)
What are the 3 lab abnormalities to fulfill Cairo-Bishop criteria for tumor lysis syndrome?
Calcium 7mg/dL or lower
Uric acid > 8mg/dL
What is milk-alkali syndrome?
Ingest excess calcium-containing antacids. Hypercalcemia shuts off PTH secretion. 1 alpha hydroxylase activity decreases, stored Vit D is not converted. Phosphorus lvls rise and calcium is lost in urine. However high calcium intake in setting of alkalosis overwhelms excretory capacity.
Once magesium drops below this range one would expect significant impairment in iPTH function or parathyroid resistance (since Mg is needed for appropriate fxn of iPTH hormone)
Mg less than 1.5 - 1.0mg/dL
Plasma aldo-renin ratio < than what is more concerning for renal art stenosis? Ratio of what value is more concerning for hyperaldosteronism?
Ratio < 10 = renal art stenosis
Ratio >20 and certainly >30 = primary hyperaldosteronism
What would explain levels of renin that are elevated but not as high as expected in patient with renal artery stenosis?
Beta adrenergic blockers (will decr lvl of renin), and bilat renal art stenosis (studies have shown that pts w/ unilateral renal art stenosis tend to have higher levels of renin vs pts that have bilat renal art stenosis)
In hospitalized patients that are non-critical, and have not lost >10% of baseline body weight, how many days can you keep them on just IVF?
In hospitalized patients are there any studies supporting use of dextrose containing fluids vs colloid fluids (ie normal saline) for those with prolonged unmet nutritional deficiency?
No benefit of dextrose containing fluids over colloid (ie normal saline)
Are noncritically ill patients w/o hx diabetes and mean glucose lvls >180mg/dL during infusion of parenteral nutrition at incr risk of complications?
Yes! Recent prospective study noted 5.6x greater risk of death vs those patients w/ glucose lvls <140mg/dL
In hospitalized pts w/ and w/o diabetes on parenteral nutrition, when should scheduled insulin therapy be considered?
1). If more than 1 blood glucose value >140mg/dL
2). If persistent need for correctional insulin > 12-24hrs
3). For one blood glucose concentration >180mg/dL
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