Lab values

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Questions and Answers

What is the total body potassium deficit for every 0.3 mmol/L decrease in serum potassium level?

50 mmol

150 mmol

200 mmol

100 mmol (correct)

What is the primary route of potassium loss in diuretic-induced hypokalemia?

Muscle weakness

Intracellular shift

Gut

Distal tubule in the kidney (correct)

What is the preferred salt for potassium replacement in hypokalemia?

Potassium chloride (KCl) (correct)

Potassium acetate

Potassium gluconate

Potassium citrate

What is the threshold for treating hypokalemia?

< 2.7 mmol/L Signup and view all the answers

What is a complication of hypokalemia?

All of the above Signup and view all the answers

What is a risk of overtreatment with potassium replacement?

All of the above Signup and view all the answers

Why is continuous ECG monitoring important during potassium replacement?

To monitor for cardiac arrhythmias Signup and view all the answers

What is the likely cause of hypokalemia in a patient with gastrointestinal losses?

Diuretic use Signup and view all the answers

What is the likely cause of hypercalcemia in a patient with bone resorption?

Bone resorption Signup and view all the answers

Which of the following is a potential cause of hypomagnesemia?

Gastrointestinal losses Signup and view all the answers

What is the likely cause of hyperphosphatemia in a patient with tumour lysis syndrome?

Tumour lysis syndrome Signup and view all the answers

Which of the following is a potential cause of hypocalcemia?

Binders such as phosphate or citrate Signup and view all the answers

What is the likely cause of hyperkalemia in a patient with renal failure?

Renal failure Signup and view all the answers

Which of the following is a potential cause of hypophosphatemia?

Binders such as calcium or aluminum Signup and view all the answers

What is the estimated CrCl if the baseline serum creatinine is 200 umol/L?

50 mL/min Signup and view all the answers

What is the primary mechanism of direct toxicity caused by drugs such as aminoglycosides and cisplatin?

Dose-related cumulative toxicity Signup and view all the answers

What is a key consideration when assessing the causality of drug-induced renal dysfunction?

Considering both temporal relationship and other potential causes of renal dysfunction Signup and view all the answers

What is the expected change in serum creatinine following the initiation of ACEI therapy in heart failure?

An increase of up to 30% Signup and view all the answers

What is the formula for estimating CrCl?

CrCl = (140-age)(IBW) / 50 x SCr (umol/L) Signup and view all the answers

What is the primary goal of managing chronic complications in renal dysfunction?

Slowing disease progression Signup and view all the answers

What is a potential consequence of drug-induced renal dysfunction?

All of the above Signup and view all the answers

What is the rationale for discontinuing offending drugs in the management of renal dysfunction?

To prevent further decline in renal function Signup and view all the answers

What is a key consideration when evaluating the impact of drug therapy on renal function?

Considering both the baseline serum creatinine and the dose of the drug administered Signup and view all the answers

What percentage of Allopurinol is renally eliminated?

30% Signup and view all the answers

Which of the following medications is not likely to be renally cleared?

Lipitor Signup and view all the answers

What is a major consideration in drug dosing for patients with renal dysfunction?

Reducing doses of renally eliminated drugs Signup and view all the answers

Which electrolyte imbalance is a concern in patients with renal dysfunction?

Hyperkalemia Signup and view all the answers

What is a common cause of drug-induced renal dysfunction?

NSAIDs Signup and view all the answers

What is the primary function of the liver?

Detoxifying medications Signup and view all the answers

What is the goal of adjusting drug dosing in patients with renal dysfunction?

To decrease the risk of toxicity Signup and view all the answers

Study Notes

Renal Function and Drug Dosing

Limit intake of sodium, potassium, magnesium, and phosphate, considering drugs and dietary sources
Reduce doses of renally eliminated drugs
Properties of drugs likely to be renally cleared:
- Water soluble
- Small molecular weight
- Low protein/tissue binding
- Small volume of distribution

Drug Dosing in Renal Dysfunction

Dose adjustments for different levels of renal function (CrCl >50, 10-50, and <10 mL/min)
Examples of drug dosing adjustments:
- Allopurinol (30% renal excretion)
- Cefazolin (85% renal excretion)
- Digoxin (80% renal excretion)

Drug Therapy Problems in Renal Disease

Drug-induced renal dysfunction:
- NSAIDs, ACE inhibitors, Angiotensin Receptor Blockers, and direct renin inhibitors
- Aminoglycosides, amphotericin B, cisplatin, and cyclosporine
Drug dosing for renal dysfunction:
- Most beta-lactam antibiotics, digoxin, and allopurinol
- Replacement doses with dialysis
Other considerations:
- Hyperkalemia, hypermagnesemia, hyperphosphatemia, and hypocalcemia
- Sodium, fluid, and protein restrictions

Assessment of Hepatic Function

Understand the physiology of liver function
Look at trends in patient's bloodwork and consider interfering substances with lab assays
Timing of sample collection is important

Disorders of Potassium

Hypokalemia:
- Signs and symptoms: cardiovascular (arrhythmias, hypotension, ischemia), muscular (weakness), and metabolic (glucose intolerance, ↓ Mg)
- Causes: extracellular shifts (acidosis, α agonists, ?β blockers), intracellular shifts (alkalosis, β agonists, insulin)
- Management: potassium replacement, considering the consequences of not treating and the risks of overtreatment
Diuretic-induced hypokalemia:
- Treatment involves potassium replacement, considering the risks of overtreatment

Electrolyte Disturbances

"Hypo" (not enough in) vs "Hyper" (too much in)
Consider cellular shifts
Disorders:
- Potassium: excessive oral or IV replacement, GI or renal losses (diuretics), cellular shifts
- Calcium: excessive oral or IV replacement, binders (phosphate, citrate), bone resorption
- Magnesium: excessive oral or IV replacement, GI or renal losses (diuretics), cellular shifts
- Phosphate: excessive oral or IV replacement, binders (calcium, aluminum), consumption ("refeeding syndrome")

Assessment of Renal Function

Understand what the kidney does
Electrolyte disturbances:
- Hypo vs Hyper
- Consider cellular shifts
Disorders:
- Potassium: side effect of diuretic, renally cleared
- Sodium: (Nephrology, Endocrinology)
- Calcium: osteoporosis, renally cleared (Nephrology, Endocrinology)
- Magnesium: side effect of diuretic, renally cleared
- Phosphate: (Critical Care), renally cleared
Bicarbonate: metabolic acidosis (Critical Care), side effect of diuretic

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Description

This quiz covers the considerations for drug dosing in patients with renal dysfunction, including limiting intake of certain nutrients and reducing doses of renally eliminated drugs.

Lab values

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Questions and Answers

What is the total body potassium deficit for every 0.3 mmol/L decrease in serum potassium level?

What is the primary route of potassium loss in diuretic-induced hypokalemia?

What is the preferred salt for potassium replacement in hypokalemia?

What is the threshold for treating hypokalemia?

What is a complication of hypokalemia?

What is a risk of overtreatment with potassium replacement?

Why is continuous ECG monitoring important during potassium replacement?

What is the likely cause of hypokalemia in a patient with gastrointestinal losses?

What is the likely cause of hypercalcemia in a patient with bone resorption?

Which of the following is a potential cause of hypomagnesemia?

What is the likely cause of hyperphosphatemia in a patient with tumour lysis syndrome?

Which of the following is a potential cause of hypocalcemia?

What is the likely cause of hyperkalemia in a patient with renal failure?

Which of the following is a potential cause of hypophosphatemia?

What is the estimated CrCl if the baseline serum creatinine is 200 umol/L?

What is the primary mechanism of direct toxicity caused by drugs such as aminoglycosides and cisplatin?

What is a key consideration when assessing the causality of drug-induced renal dysfunction?

What is the expected change in serum creatinine following the initiation of ACEI therapy in heart failure?

What is the formula for estimating CrCl?

What is the primary goal of managing chronic complications in renal dysfunction?

What is a potential consequence of drug-induced renal dysfunction?

What is the rationale for discontinuing offending drugs in the management of renal dysfunction?

What is a key consideration when evaluating the impact of drug therapy on renal function?

What percentage of Allopurinol is renally eliminated?

Which of the following medications is not likely to be renally cleared?

What is a major consideration in drug dosing for patients with renal dysfunction?

Which electrolyte imbalance is a concern in patients with renal dysfunction?

What is a common cause of drug-induced renal dysfunction?

What is the primary function of the liver?

What is the goal of adjusting drug dosing in patients with renal dysfunction?

Study Notes

Renal Function and Drug Dosing

Drug Dosing in Renal Dysfunction

Drug Therapy Problems in Renal Disease

Assessment of Hepatic Function

Disorders of Potassium

Electrolyte Disturbances

Assessment of Renal Function

Studying That Suits You

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