Disorders Of Water And Electrolyte Metabolism

Question 1

Plasma osmolality

Answer 1

2x Na plasma in mmol

Question 2

When is body in water balance

Answer 2

Water intake= water output

Question 3

Homeostasis of water and electrolytes maintained by

Answer 3

Kidney
Water transport
Ion transport

Question 4

Biochemical factors regulating water and electrolyte balance

Answer 4

Thirst mechanism
Antidiuretic hormone
RAAS system
Aldosterone
ANP
Kinins

Question 5

Thirst mechanism

Answer 5

Lack of water->increased comc or osmolarity of plasma->stimulation of thirst centre in hypothalamus->to drink water-> water in body regulated

Question 6

ADH mechanism

Answer 6

Lack of water in body->release of ADH->works on collection duct-> increases its permeability to water-> reabsorption of water-> scanty concentrated urine

Question 7

RAAS mechanism kick in?

Answer 7

When volume and pressure of blood is lost. Ie from hearmmorhage, vomiting, diarrheal . Mechanisms that lead to drop in BP

Question 8

Where is vasopressin secreted from?

Answer 8

Posterior pituitary

Question 9

RAAS mechanism?

Answer 9

Decreased BP->stimulation of receptors in juxtaglerular apparatus->release of renin->formation of angiotensin 2->contriction of afferent arteriole->restoration of BP as pressure increases.

Angiotensin 2 can also release aldosterone->causes reabsortiom of sodium amd water-> lowers irine output

Question 10

Aldosterone

Answer 10

Increases k+ losses im urine

Question 11

Hyperkalemia

Answer 11

Induces release of aldosterone

Question 12

Aldosterone

Answer 12

Acts on distal comvoluted tubule

Question 13

Adh and osmolality

Answer 13

Increased osmolality induces adh production

Question 14

Thirst mechanism and adh mechanism

Answer 14

Are responses to increased osmolality and just water is enough to solve problems since electrolytes are present

Question 15

What is atrial natriuretic peptide

Answer 15

Cardiac hormone released by right atrium in response ro increased bp

Question 16

Anp and raas

Answer 16

Anp opposes raas system and suppresses renin aldosterone and adh

Question 17

Anp stimulayes excretion of

Answer 17

Sodium and water

Question 18

Anp

Answer 18

Causes vasodilation and decreased vascular resistance

Question 19

Kinins

Answer 19

Proteins in blood that lowers bp.

Increases sodium and water excretion

Causes inflammation

Question 20

Dehydration caused by

Answer 20

No water intake
Excessive loss of fluid
Water deficiency condition
Disturbance of body electrolytes

Question 21

Types of dehydration

Answer 21

Primary
Seconday
Mixed

Question 22

Primary dehydration

Answer 22

This is due to loss of water.

Question 23

Causes of primary dehydration

Answer 23

Ill patients who cant eat
Mental patients who wont drink
Shipwrecked
Coma patients
Defect to hypothalamus 
Renal tubular disorder-no reabsorption
Diabetes insipidus

Question 24

Why may bp be normal in primary dehydration

Answer 24

Ecf depletion of water-> drawing of warer from icf-> ecf volume kept fairly constant

Question 25

PD clinical manifestations?

Answer 25

Dry tongue Pinched face Oliguria Acute nephrotic necrosis

Question 26

PD Management

Answer 26

Water ro drink | 5% iv glucose

Question 27

Mixed dehydration

Answer 27

Fluid tonicity and volume in both ecf and icf reduced Most common type of dehydration

Question 28

Manifestations of mixed type dehydration

Answer 28

Feeling of thirst Low bp Oliguria High blood urea

Question 29

Md management

Answer 29

Nacl and 5% glucose in 1:1

Question 30

Secondary dehydration

Answer 30

Occurs when fluids of high nacl are lost. | Ie sweat,gi fluids

Question 31

Causes of md

Answer 31

``` Excessive sweating Vomiting ,diarrhea Addisons dx (low aldosterone, na excretion increased) Excessive use of Diuretics Aspiration of gi fluid ```

Question 32

Events in secondary dehydration

Answer 32

Loss of electrolyte->Na conc in IF and plasma reduces->decreased osmolarity in if and plasma->water moves into intracellular space->cells swelling-> comvulsions,coma, death. Aldoaterone function reduced

Question 33

Sd manifestations

Answer 33

``` No thirst Patient listless Convulsions Anorexia,nausea Cramps in thigh, abdomen Sunken eyes Inelastic skin Low bp Low gfr ```

Question 34

Management

Answer 34

0.9% nacl

Question 35

Overhydration

Answer 35

Intake or retainment of too much water

Question 36

Causes of over hydration

Answer 36

Excessive administration of parenteral fluids Renal failuire(can excrete) Hypersecretion of adh which can also be caused by anesthesia and narcotics Excessive aldosterone secretion

Question 37

Management of over hydration

Answer 37

No drink | Hypertonic saline

Question 38

Hyponatremia

Answer 38

Na less than 130meq/l

Question 39

Hypernattrmia

Answer 39

>145meq/l

Question 40

Hypokalemia

Answer 40

<3.5meq/l

Question 41

Hyperkalemia

Answer 41

>5.1meq/l

Question 42

Conditions of water imbalance

Answer 42

Edema Diabetes insipidus Addisons dx Cushions dx

Question 43

Types of di

Answer 43

Central- problem with adh deficiency | Nephrogenic- problem with kidneys or insensitivity to adh

Question 44

Diagnosis of di

Answer 44

Dilite urine with decreased osmolarity Decreased specific gravity Fluid deprivation test( despite deprivation urine volume is constant) Electrolyte conc in serum amd urine

Question 45

Treatment of di

Answer 45

Desmopressin

Question 46

Addisons dx

Answer 46

Defect in adrenal glands which results in low aldosterone $cortisol->increased excretion of water

Question 47

Biochemical manifestations in addisons

Answer 47

Hyperkalemia Hypercalcemia Hypoglycemia Hyponatremia

Question 48

Manifestations of addisons dx

Answer 48

``` Low bp Convulsions Confusion Psychosis Syncope Slurred speech ```

Question 49

Diagnosis of addisons

Answer 49

``` Blood calcium glucose electrolytes Acth stimulating test Cortisol ```

Question 50

In acth stimulating test?

Answer 50

Using of synthetic acth hormone- TETRACOSIDE to induce increased cortisol levels. If not,gland is not working

Question 51

Management of addisons dx

Answer 51

Iv glucocorticoids-Hydrocortisone,Prednisolone Iv saline wih glucose Oral doses of fludrocortisone

Question 52

Cusions syndrome

Answer 52

Overactivity of adrenal glands. Increased aldosterone x cortisol

Question 53

Biochemical alterations

Answer 53

Hypokalemia Hypocalcemia Hyperglycemia Hypernattemia Ised for diagnosis

Question 54

Manifestation of cusions

Answer 54

``` Depression Moon face High bp Insomnia Weight gain Excessive sweating ```

Question 55

Management of cusions

Answer 55

Surgical removal in adrenal adenomas Drugs-ketoconazole,metyrapone, inhibit cortisol synthesis Glucocorticoid inhibitor- mifepristone