6. Fluid and Hemodynamics Flashcards

1
Q

What is generally the major determinant of osmolality?

A

Sodium (you can basically double Na + 10) - glucose sometimes but in general it’s mostly sodium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Which osmole freely moves from ECF to ICF?

A

Urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Do sodium and glucose move freely from ECF to ICF?

A

No - limited to the ECF component

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens to the brain in hypo vs. hypernatremia?

A

Mental status changes (hyponatremia - swelling of cells, hypernatremia - shrinking of cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Why is there essentially no glucose, fructose, or galactose in cells?

A

Gets metabolized instantly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens to serum sodium when you have hyperglycemia?

A

Hyponatremia because water leaves cells - dilution effect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

When we lose isotonic fluid, where does it come from?

A

ECF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

When do we get isotonic loss of fluid?

A

Hemorrhage, diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

When do we get isotonic gain of fluid?

A

Too much saline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is it called when we lose more salt than water?

A

Loss of hypertonic solution (e.g. when we use diuretics)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common cause of gaining pure water without salt?

A

SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What cancer has SIADH as a paraneoplastic syndrome?

A

Small cell lung cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment of choice for SIADH?

A

Free water restriction because you’re constantly absorbing pure water

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

When ADH is present do you concentrate or dilute your urine?

A

Concentrate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Serum sodium < 120 - be suspicious of?

A

SIADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What diabetic medications produce SIADH?

A

Oral sulfonylureas

17
Q

What compartment is all the total body sodium in?

A

ECF

18
Q

What clinical sign always accompanies increase in total body sodium?

A

Pitting edema (because of the increase in sodium in interstitial fluid)

19
Q

What do you call it when we lose pure water?

A

Diabetes insipidus

20
Q

What should you give an infant with diarrhea?

A

Hypotonic salt solution because they have hypotonic diarrhea

21
Q

Sodium has to be combined with what to be absorbed in the GI for oral replacement?

A

Glucose because of cotransport

22
Q

What is the tonicity of sweat?

A

Hypotonic salt solution

23
Q

What is the sympathetic response to hypovolemia (decreased cardiac output)?

A

Catecholamines!

  1. Venoconstriction - increase return to the right side of the heart
  2. Increase HR and contractility
  3. Upregulate RAA axis - increase aldosterone to reabsorb salt and water
24
Q

Where are the receptors that sense blood flow in the kidney?

A

JGA in afferent arteriole

25
Q

What do you give in hypovolemic shock if you don’t have blood?

A

ISOTONIC saline - you need to keep the fluid in ECF (normal saline is basically plasma without the protein)

26
Q

What is the tonicity of the fluid you absorb in the PCT?

A

Roughly isotonic

27
Q

What is the tonicity of the fluid you absorb via aldosterone?

A

Roughly isotonic

28
Q

What is the tonicity of the fluid you absorb via ADH?

A

Pure water (hypotonic)

29
Q

What does ANP do?

A

Gets rid of salt - only released in volume overloaded states (when right or left atria are dilated)

30
Q

What is the ADH level in central diabetes insipidus?

A

Low

31
Q

What does skin turgor tell you?

A

Total body sodium (normal if skin snaps back)

32
Q

What’s your nonpharmacologic treatment for any pitting edema state?

A

Restrict salt and water