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?

    <p>&lt; 2.7 mmol/L</p> Signup and view all the answers

    What is a complication of hypokalemia?

    <p>All of the above</p> Signup and view all the answers

    What is a risk of overtreatment with potassium replacement?

    <p>All of the above</p> Signup and view all the answers

    Why is continuous ECG monitoring important during potassium replacement?

    <p>To monitor for cardiac arrhythmias</p> Signup and view all the answers

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

    <p>Diuretic use</p> Signup and view all the answers

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

    <p>Bone resorption</p> Signup and view all the answers

    Which of the following is a potential cause of hypomagnesemia?

    <p>Gastrointestinal losses</p> Signup and view all the answers

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

    <p>Tumour lysis syndrome</p> Signup and view all the answers

    Which of the following is a potential cause of hypocalcemia?

    <p>Binders such as phosphate or citrate</p> Signup and view all the answers

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

    <p>Renal failure</p> Signup and view all the answers

    Which of the following is a potential cause of hypophosphatemia?

    <p>Binders such as calcium or aluminum</p> Signup and view all the answers

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

    <p>50 mL/min</p> Signup and view all the answers

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

    <p>Dose-related cumulative toxicity</p> Signup and view all the answers

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

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

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

    <p>An increase of up to 30%</p> Signup and view all the answers

    What is the formula for estimating CrCl?

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

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

    <p>Slowing disease progression</p> Signup and view all the answers

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

    <p>All of the above</p> Signup and view all the answers

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

    <p>To prevent further decline in renal function</p> Signup and view all the answers

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

    <p>Considering both the baseline serum creatinine and the dose of the drug administered</p> Signup and view all the answers

    What percentage of Allopurinol is renally eliminated?

    <p>30%</p> Signup and view all the answers

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

    <p>Lipitor</p> Signup and view all the answers

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

    <p>Reducing doses of renally eliminated drugs</p> Signup and view all the answers

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

    <p>Hyperkalemia</p> Signup and view all the answers

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

    <p>NSAIDs</p> Signup and view all the answers

    What is the primary function of the liver?

    <p>Detoxifying medications</p> Signup and view all the answers

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

    <p>To decrease the risk of toxicity</p> 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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    Related Documents

    PHM101 General Medicine I: Interpretation of Laboratory Values 2024 PDF

    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.

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