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Nephrology > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

How can diabetes result in hyperkalemia?

A

Decrease in insulin, hyperosmolar state, water leaves cell resulting in increase in intracellular [K+], K+ leaves cell

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2
Q

What is the familial hyperaldosteronism genetic mutation?

A

KCNJ5

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3
Q

What is the name of the disease in which aldosterone is expressed in the zona fasiculata?

A

Glucocorticoid remediable aldosteronism

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4
Q

Condition causing hypertension with hyperkalemia?

A

Gordon’s Syndrome (activation in WNK1/ deactivation in WNK4 stimulating NCC)

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5
Q

Underlying mechanism of Liddle Syndrome?

A

Hyperfunctioning ENaC

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6
Q

Underlying mechanism of Bartter Syndrome?

A

Malfunctioning NKCC2

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7
Q

Underlying mechanism of Gittleman Syndrome?

A

Malfunctioning NCC

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8
Q

How do you diagnose primary hyperaldosteronism using ARR?

A

ARR > 20

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9
Q

Name 3 drugs that increase ARR?

A

1) Beta blockers
2) Clonidine
3) NSAIDs

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10
Q

Name 4 drugs that decrease ARR?

A

1) ACEi
2) ARB
3) Amlodipine/Nifedipine
4) Potassium sparring diuretics

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11
Q

What sum of urine Na+ and urine K+ indicates that ADH is turned off?

A

< 50

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12
Q

A stroke involving what vessel can result in impaired thirst?

A

Right anterior communicating artery

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13
Q

What is a lab that can be checked to see if vasopressin is being synthesized?

A

Copeptin

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14
Q

What is the pathophysiology and treatment for gestational diabetes insipidus?

A

Placental synthesis of vasopressinase
Tx = desmopressin

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15
Q

How can a water deprivation test be used to differentiate between diabetes insipidus and polydipsia?

A

@ serum osmolarity of 295
- Urine osmolarity > 500 = polydipsia
- Urine osmolarity < 300 = diabetes insipidus

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16
Q

What are some causes of central diabetes insipidus?

A

Stroke
Trauma
Autoimmune (SLE)

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17
Q

What are some causes of nephrogenic diabetes insipidus?

A

Hypercalcemia (V2 receptor issues)
Hypokalemia (collecting duct cysts)
Lithium

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18
Q

What drug used to treat CMV can result in hypocalcemia?

A

Foscarnet

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19
Q

What type of imaging contrast can result in pseudohypocalcemia?

A

Gadolinium

20
Q

How does obstruction impact ENaC?

A

Decreased expression

21
Q

How do loop diuretics cause hypomagnesemia?

A

By blocking NKCC, the secretion of K+ back into lumen is impaired resulting in less paracellular Mg2+ reabsorption

22
Q

How does hypomagnesemia lead to hypokalemia?

A

Hypomagnesemia results in ROMK to be persistently open in collecting duct

23
Q

How do you calculate Free Water Clearance?

A

= V * [1 - (UNa+UK/SNa)]

24
Q

How do you calculate Free Water Deficit?

A

= 0.6 * W * [(SNa/140) - 1]

25
Q

How do you correct sodium for hyperglycemia?

A

For every 100 mg/dl above 100 mg/dl, add 1.6 to SNa

26
Q

Which drug used for induction treatment of ANCA associated vasculitis can result in hyponatremia?

A

Cyclophosphamide

27
Q

What is the treatment for nephrogenic diabetes insipidus due to Li2+ if patient is still on Li2+ and, in contrast, if the patient is off of Li2+?

A

On Li2+: use amiloride
Off Li2+: use thiazide

28
Q

What is the next best test following diagnosis of hypokalemic periodic paralysis?

A

TSH

29
Q

How do the urine chloride levels differ with diarrhea and emesis?

A

Diarrhea = high urine chloride
Vomiting = low urine chloride

30
Q

What chemotherapy agents can cause hypomagnesemia?

A

Cisplatin
Cetuximab

31
Q

Barium exposure can result in what electrolyte disorder?

A

Hypokalemia

32
Q

Pathophysiology of autosomal dominant hypocalcemia?

A

Activating mutation in CaSR

33
Q

How do you calculate total Na+ intake using 24 hour urine Na+?

A

23 * 24 hour urine Na+

34
Q

Toluene is associated with what electrolyte disorder?

A

Hypokalemia

35
Q

Bartter and Gitleman can be differentiated by what urine test finding?

A

High urine Ca2+ in Bartter

36
Q

What ratio of urine K to urine Cr can be used to assess for renal potassium conservation?

A

Urine K:Urine Cr < 15 mEq/g
(K+ < 25 mEq/L if 24 hour sample)

37
Q

What is the formula to estimate total free water need in a patient with hypernatremia?

A

FWC + FWD + 0.8 liters

38
Q

What lab will be elevated with hypercalcemia of immobilization?

A

N telopeptide

39
Q

Piperacillin use is associated with what electrolyte abnormality?

A

Hypokalemia

40
Q

Patiromer is associated with what electrolyte abnormality?

A

Hypomagnesemia

41
Q

Sodium retention and edema is associated with which potassium binder?

A

Sodium zirconium

42
Q

Octreotide is associated with what electrolyte abnormality?

A

Hyperkalemia (inhibits insulin release)

43
Q

What is the approximate urine Na+ (mEq/d) to estimate 2 grams of daily intake?

A

88 mEq/d

44
Q

A defect in _____________ is seen with Familial Hypocalcemia Hypercalciuria NephroCalcinosis?

A

Claudin-16

45
Q

How can a water load be used to evaluate for reset osmostat vs SIADH?

A

Majority excreted within 4 hours is consistent with reset osmostat (minimal excretion with SIADH)

46
Q

Contrast aldosterone breakthrough, aldosterone escape, and aldosterone paradox?

A

Aldosterone breakthrough: increase in aldosterone levels following period of time after ACEi/ARB initiation

Aldosterone escape: Na+ absorption without associated edema in primary hyperaldosteronism due to pressure naturiesis

Aldosterone paradox: no hypokalemia with hyperaldosteronism states due to WNK4 ROMK inhibition

47
Q

Leptospirosis is associated with what electrolyte abnormality?

A

Hypokalemia

Nephrology (10 decks)

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