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Pharmacology > Electrolyte Imbalances (Exam 2) > Flashcards

Electrolyte Imbalances (Exam 2) Flashcards

1
Q

Primary Functions of Kidneys (7)

A

regulating blood volume and blood pressure
regulating extracellular fluid, osmolarity, electrolyte concentrations and acid base balance
stabilizing pH of the blood
conserving nutrients
maintain body temperature
detoxify poisons
transport of wastes

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2
Q

like the liver, the kidneys can

A

detoxify poisons

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3
Q

other functions of kidneys (4)

A

removes wastes
secretes renin
produce erythropoietin for RBC production
converts vitamin d to active form

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4
Q

acidosis

A

arterial blood pH less than 7.35
respiratory or metabolic

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5
Q

alkalosis

A

arterial blood pH greater than 7.45
respiratory or metabolic

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6
Q

how is carbonic acid regulated?

A

lungs excrete CO2

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7
Q

how is bicarbonate regulated?

A

kidneys make or waste bicarbonate

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8
Q

normal range of albumin

A

3.4-5.4 g/dL

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9
Q

normal range of serum globulin

A

2.0-3.5g/dL

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10
Q

normal range of BUN

A

10-20mg/dL

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11
Q

normal range of BUN to creatinine ratio

A

5-18mg/dL

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12
Q

normal range of Calcium

A

8.5-10.5 mg/dL

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13
Q

normal range of phosphorus

A

1-1.5 mEq/L

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14
Q

normal range of sodium

A

135-147mEq/L

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15
Q

normal range of potassium

A

3.5 - 5 mmol/L

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16
Q

normal range of chloride

A

96 - 106 mEq/L

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17
Q

normal range of Creatinine

A

men - 0.9 to 1.5 mg/dL
women - 0.6 - 1.1 mg/dL

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18
Q

normal range of estimated GFR

A

90 - 120 mL/minute

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19
Q

normal range of glucose

A

<140 mg/dL

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20
Q

what is glucose levels for a diabetic?

A

over 200 mg/dL

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21
Q

normal range for carbon dioxide

A

less than 2.3%

smokers: 2.1% to 4.2%

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22
Q

renal blood flow

A

blood flowing through kidney/minute

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23
Q

renal plasma flow

A

plasma flowing through kidneys per minute

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24
Q

filtration fraction

A

% of plasma removed as filtrate by the Bowman’s capsule

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25
Q

Glomerular filtration rate

A

amount of filtrate formed by kidneys per minute times plasma flowing through Bowman’s capsule

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26
Q

what does GFR require in order to be measured?

A

inulin - a polysaccharide substance that is not secreted or reabsorbed at all

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27
Q

how is GFR measured?

A

inulin is injected
measure the rate of urine output, the concentration of inulin in the urine and in the blood

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28
Q

GFR is most often estimated from

A

creatinine excretion

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29
Q

creatinine renal clearance (range)

A

140 ml/min

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30
Q

creatinine clearance test

A

compares the creatinine level in a 24 hour urine sample with the creatinine level in the blood

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31
Q

what is one of the most important causes of slow by progressive kidney injury

A

electrolyte imbalances

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32
Q

glomerulus

A

extremely high water permeability
no transporters

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33
Q

proximal convoluted tubule

A

very high water permeability
Na/H, carbonic anhydrase (transporter and drug target)

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34
Q

proximal tubule, straight segments

A

very high water permeability
Acid (uric acid) and base transporters

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35
Q

thin descending limb of Henle’s loop

A

high water permeability
aquaporins

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36
Q

thick descending limb of Henle’s loop

A

very low water permeability

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37
Q

distal convoluted tubule

A

very low water permeability
Na/Cl (NCC)

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38
Q

cortical collecting tubule

A

variable water permeability
Na+ channels, K channels, H+ transporter, aquaporins

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39
Q

medullary collecting duct

A

variable water permeability
aquaporins

40
Q

body’s fluid distribution

A

2/3 - intracellular
1/3 - extracellular

41
Q

electrolyte disorders can result from

A

AKI, chronic renal failure, or from drugs used to modify renal function

42
Q

major electrolyte imbalances are all caused by

A

endocrine, vascular, GI tract and kidneys

43
Q

hypokalemia

A

K+ < 3.5 mmol/L

44
Q

hypokalemia drug and non drug causes

A

drug - loop and thiazide diuretics, corticosteroid
non drug - diarrhea/vomiting

45
Q

hypokalemia treatment

A

under 3.0 mmol/L
IV or oral K+ supplementation

46
Q

hyperkalemia

A

K+ > 5.0 mmol/L

47
Q

hyperkalemia causes

A

kidney does not excrete K+

48
Q

hyperkalemia treatment

A

loop diuretic
IV or oral sodium polystyrene sulfonate

49
Q

imbalance in potassium can also affect

A

the heart

50
Q

Acidemia can cause

A

inhibition of reabsorption of K+ which reduces K+ excretion in the urine –> hyperkalemia

51
Q

insulin stimulates

A

the reuptake of K+ resulting in hypokalemia

52
Q

hyponatremia

A

Na+ < 135 mEq/L
commonest electrolyte abnormality

53
Q

most common cause of hyponatremia

A

hypotonic plasma - excess of extracellular water (usually from secretion of vasopressin)

54
Q

treatment of hyponatremia

A

slow IV 3% saline
Bolus 150-150ml
diuretic induced - demeclocycline
AVP receptor antagonist - conivaptan

55
Q

hypernatremia

A

Na > 145 mEq/L
can be hypervolemic or euvolemic
common with fluid losses

56
Q

common non drug causes of hypernatremia

A

most common - water deprivation
2nd common - hyperglycemic osmotic diuresis in diabetic patients

57
Q

most common drug induced cause of hypernatremia

A

corticosteroids (inhibit ADH release)

58
Q

treatment of hypernatremia

A

IV 5% dextrose / half normal saline depending on patient condition
loop diuretic and 5% dextrose

59
Q

hypernatremia accompanied with high plasma osmolarity in the brain leads to

A

seizure, coma and death

60
Q

fractional excretion of sodium (FENa)

A

% of Na filtered by the kidney which is excreted in the urine
measure of renal clearance in the context of low urine output

61
Q

low fractional excretion indicates

A

sodium retention by kidney

62
Q

high fractional excretion indicates

A

sodium wasting due to acute tubular necrosis

63
Q

FENa =

A

(urine Na x serum Cr) divided by (serum Na x urine Cr)

64
Q

hypocalcemia

A

Ca < 8.5 mg/dL
uncommon overall

65
Q

hypocalcemia is most commonly observed in

A

elderly, malnourished patients, those with sepsis or alkalosis

66
Q

symptoms of hypocalcemia

A

musculo-skeletal cramping
tetany

67
Q

hypercalcemia

A

Ca > 10.5 mg/dL
less common than sodium imbalances

68
Q

hypercalcemia is most commonly observed with

A

malignancies, myeloma, benign tumors of the parathyroid gland, chronic granulomatous disease, etc.

69
Q

primary hyperPTH

A

over secretion of PTH due to adenoma, hyperplasia or carcinoma of PT glands
high PTH, serum calcium, LOW phosphates

70
Q

secondary HyperPTH

A

production of PTH due to hypocalcemia
occurs in Vit D deficiency, chronic renal failure
HIGH phosphates

71
Q

tertiary hyperPTH

A

long term secondary hyperPTH which leads to hyperplasia of PT glands
loss of response to serum calcium levels
seen in CKD
High PTH and serum calcium

72
Q

hypocalcemia meds

A

calcium citrate
calcium carbonate

73
Q

hypercalcemia meds

A

calcitonin (miacalcin)
calcimimetics
bisphosphonates
denosumab (prolia, Xgeva)
prednisone

74
Q

calcimimetics

A

control overreactive PT glands
cinacalcet (Sensipar)

75
Q

risks of bisphosphonates

A

osteonecrosis of the jaw
certain types of jaw fractures

76
Q

calcitonin

A

salmon derived hormone
helps calcium levels in the blood

77
Q

bisphosphonates

A

IV osteoporosis drugs
quickly lower calcium levels
treat hypercalcemia due to cancer

78
Q

denosumab

A

treat people with cancer-caused hypercalcemia
or those who don’t respond well to bisphosphonates

79
Q

in high level of vitamin D,

A

short term use of prednisone is usually helpful

80
Q

magnesium is related to

A

calcium metabolism

81
Q

hypomagnesemia may cause

A

nausea, vomiting, sleepiness, weakness, personality changes, muscle spasms, tremors and loss of apetite

82
Q

severe hypomagnesemia

A

can cause seizures especially in children

83
Q

hypermagnesemia

A

uncommon
develops only when people with kidney failure are given Mg salts or take drugs that contain Mg

84
Q

Hypermagnesemia can cause

A

muscle weakness
low blood pressure
impaired breathing
severe - heart stops beating

85
Q

treatment for hypermagnesemia

A

calcium gluconate
diuretics

86
Q

Magnesium is necessary for the

A

formation of bone and teeth
normal nerve and muscle function

87
Q

Hypophosphatemia

A

PO4 < 1.0 mg/dL

88
Q

Hypophosphatemia is most commonly observed with

A

chronic alcoholism, chronic ingestion of Mg/Al antacids and IV hyperalimentation without adequate phsophate

89
Q

symptoms of hypophosphatemia

A

myalgia
weakness
decreased myocardial contractility
neurologic confusion

90
Q

symptoms of hypophosphatemia relate to

A

low ATP stores and tissue hypoxia

91
Q

treatment for hypophosphatemia

A

IV phosphate in saline
oral potassium
sodium phosphate - mild cases
ergocalciferol, Vit D

92
Q

Hyperphosphatemia

A

PO4 > 4.5 mg/dL

93
Q

hyperphosphatemia is most commonly observed in

A

renal failure patients

94
Q

treatment of hyperphosphatemia

A

calcium salt infusion
oral phosphate binding calcium carbonate/acetate

95
Q

primary adverse effect of hyperphosphatemia is

A

constipation

96
Q

hypophosphatemia is associated with

A

high PTH, high serum calcium and LOW phosphates

97
Q

in hyperphophartemia, low GFR leads to inadequate phosphate excretion, causing

A

plasma phosphorus complexing with CA2+ and precipitating in soft tissues (joints, BV, heart and kidneys)

Pharmacology (16 decks)

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