Milk Alkali Syndrome: Hypercalcemia + Metabolic alkalosis + Renal insufficiency

Acute Pancreatitis EtOH Hypercalcemia Obstructive stones (#1) Hypertriglyceridemia Viralacute CMV or EBV Scorpion bite (Central Africa

Acute Liver 1. RUQ pain: 24-48 hours 2. Jaundice: 72 hours 3. Abnormal liver labs: Hypercalcemia 1. PTH (intact) 2. Ionized calcium 3. Vitamin D Hypercalcemia Tx: Fluid Lasix + replaces K Bisphosphonates Calcitonin

Rapamune: Sirolimus = mTore kinase inhibitor Prograf SE: Diabetes Cyclophosphamide SE: AIN C auses: o Drugs: o S/Sx:

Beta-lactam NSAID PPI Rifampin Cypro Cimetidine Rash + fever + peripheral eosinophilia10% 7-10 day s/p starting

o o o

Labs: Cr Peripheral eos. + Eosinophiluria Mild protein excretion FeNa Urine: WBC casts Tx: stop affending agent Autoimmunesteroids

When to dialyze (AEIOU) Acidosis Electrolytes Intoxication Overload (fluid) Uremia

Dialyzable TOXINS Salicylates Theophy

Correcting Calcium: FeNa o o o o o o The percentage of Total NA excreted over Total NA filtered FeNa reflects the tubular integrity! o FeNa < 1% = tubules are working o FeNa > 1% = damaged tubules, diuretics or patient w/ CRF The fractional excretion of sodium (FENa) measures the percent of filtered sodium that is excreted in the urine. The FENa is the most accurate screening test to help differentiate between prerenal disease and acute tubular necrosis (ATN). For each gram of albumin below 4, add 0.8 to Calcium level.

FeNa% = (UNa x PCr) / (PNa x UCr )x 100

< 1 % PRERENAL disease: In addition to prerenal disease, the FENa can be less than 1 percent in patients with postischemic ATN, ATN superimposed upon a chronic prerenal disease, approximately 10 percent of patients with nonoliguric ATN, AKI due to radiocontrast media or heme pigments, acute glomerulonephritis or vasculitis, some cases of acute interstitial nephritis, and (rarely) acute urinary tract obstruction. o 1 -2% may be seen with either disorder, o > 2 percent usually indicates ATN. The FENa and the urine sodium concentration are difficult to interpret with concurrent diuretic therapy. The fractional excretion of urea (FEurea) may be most useful in this setting, although inconsistent results o

have been reported. In general, the FEurea is between 50 to 65 percent in ATN and usually below 35 percent in prerenal disease.

Framingham Criteria (8 major/7 minor) Major Criteria o PND o Neck vein distension o Rales o Cardiomegaly o Acute pulm edema o S3 gallop o venous pressure o Hepatojugular reflux 7 minor Criteria o Extremity edema o Night cough o Dyspnea on exertion o Hepatomegaly o Pleural effusion

o Vital capacity reduced by one-third o Tachycardia > 120 bpm Diagnosis of CHF requires at least one major & 2 minor criteria