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URN Biweekly 2 > Disorders of water balance- Al Jaber > Flashcards

Disorders of water balance- Al Jaber Flashcards

1
Q

too much water

A

hyponatremia

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2
Q

water loss

A

dehydration (hypernatremia)

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3
Q

a deficiency of ECF volume (saline)

A

volume depletion

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4
Q

passes freely between compartments in response to changes in solute concentrations

A

water

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5
Q

equal in all compartments

A

osmolality

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6
Q

total concentration of all particles in solution

A

osmolality

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7
Q

concentration of only the osmotically active particles

A

tonicity

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8
Q

formula for plasma osmolality

A

2[Na] + [Gluc]/18 + [BUN]/2.8

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9
Q

total body weight=

A

0.6 x weight (kg)

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10
Q

effectors of volume regulation

A

RAAS
SNS
ANP

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11
Q

effectors of osmoregulation

A

ADH and thirst

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12
Q

1 stimulus for ADH

A

high osmolality

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13
Q

2 stimulus for ADH

A

hypovolemia

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14
Q

plasma osmolality where ADH is released

A

280-285

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15
Q

movement of water into and out of cells is governed by _____

A

tonicity (Na+)

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16
Q

changes in cell size ______ tissue function

A

disrupt

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17
Q

ex. of cell size disrupting tissue function

A

brain edema

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18
Q

Na+ concentration < 135 mEq/L due to too much water

A

hyponatremia

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19
Q

Na+ conc. is low but osmolality is high or normal

A

pseudohyponatremia

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20
Q

both the sodium and osmolality are low

A

true hyponatremia

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21
Q

what to check for status of ADH in patient

A

urine Na+ and osmolality

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22
Q

Increased protein or lipids can cause a lab error causing a falsely lowered sodium

A

pseudohyponatremia (normal osmolality)

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23
Q

water intake > water excretion

A

true hyponatremia

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24
Q

psychogenic polydipsia causes what

A

hyponatremia

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25
Q

max amount of urine that can be produced a day

A

12L

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26
Q

minimum conc. of urine

A

50

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27
Q

max conc. of urine

A

1200

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28
Q

what happens if you drink more than 12L of water in a day

A

water intoxication (hyponatremia)

29
Q

2 main causes of decreased excretion of water

A

renal failure
ADH release

30
Q
  1. deliver water to diluting segments
  2. functional diluting segments
  3. CD impermeable to water (lack of ADH)
A

3 steps to generating dilute urine

31
Q

one cause of failure to generate dilute urine

A

renal failure (lack of water delivery to diluting segments)

32
Q

failure of solute reabsorption and secretion from TAL and DCT causes what

A

failure to generate dilute urine

33
Q

permeable collecting ducts (due to ADH presence) causes what

A

failure to generate dilute urine

34
Q

patient is not volume depleted yet has high urine osmolality and urine sodium meaning water is being reabsorbed (pt has normal kidney, adrenal, thyroid fx)

A

SIADH

35
Q

what is the main cause of SIADH

A

SSRIs (depression meds)

36
Q

another reason (paraneoplastic) that causes SIADH

A

small cell lung carcinoma (any lung disease)

37
Q

dialysis patients have a fixed urine _____

A

osmolality

38
Q

these patients have very dilute urine (polyuria)

A

Diabetes Insipidus

39
Q

excess ADH due to SIADH, CHF, volume depletion causes what kind of urine

A

very concentrated

40
Q

Osmolality doesn’t cause problems, rather ________causes changes in cell volume which cause clinical syndromes

A

tonicity

41
Q

________is the dominant osmotically active solute of serum to the point that others can be ignored

A

Na+

42
Q

Urine has a significant potassium content so in urine ______ and _____ are equal partners in determining urinary tonicity

A

Na+ and K+

43
Q

If kidneys are functioning normally, what would you expect to happen with a person with hyponatremia?

A

expect kidneys to secrete more water (check urine Na+ and K+ and osmolality)

44
Q

happens less than 48 hrs
neurologic sx’s due to brain edema
rapid correction tolerated

A

acute hyponatremia

45
Q

happens more than 48 hours
mild brain edema
does not respond well to rapid correction

A

chronic hyponatremia

46
Q

what can happen if you try to correct hyponatremia too rapidly in patient with chronic hyponatremia

A

osmotic demyelination syndrome

47
Q

what to do in patient with symptomatic hyponatremia

A

give hypertonic saline immediately

48
Q

what to do in patient that has asymptomatic hyponatremia

A

no rush
salt tablets (lasix)
-vaptans

49
Q

_____ hyponatremia can cause death from cerebral edema and brain herniation

A

acute

50
Q

symptomatic but less impaired= _____ hyponatremia

A

chronic

51
Q

symptomatic and really impaired (life threatening)= ______ hyponatremia

A

acute

52
Q

target correction for chronic hyponatremic patient

A

6-8 mEq/24 hrs

53
Q

what can alcoholism cause

A

ODS (osmotic demyelination syndrome)

54
Q

limit of correction of chronic hyponatremia

A

dont exceed 8mEq/24 hrs

55
Q

what to do for asymptomatic hyponatremia

A

no rush
fluid restrict

56
Q

treatment for asymptomatic hyponatremia

A

-vaptans and urea

57
Q

mechanism of urea for treating asymptomatic hyponatremia

A

osmotic diuresis

58
Q

urine Na+ and K+/ plasma Na+ ratio <1 means

A

kidneys doing their job of getting rid of water

59
Q

urine Na+ and K+/ plasma Na+ ratio>1 means

A

fluid restriction + urea will help patient

60
Q

either caused by renal or nonrenal loss of water or by concentrated salt intake. Water loss is overwhelmingly the more common cause

A

hypernatremia

61
Q

Small increases in plasma ______stimulates both ADH release and thirst

A

tonicity

62
Q

Kidneys able to balance our water system
by _____ or ______ our urine

A

diluting or concentrating

63
Q

hypernatremia and urine dilute

A

diabetes insipidus

64
Q

lack of ADH production

A

central DI

65
Q

impaired response by CD to ADH

A

nephrogenic DI

66
Q

treatment for hypernatremia if patient is awake

A

give water

67
Q

goal of correction for chronic hypernatremia

A

8-10 mEq/24 hrs

68
Q

how to correct hypernatremia in patient who isnt awake

A

fluid bolus (D5W)

URN Biweekly 2 (15 decks)

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