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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
Causes K movement into cells - Simtulates Na-H exchange - This activates Na-K ATPase
Insulin
21
Clincial manifestations of Hyperkalemia result primarily from
Depolarization of resting Vm in myocytes and neurons
21
What beta agonist is used for Hyperkalemia? How does it work?
Albuterol - Activates Na-K pump via beta 2 receptor
21
K imblanace in Renin-Secreting Tumor
Hypokalemia
22
Onset and duration of Kayexalate in Hyper K tx
2-3 hours, 4-6 hours
23
What K imbalance is caused by decreased plasma osmolality
Hypokalemia
24
How does increase in Plasma Osmolality change K balance
(1) Fluid shifts out cell and drags K with it; (2) Loss of water causes conc. gradient, K exits down gradient passively
26
How does insulin affect K movement
Causes movement into cells - Simtulates Na-H exchange - This activates Na-K ATPase
26
At what plasma [K] will you see sine wave morphology
12 mEq/L
27
K imbalance in Bartter's, Gitelman's
Hypokalemia
28
Rapid infusion of K can cause
Cardiac Arrhythmias
29
K imbalance in Conn's Syndrome
Primary Hyper-Aldosteronism - Hypokalemia
31
What potentiates the affect of DT flow rate on K secretion
High vs Low K diet
31
What K imbalance is caused by renal failure
Hyperkalemia - Impaired secretion
31
EKG changes in Hyperkalemia
(1) Peaked T wave; (2) Wide QRS, Short QT, Long PR; (3) Further wide QRS, absent P wave; (4) Sine Wave
33
4 significant locations of intracellular K
Muscle, Liver, RBC, Bone
34
At what plasma [K] will you see peaked T wave
6 mEq/L
34
Renal clinical manifestations of Hypokalemia
Nephrogenic Diabetes Insipidus
35
Onset and duration of Furosemide in HyperK tx
5 min, 2 hours
37
How does Hyperaldosteronism affect K balance
Hypokalemia due to increased Aldosterone
38
Major site of K secretion
CD
40
How does rapid cellular proliferation affect K balance?
Rapid intake -- Hypokalemia
41
Onset and duration of Ca2+ for HyperK tx
1-3 mins, 30-60 mins
42
2 classes of K-sparing diuretics used for Hypokalemia
(1) Aldosterone R Blockers; (2) ENaC inhibitors
42
Inhibiting this channel will inc. postive charge in lumen, prevent K secretion
ENaC
43
Onset and duration of Albuterol for HyperK tx
30 mins, 2-4 hours
45
How does too much Na reabsorption affect K secretion
Not enough Na enters ENaC on Principal cells, and there is a small electochemical gradient that is necessary to drive K secretion
46
At what plasma [K] will you see wide QRS, short QT, long PR?
8 mEq/L
48
Prolonged depolarization from Hyperkalemia decreases
Na permeability thru inactivation of V-gated Na channels - Reduction in membrane excitability
50
How does alpha receptor affect K movement
Inhibits Na-K ATPase, so prevents movement of K into cells
51
How do ENaC inhibitors tx Hypokalemia
Inhibiting this channel will inc. postive charge in lumen, prevent K secretion
53
How does High K diet affect amount of K secreted for given DT flow rate
Increases
55
How do Bartter's and Gitelman's affect K balance?
Hypokalemia due to increased distal Na delivery
56
4 Causes of Hypokalemia due to Internal Redistribution
Insulin excess, Catecholamine excess, Alkalemia, Cell proliferation
57
How do acid base disturbances affect K
Changes in extracellular pH produce reciprocal shifts in H+ and K+ across membrane
58
Smooth muscle manifestations of Hypokalemia
HTN, Ileus
60
Stimulates Na-K ATPase via B2 receptors - Move K intracellularly
Epinephrine
61
K imbalance in Prolonged Vomitting, NG suction
Hypokalemia
62
Which have greater effect on K: metabolic or respiratory acid base disturbances
Metabolic
64
Onset and duration of Insulin for HyperK tx
30 mins, 4-6 hours
65
How are diuretics used to tx Hypokalemia
K-sparing diuretics increase K reabsorption
66
K imblanace in Uretral diversion
Hypokalemia
66
Most common clinical cause of Hypokalemia
Exogenous glucocorticoid excess - Steroid Admin
68
K imbalance in Primary Hyper-Aldosteronism
Hypokalemia
69
What K imbalance is caused by increased plasma osmolality
Hyperkalemia
70
Alkalosis causes what change in K
H+ exits cell, K enters
71
EKG changes in Hypokalemia
(1) Flat T wave; (2) Prominent U wave; (3) Depressed ST segment
72
How does Epi affect K movement
Stimulates Na-K ATPase via B2 receptors - Move K intracellularly
73
How and why does distal tubular flow rate affect K secretion
Increase flow = Inc secretion Na delivery to DT
74
How do diuretics (Loop, Thiazide) affect K balance
Hypokalemia due to increased distal Na delivery
75
How is K usually given clinically
KCl, KPO4 - KCl tab or mixed with IV fluids
76
First-line tx of Hyperkalemia
Ca2+ (doesn't lower K, just counters)
77
Amount of Intracellular K
3300 mEq
78
How does Beta receptor affect K movement
Stimulates Na-K ATPase, so moves K into cells
79
How does Na reabsorption affect K Secretion
If more Na is delivered distally, it enters thru ENaC channels in Principal Cells and creates electrochemical gradient favor K secretion
80
Why and How does beta blockade affect K balance
B2 receptors activate Na-K -\> Without activation, K not taken up into cell -\> Hyperkalemia
81
Hyperaldosteronism will cause what K imbalance
Hypokalemia (increases secretion)
82
4 causes of decreased renal K secretion
Kindey Failure, DT dysfxn, Dec DT flow, Hypoaldosteronism
83
If there is a deficiency in insulin, what channel is impaired and what ion is dysregulated?
Na-K pump is impaired, Elevated K in ECF

Renal (31 decks)

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