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Transition SB > Biochemistry > Flashcards

Biochemistry Flashcards

1
Q

how are sodium and water controlled

A

Mineralocorticoid activity [sodium]

ADH release and action [water]

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2
Q

how is sodium controlled by mineralocorticoid activity

A

sodium retention in exchange for potassium and/or hydrogen ions

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3
Q

what happens if there is too much mineralocorticoid activity

A

sodium retention

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4
Q

what happens if there is too little mineralocorticoid activity

A

sodium loss

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5
Q

what does sodium loss result in

A

water loss

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6
Q

what is the main mineralocorticoid that influences sodium

A

aldosterone

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7
Q

what effects does an increase in ADH cause

A

concentrated urine

[high urine osmolality]

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8
Q

what affect does a decrease in ADH cause

A

dilutes urine

[low urine osmolality]

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9
Q

how does ADH work

A

acts on the renal tubules to cause water reabsorption

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10
Q

what can decreased sodium be due to

A

SIADH [too much water, decreased secretion]

Addison’s disease [increased sodium loss via adrenal insufficiency]

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11
Q

what can increased sodium be due to

A

diabetes insipidus [increase water loss]

decreased water intake

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12
Q

what blood results are seen in addison’s

A

low sodium

high potassium

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13
Q

what non-osmotic stimuli can cause the release of ADH

A

Hypovolaemia/hypotension
Pain
Nausea/vomiting

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14
Q

Tx for too little sodium

A

give sodium

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15
Q

Tx for too much water

A

fluid restrict

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16
Q

Tx for too little water

A

give water

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17
Q

Tx for too much sodium

A

get rid of excess sodium (and water with it) e.g. diuretics

18
Q

what are the 2 most important factors that determine potassium excretion

A

GFR

plasma potassium concentration

19
Q

what ECG changes are seen in hyperkalaemia

A

tall tented T waves

widen of the QRS complexes

20
Q

what are Sx of hyperkalaemia

A

cardiac arrest
muscle weakness
paraesthesia

21
Q

what are the 3 categories of causes of hyperkalaemia

A

increased intake
redistribution
decreased excretion

22
Q

what are causes of decreased excretion leading to hyperkalaemia

A

renal failure
- reduced GFR seen

hypoaldosteronism
- deficiency of aldosterone results in loss of sodium, decreased GFR with retention of potassium and hydrogen

23
Q

what is the role of aldosterone in potassium absorption

A

stimulates sodium reabsorption at the expense of potassium and hydrogen

24
Q

when is hyperkalaemia cause by hypoaldosteronism often seen

A

with the use of ACEi and ARB to treat HTN

25
Q

what are causes of redistribution out of cells leading to hyperkalaemia

A

potassium release from damaged cells
- rhabdomyolysis, trauma

metabolic acidosis
- has hydrogen ions increase so do potassium ions

insulin deficiency
- insulin stimulates the uptake of potassium

26
Q

Tx of hyperkalaemia

A

Calcium gluconate

Insulin + glucose

Tx underlying cause

27
Q

Sx of hypercalcaemia

A

Stones = kidney stones
Bones = bone pain and fractures
Groans = constipation, anorexia, abdo pain, N+V
Moans = fatigue, myalgia, proximal muscle weakness, joint pain
Psychic Overtones= depression, memory loss, confusion, lethargy, coma

28
Q

what are the commonest causes of hypercalcaemia

A

primary hyperparathyroidism

hypercalcaemia of malignancy

29
Q

how can you differentiate between cancer and hyperparathyroid as a cause of hypercalcaemia

A

PTH is high in primary hyperparathyroidism

30
Q

Tx of hypercalcaemia

A

IV saline

Biphosphonates e.g. pamidtronate

31
Q

what happens in familial hypocalciuric hypercalcaemia

A

a high calcium level is sense by the parathyroids as normal i.e. have normal levels of PTH

32
Q

how can hypocalciuric hypercalcaemia be differentiate from hyperparathyroidism

A

urinary calcium excretion is inappropriately low in FHH

33
Q

what are features of adrenal insufficiency

A 
lethargy 
anorexia
pigmentation of hands/mouth
abdo pain
weight loss
34
Q

what are features of adrenal insufficiency acute crisis

A

postural hypotension
vomiting
nausea
dehydration

35
Q

what can cause adrenal insufficiency

A

TB

Autoimmune i.e. Addison’s disease

36
Q

what blood results are seen in Addison’s disease

A

hyponatraemia
hyperkaelamia
elevated serum urea

37
Q

Ix for Addison’s

A

short ACTH stimulation test/Synacthen test;

  • ACTH given, which should stimulate the release of cortisol
  • in Addison’s plasma cortisol remains low
38
Q

what is not being made in hypo function of the adrenal cortex

A

cortisol

aldosterone

39
Q

what test can be done to see if secondary failure of the adrenal cortex is due to pituitary insufficiency

A

insulin stress test

40
Q

Tx of Addison’s

A

15-25mg hydrocortisone (as cortisol replacement) daily in 2-3 doses.

Fludrocortisone as aldosterone replacement

Transition SB (5 decks)

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