What is the normal range for BUN?
10-23 mg/dL
What is the normal range for creatinine in males?
0.8-1.4 mg/dL
What is the normal range for creatinine in females?
0.6-1.1 mg/dL
What is the normal Glomerular Filtration Rate (GFR)?
125 mL/minute
What is the normal range for Urine Specific Gravity (SG)?
1.010-1.020
What is the normal Spot Urine Na+ level?
20 mEq/L
What is the normal Serum Osmolarity range?
275-295 mOsm/kg
What is the normal Urine Output (UOP)?
30 mL/hr or 1,000 mL/day or 0.5ml/kg/hr
What are some nephrotoxic substances?
Antibiotics, NSAIDS, ACE inhibitors, ARBS, Antineoplastics, Contrast media, Diuretics, Metformin
What does BUN measure?
Amount of nitrogen in blood from urea.
What is creatinine?
Nonprotein waste product of creatine phosphate metabolism.
What does GFR indicate? What is best indicator of GFR:
Volume of plasma filtered per minute. 24 hour urine collection for creatinine clearance
What is proteinuria, normoalbuminuria, & microalbuminuria
Normoalbuminuria: less than 30 mg/day albumin Microalbuminuria: persistent excretion of albumin (30-300 mg/day) Proteinuria: Early indication of renal disease; excretion of >300 mg of albumin/day.
What is the BUN:Creatinine Ratio in prerenal failure?
20-40:1
What is the BUN:Creatinine Ratio in intrarenal failure?
10-15:1
What is the urine sodium level in prerenal failure?
<20 mEq/L
What is the urine sodium level in intrarenal failure?
20 mEq/L
What is a common treatment for intrarenal failure?
Lasix to convert to non-oliguric.
What is post-renal failure?
Obstruction in urine flow from the kidneys.
What is acute tubular necrosis?
Condition caused by crush injuries, prolonged immobility, hyperthermia, DT’s, compartment syndrome
What is the treatment for contrast medium nephropathy?
Hydrate with 0.9 NS (BEFORE and after), avoid nephrotoxic drugs, treat with diuretics//if no response treat as intrarenal failure
What are the dialysis candidates?
AEIOU: Acidemia, Electrolyte disorders, Intoxication, Overload, Uremia.
What is the lab value range for sodium?
135—145
What is hypernatremia?
Elevated serum sodium, lab value >145
What are the causes of hypernatremia?
Inadequate water intake, excessive water loss, sodium gain
What are the symptoms of hypernatremia?
Dehydration of brain cells, changes in mental status, thirst, lethargy, agitation, seizures
What is the treatment for hypernatremia?
Replace fluids orally or IV with isotonic or hypotonic fluids; dilute sodium with sodium-free fluids
What is hyponatremia?
Not enough sodium, lab value <135
What are the causes of hyponatremia?
Excessive loss of sodium-containing fluids, water excess
What are the symptoms of hyponatremia?
Headache, irritability, confusion
What is the treatment for hyponatremia?
Fluid restriction, IV hypertonic solution (3% NaCl) in severe cases
What is the lab value range for potassium?
3.5—5.0
What is hyperkalemia?
Elevated potassium, lab value >5.0
What are the causes of hyperkalemia?
Impaired renal secretion, excessive potassium intake
What are the symptoms of hyperkalemia?
Cramping leg pain, weak/paralyzed skeletal muscles, abdominal cramping, cardiac dysrhythmias
What is the treatment for hyperkalemia?
Stop potassium intake, increase potassium excretion, insulin, sodium polystyrene sulfonate, calcium gluconate
What is hypokalemia?
Low potassium, lab value <3.5
What are the causes of hypokalemia?
GI tract losses, kidney losses
What are the symptoms of hypokalemia?
Cardiac problems, skeletal muscle weakness, respiratory muscle weakness, decreased GI motility
What is the treatment for hypokalemia?
Potassium chloride (KCl) orally or IV, dilute KCl, monitor infusion rate
What is the lab value range for calcium?
8.5-10.5
What are the functions of calcium?
Formation of teeth and bone, blood clotting, nerve impulse transmission, muscle contractions, heart contractions
What is hypercalcemia?
Elevated calcium, lab value >10.5
What are the causes of hypercalcemia?
Hyperparathyroidism, bone malignancy, prolonged immobilization
What are the symptoms of hypercalcemia?
Lethargy, weakness, stupor, coma
What is hypercalcemia?
A condition characterized by elevated calcium levels in the blood.
What is the lab value indicating hypercalcemia?
10.5
What are the causes of hypercalcemia?
What are the symptoms of hypercalcemia?
Lethargy, weakness, stupor, coma.
Serum CK:
high levels are indicative of rhabdomyolysis
Metabolic Acidosis:
occurs if the pt is in intrarenal failure and has an AKI
Serum Albumin:
if it is low, there may be a decrease in oncotic pressure, increased third spacing and decreased vascular volume
Acute Renal Failure (AKI): increase in serum creatine by >1.5 times the baseline within 7 days
increase in serum creatine by >1.5 times the baseline within 7 days
Prerenal Failure:
perfusion to the kidneys is reduced, but there is no destruction in the tubular basement membranes; most common (issue before the kidneys)
Prerenal Failure Cause
o Impaired Cardiac Performance: HF, MI, low CO, PE, tamponade, cardiogenic shock o Vasodilation: sepsis, anaphylaxis, drugs (ACE inhibitors, NSAIDS) o Vasoconstriction: pressors o Intravascular Volume Depletion: hemorrhage, GI loss, diuresis, burns, pancreatitis, ileus
Intrarenal Failure:
destruction of the tubular basement membrane occurs (issue directly with the kidneys)
Intrarenal Failure Cause:
o Cortical: strep, hepatitis, varicella, or lupus o Nephrotoxic: contrast dye, drugs, rhabdomyolysis, organic solvents o Ischemic: all causes of prerenal failure, surgery (cardiac), cardiopulmonary bypass, hypotension
Intrarenal Failure Treatment:
o Lasix—attempt to convert acute intrarenal failure to non-oliguric o Infection is the highest cause of mortality in these pts o Address anemia—Epogen and platelets
Prerenal v Intrarenal: BUN: Creatinine Ratio Urine Sodium Urine Concentration Urine Osmolality Specific Gravity Urinary Sediment Fractional Excretion of Sodium Response to Furosemide
Prerenal: 20-40:1 (wide ratio) <20 mEq/L Concentrated High >500 mOsm/kg High >1.020
Intrarenal: 10-15:1 (narrow ratio)
20 mEq/L Dilute Low <300 mOsm/kg Low <1.010 Abnormal (cellular casts and debris) 1% No Response
Normal (hyaline casts) <1%
40mL/hr
Post Renal Etiology:
kidney stones, prostate stricture or benign prostatic hypertrophy, neurogenic bladder, tumor
S/S Acute Tubular Necrosis:
decreased UOP and tea-colored urine
Tx Acute Tubular Necrosis:
fluids, treat hyperkalemia, give bicarbonate to alkalize urine
Magnesium lab value:
Hypermagnesemia S/S:
lethargy, nausea and vomiting, impaired reflexes (flaccid), depressed CNS, respiratory and cardiac arrest
Hypomagnesia S/S:
Resembles hypocalcemia Cardiac dysrhythmias, tremors, confusion, hyperactive DTR, muscle cramps, seizures
Phosphorus Lab Value
Phosphorus is controlled by:
PTH
Phosphorus has a reciprocal relationship with
Calcium
Hyperphosphatemia S/S:
Think hypocalcemia s/s Neuromuscular irritability and tetany, calcified deposition of soft tissue including joints, arteries, skin, kidneys, and cornea (can cause organ dysfunction)
Hypophosphatemia S/S:
confusion, muscle weakness and pain, dysrhythmias, CNS depression (can be fatal), confusion, decreased diaphragmatic movement can cause hypoventilation
Chlorine Values
95-105 mEq/L
Isotonic Fluids:
Isotonic Fluids: - 0.9% Sodium Chloride (NS) - LR - D5W - Indications: surgery, blood loss, dehydration, fluid loss, maintenance fluids, NPO clients
Hypotonic Fluids:
Hypotonic Fluids: - 0.45 NaCl - 0.33 or 0.2% NaCl - 2.5 Dextrose in Water - Indications: DKA, HHS, hyperNa+
Hypertonic Fluids:
Hypertonic Fluids: - 1.5%, 3%, 5% NaCl - D5NS - D5LR - D10W - Indications: hypoNa+, cerebral edema
What are some nephrotoxic substances?
Antibiotics, NSAIDS, ACE inhibitors, ARBS, Antineoplastics, Contrast media, Diuretics, Metformin
What does GFR indicate? What is best indicator of GFR:
Volume of plasma filtered per minute. 24 hour urine collection for creatinine clearance
What is proteinuria, normoalbuminuria, & microalbuminuria
Normoalbuminuria: less than 30 mg/day albumin Microalbuminuria: persistent excretion of albumin (30-300 mg/day) Proteinuria: Early indication of renal disease; excretion of >300 mg of albumin/day.
What is acute tubular necrosis?
Condition caused by crush injuries, prolonged immobility, hyperthermia, DT’s, compartment syndrome
What is the treatment for contrast medium nephropathy?
Hydrate with 0.9 NS (BEFORE and after), avoid nephrotoxic drugs, treat with diuretics//if no response treat as intrarenal failure
What are the dialysis candidates?
AEIOU: Acidemia, Electrolyte disorders, Intoxication, Overload, Uremia.
What are the symptoms of hypernatremia?
Dehydration of brain cells, changes in mental status, thirst, lethargy, agitation, seizures
What is the treatment for hypernatremia?
Replace fluids orally or IV with isotonic or hypotonic fluids; dilute sodium with sodium-free fluids
What is the treatment for hyponatremia?
Fluid restriction, IV hypertonic solution (3% NaCl) in severe cases
What are the symptoms of hyperkalemia?
Cramping leg pain, weak/paralyzed skeletal muscles, abdominal cramping, cardiac dysrhythmias
What is the treatment for hyperkalemia?
Stop potassium intake, increase potassium excretion, insulin, sodium polystyrene sulfonate, calcium gluconate
What are the symptoms of hypokalemia?
Cardiac problems, skeletal muscle weakness, respiratory muscle weakness, decreased GI motility
What is the treatment for hypokalemia?
Potassium chloride (KCl) orally or IV, dilute KCl, monitor infusion rate
What are the functions of calcium?
Formation of teeth and bone, blood clotting, nerve impulse transmission, muscle contractions, heart contractions
What are the causes of hypercalcemia?
Hyperparathyroidism, bone malignancy, prolonged immobilization
What are the causes of hypercalcemia?
Serum Albumin:
if it is low, there may be a decrease in oncotic pressure, increased third spacing and decreased vascular volume
Acute Renal Failure (AKI): increase in serum creatine by >1.5 times the baseline within 7 days
increase in serum creatine by >1.5 times the baseline within 7 days
Prerenal Failure:
perfusion to the kidneys is reduced, but there is no destruction in the tubular basement membranes; most common (issue before the kidneys)
Prerenal Failure Cause
o Impaired Cardiac Performance: HF, MI, low CO, PE, tamponade, cardiogenic shock o Vasodilation: sepsis, anaphylaxis, drugs (ACE inhibitors, NSAIDS) o Vasoconstriction: pressors o Intravascular Volume Depletion: hemorrhage, GI loss, diuresis, burns, pancreatitis, ileus
Intrarenal Failure:
destruction of the tubular basement membrane occurs (issue directly with the kidneys)
Intrarenal Failure Cause:
o Cortical: strep, hepatitis, varicella, or lupus o Nephrotoxic: contrast dye, drugs, rhabdomyolysis, organic solvents o Ischemic: all causes of prerenal failure, surgery (cardiac), cardiopulmonary bypass, hypotension
Intrarenal Failure Treatment:
o Lasix—attempt to convert acute intrarenal failure to non-oliguric o Infection is the highest cause of mortality in these pts o Address anemia—Epogen and platelets
Prerenal v Intrarenal: BUN: Creatinine Ratio Urine Sodium Urine Concentration Urine Osmolality Specific Gravity Urinary Sediment Fractional Excretion of Sodium Response to Furosemide
Prerenal: 20-40:1 (wide ratio) <20 mEq/L Concentrated High >500 mOsm/kg High >1.020
Intrarenal: 10-15:1 (narrow ratio)
20 mEq/L Dilute Low <300 mOsm/kg Low <1.010 Abnormal (cellular casts and debris) 1% No Response
Normal (hyaline casts) <1%
40mL/hr
Post Renal Etiology:
kidney stones, prostate stricture or benign prostatic hypertrophy, neurogenic bladder, tumor
Hypermagnesemia S/S:
lethargy, nausea and vomiting, impaired reflexes (flaccid), depressed CNS, respiratory and cardiac arrest
Hypomagnesia S/S:
Resembles hypocalcemia Cardiac dysrhythmias, tremors, confusion, hyperactive DTR, muscle cramps, seizures
Hyperphosphatemia S/S:
Think hypocalcemia s/s Neuromuscular irritability and tetany, calcified deposition of soft tissue including joints, arteries, skin, kidneys, and cornea (can cause organ dysfunction)
Hypophosphatemia S/S:
confusion, muscle weakness and pain, dysrhythmias, CNS depression (can be fatal), confusion, decreased diaphragmatic movement can cause hypoventilation
Isotonic Fluids:
Isotonic Fluids: - 0.9% Sodium Chloride (NS) - LR - D5W - Indications: surgery, blood loss, dehydration, fluid loss, maintenance fluids, NPO clients
Hypotonic Fluids:
Hypotonic Fluids: - 0.45 NaCl - 0.33 or 0.2% NaCl - 2.5 Dextrose in Water - Indications: DKA, HHS, hyperNa+
Hypertonic Fluids:
Hypertonic Fluids: - 1.5%, 3%, 5% NaCl - D5NS - D5LR - D10W - Indications: hypoNa+, cerebral edema
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