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urinary > 5- Fluid replacement and renal response > Flashcards

5- Fluid replacement and renal response Flashcards

1
Q

What is osmolality

A

Number of particles of solute per Kg of solvent mOsm/g

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2
Q

What is osmolarity

A

Solute per litre of solution mOsm/L

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3
Q

What is tonicity

A

Effective osmotic pressure gradient of two solutions separated by semipermeable membrane

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4
Q

Where does water move when hypotonic

A

Into cells = swells

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5
Q

Distribution of water in Male

A 
60% 
2/3 ICF
1/3 ECF
25% plasma
75% interstitial
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6
Q

Why do women have less fluid

A

More fluid in muscle then in fat

55% in women 60% men

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7
Q

Total body water of baby

A

75%

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8
Q

Total body water of elderly

A

45%

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9
Q

Main intracellular cation and anion

A

K and PO4

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10
Q

Main extracellular cation and anion

A

Na and Cl-

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11
Q

What happens to water in hypernatremia

A

Water drawn out of cell
Shrinks
Confusion/ seizures

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12
Q

What happens to water in hyponatremia

A

Water moves into cells
Swells
Cerebral oedema
Headache/ seizures

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13
Q

Where does 5% dextrose distribute

A 
Glucose taken up by cell
H2O reduces osmolarity of all compartments
2/3 rd to intracellular
1/3 to interstitial
1/12 to intravascular
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14
Q

Where does NaCl 0.9% go

A

Remains in ECF
3/4 interstitial
1/4 intravascular

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15
Q

Where does Hartmanns go

A

Majority retained in ECF

3/4 and 1/4

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16
Q

Composition of Hartmanns

A

Na, K, Ca, Lactate (metabolised into HCO3)

17
Q

Where does 4% dextrose, 0.18% saline go

A

Effectively 200ml NaCl and 800ml dextrose
200ml remains in ECF
Then 800 ml distributes 2/3, 1/4, 1/12

18
Q

Why do patients need fluid

A 
NBM
GI malfunction
Fluid loss
Dehydration
Electrolyte imbalance
19
Q

How are hospitalised patients requirements different

A

Do not sweat excessively
Stress response- RAAS - Na reabsorbed = retention
ADH- pain, nausea, drugs

20
Q

NICE guidelines- maintenance

A

25-30ml/kg/day water
1mmol kg/day K,Na,Cl
50-100g/day glucose

21
Q

NICE guidelines- resus

A

500ml bolus

Up to 2L

22
Q

How do we lose Na

A

Vomiting
NG tube
Biliary drainage lost
Pancreatic drain, colostomy, ileostomy

23
Q

How do we lose K

A

Vomiting

Diarrhoea

24
Q

When does congestive cardiac failure occur

A

When heart muscle pump cannot cope with workload
Output falls
Fails to perfuse tissues

25
Q

What does hypoperfusion in CCF lead to

A

Renal hypoperfusion sensed by kidneys as hypovolemia which results in compensation and retention in NaCl and water to increase circulating volume.
Edema

26
Q

How does pulmonary oedema come around

A

Increased pulmonary venous pressure = transudate from capillaries in lungs

27
Q

How do you manage pulmonary oedema

A

ACEI
Diuretics
Vasodilators

28
Q

Causes of fluid overload

A 
Excess of body salt and water
Retention by kidneys
Reduced effective arterial volume
Decreased effective circulating volume- CCF
Cirrhosis- protein in plasma
Hyperaldosteronism
29
Q

How does hypovolemia lead to shock

A

Inadequate perfusion
Hypoxic state leading to anaerobic metabolism and inefficient clearance of metabolites
Tired, dizzy, thirst
Vasodilation occurs to maintain blood supply = acute tubular necrosis = AK

30
Q

Severe decrease in circulating volume leads to

A

Stimulation of sympathetic activity by increases HR, peripheral vasoconstriction and increased contractility of heart.

31
Q

How to kidneys react to systemic vasoconstriction

A

Prostaglandins released to maintain GFR by dilating afferent

32
Q

Acid base disturbances in hypovolemic shock

A

Na involved in co-transport of H, K, Cl
as Na is retained this disturbs H distribution
Initially increase in H and K secretion = met alkalosis and hypokalemia
Then shift to anaerobic metabolism as a result of hypoxia = metabolic acidosis
As hypovolemia worsens less urine and less H secretion = more acidosis.

33
Q

Changes seen in hypertensive renal disease

A

Arteriosclerosis of renal arteries
Hyalinization of small vessels with intimal thickening- respond to myogenic feedback
Can lead to reduced kidney size and chronic renal damage (hypertensive nephrosclerosis)

34
Q

Secondary hypertension

  1. Impaired excretion
  2. Stenosis
A
  1. Renal causes
    Impaired Na and water excretion = increase blood volume
    Renin release
  2. Renal artery stenosis = reduced perfusion = excessive activation of RAAS

urinary (11 decks)

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