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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
Q

Serum calcium and total body calcium

A

Serum calcium does not tell you a lot about total body calcium

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26
Q

Where is most Ca2++

A

Bone (99%)

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27
Q

How much blood serum is bound to albumin

A

45%

This will not filter, so the kidney does not handle much Ca2++ at all

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28
Q

What does renal excretion of Ca2++ in adults do

A

Balances GI absoprtion and fecal excretion

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29
Q

What are the hormones that play a role in calcium balance

A

Calcitrol
Calcitonin
PTH

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30
Q

What is the main hormonal control of Ca balance

A

PTH and calcitonin

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31
Q

What do PTH and calcitonin control

A

Only control free Ca levels

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32
Q

What is PTH inhibited by

A

High Ca

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33
Q

What is PTH stimulated by

A

Low Ca

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34
Q

What is calcitonin inhibited by

A

Low Ca

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35
Q

What is calcitonin stimulated by

A

High Ca

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36
Q

What Ca regulating hormones are essential for life

A

PTH and calcitrol (Vit D)

Calcitonin not required for humans

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37
Q

What is the last step in making active vitamin D

A

Kidney. The main regulation

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38
Q

How much filtered Ca is reabsorbed

A

About 99%

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39
Q

PCT reabsorption of Ca

A

80% is reabsorbed paracellularly, rest is active

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40
Q

TAL and Ca reabsorption

A

Occurs similarly to PCT
-no solvent drag because no water reabsorption.

Lasix (loop diuretics can make you lose more K)

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41
Q

Ca reabsorption in the DCT

A

Entirely active

Thiazides will increase Ca reabsorption

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42
Q

How does Ca diffuse into the cell

A

through apical channels and actively transported via the PMCa (Ca ATPase) and Na/Ca exchanger

43
Q

How does PTH enhance Ca diffusion into the cell

A

Enhances the effect opening more apical channels and increases PMCas activity
-most important PTH function is hydroxylation of Vit D

44
Q

What hydroxylates Vit D

A

PTH

45
Q

Ca balance and linkage to Na in the PT and TAL

A

Na and Ca move in parallel. Volume expansion inhibits Na and Ca reabsorption

46
Q

Look diuretics and reabsorption of Ca

A

Inhibits Ca reabsorption

47
Q

TZD diuretics and Ca reabsorption

A

Promotes the reabsorption of Ca

48
Q

Hypoalbuminemia would have what effect on total body calcium levels

A

Decrease. More will filter. Body will think you have hypocalcemia

49
Q

Where is phosphate absorbed

A

GI tract

50
Q

Kidneys and phosphate

A

Kidneys regulate excretion to maintain balance

51
Q

Main reservoirs of phosphate

A

Bone and ICF

52
Q

Kidney reabsorption of phosphate

A

Usually at a maximal rate, any increased load is lost

53
Q

Diets high in Pi do what to reabsorption

A

Reduce maximal rate

54
Q

Diets low in Pi do what to reabsorption

A

Increase renal ability to reabsorbs Pi

55
Q

How does Pi reabsorption occur

A

Via exchange with organic anions in the PCT

56
Q

Where is the major regulation of Pi

A

PCT (with PTH_

57
Q

How does the PCT exchange Pi with organic anions

A

Symport with Na
-PTH lowers this activity and abundance in apical membrane
Removed from cell by exchanging with organic anion

58
Q

Interaction of Ca and Pi in renal failure

A
  • 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
Q

What kind of disorder do you get from long term renal failure

A

Osteoporosis

60
Q

What do osmotic diuretics do to urine flow

A

Increase it because of presence of solute in tubular fluid that either shouldn’t be there or is there into high a concentration

61
Q

Osmotic diuretics how they work

A
  • 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
Q

Where do osmotic diuretics work

A

DTL

63
Q

Where do loop diuretics work

A

TAL

64
Q

How does Loop diuretics work

A

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
Q

What kind of diuretic causes the most drastic increase in potassium loss

A

Loop diuretics

66
Q

What do TZD diuretics do

A

Blocks Na-Cl symporters in DCT

67
Q

What do CA diuretics do

A

Inhibits carbonic anhydrase in PCT

68
Q

What can CA diuretics lead to

A

Acidosis

Keeps Na, HCO3, and water in urine

69
Q

What is another name for aldosterone inhibitors

A

K sparing

70
Q

What do aldosterone inhibitors do

A
  • Block aldosterone from working

- blocks reabsorption of Na and secretion of K

71
Q

What do aldosterone inhibitors lead to

A

A diuretics without hypokalemia associated with loops or TZDs

72
Q

What can an excessof aldosterone inhibitors cause

A

Hyperkalemia. Normal function of aldosterone is blocked

73
Q

What are the two compartments that total body water is divided into

A

ECF

ICF

74
Q

What is the ECF divided into

A

Blood plasma and interstitial fluid

75
Q

What is the IF separated from the ECF by

A

Cell membrnae

76
Q

How do you measure body fluid compartments

A

Inject a tracer that is distributed where you want it

77
Q

Plasma tracers

A
  • must not cross the caps

- albumin, Evans blue dye

78
Q

ECF tracers

A
  • must cross caps but not cell membranes

- inulin, Na

79
Q

Total boy water tracers

A

Must get into cells

Tritium

80
Q

How do you find the interstitial ?

A

ECF-plasma

81
Q

How do you find the ICF

A

TBW-ECF

82
Q

How do you visualize changes in body fluids

A

Darrow yannet diagrams

  • osm on Y
  • volume on X
83
Q

Where must all fluid originate from

A

ECF

84
Q

Changes to ECF volume and ICF

A

Changes to only ECF volume will not affect ICF

85
Q

Changes to ECF osm

A

Changes to ECF osm will affect ICF

86
Q

Inability to concentrate urine due to decreased production (central) or response to (nephrogenic) ADH

A

Diabetes insipidus

87
Q

What does diabetes insipidus do to ICF and ECF

A

Hyperosmotic contraction

-both volumes decrease, both osm increase

88
Q

What does decreased blood volume activate

A

RAAS

89
Q

What does RAAS do in times of decreased blood volume

A
  • Na and water reabsorption

- still lose water, but retain Na, so hypernatremia

90
Q

high aldosterone

A

Secretion of potassium and acid

-hypokalemia and alkalosis

91
Q

What does high levels of aldosterone cause

A

Hypokalemia and alkalosis

92
Q

How do you differentiate between high aldosterone levels and water deprivation

A

Look at free water clearance. High aldosterone will have more free water clearance and water deprivation will have little free water clearance

93
Q

SIADH

A
  • Inability to make dilute urine, cant make enough ADH
  • hypoosmotic volume expansion (dilute ECF)
  • increased blood volume, inhibits RAAS (hyponatremia)
  • acidosis
94
Q

What does hyperaldosteronism do

A

Increased reabsorption of equal amounts Na and water, no direct effect on plasma Na
-hypertension and hypovolemia

95
Q

What does hypovolemia in hyperaldosteronism do

A

Reduces ADH secretion, so lose water but not salt, leads to hypernatremia

96
Q

What can hyperaldosteronism cause

A

Alkalosis and hypokalemia due to increased tubular flow rate

97
Q

Low amounts of aldosterone, lose Na and water at an equal rate

A

Hypoaldosteronism

98
Q

What does the low blood volume inhypoaldosteronism do

A

Increases ADH, so water is reabsorbed but not Na, so hyponatremia (ICF volume expansion)

99
Q

What can hypoaldosteronism ultimately result in

A

Acidosis and hyperkalemia due to reduced K excretion

100
Q

What happens to ICF and ECF if you add isotonic saline

A

Increase volume

101
Q

How do we get rid of increased volume in the ECF and ICF

A

Pee more

102
Q

What does ANP do to asoosmotic volume expression

A

makes you lose salty water because of too much blood

103
Q

How do we fix isoosmotic volume loss

A

RAAS and ADH if you increase fluid intake

104
Q

What will increased RAAS and ADH do to correct isoosmotic volume loss

A

Will quickly alleviate this IF fluid intake is sufficient

Physiology Block 7 (10 decks)

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