FCM Renal

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FCM Renal
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PAP-590 Renal
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  1. acidosis
    An abnormal increase in the acidity of the body's fluids, caused either by accumulation of acids or by depletion of bicarbonates.
  2. acute tubular necrosis
    • (ATN)
    • acute renal failure with mild to severe damage or necrosis of tubule cells, usually resulting from nephrotoxicity, ischemia after major surgery, trauma (crush syndrome), severe hypovolemia, sepsis, or burns
  3. alkalosis
    a condition of the blood and other body fluids in which the bicarbonate concentration is above normal, tending toward alkalinity
  4. anion gap
    the difference between the concentrations of serum or plasma cations and anions, determined by measuring the concentrations of sodium cations and chloride and bicarbonate anions. It is helpful in the diagnosis and treatment of acidosis, and it is estimated by subtracting the sum of chloride and bicarbonate concentrations in the plasma from that of sodium. It is normally about 8 to 14 mEq/L and represents the negative charges contributed to plasma by unmeasured ions or ions other than those of chloride and bicarbonate, mainly phosphate, sulfate, organic acids, and plasma proteins. Anions other than chloride and bicarbonate normally constitute about 12 mEq/L of the total anion concentration in plasma. Acidosis can develop with or without an associated anion increase. An increase in the anion gap often suggests diabetic ketoacidosis, drug poisoning, renal failure, or lactic acidosis and usually warrants further laboratory tests.
  5. anuria
    the absence of urine production or a urinary output of less than 100 mL per day. Anuria may be caused by a failure or kidney dysfunction, a decline in blood pressure below that required to maintain filtration pressure in the kidney, or an obstruction in the urinary passages. A rapid decline in urinary output, leading ultimately to anuria and uremia, occurs in acute renal failure. Kinds of anuria include angioneurotic anuria, obstructive anuria, postrenal anuria, and renal anuria.
  6. azotemia
    Azotemia is an elevation of blood urea nitrogen and creatinine levels and usually reflects a decreased glomerular filtration rate (GFR). GFR may be decreased as a consequence of intrinsic renal disease or extrarenal causes. Prerenal azotemia is encountered when there is hypoperfusion of the kidneys, which decreases GFR in the absence of parenchymal damage. Postrenal azotemia results when urine flow is obstructed below the level of the kidney. Relief of the obstruction is followed by correction of the azotemia.
  7. calcium oxalate crystals
    a salt of oxalic acid, which in excess in the urine may lead to formation of oxalate calculi.
  8. calculus
    An abnormal concretion in the body, usually formed of mineral salts and most commonly found in the gallbladder, kidney, or urinary bladder. Also called stone.
  9. coffin lid crystals
    • A descriptor for 3–6-sided colorless prism-shaped crystals seen in various fluids
    • Synovial fluid CLCs are associated with acromegaly, hyperparathyroidism, hemochromatosis, hypomagnesemia, hypophosphatasia, myxedema, ochronosis, Wilson’s disease
    • DiffDx Other arthritic conditions—e.g., gout, osteoarthritis, rheumatoid arthritis, chondrocalcinosis
    • Urine Ammonium magnesium phosphate—triple phosphate crystals—seen in neutral or alkaline urine, and linked to urinary tract infections of urea-splitting bacteria
  10. cystitis
    inflammation of the urinary bladder.
  11. dysuria
    Difficult or painful urination.
  12. ESRD
    • End-stage renal disease; chronic or permanent kidney failure.
    • chronic irreversible renal failure.
  13. hematuria
    blood (erythrocytes) in the urine
  14. hyperfiltration
    an elevation in the glomerular filtration rate, often a sign of early type 1 diabetes mellitus.
  15. IgA nephropathy
    • (glomerulonephritis)
    • Acute glomerulonephritis is an inflammatory disease of both kidneys predominantly affecting children from ages two to 12. Chronic glomerulonephritis can develop over a period of 10-20 years and is most often associated with other systemic disease, including diabetes, malaria, hepatitis, or systemic lupus erythematosus.
  16. lactic acidosis
    a metabolic acidosis occurring as a result of excess lactic acid in the blood, due to conditions causing impaired cellular respiration.
  17. microalbuminuria
    the urinary excretion of small amounts of albumin, below the detection level of routine dipstick analysis. The condition is an early indicator of altered glomerular permeability in diabetes.
  18. minimal change disease
    subtle alterations in kidney function demonstrable by clinical albuminuria and the presence of lipid droplets in cells of the proximal tubules, seen primarily in young children.
  19. nephrosclerosis
    hardening of the kidney, usually associated with hypertension and disease of the renal arterioles. It is characterized as benign or malignant depending on the severity and rapidity of the hypertension and arteriolar changes.
  20. oliguria
    a diminished capacity to form and pass urine-less than 500 mL in every 24 hours-so that the end products of metabolism cannot be excreted efficiently. It is usually caused by imbalances in body fluids and electrolytes, renal lesions, or urinary tract obstruction
  21. osmolality
    the concentration of a solution in terms of osmoles of solutes per kilogram of solvent.
  22. serum osmolality
    a measure of the number of dissolved particles per unit of water in serum. In a solution, the fewer the particles of solute in proportion to the number of units of water (solvent), the less concentrated the solution. A low serum osmolality means a higher than usual amount of water in relation to the amount of particles dissolved in it, and accompanies overhydration, or edema. An increased serum osmolality indicates deficient fluid volume. Measurement of the serum osmolality gives information about the hydration status within the cells because of the osmotic equilibrium that is constantly being maintained on either side of the cell membrane (homeostasis). Water moves freely back and forth across the membrane in response to the osmolar pressure being exerted by the molecules of solute in the intracellular and extracellular fluids. Serum osmolality reflects the status of hydration of the intracellular as well as the extracellular compartments and thus describes total body hydration. The normal value for serum osmolality is 270–300 mOsm/kg water.
  23. urine osmolality
    a measure of the number of dissolved particles per unit of water in the urine. A more accurate measure of urine concentration than specific gravity, urine osmolality is useful in diagnosing renal disorders of urinary concentration and dilution and in assessing status of hydration. The normal value is 500 to 800 mOsm/L.
  24. osmolarity
    The osmotic concentration of a solution expressed as osmoles of solute per liter of solution.
  25. proteinuria
    an excess of serum proteins in the urine, as in renal disease or after strenuous exercise
  26. pyelonephritis
    Infection of the upper urinary tract involves the spread of bacteria to the kidney and is called pyelonephritis.
  27. pyuria
    The presence of pus in the urine, usually a sign of urinary tract infection.
  28. staghorn calculi
    a urinary calculus, usually a phosphate calculus, found in the renal pelvis and shaped like the antlers of a stag because it extends into multiple calices.
  29. struvite crystals
    magnesium-ammonium-phosphate hexahydrate; found in some renal calculi.
  30. uremia
    When azotemia gives rise to clinical manifestations and systemic biochemical abnormalities, it is termed uremia. Uremia is characterized not only by failure of renal excretory function but also by a host of metabolic and endocrine alterations incident to renal damage. There is, in addition, secondary gastrointestinal (e.g., uremic gastroenteritis); neuromuscular (e.g., peripheral neuropathy); and cardiovascular (e.g., uremic fibrinous pericarditis) involvement.
  31. urethritis
    Urethritis is an inflammation of the urethra, which is the passageway that connects the bladder with the exterior of the body.
  32. volume excess
    CHF, DM
  33. volume depletion
    • A state of vascular instability characterized by ↓ sodium in the extracellular space–intravascular and interstitial fluid after GI hemorrhage, vomiting, diarrhea, diuresis
    • Management 0.9% saline ASAP.
  34. 24 hour urine for protein
    test for creatinine levels to dx kidney dz
  35. BUN
    • Blood urea nitrogen
    • A waste product that is formed in the liver and collects in the bloodstream; patients with kidney failure have high BUN levels.
  36. casts - dirty brown
    • acute tubular necrosis
    • (nephritic syndromes)
  37. casts - fatty
    • nephrotic syndrome
    • (hyperproteinuria)
  38. casts - hyaline
    dehydration - anyone
  39. casts - red cell
    • hematuria
    • (nephritic syndromes)
  40. casts - waxy
    Chronic kidney disease
  41. casts - white cell
    infection
  42. creatinine
    an anhydride of creatine, the end product of phosphocreatine metabolism; measurements of its rate of urinary excretion are used as diagnostic indicators of kidney function and muscle mass.
  43. chem profile
  44. creatinine clearance
    The ratio of the rate of creatinine excretion in urine to its concentration in serum, a value that reflects the body's ability to excrete creatinine; it is used to diagnose and monitor renal function
  45. GFR
    • glomerular filtration rate
    • an expression of the quantity of glomerular filtrate formed each minute in the nephrons of both kidneys, usually measured by the rate of clearance of creatinine.
    • Rate > 60 mL/min is considered normal
    • GFR = (Urine concentration x Urine flow)/Plasma Concentration
  46. serum electrolytes (Na, K, Cl, Mg)
    • Sodium (Na). A positively charged electrolyte that helps to balance fluid levels in the body and facilitates neuromuscular functioning.
    • Potassium (K). A main component of cellular fluid, this positive electrolyte helps to regulate neuromuscular function and osmotic pressure.
    • Calcium (Ca). A cation, or positive electrolyte, that affects neuromuscular performance and contributes to skeletal growth and blood coagulation.
    • Magnesium (Mg). Influences muscle contractions and intracellular activity. A cation.
    • Chloride (CI). An anion, or negative electrolyte, that regulates blood pressure.
    • Phosphate (HPO4). Negative electrolyte that impacts metabolism and regulates acid-base balance and calcium levels.
    • Bicarbonate (HCO3). A negatively charged electrolyte that assists in the regulation of blood pH levels. Bicarbonate insufficiencies and elevations cause acid-base disorders (i.e., acidosis, alkalosis).
  47. urinalysis
    • a diagnostic physical, chemical, and microscopic examination of a urine sample (specimen). Specimens can be obtained by normal emptying of the bladder (voiding) or by a hospital procedure called catheterization.
    • Purpose:
    • Urinalyses are performed for several reasons:
    • general evaluation of health
    • diagnosis of metabolic or systemic diseases that affect kidney function
    • diagnosis of endocrine disorders. Twenty-four hour urine studies are often ordered for these tests
    • diagnosis of diseases or disorders of the kidneys or urinary tract
    • monitoring of patients with diabetes
    • testing for pregnancy
    • screening for drug abuse
  48. urine culture
    • ordered when symptoms indicate the possibility of a urinary tract infection, such as pain and burning when urinating and frequent urge to urinate. Antibiotic therapy may be prescribed without requiring a urine culture for symptomatic young women who have an uncomplicated lower urinary tract infection. If there is suspicion of a complicated infection or symptoms do not respond to initial therapy, then a culture of the urine is recommended. Pregnant women without any symptoms may be screened for bacteria in their urine, which could affect the health and development of the fetus.
    • A urine culture may be ordered with a urinalysis or as follow up to abnormal results on a urinalysis.
  49. urine microscopy
    typically be done when there are abnormal findings on the physical or chemical examination of urine. It is performed on urine sediment to detect RBCs, WBC, epithelial cells, microorganisms (bacteria, yeast, trichomonads), casts, crystals.
  50. allopurinol
    • an isomer of hypoxanthine, capable of inhibiting xanthine oxidase and thus of reducing serum and urinary levels of uric acid; used in prophylaxis and treatment of hyperuricemia and uric acid nephropathy and prophylaxis of renal calculus recurrence.
    • A drug that inhibits the synthesis of uric acid and is used to treat gout and other hyperuricemic conditions
  51. calcium
    maintenance of normal calcium metabolism by the combined effects of adequate alimentary intake, renal excretion, parathyroid hormone involvement, 1,25 dihydroxycholecalciferol (or calcitriol) and calcitonin, plasma protein binding and deposition in tissues.
  52. ciprofloxacin
    • ciprofloxacin and its hydrochloride derivative.
    • Anti-infective of the Fluoroquinolone class of drugs
    • Inhibits bacterial DNA synthesis by inhibiting DNA gyrase in susceptible gram-negative and gram-positive organisms
  53. fluoroquinolones
    • Any of a group of broad-spectrum antibiotics that are fluorinated derivatives of quinolone compounds and are especially effective against gram-negative bacteria.
    • a group of antibiotics which exert their antimicrobial effects by inhibiting bacterial DNA gyrase. They are effective primarily against gram-negative organisms. Includes ciprofloxacin, norfloxacin, enrofloxacin.
  54. IV calcium gluconate
    a calcium salt used to treat or prevent hypocalcemia, nutritional deficiency, and hyperkalemia; also used as a treatment adjunct in cardiac arrest.
  55. IV insulin
    renal disease decreases insulin requirements
  56. IV sodium bicarbonate
    the monosodium salt of carbonic acid, used as a gastric and systemic anatacid and to alkalize urine; also used, in solution, for washing the nose, mouth, and vagina, as a cleansing enema, and as a dressing for minor burns.
  57. kayexalate
    • (sodium polystyrene sulfonate)
    • a potassium exchange resin that may be administered orally or rectally in the treatment of hyperkalemia.
    • Exchanges sodium ions for potassium ions in intestine; potassium is then eliminated in feces, which decreases serum potassium level.
  58. loop diuretics
    • A class of diuretic agents that act by inhibiting reabsorption of sodium and chloride.
    • a high-potency therapeutic agent used to control hypertension by exerting influence on the loop of Henle in order to facilitate the removal of surplus water and sodium from the body. (furosemide)
  59. nitrofurantoin
    • an antibacterial effective against many gram-negative and gram-positive organisms; used in urinary tract infections.
    • Indications:
    • It is prescribed in the treatment of urinary tract infections caused by some gram-negative bacteria and a few gram-positive bacteria. Some of the more common bacteria that cause urinary tract infections are resistant to it.
    • Contraindications:
    • Kidney dysfunction or known hypersensitivity to this drug prohibits its use. It is not given to children under 1 month of age or to pregnant or lactating women. It should be used with caution in people with glucose-6-phosphate dehydrogenase deficiency, vitamin B deficiency, anemia, diabetes mellitus, or electrolyte disturbances.
    • Adverse Effects:
    • Among the most serious adverse effects is hypersensitivity pneumonitis, which can lead to fibrosis, neurotoxicity, and hemolytic anemia in patients with glucose-6-phosphate dehydrogenase deficiency. GI disturbances and fever are common.
  60. Penicillamine
    • A drug used to treat medical problems (such as excess copper in the body and rheumatoid arthritis) and to prevent kidney stones. It is also sometimes prescribed to remove excess lead from the body.
    • a chelating agent.
    • Indications:
    • It is prescribed for the treatment of Wilson's disease and cystinuria and can be prescribed to bind with and remove heavy metals from the blood when there is poisoning resulting from metals such as copper, lead, mercury, arsenic, and gold (succimer is preferred for lead and mercury toxicity). It is also prescribed as a palliative in the treatment of systemic sclerosis (scleroderma) and rheumatoid arthritis when other medications have failed.
    • Contraindications:
    • Known hypersensitivity to this drug or penicillamine-related aplastic anemia prohibits its use. It is not given to patients who are pregnant or who have kidney dysfunction.
    • Adverse Effects:
    • Among the more serious adverse effects are fever, rashes, and blood dyscrasias. Severe bone marrow depression and immune disorders have been associated with long-term use of this drug. d-penicillamine is less toxic than the l form, and much of the reported toxicity is caused by the use of the l or dl form.
  61. thiazide diuretics
    a group of synthetic compounds that decrease reabsorption of sodium by the kidney and thereby increase loss of water and sodium; they enhance excretion of sodium and chloride equally.
  62. biopsy
  63. cystoscopy
    a diagnostic procedure that is used to look at the bladder (lower urinary tract), collect urine samples, and examine the prostate gland. Performed with an optic instrument known as a cystoscope (urethroscope), this instrument uses a lighted tip for guidance to aid in diagnosing urinary tract disease and prostate disease. Performed by a urologist, this surgical test also enables biopsies to be taken or small stones to be removed by way of a hollow channel in the cystoscope.
  64. extracorporeal shock wave therapy
    • ESWL
    • lithotripsy
    • the use of high-energy shock waves to fragment and disintegrate kidney stones. The shock wave, created by using a high-voltage spark or an electromagnetic impulse, is focused on the stone. This shock wave shatters the stone and this allows the fragments to pass through the urinary system. Since the shock wave is generated outside the body, the procedure is termed extracorporeal shock wave lithotripsy, or ESWL.
  65. IVP
    • Intravenous pyelography
    • An imaging study of the transitional mucosa of kidneys, ureter, and bladder after IV injection of a radiocontrast which concentrates in the urine; an IVP outlines the renal pelvis, ureters, bladder
  66. lithotripsy
    the use of high-energy shock waves to fragment and disintegrate kidney stones. The shock wave, created by using a high-voltage spark or an electromagnetic impulse, is focused on the stone. This shock wave shatters the stone and this allows the fragments to pass through the urinary system. Since the shock wave is generated outside the body, the procedure is termed extracorporeal shock wave lithotripsy, or ESWL.
  67. renal arteriogram
    A diagnostic test that involves viewing the arteries and/or attached organs by injecting a contrast medium, or dye, into the artery and taking an x ray.
  68. renal US
    A painless and non-invasive procedure in which sound waves are bounced off the kidneys. These sound waves produce a pattern of echoes that are then used by the computer to create pictures of areas inside the kidney (sonograms). Used for kidney biopsies and kidney cancer.
  69. VCUG
    • voiding cystourethrogram
    • A study in which a catheter is inserted into the bladder, radiocontrast injected and images obtained to determine whether urine is flowing normally–through the urethra to the outside or has partially reversed its flow into the ureters, as occurs in vesicoureteral reflux
  70. renal scan
    a radiographic scan of the kidneys performed after the IV injection of a radioactive substance. It is used to assess renal perfusion and function, particularly in renal failure and renovascular hypertension and following kidney transplantation.
  71. cancers
    • clear cell carcinoma; carcinoma of the renal parenchyma, composed of tubular cells in varying arrangements.
    • a malignant neoplasm of the kidney. Also called adenocarcinoma of the kidney, clear cell carcinoma of the kidney.
    • Wilms' tumor:
    • a cancerous tumor of the kidney that usually occurs in young children. It is named for Max Wilms, a German surgeon (1867–1918) and is also known as a nephroblastoma. When an unborn baby is developing, the kidneys are formed from primitive cells. Over time, these cells become more specialized. The cells mature and organize into the normal kidney structure. Sometimes, clumps of these cells remain in their original, primitive form. If these cells begin to multiply after birth, they may ultimately form a large mass of abnormal cells. This is known as a Wilms' tumor.
  72. UTI
    cystitis and urethritis are referred to collectively as a lower urinary tract infection, or UTI.
  73. nephrolithiasis
    a condition marked by the presence of renal calculi. See also urolithiasis.
  74. kidney failure
    • (renal failure)
    • inability of the kidney to excrete metabolites at normal plasma levels under normal loading, or inability to retain electrolytes when intake is normal; in the acute form, marked by uremia and usually by oliguria, with hyperkalemia and pulmonary edema.
  75. prerenal causes of acute renal failure
    • sudden or severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness
    • BUN/Creatinine ratio: > 20:1
  76. intrarenal causes of acute renal failure
    • direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply
    • BUN/Creatinine ratio: < 10:1
  77. postrenal causes of acute renal failure
    • sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumor, or injury
    • BUN/Creatinine ratio: 10-20:1
  78. electrolyte disorders
    • An electrolyte disorder is an imbalance of certain ionized salts (i.e., bicarbonate, calcium, chloride, magnesium, phosphate, potassium, and sodium) in the blood.
    • Electrolytes are ionized molecules found throughout the blood, tissues, and cells of the body. These molecules, which are either positive (cations) or negative (anions), conduct an electric current and help to balance pH and acid-base levels in the body. Electrolytes also facilitate the passage of fluid between and within cells through a process known as osmosis and play a part in regulating the function of the neuromuscular, endocrine, and excretory systems.
    • The serum electrolytes include:
    • Sodium (Na). A positively charged electrolyte that helps to balance fluid levels in the body and facilitates neuromuscular functioning.
    • Potassium (K). A main component of cellular fluid, this positive electrolyte helps to regulate neuromuscular function and osmotic pressure.
    • Calcium (Ca). A cation, or positive electrolyte, that affects neuromuscular performance and contributes to skeletal growth and blood coagulation.
    • Magnesium (Mg). Influences muscle contractions and intracellular activity. A cation.
    • Chloride (CI). An anion, or negative electrolyte, that regulates blood pressure.
    • Phosphate (HPO4). Negative electrolyte that impacts metabolism and regulates acid-base balance and calcium levels.
    • Bicarbonate (HCO3). A negatively charged electrolyte that assists in the regulation of blood pH levels. Bicarbonate insufficiencies and elevations cause acid-base disorders (i.e., acidosis, alkalosis).
    • Medications, chronic diseases, and trauma (for example, burns, or fractures etc.) may cause the concentration of certain electrolytes in the body to become too high (hyper-) or too low (hypo-). When this happens, an electrolyte imbalance, or disorder, results.
  79. acid-base disorders
  80. glomerular disorders
    any of a group of diseases in which the glomerulus of the kidney is affected. Depending on the particular disease, there may be hyperplasia, atrophy, necrosis, scarring, or deposits in the glomeruli. The symptoms may be abrupt in onset or slowly progressive.
  81. polycystic
    containing many cysts
  82. Renal tests
    • urinalysis - gross examination, biochemical evaluation (dip stick), and microscopic evaluation
    • Biochemical evaluates for - leukocytes, nitrites, urobilinogen, protein, pH, blood, specific gravity, ketone, bilirubin, glucose
    • Microscopic evaluates for - RBC, WBC, epithelial, casts, yeast, parasites, spermatozoa, crystals, mucous, fat bodies
  83. Nephritic syndrome
    results from glomerular injury and is dominated by the acute onset of usually grossly visible hematuria (red blood cells and red cell casts in urine), proteinuria of mild to moderate degree, azotemia, edema, and hypertension; it is the classic presentation of acute poststreptococcal glomerulonephritis.
  84. Nephrotic syndrome
    is a glomerular syndrome characterized by heavy proteinuria (excretion of greater than 3.5 g of protein/day in adults), hypoalbuminemia, severe edema, hyperlipidemia, and lipiduria (lipid in the urine).
  85. Asymptomatic hematuria
    or non-nephrotic proteinuria, or a combination of these two, is usually a manifestation of subtle or mild glomerular abnormalities.
  86. Rapidly progressive glomerulonephritis
    is associated with severe glomerular injury and results in loss of renal function in a few days or weeks. It is manifested by microscopic hematuria, dysmorphic red blood cells and red cell casts in the urine sediment, and mild to moderate proteinuria.
  87. Acute kidney injury
    is dominated by oliguria or anuria (no urine flow), and recent onset of azotemia. It can result from glomerular injury (such as rapidly progessive glomerulonephritis), interstitial injury, vascular injury (such as thrombotic microangiopathy), or acute tubular injury.
  88. Chronic kidney disease
    characterized by prolonged symptoms and signs of uremia, is the result of progressive scarring in the kidney from any cause and may culminate in end-stage kidney disease, requiring dialysis or transplantation.
  89. Urinary tract infection
    is characterized by bacteriuria and pyuria (bacteria and leukocytes in the urine). The infection may be symptomatic or asymptomatic, and it may affect the kidney (pyelonephritis) or the bladder (cystitis) only.
  90. Nephrolithiasis
    • (renal stones)
    • is manifested by renal colic, hematuria (without red cell casts), and recurrent stone formation.
  91. HYPERNATREMIA
    • Sodium helps the kidneys to regulate the amount of water the body retains or excretes. Consequently, individuals with elevated serum sodium levels also suffer from a loss of fluids, or dehydration. Hypernatremia can be caused by inadequate water intake, excessive fluid loss (i.e., diabetes insipidus, kidney disease, severe burns, and prolonged vomiting or diarrhea), or sodium retention (caused by excessive sodium intake or aldosteronism). In addition, certain drugs, including loop diuretics, corticosteroids, and antihypertensive medications may cause elevated sodium levels.
    • Symptoms of hypernatremia include:
    • thirst
    • orthostatic hypotension
    • dry mouth and mucous membranes
    • dark, concentrated urine
    • loss of elasticity in the skin
    • irregular heartbeat (tachycardia)
    • irritability
    • fatigue
    • lethargy
    • heavy, labored breathing
    • muscle twitching and/or seizures
  92. HYPONATREMIA
    • Up to 1% of all hospitalized patients and as many as 18% of nursing home patients develop hyponatremia, making it one of the most common electrolyte disorders. A 2004 study questioned the routine make-up of fluids prescribed for children and delivered intravenously (through a needle into a vein) in hospitals today. The authors recommended only using IV fluids when necessary and then using isotonic saline. Diuretics, certain psychoactive drugs (i.e., fluoxetine, sertraline, haloperidol), specific antipsychotics (lithium), vasopressin, chlorpropamide, the illicit drug "ecstasy," and other pharmaceuticals can cause decreased sodium levels, or hyponatremia. Low sodium levels may also be triggered by inadequate dietary intake of sodium, excessive perspiration, water intoxication, beer potomania, and impairment of adrenal gland or kidney function.
    • Symptoms of hyponatremia include:
    • nausea, abdominal cramping, and/or vomiting
    • headache
    • edema (swelling)
    • muscle weakness and/or tremor
    • paralysis
    • disorientation
    • slowed breathing
    • seizures
    • coma
  93. HYPERKALEMIA
    • Hyperkalemia may be caused by ketoacidosis (diabetic coma), myocardial infarction (heart attack), severe burns, kidney failure, fasting, bulimia nervosa, gastrointestinal bleeding, adrenal insufficiency, or Addison's disease. Diuretic drugs, cyclosporin, lithium, heparin, ACE inhibitors, beta blockers, and trimethoprim can increase serum potassium levels, as can heavy exercise. The condition may also be secondary to hypernatremia (low serum concentrations of sodium).
    • Symptoms may include:
    • weakness
    • nausea and/or abdominal pain
    • irregular heartbeat (arrhythmia)
    • diarrhea
    • muscle pain
  94. HYPOKALEMIA
    • Severe dehydration, aldosteronism, Cushing's syndrome, kidney disease, long-term diuretic therapy, certain penicillins, laxative abuse, congestive heart failure, and adrenal gland impairments can all cause depletion of potassium levels in the bloodstream. A substance known as glycyrrhetinic acid, which is found in licorice and chewing tobacco, can also deplete potassium serum levels.
    • Symptoms of hypokalemia include:
    • weakness
    • paralysis
    • increased urination
    • irregular heartbeat (arrhythmia)
    • orthostatic hypotension
    • muscle pain
    • tetany
  95. HYPERCALCEMIA
    • Blood calcium levels may be elevated in cases of thyroid disorder, multiple myeloma, metastatic cancer, multiple bone fractures, milk-alkali syndrome, and Paget's disease. Excessive use of calcium-containing supplements and certain over-the-counter medications (i.e., antacids) may also cause hypercalcemia. In infants, lesser known causes may include blue diaper syndrome, Williams syndrome, secondary hyperparathyroidism from maternal hypocalcemia, and dietary phosphate deficiency.
    • Symptoms include:
    • fatigue
    • constipation
    • depression
    • confusion
    • muscle pain
    • nausea and vomiting
    • dehydration
    • increased urination
    • irregular heartbeat (arrhythmia)
  96. HYPOCALCEMIA
    • Thyroid disorders, kidney failure, severe burns, sepsis, vitamin D deficiency, and medications such as heparin and glucogan can deplete blood calcium levels.
    • Lowered levels cause:
    • muscle cramps and spasms
    • tetany and/or convulsions
    • mood changes (depression, irritability)
    • dry skin
    • brittle nails
    • facial twitching
  97. HYPERMAGNESEMIA
    • Excessive magnesium levels may occur with end-stage renal disease, Addison's disease, or an overdose of magnesium salts.
    • Hypermagnesemia is characterized by:
    • lethargy
    • hypotension
    • decreased heart and respiratory rate
    • muscle weakness
    • diminished tendon reflexes
  98. HYPOMAGNESEMIA
    • Inadequate dietary intake of magnesium, often caused by chronic alcoholism or malnutrition, is a common cause of hypomagnesemia. Other causes include malabsorption syndromes, pancreatitis, aldosteronism, burns, hyperparathyroidism, digestive system disorders, and diuretic use.
    • Symptoms of low serum magnesium levels include:
    • leg and foot cramps
    • weight loss
    • vomiting
    • muscle spasms, twitching, and tremors
    • seizures
    • muscle weakness
    • arrthymia
  99. HYPERCHLOREMIA
    • Severe dehydration, kidney failure, hemodialysis, traumatic brain injury, and aldosteronism can also cause hyperchloremia. Drugs such as boric acid and ammonium chloride and the intravenous (IV) infusion of sodium chloride can also boost chloride levels, resulting in hyperchloremic metabolic acidosis.
    • Symptoms include:
    • weakness
    • headache
    • nausea
    • cardiac arrest
  100. HYPOCHLOREMIA
    • Hypochloremia usually occurs as a result of sodium and potassium depletion (i.e., hyponatremia, hypokalemia). Severe depletion of serum chloride levels causes metabolic alkalosis.
    • This alkalization of the bloodstream is characterized by:
    • mental confusion
    • slowed breathing
    • paralysis
    • muscle tension or spasm
  101. HYPERPHOSPHATEMIA
    • Skeletal fractures or disease, kidney failure, hypoparathyroidism, hemodialysis, diabetic ketoacidosis, acromegaly, systemic infection, and intestinal obstruction can all cause phosphate retention and build-up in the blood. The disorder occurs concurrently with hypocalcemia. Individuals with mild hyperphosphatemia are typically asymptomatic, but
    • signs of severe hyperphosphatemia include:
    • tingling in hands and fingers
    • muscle spasms and cramps
    • convulsions
    • cardiac arrest
  102. HYPOPHOSPHATEMIA
    • Serum phosphate levels of 2 mg/dL or below may be caused by hypomagnesemia and hypokalemia. Severe burns, alcoholism, diabetic ketoacidosis, kidney disease, hyperparathyroidism, hypothyroidism, Cushing's syndrome, malnutrition, hemodialysis, vitamin D deficiency, and prolonged diuretic therapy can also diminish blood phosphate levels. There are typically few physical signs of mild phosphate depletion.
    • Symptoms of severe hypophosphatemia include:
    • muscle weakness
    • weight loss
    • bone deformities (osteomalacia)

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