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Physiology Block 7 > Control Of Other Solutes, Diuretics And Body Fluids > Flashcards

Control Of Other Solutes, Diuretics And Body Fluids Flashcards

1
Q

What is a normal K

A

4mEq/L

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2
Q

What serves a K reservoir to buffer changes in ECF K

A

intracellular space

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3
Q

What must be monitored to find K+ balance in the intracellular space

A

Intake and output

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4
Q

Serum measure of K

A

Insufficient

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5
Q

What are hte most dangerous affects of increased K

A

Alterations of APs

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6
Q

What are factors that shift K into the cells (decrease extracellular K)

A

Insulin
Aldosterone
B-adrenergic stimulation
Alkalosis

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7
Q

What re factors that shift K out of the cells (increase extracellular K)

A 
Insulin deficiency (DM)
Aldosterone deficiency 
B-adrenergic blockade 
Acidosis 
Cell lysis 
Strenuous exercise 
Increase ECF osmolarity
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8
Q

Renal potassium secretion

A

Reabsorbs almost 100% of filtered K and then secrete what you need to

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9
Q

Where does most control of K levels occur

A

DCT and CCD

  • principle cells and type B cells
  • type A can reabsorb if on a low potassium diet
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10
Q

What is potassium excretion controlled by

A

Plasma K levels
Aldosterone levels
Rate of tubular flow

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11
Q

What does high plasma K do on K excretion

A

Increases Na/K ATPase activity and number of apical K channels
-more K gets pumped into the principle cells, allowing more to diffuse out into the urine

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12
Q

What effect does aldosterone have on K excretion

A

Further increases activity and number of K and Na channels (similar to high plasma K)
-aldosterone secretion is regulated by potassium concentration in plasma

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13
Q

What is aldosterone secretion regulated by

A

[K+] plasma levels

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14
Q

How does increases tubular flow effect potassium excretion

A

Increases it
-reabsorbs sodium at the expense of potassium. Ciliary get bent with high flow, causes increased secretion of K. Too much flow you get too much Na, wants to reabsorbs it, so have to secrete K+

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15
Q

What is a side effect of loop diuretics

A

Affects urine flow before the DCT, secreting K

Also called K wasting diuretics

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16
Q

Where is most K reabsorption

A

PCT

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17
Q

How much K will be secreted

A

Almost all K in a day on increased K diet

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18
Q

High sodium levels and Na/K ATPase

A

Increased intracellular Na increases activity of Na/K ATPase

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19
Q

Which side of the epithelial cells are more permeable to K

A

K permeability of apical membrnae is greater than the basal, K more likely to leak into urine

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20
Q

Why are loop diuretics and TZDs K wasting

A

Because of the increases tubular flow and load of Na in the DCT

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21
Q

When does aldosterone promote K secretion

A

When chronically elevated (>24 hours)

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22
Q

How does aldosterone increase K secretion

A

Increases # of Na/K pumps

Increases # of apical Na channels

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23
Q

What is the net effect of aldosterone on K secretion

A

K is pumped into tubular cells from blood, then diffuses into tubular fluid

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24
Q

Administration of furosemide (loop diuretic) increases potassium excretion. What is the mechanism for this increased excretion

A

Increased tubular flow

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25
Serum calcium and total body calcium
Serum calcium does not tell you a lot about total body calcium
26
Where is most Ca2++
Bone (99%)
27
How much blood serum is bound to albumin
45% | This will not filter, so the kidney does not handle much Ca2++ at all
28
What does renal excretion of Ca2++ in adults do
Balances GI absoprtion and fecal excretion
29
What are the hormones that play a role in calcium balance
Calcitrol Calcitonin PTH
30
What is the main hormonal control of Ca balance
PTH and calcitonin
31
What do PTH and calcitonin control
Only control free Ca levels
32
What is PTH inhibited by
High Ca
33
What is PTH stimulated by
Low Ca
34
What is calcitonin inhibited by
Low Ca
35
What is calcitonin stimulated by
High Ca
36
What Ca regulating hormones are essential for life
PTH and calcitrol (Vit D) Calcitonin not required for humans
37
What is the last step in making active vitamin D
Kidney. The main regulation
38
How much filtered Ca is reabsorbed
About 99%
39
PCT reabsorption of Ca
80% is reabsorbed paracellularly, rest is active
40
TAL and Ca reabsorption
Occurs similarly to PCT -no solvent drag because no water reabsorption. Lasix (loop diuretics can make you lose more K)
41
Ca reabsorption in the DCT
Entirely active Thiazides will increase Ca reabsorption
42
How does Ca diffuse into the cell
through apical channels and actively transported via the PMCa (Ca ATPase) and Na/Ca exchanger
43
How does PTH enhance Ca diffusion into the cell
Enhances the effect opening more apical channels and increases PMCas activity -most important PTH function is hydroxylation of Vit D
44
What hydroxylates Vit D
PTH
45
Ca balance and linkage to Na in the PT and TAL
Na and Ca move in parallel. Volume expansion inhibits Na and Ca reabsorption
46
Look diuretics and reabsorption of Ca
Inhibits Ca reabsorption
47
TZD diuretics and Ca reabsorption
Promotes the reabsorption of Ca
48
Hypoalbuminemia would have what effect on total body calcium levels
Decrease. More will filter. Body will think you have hypocalcemia
49
Where is phosphate absorbed
GI tract
50
Kidneys and phosphate
Kidneys regulate excretion to maintain balance
51
Main reservoirs of phosphate
Bone and ICF
52
Kidney reabsorption of phosphate
Usually at a maximal rate, any increased load is lost
53
Diets high in Pi do what to reabsorption
Reduce maximal rate
54
Diets low in Pi do what to reabsorption
Increase renal ability to reabsorbs Pi
55
How does Pi reabsorption occur
Via exchange with organic anions in the PCT
56
Where is the major regulation of Pi
PCT (with PTH_
57
How does the PCT exchange Pi with organic anions
Symport with Na -PTH lowers this activity and abundance in apical membrane Removed from cell by exchanging with organic anion
58
Interaction of Ca and Pi in renal failure
- kidney is unable to excrete Pi - plasma Pi rises - Pi complexes with Ca - lowers free Ca - increases PTH - PTH breaks down bone - excessive Pi also suppresses formation of calcitrol - exacerabates hypocalcemia
59
What kind of disorder do you get from long term renal failure
Osteoporosis
60
What do osmotic diuretics do to urine flow
Increase it because of presence of solute in tubular fluid that either shouldn't be there or is there into high a concentration
61
Osmotic diuretics how they work
- Solutes pull water because of osmotic effects, reduces reabsorption of water without affecting GFR - increased tubular flow from point of excess origination - increases flow and solutes alters balances of other solutes, especially K
62
Where do osmotic diuretics work
DTL
63
Where do loop diuretics work
TAL
64
How does Loop diuretics work
Inhibit Na-Cl-K symporter - increases excretion of Na, CL, K, water and other electrolytes, drastically increases potassium because of high flow - wash out medullary osmotic gradient because of high tubular flow
65
What kind of diuretic causes the most drastic increase in potassium loss
Loop diuretics
66
What do TZD diuretics do
Blocks Na-Cl symporters in DCT
67
What do CA diuretics do
Inhibits carbonic anhydrase in PCT
68
What can CA diuretics lead to
Acidosis | Keeps Na, HCO3, and water in urine
69
What is another name for aldosterone inhibitors
K sparing
70
What do aldosterone inhibitors do
- Block aldosterone from working | - blocks reabsorption of Na and secretion of K
71
What do aldosterone inhibitors lead to
A diuretics without hypokalemia associated with loops or TZDs
72
What can an excessof aldosterone inhibitors cause
Hyperkalemia. Normal function of aldosterone is blocked
73
What are the two compartments that total body water is divided into
ECF | ICF
74
What is the ECF divided into
Blood plasma and interstitial fluid
75
What is the IF separated from the ECF by
Cell membrnae
76
How do you measure body fluid compartments
Inject a tracer that is distributed where you want it
77
Plasma tracers
- must not cross the caps | - albumin, Evans blue dye
78
ECF tracers
- must cross caps but not cell membranes | - inulin, Na
79
Total boy water tracers
Must get into cells | Tritium
80
How do you find the interstitial ?
ECF-plasma
81
How do you find the ICF
TBW-ECF
82
How do you visualize changes in body fluids
Darrow yannet diagrams - osm on Y - volume on X
83
Where must all fluid originate from
ECF
84
Changes to ECF volume and ICF
Changes to only ECF volume will not affect ICF
85
Changes to ECF osm
Changes to ECF osm will affect ICF
86
Inability to concentrate urine due to decreased production (central) or response to (nephrogenic) ADH
Diabetes insipidus
87
What does diabetes insipidus do to ICF and ECF
Hyperosmotic contraction | -both volumes decrease, both osm increase
88
What does decreased blood volume activate
RAAS
89
What does RAAS do in times of decreased blood volume
- Na and water reabsorption | - still lose water, but retain Na, so hypernatremia
90
high aldosterone
Secretion of potassium and acid | -hypokalemia and alkalosis
91
What does high levels of aldosterone cause
Hypokalemia and alkalosis
92
How do you differentiate between high aldosterone levels and water deprivation
Look at free water clearance. High aldosterone will have more free water clearance and water deprivation will have little free water clearance
93
SIADH
- Inability to make dilute urine, cant make enough ADH - hypoosmotic volume expansion (dilute ECF) - increased blood volume, inhibits RAAS (hyponatremia) - acidosis
94
What does hyperaldosteronism do
Increased reabsorption of equal amounts Na and water, no direct effect on plasma Na -hypertension and hypovolemia
95
What does hypovolemia in hyperaldosteronism do
Reduces ADH secretion, so lose water but not salt, leads to hypernatremia
96
What can hyperaldosteronism cause
Alkalosis and hypokalemia due to increased tubular flow rate
97
Low amounts of aldosterone, lose Na and water at an equal rate
Hypoaldosteronism
98
What does the low blood volume inhypoaldosteronism do
Increases ADH, so water is reabsorbed but not Na, so hyponatremia (ICF volume expansion)
99
What can hypoaldosteronism ultimately result in
Acidosis and hyperkalemia due to reduced K excretion
100
What happens to ICF and ECF if you add isotonic saline
Increase volume
101
How do we get rid of increased volume in the ECF and ICF
Pee more
102
What does ANP do to asoosmotic volume expression
makes you lose salty water because of too much blood
103
How do we fix isoosmotic volume loss
RAAS and ADH if you increase fluid intake
104
What will increased RAAS and ADH do to correct isoosmotic volume loss
Will quickly alleviate this IF fluid intake is sufficient

Physiology Block 7 (10 decks)

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