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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 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?
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?
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?
What is the threshold for treating hypokalemia?
What is a complication of hypokalemia?
What is a complication of hypokalemia?
What is a risk of overtreatment with potassium replacement?
What is a risk of overtreatment with potassium replacement?
Why is continuous ECG monitoring important during 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 hypokalemia in a patient with gastrointestinal losses?
What is the likely cause of hypercalcemia in a patient with bone resorption?
What is the likely cause of hypercalcemia in a patient with bone resorption?
Which of the following is a potential cause of hypomagnesemia?
Which of the following is a potential cause of hypomagnesemia?
What is the likely cause of hyperphosphatemia in a patient with tumour lysis syndrome?
What is the likely cause of hyperphosphatemia in a patient with tumour lysis syndrome?
Which of the following is a potential cause of hypocalcemia?
Which of the following is a potential cause of hypocalcemia?
What is the likely cause of hyperkalemia in a patient with renal failure?
What is the likely cause of hyperkalemia in a patient with renal failure?
Which of the following is a potential cause of hypophosphatemia?
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 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 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 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 expected change in serum creatinine following the initiation of ACEI therapy in heart failure?
What is the formula for estimating CrCl?
What is the formula for estimating CrCl?
What is the primary goal of managing chronic complications in renal dysfunction?
What is the primary goal of managing chronic complications in renal dysfunction?
What is a potential consequence of drug-induced 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 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 is a key consideration when evaluating the impact of drug therapy on renal function?
What percentage of Allopurinol is renally eliminated?
What percentage of Allopurinol is renally eliminated?
Which of the following medications is not likely to be renally cleared?
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?
What is a major consideration in drug dosing for patients with renal dysfunction?
Which electrolyte imbalance is a concern in 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 a common cause of drug-induced renal dysfunction?
What is the primary function of the liver?
What is the primary function of the liver?
What is the goal of adjusting drug dosing in patients with renal dysfunction?
What is the goal of adjusting drug dosing in patients with renal dysfunction?
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.
