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Renal > 05.08 - K Balance (Showkat) - PP, No reading > Flashcards

05.08 - K Balance (Showkat) - PP, No reading Flashcards

1
Q

Daily intake and output of K

A

100 mEq/d in; 90-95 out kidney, 5-10 out GI

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1
Q

3 Factors Affecting K Secretion

A

(1) [K] across membrane - depends on serum [K]; (2) Electrical gradient deteremined by Na delivery to DT; (3) K permeability of luminal membrane determined by Aldosterone

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2
Q

3 Groups of Causes of Hyperkalemia

A

(1) Excessive K intake; (2) Dec Renal Excretion; (3) Internal Redistribution

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3
Q

How does vomitting affect K balance

A

Hypokalemia due to increased Aldosterone

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3
Q

K imbalance in Congenital Adrenal Hyperplasia

A

Hypokalemia

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4
Q

How is K reabsorbed in ThickALOH, and what else travels thru this route?

A

Paracellular Diffusion, also Na+, Ca2+, Mg+

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5
Q

5 Causes of Internal Redistribution of K leading to HyperK

A

Insulin Def., B2 blockade, Hypertonicity, Acidemia, Cell lysis

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6
Q

How does NG suction affect K balance

A

Hypokalemia due to increased Aldosterone

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6
Q

Three ways to move K outside body in Hyperkalemia Tx

A

Diuretics, Resins (cation exchange), Dialysis

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7
Q

What eliminates effect of DT flow rate on K secretion

A

Low K diet

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8
Q

Skeletal muscle clinical manifestations of Hypokalemia

A

Weakness, Rhabdomyolysis

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9
Q

Which has greater effect on K: Metabolic acidosis due to Organic Acids or Mineral Acids

A

Mineral Acids

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9
Q

K imbalance in Cushing’s

A

Hypokalemia

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9
Q

When are diuretics usually used for hypokalemia

A

K sparing in cases of chronic hypokalemia

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11
Q

K-related channels in ThickALOH

A

NaK2Cl on luminal border; K channel on luminal border; Na-K ATPase on basolateral border

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12
Q

What channel does Bartter’s affect?

A

Na-K-2Cl

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13
Q

What determines the number of K channels in luminal membrane of DT/CD

A

Aldosterone

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13
Q

What 3 factors promote K movement across cells

A

Plasma [K], Insulin, Epinephrine

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15
Q

Hypoaldosteronism will cause what K imbalance

A

Hyperkalemia (decreases secretion)

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16
Q

Metabolic Acidosis causes what change in K

A

H+ enters cell, K exits

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16
Q

Three ways to move K inside cells in Hyperkalemia tx

A

Insulin, Beta agonists, Bicarb

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17
Q

K imbalance in Renal Artery Stenosis

A

Hyper-reninemia - Hypokalemia

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19
Q

2 Actions of Aldosterone in Principal cells

A

(1) Adds ENaC (in) and ROMK (out) channels to luminal surface; (2) Stimulates Na-K pump -> Creates electronegativity -> Reabsorption of Na thru epithelial channel (ENaC)

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20
Q

Major site of K reabsorption

A

PT

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21
Q

Causes K movement into cells - Simtulates Na-H exchange - This activates Na-K ATPase

A

Insulin

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21
Q

Clincial manifestations of Hyperkalemia result primarily from

A

Depolarization of resting Vm in myocytes and neurons

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21
Q

What beta agonist is used for Hyperkalemia? How does it work?

A

Albuterol - Activates Na-K pump via beta 2 receptor

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21
Q

K imblanace in Renin-Secreting Tumor

A

Hypokalemia

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22
Q

Onset and duration of Kayexalate in Hyper K tx

A

2-3 hours, 4-6 hours

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23
Q

What K imbalance is caused by decreased plasma osmolality

A

Hypokalemia

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24
Q

How does increase in Plasma Osmolality change K balance

A

(1) Fluid shifts out cell and drags K with it; (2) Loss of water causes conc. gradient, K exits down gradient passively

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26
Q

How does insulin affect K movement

A

Causes movement into cells - Simtulates Na-H exchange - This activates Na-K ATPase

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26
Q

At what plasma [K] will you see sine wave morphology

A

12 mEq/L

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27
Q

K imbalance in Bartter’s, Gitelman’s

A

Hypokalemia

28
Q

Rapid infusion of K can cause

A

Cardiac Arrhythmias

29
Q

K imbalance in Conn’s Syndrome

A

Primary Hyper-Aldosteronism - Hypokalemia

31
Q

What potentiates the affect of DT flow rate on K secretion

A

High vs Low K diet

31
Q

What K imbalance is caused by renal failure

A

Hyperkalemia - Impaired secretion

31
Q

EKG changes in Hyperkalemia

A

(1) Peaked T wave; (2) Wide QRS, Short QT, Long PR; (3) Further wide QRS, absent P wave; (4) Sine Wave

33
Q

4 significant locations of intracellular K

A

Muscle, Liver, RBC, Bone

34
Q

At what plasma [K] will you see peaked T wave

A

6 mEq/L

34
Q

Renal clinical manifestations of Hypokalemia

A

Nephrogenic Diabetes Insipidus

35
Q

Onset and duration of Furosemide in HyperK tx

A

5 min, 2 hours

37
Q

How does Hyperaldosteronism affect K balance

A

Hypokalemia due to increased Aldosterone

38
Q

Major site of K secretion

A

CD

40
Q

How does rapid cellular proliferation affect K balance?

A

Rapid intake – Hypokalemia

41
Q

Onset and duration of Ca2+ for HyperK tx

A

1-3 mins, 30-60 mins

42
Q

2 classes of K-sparing diuretics used for Hypokalemia

A

(1) Aldosterone R Blockers; (2) ENaC inhibitors

42
Q

Inhibiting this channel will inc. postive charge in lumen, prevent K secretion

A

ENaC

43
Q

Onset and duration of Albuterol for HyperK tx

A

30 mins, 2-4 hours

45
Q

How does too much Na reabsorption affect K secretion

A

Not enough Na enters ENaC on Principal cells, and there is a small electochemical gradient that is necessary to drive K secretion

46
Q

At what plasma [K] will you see wide QRS, short QT, long PR?

A

8 mEq/L

48
Q

Prolonged depolarization from Hyperkalemia decreases

A

Na permeability thru inactivation of V-gated Na channels - Reduction in membrane excitability

50
Q

How does alpha receptor affect K movement

A

Inhibits Na-K ATPase, so prevents movement of K into cells

51
Q

How do ENaC inhibitors tx Hypokalemia

A

Inhibiting this channel will inc. postive charge in lumen, prevent K secretion

53
Q

How does High K diet affect amount of K secreted for given DT flow rate

A

Increases

55
Q

How do Bartter’s and Gitelman’s affect K balance?

A

Hypokalemia due to increased distal Na delivery

56
Q

4 Causes of Hypokalemia due to Internal Redistribution

A

Insulin excess, Catecholamine excess, Alkalemia, Cell proliferation

57
Q

How do acid base disturbances affect K

A

Changes in extracellular pH produce reciprocal shifts in H+ and K+ across membrane

58
Q

Smooth muscle manifestations of Hypokalemia

A

HTN, Ileus

60
Q

Stimulates Na-K ATPase via B2 receptors - Move K intracellularly

A

Epinephrine

61
Q

K imbalance in Prolonged Vomitting, NG suction

A

Hypokalemia

62
Q

Which have greater effect on K: metabolic or respiratory acid base disturbances

A

Metabolic

64
Q

Onset and duration of Insulin for HyperK tx

A

30 mins, 4-6 hours

65
Q

How are diuretics used to tx Hypokalemia

A

K-sparing diuretics increase K reabsorption

66
Q

K imblanace in Uretral diversion

A

Hypokalemia

66
Q

Most common clinical cause of Hypokalemia

A

Exogenous glucocorticoid excess - Steroid Admin

68
Q

K imbalance in Primary Hyper-Aldosteronism

A

Hypokalemia

69
Q

What K imbalance is caused by increased plasma osmolality

A

Hyperkalemia

70
Q

Alkalosis causes what change in K

A

H+ exits cell, K enters

71
Q

EKG changes in Hypokalemia

A

(1) Flat T wave; (2) Prominent U wave; (3) Depressed ST segment

72
Q

How does Epi affect K movement

A

Stimulates Na-K ATPase via B2 receptors - Move K intracellularly

73
Q

How and why does distal tubular flow rate affect K secretion

A

Increase flow = Inc secretion Na delivery to DT

74
Q

How do diuretics (Loop, Thiazide) affect K balance

A

Hypokalemia due to increased distal Na delivery

75
Q

How is K usually given clinically

A

KCl, KPO4 - KCl tab or mixed with IV fluids

76
Q

First-line tx of Hyperkalemia

A

Ca2+ (doesn’t lower K, just counters)

77
Q

Amount of Intracellular K

A

3300 mEq

78
Q

How does Beta receptor affect K movement

A

Stimulates Na-K ATPase, so moves K into cells

79
Q

How does Na reabsorption affect K Secretion

A

If more Na is delivered distally, it enters thru ENaC channels in Principal Cells and creates electrochemical gradient favor K secretion

80
Q

Why and How does beta blockade affect K balance

A

B2 receptors activate Na-K -> Without activation, K not taken up into cell -> Hyperkalemia

81
Q

Hyperaldosteronism will cause what K imbalance

A

Hypokalemia (increases secretion)

82
Q

4 causes of decreased renal K secretion

A

Kindey Failure, DT dysfxn, Dec DT flow, Hypoaldosteronism

83
Q

If there is a deficiency in insulin, what channel is impaired and what ion is dysregulated?

A

Na-K pump is impaired, Elevated K in ECF

Renal (31 decks)

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