Which of the following are NOT characteristic findings of acute renal failure?
Hyperkalemia, severe acidosis, uremic encephalopathy, and uremic pericarditis are all indications oflife-threatening problems, and urgent correction is mandatory. Elevation of BUN is commonly seen as well, but is not itself an indication for dialysis.
An elderly diabetic patient who has acute cholecystitis is found to have a serum sodium level of 122 mEq/L and a blood glucose of 600 mg/dL. After correcting the glucose concentration to 100 mg/dL with insulin, the serum sodium concentration would:
A rise in the extracellular fluid concentration of a substance that does not diffuse passively across cell membranes ( eg, glucose or urea) causes an increase in effective osmotic pressure, a transfer of water from cells, and dilutional hyponatremia. For each 100 mg/dL rise in blood glucose above normal, the serum sodium level falls approximately to 3 mEq/L. Alternatively, the serum sodium level would increase by about 15 mEq/L if the blood glucose level fell from 600 to 100 mg/dL.
Excessive administration of normal saline for fluid resuscitation can lead to what metabolic derangement?
Sodium chloride is mildly hypertonic, containing 1 54 mEq of sodium that is balanced by 1 54 mEq of chloride. The high chloride concentration imposes a significant chloride load on the kidneys and may lead to a hyperchloremic metabolic acidosis. Sodium chloride is an ideal solution, however, for correcting volume deficits associated with hyponatremia, hypochloremia, and metabolic alkalosis.
The first step in the management of acute hypercalcemia should be
Patients with acute hypercalcemia usually have either acute hyperparathyroidism or metastatic breast carcinoma with multiple bony metastases. These patients develop severe headaches, bone pain, thirst, emesis, and polyuria. Unless treatment is instituted promptly, the symptoms may be rapidly fatal. Immediate correction of the associated deficit of extracellular fluid volume is the most important step in treatment. When effective, this results in the lowering of the serum calcium level by dilution. Once extracellular fluid volume has been replaced, furosemide is effective treatment. Hemodialysis may also be employed, but its effect is less rapid. Mithramycin is very useful in controlling metastatic bone disease, but its effect is slow, and it cannot be depended upon when the patient has acute hypercalcemia.
A victim of a motor vehicle accident arrives in hemorrhagic shock.
His arterial blood gases are:
The patient's metabolic acidosis would be treated best with:
In patients suffering from hemorrhagic shock, the presence of a metabolic acidosis early in the postresuscitative period is indicative of tissue hypoxia due to persistent inadequate tissue perfusion. Attempts to correct this problem by administering an alkalizing agent will not solve the basic problem.
However, proper volume replacement by means of a balanced salt solution such as lactated Ringer solution will restore perfusion and correct the metabolic acidosis by ending anaerobic metabolism.
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