eQuizShow

AKI

Question: 80-90% of patients are oliguric, the urine expected of an oliguric patient to produce. What is normal urine production?
Answer: Oliguria - less than 0.5mL/kg/hr Normal - 1-2mL/kg/hr

Question: On a chemistry you may will see elevated BUN, creatinine, Phos, and K. How do you differentiate AKI from pre-renal azotemia?
Answer: USG! pre-renal azotemia. Also urine Na will be elevated in patients with AKI.

Question: Mechanism of hypovolemia leading to AKI?
Answer: Hypovolemia -> hypoperfusion -> hypoxemia -> necrosis of epithelial cells of renal tubules

Question: The four stages of AKI are: initiation, extension, maintenance, and recovery. During maintenance oliguria is the main reason for euthanasia is due to two consequences of the oliguric phase.

Answer: What is hyperkalemia and overzealous fluid therapy?

Question: The four serovars of Leptospirosis most likely to be associated with AKI.
Answer: L. pomona, L. canicola, L. grippotyphosa and L. bratislava

Clinical Scenarios

Question: A 5 kg DSH has come in for suspected AKI. The technicians and doctors started fluid therapy, the cat has been urinating an unknown quantity of fluid. This quick test using a common hospital item can assess if this animal is at risk of fluid overload.

Answer: What is weighing the animal?

Question: (True of False) Fluid therapy should be withheld from a patient to prevent hemodilution especially in cases of hypotensive shock.
Answer: False

Question: This condition should always be on your df/dx list and should be a reason for wearing gloves in unknown cases of AKI.

Answer: What is Lepto?

Question: One of these three treatments can be given IV to lower K levels.

Answer: What are sodium bicarbonate, glucose w/ or w/o insulin, and calcium gluconate?

Question: A 4 kg patient with a temperature of 105.6 has been on IV fluid therapy that has accommodated for hydration deficit, maintenance of body weight, and continual loss. This is the factor that you forgot to factor in.
Answer: What is increasing the maintenance fluid volume by at least 10% for each 2 degrees rise in body temperature?

Toxic Injury

Question: For 100 each. These are the two most nephrotoxic injested plant for dogs and cats respectively.

Answer: What are raisins and grapes for dogs and lily's for cats?

Question: Name 2. These are nephrotoxic antibiotics.

Answer: What are aminoglycosides, cephalosporins, nafcillin, polymycin B, sulfonamides, tetracyclines?

Question: This common household item is responsible for Calcium Oxalate crystals.

Answer: What is ethylene glycol?

Question: This is the mechanism for NSAID renal toxicity.

Answer: What is cox inhibitors decrease prostaglandins responsible for vasodilation in the kidney, constricting afferent arterials, decreasing perfusion, leading to ischemia?

Question: Name 3. These heavy metals can result in AKI.

Answer: What are lead, mercury, arsenicals, thallium?

Fluid Types

Question: This crystaloid replacement carries Lactate, a bicarbonate precursor.

Answer: What is LRS?

Question: This crystalloid fluid contains no electrolytes.

Answer: What is 5% Dextrose?

Question: A hyperkalemic patient can receive these types of crystalloids.

Answer: What is saline or dextrose?

Question: This natural colloid contains the lease K.

Answer: What is 25% Albumin?

Question: This synthetic colloid has a pH of 5.9.

Answer: What is 6% Hetastarch?

Fluid Therapy

Question: When correcting serum sodium (increase or decrease) this is the rate you do not want to exceed.

Answer: What is 0.5-1 mEq/L/hour?

Question: This is the rule of thumb you don't want to correct a potassium deficit with more than than this value (mEq/kg/hr).

Answer: What is 0.5 mEq/kg/hr?

Question: These type of fluid is counter-indicated in a patient who is alkalotic.

Answer: What is fluids with bicarbonate precursors?

Question: This is the approximate fluid deficit where one begins to see sunken eyes.
Answer: What is 10%?

Question: These five signs should be values/observations should be monitored for signs of fluid overload.

Answer: What is PCV, Central Venous Pressure, Blood Pressure, Skin Turgor, and Body Weight?