3. Sodium and Water II Flashcards
hypovolemia will activate what responses?
RAAS system and ADH
what is the most common cause of renal sodium wasting?
diuretics: loop diuretics, thiazide, osmotic
what are causes of hypovolemia/renal sodium wasting that are not due to diuretic therapy?
non-renal losses, rare genetic conditions such as Bartter’s, Gitelman’s
edematous state: what will Effective Circ Volume be?
decreased ECV despite excess of total body fluid.
in an edematous state, what mechanisms may have caused the edema?
venous HTN, or vascular hypoalbuminemia pushing fluid into the interstitium
CHF: how can this lead to a state of edema?
- poor cardiac function leads to a decr effective circ volume
- incr aldosterone leads to fluid retention via kidney
- impaired forward flow leads to venous congestion
CHF: urine Na level is high or low? urine osmolarity is high or low?
urine Na is low
urine osmolarity is high
CHF: the decrease in ECV can lead to what if it’s severe enough?
can be sufficient to cause renal failure “cardiorenal syndrome”
what are 4 general systemic issues that cause a state of edema?
- congestive heart failure
- cirrhosis
- nephrotic syndrome
- systemic inflammatory response syndrome (SIRS)
what is hepatorenal syndrome?
decr ECV due to cirrhosis, leading to renal failure
how can cirrhosis result in fluid retention?
high aldosterone, high ADH
in nephrotic syndrome, why do pts get proteinuria?
increased capillary permeability -> hypoalbuminemia + proteinuria -> decreased vascular oncotic pressure -> edema
in nephrotic syndrome, why do pts get edema?
hypoalbuminemia + incr capillary permeability
what is SIRS?
systemic inflammatory response syndrome. think cytokine storm
when does SIRS tend to occur?
critically ill patients, in the setting of sepsis.
