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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
max amount of urine that can be produced a day
12L
26
minimum conc. of urine
50
27
max conc. of urine
1200
28
what happens if you drink more than 12L of water in a day
water intoxication (hyponatremia)
29
2 main causes of decreased excretion of water
renal failure ADH release
30
1. deliver water to diluting segments 2. functional diluting segments 3. CD impermeable to water (lack of ADH)
3 steps to generating dilute urine
31
one cause of failure to generate dilute urine
renal failure (lack of water delivery to diluting segments)
32
failure of solute reabsorption and secretion from TAL and DCT causes what
failure to generate dilute urine
33
permeable collecting ducts (due to ADH presence) causes what
failure to generate dilute urine
34
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)
SIADH
35
what is the main cause of SIADH
SSRIs (depression meds)
36
another reason (paraneoplastic) that causes SIADH
small cell lung carcinoma (any lung disease)
37
dialysis patients have a fixed urine _____
osmolality
38
these patients have very dilute urine (polyuria)
Diabetes Insipidus
39
excess ADH due to SIADH, CHF, volume depletion causes what kind of urine
very concentrated
40
Osmolality doesn’t cause problems, rather ________causes changes in cell volume which cause clinical syndromes
tonicity
41
________is the dominant osmotically active solute of serum to the point that others can be ignored
Na+
42
Urine has a significant potassium content so in urine ______ and _____ are equal partners in determining urinary tonicity
Na+ and K+
43
If kidneys are functioning normally, what would you expect to happen with a person with hyponatremia?
expect kidneys to secrete more water (check urine Na+ and K+ and osmolality)
44
happens less than 48 hrs neurologic sx's due to brain edema rapid correction tolerated
acute hyponatremia
45
happens more than 48 hours mild brain edema does not respond well to rapid correction
chronic hyponatremia
46
what can happen if you try to correct hyponatremia too rapidly in patient with chronic hyponatremia
osmotic demyelination syndrome
47
what to do in patient with symptomatic hyponatremia
give hypertonic saline immediately
48
what to do in patient that has asymptomatic hyponatremia
no rush salt tablets (lasix) -vaptans
49
_____ hyponatremia can cause death from cerebral edema and brain herniation
acute
50
symptomatic but less impaired= _____ hyponatremia
chronic
51
symptomatic and really impaired (life threatening)= ______ hyponatremia
acute
52
target correction for chronic hyponatremic patient
6-8 mEq/24 hrs
53
what can alcoholism cause
ODS (osmotic demyelination syndrome)
54
limit of correction of chronic hyponatremia
dont exceed 8mEq/24 hrs
55
what to do for asymptomatic hyponatremia
no rush fluid restrict
56
treatment for asymptomatic hyponatremia
-vaptans and urea
57
mechanism of urea for treating asymptomatic hyponatremia
osmotic diuresis
58
urine Na+ and K+/ plasma Na+ ratio <1 means
kidneys doing their job of getting rid of water
59
urine Na+ and K+/ plasma Na+ ratio>1 means
fluid restriction + urea will help patient
60
either caused by renal or nonrenal loss of water or by concentrated salt intake. Water loss is overwhelmingly the more common cause
hypernatremia
61
Small increases in plasma ______stimulates both ADH release and thirst
tonicity
62
Kidneys able to balance our water system by _____ or ______ our urine
diluting or concentrating
63
hypernatremia and urine dilute
diabetes insipidus
64
lack of ADH production
central DI
65
impaired response by CD to ADH
nephrogenic DI
66
treatment for hypernatremia if patient is awake
give water
67
goal of correction for chronic hypernatremia
8-10 mEq/24 hrs
68
how to correct hypernatremia in patient who isnt awake
fluid bolus (D5W)

URN Biweekly 2 (15 decks)

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