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diagnosis differential causes algorithm lactic management alkalosis anticoagulation chloride citrate classification criticalcare elevation gitelman heat heatstroke hypokalemia illness pathophysiology rhabdomyolysis
Hypernatremia - Differential Diagnosis Workup Algorithm 1) Check Urine Osmolality: > 600 mOsm/kg - Implies extrarenal mechanism
• Euvolemic (Low ... Hypervolemic: Conn syndrome ... , Cushing syndrome ... Workup #Algorithm #nephrology ... #sodium
Metabolic Alkalosis - Urinary Chloride Algorithm Cl- responsive metabolic alkalosis • Kidney loss of Cl-
alkalosis • Normal/low ... diuretic use, Bartter syndrome ... , Gitelman syndrome ... the excretion of sodium ... urine #Algorithm #nephrology
Lactic Acidosis - Differential Diagnosis Framework Type A: Impaired O2 Delivery (DO2) • Decreased O2 Delivery: Hypotension
Ischemia, Compartment Syndrome ... Hypothermia & Shivering, Seizures ... toxic alcohols, Sodium ... Inborn Errors of Metabolism ... in Short Bowel Syndrome
Causes of Lactate Elevation, Lactic Acidosis - Differential Diagnosis The most common causes of hyperlactatemia are usually:
impairment of cellular metabolism ... sweat) - its metabolism ... Heavy exercise - Seizures ... LV failure - Low ... - Compartment syndrome
Citrate Anticoagulation Toxicity Hypernatremia (HyperNa): - Citrate solutions may have ↑ sodium content and should be paired
Anticoagulation Toxicity Hypernatremia ... solutions may have ↑ sodium ... Acidosis: - Citrate ... dysfunction or low ... Toxicity #toxicology #nephrology
Heat Illnesses and Heat Stroke - Differential Diagnosis Framework Heat Cramps: • Muscle pain or spasm -
Dehydration - Loss of sodium ... conditions - Neurogenic ... heat illness → Hypernatremia ... • Labs: - Metabolic ... 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 ... alkalosis • Normal or low ... Renal tubular acidosis ... tachycardia • Seizures ... #diagnosis #nephrology
Rhabdomyolysis - Differential Diagnosis Framework and Management Summary Causes of Rhabdomyolysis: • Trauma: - Immobilization - Crush injury - Compartment
Heat stroke - Metabolic ... exertion/training - Seizures ... Hyperuricemia • Hyponatremia ... Isotonic fluid/Lactated ... causes #treatment #nephrology
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