CSR Electrolyte Management in Renal Disease 2

Question 1

A hemodialysis patient consistently has pre-dialysis serum bicarbonate of 17 mEq/L. What dietary intervention, in addition to oral sodium bicarbonate supplementation, can help correct metabolic acidosis?

Accepted Answer

Increasing intake of base-producing foods: fruits and vegetables (with attention to potassium content)

Answer

Fruits and vegetables produce bicarbonate precursors (organic anions like citrate, malate) when metabolized. A diet rich in plant foods increases dietary alkali load, helping correct metabolic acidosis in CKD. Potassium content must be monitored in HD patients.

Question 2

Which statement BEST describes the management of hypermagnesemia in an end-stage renal disease patient on hemodialysis?

Accepted Answer

Avoid magnesium-containing medications (antacids, laxatives) and foods excessively high in magnesium; dialysate magnesium concentration can be adjusted for severe cases

Answer

In ESRD, the kidney cannot excrete excess magnesium, so magnesium-containing medications (Maalox, Milk of Magnesia, magnesium-containing laxatives) are the most common cause of dangerous hypermagnesemia. Dietary and medication restriction plus dialysate concentration adjustment are the management strategies.

Question 3

In dialysis patients, 'rebound hyperkalemia' can occur within hours after dialysis. Which physiological mechanism PRIMARILY explains this phenomenon?

Accepted Answer

Shift of potassium from the intracellular compartment back to the extracellular space following removal of dialysis-induced alkalosis effects

Answer

During dialysis, potassium is removed rapidly from plasma, but intracellular potassium equilibrates slowly. Post-dialysis, the electrochemical gradient drives K+ back from the intracellular compartment to plasma (rebound). Correction of dialysis-induced alkalosis also shifts K+ back extracellularly.

Question 4

Which phosphate binder is MOST appropriate for a CKD Stage 5D patient with both hyperphosphatemia AND iron-deficiency anemia?

Accepted Answer

Sucroferric oxyhydroxide (Velphoro) or ferric citrate (Auryxia)

Answer

Ferric citrate (Auryxia) and sucroferric oxyhydroxide (Velphoro) are iron-based phosphate binders that simultaneously bind dietary phosphate and provide systemic iron (via absorption of released iron), addressing both hyperphosphatemia and iron-deficiency anemia.

Question 5

A dialysis patient develops sudden onset swelling of the tongue and difficulty swallowing. Serum calcium is 6.8 mg/dL (corrected). Which nutritional intervention is MOST urgently indicated?

Accepted Answer

Ensure adequate calcium and vitamin D supplementation, and alert the medical team for IV calcium gluconate if severe hypocalcemia is causing tetany/laryngospasm

Answer

Corrected serum calcium of 6.8 mg/dL represents severe hypocalcemia. Hypocalcemia can cause laryngospasm and tetany (emergency). The immediate response is to alert the medical team and provide calcium support; IV calcium gluconate is the emergency treatment.

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

(CSR) Board Certified Specialist in Renal Nutrition Practice Test

CSR Electrolyte Management in Renal Disease 2