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renal final > CIS disorders of salt and water balance > Flashcards

CIS disorders of salt and water balance Flashcards

1
Q

what is hyponatremia and where does water move

A

sodium is too low so water moves into cells

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2
Q

what is hypernatremia and where does water move

A

sodiu is too high and fluid moves out of the cell

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3
Q

What is the normal response to hyponatremia

A

inhibit release of ADH so excrete dilute urine

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4
Q

What is an example of a condition where ADH release is appropriate but patient still develops hyponatremia

A

psychogenic polydipsia

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5
Q

What are the two types of True hyponatremia

A

dilute urine with low ADH

concentrated urine with high ADH

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6
Q

what are examples where patients have a low ADH and dilute urine yet still hyponatremic

A

psychogenic polydipsia

reset osmostat like during pregnancy

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7
Q

What are examples of true hyponatremia that result in high levels of ADH

A

a decrease in effective circulating volume
SIADH
cortisol deficiency
hypothyroidism

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8
Q

What can cause a decrease in effective circulating volume

A

CHF and cirrhosis

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9
Q

What can result in a rapid onset of hyponatremia

A

cell swelling and neurological problems

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10
Q

what is a normal osmolar gap

A

<10 mOsm/kg H2O

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11
Q

how can you tell is someone is true hyponatremia

A

both plasma Na [ ] and osmolality are below normal

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12
Q

what is the normal response to hyponatremia

A

dilute urine in high volumes

circulating AVP or ADH is low

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13
Q

Pregnant women usually have what in regards to hyponatremia

A

reset osmostat, less osmolility triggers AVP

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14
Q

A patient with low Posm and high ADH what do you suspect

A

SIADH

Uosm/Posm>1

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15
Q

A patient with low Posm and low ADH what do you suspect

A

primary polydipsia with Uosm/Posm<1

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16
Q

A patient with high Posm and high ADH what do you suspect

A

dehydration or nephrogenic DI

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17
Q

how can you distinguis a patient from dehydration of nephrogenic DI

A

Uosm/Posm>1 in dehydration

Usom/Posm<1 in nephrogenic DI

18
Q

if a patient has high Posm and low ADH what do you suspect

A

neuro(central) DI

19
Q

If you deprive a normal patient of water what is the expected result

A

increase urine osmolarity

20
Q

In a patient with either type of DI, what would be the result of the water deprivation test

A

no change

21
Q

in a patient with nephrogenic DI what would be the measured response of ADH in water deprivation? what about after administration of desmopressin?

A

ADH elevated

no effect from desmopressin

22
Q

how can you differentiate between the types of DI

A

give ADH and if no change then nephrogenic

if gets better than central

23
Q

what are the two main causes of hypernatremia

A

extrarenal water loss and renal water loss

24
Q

how do the collecting ducts change in someone who is hydrated then dehydrated

A

increase permeability to water–> water reabsorption

25
Q

what allows for water reabsorption to take place in dehydrated individuals

A

ADH increases permeability via V2 R and insertion of AQP channels

26
Q

antidiuresis is considered high ADH or low

A

high

27
Q

water diuresis is high ADH or low

A

low

28
Q

how is the concentration of the medullary interstitium different in water diuresis

A

lower [ ] in medullary interstitium so doesn’t pull water out of the tubule

29
Q

What effect can the drug lithium have on the renal system

A

limits ability of V2 R to generate cAMP resulting in diminished biologic activity of ADH
leading to Nephrogenic DI

30
Q

What are common causes for nephrogenic DI

A

Lithium drug
hypercalcemia
hyperkalemia (acidosis)

31
Q

What can postpartum hypophysitis cause

A

Ab against ADH secreting neurons thus central DI

32
Q

common causes for central DI

A

head trauma
postpoartum hypophysitis
hypothalamic or pituitary tumor

33
Q

causes of SIADH

A 
pulmonary tuberculosis
oat cell carcinoma
CHF
CNS issues
intubation with mechanical ventilation
34
Q

how do you treat SIADH

A

water retention

ADH antagonists like conivaptin and demclocycline

35
Q

What is the result of CHF on ANG II aldosterone, ADH and ANP

A

everything increases because low circulating volume but in the heart stretch R activate ANP

36
Q

In someone with CHF with edema and fluid overload what most likely causes hyponatremia

A

decreased free water clearance. dilution of solutes

37
Q

What causes a patient with CHF to have edema

A

increased ECF volume and imbalance of the starlings forces favoring filtration

38
Q

When BUN/Cr is above 20 what does this say

A

pre renal and BUN reabsorption is increased

hypovolemia- reduced renal perfusion

39
Q

when BUN/Cr is below 10 what does this say

A

intra renal, reduced reabsorption of BUN

40
Q

What are physical signs of hypovolemia

A

orthostatic hypotension
orthostatic tachycardia
loss of skin turgor
dry mucous membranes

renal final (6 decks)

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