Clinical Examples Flashcards
Conn syndrome can cause hypertension/hypotension
Hypertension
If you are given a patient’s plasma creatinine, urine flow, and urine creatinine, could you calculate their GFR?
Yes, but if their urine creatinine was given to you in a value of mg/day, you’d have to change it to mg/min HINT HINT
Conn’s syndrome will cause excessive _________ release
Aldosterone
Conn’s syndrome will cause an increased _____ retention and an increased ________ excretion
Na+ retention
K+ excretion
Conn’s Syndrome will cause an ECF (expansion/contraction)
Expansion
You’re retaining a ton of salt, and water follows salt
Why would Conn syndrome cause an alkalosis?
Because all the extra aldosterone, in addition to increasing Na+ retention, will stimulate H+-ATPase in the α-intercalated cells of the distal tubule. This will increase the secretion of H+ and the return of HCO3 to the plasma
Is Conn Syndrome a cancer?
Yes, it doesnt care about the persons acid-base status or whatever
Why might Conn syndrome cause muscle weakness?
The hypokalemia
will hyperpolarize the membranes and make it harder to fire
Why isn’t renin elevated in Conn Syndroe?
Because you will be volume EXPANDED (retaining too much Na+)
RAS responds to volume contractions
Why would you see these signs in someone in DKA:
Hypotension
Sunken eyes
Decreased skin turgor
Rapid HR
Volume depletion
Why would someone in Diabetic Ketoacidosis have a super low bicarb?
Because of the production of all of the ketones!! (Causes FIXED ACID production which eats up all the bicarb!)
This would also increase the anion gap….
Why does someone in DKA have super deep and rapid Kussmaul’s respirations?
Its the lungs trying to blow off more CO2 to compensate for the metabolic acidosis
Why does someone in DKA have an elevated anion gap?
Due to the production of Ketoacids (fixed acids: acetoacetic acid, β-OH-butyric acid)
This depletes HCO3 with no increases in Cl-
Anion gap= Na- Cl- HCO3
Why does someone in DKA urinate all the time?
Their glucose transporters are overwhelmed, so glucose spills out into the urine causing osmosis diuresis (causing an increased Cosm as well)
WHY is someone in DKA HYPERkalemic?
Low insulin and hyper osmolality promotes K+ efflux from cells
Your patient in DKA is volume depleted and hyperosmotic. What hormones do you expect to be high?
Volume depletion: Renin, angiotensin II, aldosterone
Hyperosmotic: ADH
Your patient in DKA is volume depleted and hyperosmotic. Which hormone will LOWER than normal?
ANP (which is released in high pressure states)
TEST QUESTION HE SIAD THIS IS A TEST Q!!**
If someone is in metabolic alkalosis, what will happen to their breathing rate?
Decreased
Trying to increase CO2 aka acid
Your patient is in a metabolic alkalosis due to excessive vomiting. However, her body is MAINTAINING it. What does this mean?
The volume contraction caused the activation of RAAS!
Angiotensin II stimulated NHE in the proximal tubule which therefore increases HCO3- reabsorption
Aldosterone stimulated the secretion of H+ via the H+ATPase from α-intercalated cells and K+ from principal cells.
Why is the patient who is in metabolic alkalosis from vomiting for 3 days straight also HYPOkalemic?
The volume contraction stimulated aldosterone, which increases alkalosis and K+ loss from the principal cells in the distal tubule
How do you treat the patient who is in metabolic alkalosis due to vomiting for 3 days straight and whose body is now maintaining her alkalosis?
Give her saline and she will be all better
This type of metabolic alkalosis responds to saline
