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diagnosis differential nephrology causes lactic algorithm anticoagulation classification comparison criticalcare effects elevation gitelman heat heatstroke hypokalemia illness lactated lr management
Lactated Ringers (LR) vs Normal Saline (NS) - Comparison Composition of LR: • Sodium 130 mEq/L •
Lactated Ringers ... /L of sodium lactate ... same line - Citrate ... gap metabolic acidosis ... decreased renal blood flow
Hypernatremia - Differential Diagnosis Workup Algorithm 1) Check Urine Osmolality: > 600 mOsm/kg - Implies extrarenal mechanism
• Euvolemic (Low ... insipidus (central or nephrogenic ... Hypervolemic: Conn syndrome ... , Cushing syndrome ... Algorithm #nephrology #sodium
Lactic Acidosis - Differential Diagnosis Framework Type A: Impaired O2 Delivery (DO2) • Decreased O2 Delivery: Hypotension
Lactic Acidosis ... Ischemia, Compartment Syndrome ... Hypothermia & Shivering, Seizures ... toxic alcohols, Sodium ... in Short Bowel Syndrome
Citrate Anticoagulation Toxicity Hypernatremia (HyperNa): - Citrate solutions may have ↑ sodium content and should be paired
Toxicity Hypernatremia ... solutions may have ↑ sodium ... paired with a lower sodium ... Anion-Gap Metabolic Acidosis ... dysfunction or low
Causes of Lactate Elevation, Lactic Acidosis - Differential Diagnosis The most common causes of hyperlactatemia are usually:
Elevation, Lactic Acidosis ... circulation If drugs, seizures ... Heavy exercise - Seizures ... LV failure - Low ... - Compartment syndrome
Heat Illnesses and Heat Stroke - Differential Diagnosis Framework Heat Cramps: • Muscle pain or spasm -
Dehydration - Loss of sodium ... conditions - Neurogenic ... heat illness → Hypernatremia ... - Metabolic acidosis ... consciousness, Coma/seizure
Gitelman Syndrome Overview What? • Inherited (AR) hypokalemic salt-losing tubulopathies affecting the thiazide-sensitive sodium chloride cotransporter • Gitelman's syndrome
thiazide-sensitive sodium ... thiazide-sensitive sodium ... alkalosis • Normal or low ... Renal tubular acidosis ... tachycardia • Seizures
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