Title: Bone Wizardry / Mnemonics / Renal
Tags: bw-mnemonics renal

Acronym: Rule of 9's
Title: Burn Surface Area
System: renal
Emoji: 🔥
Path: ? 9
. Head/neck = 9%
? 9
. Each arm = 9%
? 18
. Front torso = 18%
? 18
. Back torso = 18%
? 18
. Each leg = 18%
? 1
. Genitalia = 1%
? Note
. Parkland: 4cc x kg x %burn
? Note
. Half in first 8 hrs, half in next 16
? Note
. Newborn head = 27%

Acronym: PPUNCH SB
Title: Urease Positive Bugs
System: renal
Emoji: 🧫
Path: ? P
. Proteus
? P
. Pseudomonas
? U
. Ureaplasma
? N
. Nocardia
? C
. Cryptococcus
? H
. H. pylori
? S
. Staph saprophyticus
? B
. Brucellosis + Klebsiella
? Note
. Urease splits urea to NH3
? Note
. Struvite (staghorn) stones
? Note
. Alkaline urine = clue

Acronym: BUN/Cr > 20:1 = Pre-renal; < 20:1 = Intra-renal
Title: Acute Renal Failure Differentiation
System: renal
Emoji: 🔢
Path: ? > 20:1 . 🏜️ Pre-renal: BUN reabsorbed disproportionately (dehydration, CHF) ? < 20:1 . 🫘 Intra-renal: tubular damage prevents BUN reabsorption ? Note . Pre-renal: FeNa < 1%, concentrated urine ? Note . Intrinsic: FeNa > 2%, muddy brown casts = ATN ? Note . Upper GI bleed also raises ratio > 20

Acronym: Pediatric Fluids: Daily 100/50/20 per kg; Hourly 4/2/1 per kg
Title: Holliday-Segar Method
System: renal
Emoji: 💧
Path: ? First 10 kg
. 💯 100 mL/kg/day (or 4 mL/kg/hr)
? 11-20 kg
. 5 50 mL/kg/day (or 2 mL/kg/hr)
? > 20 kg
. 2 20 mL/kg/day (or 1 mL/kg/hr)
? Note
. 25 kg child = 1000+500+100 = 1600 mL/day
? Note
. Prevents over-hydration heart failure
? Note
. Hourly: 40+20+5 = 65 mL/hr for 25 kg

Acronym: 60% TBW: 2/3 ICF, 1/3 ECF; ECF = 3/4 Interstitial + 1/4 Plasma
Title: Body Water Compartments
System: renal
Emoji: 🌊
Path: ? 60%
. 💧 Total body water = 60% body weight
? 2/3 ICF
. 🔴 Intracellular = largest compartment
? 1/3 ECF
. 🔵 Extracellular fluid
? 3/4 Interstitial
. 🫧 3/4 of ECF
? 1/4 Plasma
. 🩸 1/4 of ECF (directly measured)
? Note
. 70 kg man: TBW=42L, ICF=28L, ECF=14L, plasma=3.5L
? Note
. Women/obese have less TBW%
? Note
. Albumin keeps fluid in plasma (oncotic pressure)

Acronym: Central Pontine Myelinolysis: Correct Na Max 0.5 mEq/hr or 10 mEq/day
Title: Osmotic Demyelination Prevention
System: renal
Emoji: 🧠
Path: ? Rate Limit
. ⏱️ Max 0.5 mEq/L per hour OR 10 mEq/L per day
? Mechanism
. 🧊 Rapid correction = water rushes OUT of brain = myelin destroyed in pons
? Prevention
. 🐌 Correct hyponatremia SLOWLY
? Note
. Locked-in syndrome is feared outcome
? Note
. Most common in alcoholics/malnourished
? Note
. If overcorrected: give D5W or desmopressin

Acronym: Hyperkalemia Treatment (C BIG K)
Title: Critical if K >6.5 or EKG changes
System: renal
Emoji: ⚡
Path: ? Calcium gluconate
. 🛡️ Protect SA node
? Bicarb (HCO3-)
. 🧪 Induce alkalosis, increase K excretion
? Insulin + Glucose
. 💉 Push K into cells; glucose prevents hypoglycemia
? (al)B(uterol)
. 💊 Induces insulin, K influx into cells
? Kayexalate
. 🫁 Pull K out of GI tract
? Hemodialysis
. 🫘 If refractory