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renal > disorders of water balance > Flashcards

disorders of water balance Flashcards

1
Q

hypernatremia

A

hyper-osmolality indicating a water deficit (high serum sodium concentration)

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2
Q

hyponatremia

A

hypoosmolality indicating a water excess (low serum concentration)

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3
Q

water in body provide information on sodium content?

A

nope

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4
Q

what refers to sodium content

A

volume

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5
Q

fluid in the vascular space that perfuse tissue

A

effective circulating volume

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6
Q

conditions of inadequate perfusion

A

ineffective circulating volume

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7
Q

conditions of ineffective circulating volume

A
  1. heart failure
  2. cirrhosis
  3. nephrotic syndrome
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8
Q

reflects total number of particles in solution

A

osmolality

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9
Q

reflects total number of osmotically active particles in solution

A

osmotic pressure

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10
Q

true or false:

osmotically active solute diffuse freely

A

nope

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11
Q

sensor for osmolality

A

osmoreceptors in the anterior hypothalamus

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12
Q

mediators for regulating osmolality

A
  1. ADH/vasopressin

2. thirst

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13
Q

vasopressin regulates

A

vascular smooth muscle tone

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14
Q

sensor for vasopressin

A

baroreceptors in the carotid sinus

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15
Q

effect of vasopressin and why

A

binds to V1aR to help limit blood loss by vasocontrisciton

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16
Q

at high concentration urine is ADH high or low

A

high

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17
Q

hyponatremia is definec by

A

a fall in Posm <280

18
Q

hyponatremia can occur from

A

insufficient water loss either from ADH disorder or excessive water intake

19
Q

tea and toast diet

A

low dietary solute intake with water intake

20
Q

SIADH

A

normal volume status (euvolemia) but apropiadamente ADH presence

21
Q

manifestations of chronic or actue hyponatremia:

seizure, coma, respiratory distress, cerebral herniation

A

acute

22
Q

V2 antagonist

A

blocks tubule effect of ADH

23
Q

treatment of chronic hyponatremia

A

correct underlying cause and restore balance by decreasing water and increasing solute

24
Q

in settings of normal volume status, concentrated urine is inappropriate and identifies a diluting defect

A

SIADH

25
Q

hypersomolality can be due to

A
  1. diabetes insipidus
  2. loop diuretics
  3. sodium/solute gain
26
Q

hypernatremia usually does not occur due to

A

thrist activation

27
Q

disbetes insipidus in the absence of ADH

A

central

28
Q

diabetes insipidus in the setting of resistance of ADH

A

nephrogenic

29
Q

no or poor response to ADH

A

nephrogenic

30
Q

what doe lithium might cause

A

nephrogenic diabetes insipidus

31
Q

hyperosmolality will often be hypovolemic/euvolemic/hypervolemic

A

euvolemic

32
Q

which diuretic might block Li+ effect

A

amiloride

33
Q

managment of DI

A
  1. access to water
  2. ADH if central
  3. limit distal solute delivery
34
Q

Plasma osmolality can often be estimated

A

by doubling the serum Na concentration

incorrect when non-electrolyte osmoles are present in high concentration

35
Q

ADH is release from the posterior pituitary under circumstances of (2)

A

1) hyperosmolality sensed by the osmoreceptors of the hypothalamus,
2) significant ineffective circulating volume sensed by the carotid and aortic bodies.

36
Q

The kidney handles water by (5)

A

1) filtration,
2) bulk reabsorption in the PCT,
3) creation of a hypertonic medulla by the counter-current multiplier in the LOH,
4) creation of a dilute filtrate in the DCT, and
5) variable permeability of the CT according to the presence or absence of ADH.

37
Q

The serum Na concentration should be raised by no more than 0.5 mEq/L/hr to prevent

A

central pontine myelinolysis

38
Q

Treatment of hypoosmolality requires inducing a negative water balance with ______ water intake and ________ water excretion.

Increased water excretion can be achieved by suppressing _____(if possible), blocking ______ (with drugs called Vaptans), or providing extra ______ to facilitate additional water excretion (at the same urine osmolality).

A

Treatment of hypoosmolality requires inducing a negative water balance with decreased water intake and increased water excretion.

Increased water excretion can be achieved by suppressing ADH (if possible), blocking ADH receptors (with drugs called Vaptans), or providing extra osms to facilitate additional water excretion (at the same urine osmolality).

39
Q

The serum Na concentration should be lowered by no more than ____ mEq/L/hr to prevent brain swelling and herniation

A

0.5

40
Q

Treatment of hyperosmolality requires ______

A

water administration.

renal (21 decks)

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