acute kidney injury
what does KDIGO define as AKI
incr. Scr of 0.3mg/dL within 48 hrs
incr. Scr at least 1.5x baseline in the past 7 days
decr. urine volume to <0.5mL/kg/hr for 6 hr
what are the 3 components of qSOFA to dx. sepsis
RR>22
mental status <15
SBP<100
a pt has Addison's dz (RIP JFK) and wants to know why she has two different steroid prescriptions. she is holding a bottle of fludrocortisone and hydrocortisone. she also tells you that her dr. recommends she wears a bracelet and gets an injectable drug incase she passes out but she doesn't know what that drug is? explain the chronic vs. acute stress tx. and what drug she needs to carry on her/.
hydrocortisone is the usually drug but if she is under stress fludrocortisone is more potent.
if she had a minor illness she can double the hydrocortisone dose for 2-3 days
the injectable drug is dexamethasone in case of emergency she should wear a med. bracelet saying she has Addison's dz
why is an incr. in BG a concern in the hospital
who should you perform a HbA1c on
incr. BG-> more bacteria (risk of infection)
all patients with DM or hyperglycemia (>140) if not done in prior 3 mos.
what are characteristics for DKA?
for HHS?
DKA; hyperglycemia, ketonemia, incr. anion gap
HHS; hyperglycemia, ketosis (maybe), severe dehydration
a 73 yo pt comes in complaining of a rash, fever, pyuria after being on penicillin for 4 weeks. you find that it is due to poor kidney filtration and decide to D/C the med. what do you use to tx this and what abx. would cause a worse outcome than penicillins?
corticosteroids to tx
aminoglycosides are worse outcomes.
what is the target MAP
what is the first line tx for sepsis after fluids
65
norepinephrine
what are the hyponatremia correction guidelines
aggressively tx until >120
rate of <0.5mEq/L/hr
only raise 8-12 mEq/L in 24 hours. no more than 18 in 48 hrs
a patient is hypoglycemic in the ER what is the tx for this patient
150ml dextrose 10%. ???
no specific diet, consistent carbs, time insulin with meals
your pt has DKA and has a K level of 2.1. you have already treated with fluids and would like to start insulin therapy. is this appropriate at this time? why or why not
K needs to be >3.3 to start insulin therapy
what is the most common dialysis?
what are the pros and cons of this
intermittent hemodialysis
pros:
- rapid removal of volume and solutes
cons:
- hypotension, venous access is difficult if hypotensive
what are causes of distributive shock and how do you treat it
anaphylaxis, sepsis
tx by squeezing vasculature (need to incr. after load)
what labs show primary adrenal insufficiency only
Hyperkalemia hyperreninemia
what is the target BG for hospitalized patients once insulin is started
140-180
start insulin when BG>180 on 2 measures
name some drugs that can cause DKA
- corticosteroids
- thiazides
- cocaine
- 2nd. gen. anti-psychs.
- SGLT-2 inhibitor.
what are some ways to prevent lithium induced AKI
once daily dosing
stay hydrated
avoid alt. in sodium intake
DI's
keep lowest serum concentration
cardiac shock has 4 areas that cover causes of this subset of shock. name the types, try to name at least 1 thing per category
myopathic; MI, myocarditis, dilated cardiomyocytes
arrhythmic; afib/flutter, vtach, bradyarrhythmias
mechanical; valvular defects, ventricular rupture
obstructive; PE, tension pneumothorax, severe pulmonary HTN
what is the only 100% cure for Cushings tx
surgery; suppression of the HPA axis for months--> need glucocorticoid replacement
a patient is in your ICU and is not going to last more than 2 days. what is the BG goal for this patient
>250 if terminal
which has a faster onset DKA or HHS?
what are symptoms specific to DKA
DKA; few hours
HHS; days-weeks
ab pain, kussmal resp.
what are the 3 factors that influence RRT drug clearance
1. MW: Cl decr. when MW incr.
2. protein binding: more unbound drug= more Cl
3. Vd; incr. Vd= incr. in tissues= decr. drug removal
low Vd, low MW, low protein bound= IHD
a pt comes in to the ER with a collapsed lung causing a decr. in cardiac output. what type of shock are they at a risk for? and how do you treat this?
obstructive, relieve obstruction
name some signs of Cushings syndrome
moon face, obese, buffalo hump, thin skin, skin ulcers, acne, HTN, glucose intolerance, delayed bone age in children
a patient is a type 1 diabetic and has not been eating at mealtime, should the insulin be held?
no, do not hold for type 1
do not use sliding scale only inpatient
when is ketosis resolved
no ketones, BG<200, bicarb. >15, pH>7.3
ketones take longer to resolve, monitor once BG<200