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Nephrology > 49 Electrolytes > Flashcards

49 Electrolytes Flashcards

1
Q

What is the free water deficit? 53F. 60 Kgs. CBG 322. Serum sodium 155 mg/dl

A

3.2L

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2
Q

A 24F diabetic presents with vomiting and abdominal pain. She is dehydrated and Febrile. CBG shows 420 mg/dl. Na 134 mg/dl. K 4.8 mmol/ml. Creatinine is 1.6 mg/dl. What is her corrected sodium?

A

Corrected Na is 140

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3
Q

Osmolality of human fluid

A

280-295 mOsm/kg

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4
Q

Half life of AVP

A

10-20 minutes

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5
Q

Site of action of AVP/vasopressin

A

V2 receptor of thick ascending loop of Henle (TALH) and

Principal cells of collecting duct

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6
Q

Site where 2/3 of NaCl is reabsorbed? The remaining 1/3?

A

2/3 in Proximal tubule

1/3 in TALH

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7
Q

Site sensitive to aldosterone

A

Distal convoluted tubile
Connecting tubule
Collecting duct

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8
Q

Site sensitive to thiazide

A

Apical NaCl Co transporter

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9
Q

More reliable signs of hypovolemia

A

Decreased jugular venous pressure
Ortho static Tachycardia
Orthostatic hypotension

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10
Q

What is Orthostatic tachycardia? Orthostatic hypotension?

A

Orthostatic tachycardia: increase of 15-20 beats while standing
Orthostatic hypotension: 10-20 mmHg drop in blood pressure while standing

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11
Q

More dependable measure of GFR: Creatinine or BUN?

A

Creatinine

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12
Q

Decreased TBW. Decreased body sodium. Urine Na more than 20

A

Renal losses
Diuretic excess
Cerebral Salt wasting syndrome
Ketonuria

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13
Q

Decreased TBW. Decreased body sodium. Urine Na less than 20

A 
Extra renal losses
Vomiting
Diarrhea
Third spacing of fluids
Burns
Pancreatitis
Trauma
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14
Q

Euvolemia. Hyponatremia. Urine sodium more than 20

A 
Hypothyroidism
Stress
Drugs
SIADH
Glucocorticoids deficiency

SS HGD
Sige higda

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15
Q

Increased TBW. Decreased body sodium. Urine sodium less than 20

A

Acute or chronic renal failure

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16
Q

Increased TBW. Decreased body sodium. Urine Na less than 20

A

Nephrotic syndrome
Cirrhosis
Cardiac failure

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17
Q

Rare cause of hypovolemic Hyponatremia and inappropriate natriuresis in association with Intracranial disease

A

Cerebral Salt wasting

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18
Q

Management of cerebral Salt wasting

A

Aggressive NaCl repletion

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19
Q

Most frequent cause of euvolemic hyponatremia

A

SIADH

20
Q

Common causes of SIADH

A

Pulmonary disease: pneumonia, tuberculous, pleural effusion

CNS disease: tumor, Sah, Meningitis

21
Q

Loss of oligodendrocytes due to rapid reaccumulation of organic osmolytes; brain area classically affected

A

Osmotic demyelination syndrome;

Lesion affects the pons, cerebellum, lateral geniculate, thalamus, putamen, cerebral cortex or subcortex

22
Q

Na concentration correction allowed in 24 hours

A

8-10 mM within first 24 hours

Not more 18 mM within first 48 hours

23
Q

Cornerstone in the therapy of hyponatremia

A

Water deprivation

24
Q

Quick indicator of electrolytre- free water excretion

A

Urine to plasma electrolyte ratio (urinary Sodium + urinary Potassium/ plasma sodium)

25
Q

Interpretation of urine to plasma electrolyte ratio

A

More than 1: water aggressive restricted to less than 500 ml/day
About 1: fluid restricted to 500-700 ml
Less than 1: water restricted to 1 L/day

26
Q

Causes of Acute Hyponatremia

A 
Thiazides
Polydipsia
MDMA (ecstasy)
Exercise
Polydipsia
Colonoscopy preparation
Glycine irrigation in TURP or uterine surgery
27
Q

Causes of hypernatremia. ECF volume increased. Minimum volume of maximally concentrated urine, Yes.

A

Insensible water loss
GI water loss
Remote renal water loss

28
Q

Causes of hypernatremia. Increased ECF volume. Minimal maximally concentrated urine, No. Urine osmole excretion rate more than 750 mOsm/day

A

Diuretic use

Osmotic diuresis

29
Q

Causes of hypernatremia. Increased ECF volume. Minimal maximally concentrated urine, No. Urine osmole excretion rate less than 750 mOsm/day. Desmopressin given. Urine osomolality increased

A

Central diabetes insipidus

30
Q

Causes of hypernatremia. Increased ECF volume. Minimal maximally concentrated urine, No. Urine osmole excretion rate less than 750 mOsm/day. Desmopressin given. Urine osomolality unchanged

A

Nephrologenic diabetes insipidus

31
Q

Causes of Hypokalemia. Decreased intake

A

Starvation

Clay ingestion

32
Q

Causes of Hypokalemia. Redistribution to cells

A 
Metabolic alkalosis
Bronchodilators/tocolytics
Insulin
Downstream regulation of NaKATPase: theophylline, caffeine 
Thyrotoxic periodic paralysis
---
Vit B administration
TPN
33
Q

Hypokalemia. Urine K less than 15. ABG normal

A

Extra renal cause

Profuse sweating

34
Q

Hypokalemia. Urine K less than 15. ABG metabolic acidosis

A

GI K loss

35
Q

Hypokalemia. Urine K less than 15. ABG metabolic alkalosis

A

Diuretic use
Vomiting or stomach drainage
Profuse sweating

36
Q

Hypokalemia. Urine K more than 15. TTKG more than 4. BP high. Aldosterone high. Renin high.

A 
Renal loss
Increased Distal K secretion
--
Renal artery stenosis
Renin secreting tumor
Malignant hypertension
37
Q

Hypokalemia. Urine K more than 15. TTKG less than 2.

A

Increased tubular flow

Osmotic diuresis

38
Q

Hypokalemia. Urine K more than 15. TTKG more than 4. BP high. Aldosterone high. Renin low

A

Primary aldosteronism
Familial hyperaldosteronism type I

39
Q

Hypokalemia. Urine K more than 15. TTKG more than 4. BP high. Aldosterone low. Renin normal. Cortisol normal

A

Liddle syndrome
Licorice
Syndrome of apparent mineralocorticoid excess

40
Q

Hypokalemia. Urine K more than 15. TTKG more than 4. BP high. Aldosterone low. Renin normal. Cortisol high

A

Cushing syndrome

41
Q

Hypokalemia. Urine K more than 15. TTKG more than 4. BP low to normal. ABG metabolic acidosis

A

RTA
DKA
Amphotericin B
Acetazolamide

42
Q

Hypokalemia. Urine K more than 15. TTKG more than 4. BP low to normal. ABG metabolic alkalosis. Urine Chloride less than 10

A

Vomiting

Chloride diarrhea

43
Q

Hypokalemia. Urine K more than 15. TTKG more than 4. BP low to normal. ABG metabolic alkalosis. Urine Chloride more than 20. Urine Ca/CR ratio more than 0.2

A

Loops diuretic

Barterrs syndrome

44
Q

Hypokalemia. Urine K more than 15. TTKG more than 4. BP low to normal. ABG metabolic alkalosis. Urine Chloride more than 20. Urine Ca/CR ratio less than 0. 15

A

Thiazides diuretic

Gitelmans syndrome

45
Q

Causes of Hyperkalemia. Pseudo hyperkalemia

A

Cellular efflux: thrombocytosis, erythrocytosis, leukocytosis

Nephrology (6 decks)

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