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Senior - GU Test 1 > 14 - Fluid And Electrolyte > Flashcards

14 - Fluid And Electrolyte Flashcards

1
Q

Gold standard for measuring urine concentration of electrolyte?

A

24 hr urine collection

- thought the fractional excretion from spot urine is more convenient

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2
Q

What does fractional excretion help determine? (Results)

A

The kidney’s response to a specific electrolyte

  • Low fractional excretion - renal absorption
  • High fractional excretion - renal wasting
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3
Q

Disorders of sodium concentration are a result of?

A

Water balance

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4
Q

Disorders of ECF volume are a result of?

A

Disturbances in sodium balance

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5
Q

What does serum sodium indicate?

What does it not reflect?

A

Indicates - relative amounts of sodium and water

Does not reflect ECF volume status

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6
Q

Hyponatremia is (level)?

A

Serum sodium <135 mEq/L

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7
Q

Clinical findings of hyponatremia?

A 
Nausea
Malaise
HA
Lethargy 
Disorientation

Respiratory arrest
Seizure
Coma
Brainstem herniation

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8
Q

hyponatrema needs to be carefully corrected to avoid?

A

Central pontine myelinolysis

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9
Q

Hyponatremic pts serum osmolality?

A

Can be
low - isotonic hyponatremia
normal- hypotonic hyponatremia
high - hypertonic hyponatremia

Chart on slid 11 if you want

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10
Q

Hypernatremia is (level)?

A

Serum sodium >145mEq/L

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11
Q

Hypernatremia always has?

A

Hyperosmolality

But may still be hypo, eu, or hypervolemic

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12
Q

Urine osmolality is used to measure?

A

The kidneys ability to conserve water

Distinguish between renal and non-renal losses

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13
Q

Tx for hypernatremia?

A

Fluid replacement

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14
Q

Disorders of sodium balance include?

A

Hypervolemia - volume overload
- abnormal na retention

Hypovolemia - decreased ECF volume
- Na excretion > Na input

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15
Q

How is a pts acid-base status measured?

A

Combination of

  • arterial pH
  • PCO2
  • Plasma bicarbonate (HCO3)

Chart of results on slide 16

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16
Q

How do kidneys regulate acid-base balance?

A

Reabsorbing HCO3
Creating new HCO3
Excretion of H

17
Q

Acid base mnemonic?

ROME

A 
R - respiratory
O - opposite (respiratory)
—H pH; L PCO2 = alkalosis
—L pH; H PCO2 = acidosis
M - metabolic
E - equal  (metabolic)
—H pH; H HCO3 = alkalosis
—L pH; L HCO3 - acidosis
18
Q

Different acid base d/o s/s?

A

Slid 18 there are pics

19
Q

Analysis of acid-base status steps?

A

Step 1 - determine metabolic vs respiratory
Step 2 - calculate range of compensatory respobses
- determines presence of mixed d/o
Step 3 - calculate anion gap
Step 4 - calculated corrected HCO3
Step 5 - look for clinical signs

20
Q

Acid base d/o results down and dirty?

A 
(Metabolic is equal)
Metabolic acidosis (all low)
- L pH; L HCO3; L CO2
Metabolic alkalosis 
- H pH; H HCO3; H CO2
(Respiratory is opposite)
Respiratory acidosis 
- L pH; H HCO3; H CO2
Respiratory alkalosis 
- H pH; L HCO3; L CO2
21
Q

Metabolic acidosis is classified as?

A

Normal
Or
Increased anion gap

Anion gap is slide 21

22
Q

RTA (renal tubular acidosis) must have?

A

Normal anion gap
Normal GFR
NOT CAUSED by diarrhea

23
Q

RTA is?

A

Impaired renal bicarb absorption or hydrogen excretion

Not caused by diarrhea

24
Q

classic distal RTA type I?

A

Hyperchloremic acidosis
- usually hypokalemic

Deficiency in H+ secretion at DCT

Urine will be alkaline (>5.5)

25
Q

___ and ___ are common with RTA type I?

A

Nephrocalcinosis

Nephrolithiasis

Chronic acidosis leads to low calcium reabsorption so lots ends up in the urinary tract

26
Q

Proximal RTA type II?

A

Hyperchloremic acidosis
- hypokalemic

Deficiency of HCO3 reabsorption
- DCT cannot reabsorb HCO3 leads to acidosis

27
Q

Meds that can cause RTA type II?

A

Carbonic anhydrase inhibitors

- acetazolamide

28
Q

What is fanconi syndrome?

A

Generalized dysfunction of the proximal tubules
- bad reabsorption of HCO3, glucose, amino acids, protein, uric acid, water, phosphorous, K, NA

  • leads to renal tubular acidosis

Basically you pee everything out

29
Q

MC RTA?

A

Hyporenimeic hypoaldosteroneic RTA type IV

30
Q

Hyporenimeic hypoaldosteroneic RTA type IV?

A

Aldosterone deficiency
Tubular resistance to aldosterone

  • salt wasting and hyperkalemia
31
Q

Common causes of RTA type IV?

A

Diabetic neuropathy
Tubulointerstitial disease
Hypertensive nephrosclerosis
AIDS

32
Q

Symptoms of RTA?

A

Mostly whatever caused it

But you will see tachypnea

33
Q

Labs for RTA?

A

L

  • blood pH
  • Serum HCO3
  • PCO2
34
Q

RTA tx?

A

Nephrology referral

Correct metabolic abnormalities w alkali stuff

35
Q

TYPE IV RTA specific tx?

A

Dietary potassium restriction

D/C potassium-retaining drugs

36
Q

Differentiating RTA types?

A

Chart on 32

Pic on 33

37
Q

What happened to the man who was stopped for having sodium chloride and a nine-volt battery in his car?

A

He was charged with a salt and battery

Senior - GU Test 1 (13 decks)

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