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Clinical Chemistry 1 > Electrolytes and Water Balance > Flashcards

Electrolytes and Water Balance Flashcards

1
Q

What has chemo receptors that stimulate the adrenals? 

A

The hypothalamus

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2
Q

What are two cation electrolytes

A

Sodium (Na+)
Potassium (K+)

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3
Q

What are two anion electrolytes?

A

Chloride (Cl-)
Bicarbonate (HCO3-)

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4
Q

….

A

Anion gap

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5
Q

How does the body achieve neutrality? 

A

Balance between cations and anions 

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6
Q

Water always follows _________.

A

Sodium***

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7
Q

What does GFR stand for?

A

Glomerulus filtration rate

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8
Q

What is the functional unit of the kidney? 

A

Nephron***

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9
Q

Where does filtration happen in the nephron? 

A

Glomerulus

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10
Q

Where in the nephron is 80% of filtrate reabsorbed?

A

Proximal tubule

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11
Q

What part of the nephron runs from cortex to medulla of the kidney?

A

Loop of Henle

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12
Q

Which part of the loop of Henley is permeable to electrolytes and which part is permeable to water? 

A

Ascending- Electrolytes
Descending-Water

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13
Q

What controls aquaporin (water channels)?

A

ADH (vasopressin)

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14
Q

The nephron is impermeable to large molecules and cells that are greater than _________ in size.  anything equal to or less than this number can be filtered.

A

66 kilodaltons

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15
Q

What charge do proteins have? 

A

Negative charge

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16
Q

 what three things can we use to calculate osmolarity?

A

Na+
Glucose
Urea

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17
Q

In the renal cortex, the proximal tubule ____________ about 75 to 80% of filtrate volume.

A

Reabsorbs

(Water, HCO3-, Na+) 

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18
Q

 how much glucose does the proximal tubule reabsorb? 

A

All glucose up to threshold

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19
Q

What does the proximal tubule reabsorb?

A

-glucose
-Almost all amino acids, vitamins, proteins
-Varying amounts of urea, uric acid
-Varying amounts of ions (Mg+, Ca2+, P, K+) 

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20
Q

There is ______ Secretion at the proximal tubule. 

A

Some (Proximal tubule mostly reabsorbs)

H+, K+, NH3, and drugs

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21
Q

What is normal glucose levels?

A

80-120?

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22
Q

What does (mod SM) mean?

A

It means that it can contract and relax so blood flow can be regulated

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23
Q

?*** The Capillary tuft surrounded by Bowmans capsules (Extended end of Renal tubule) Is made of what two cells?

A

-endothelial cells
-mesangial cells (mod SM)

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24
Q

Water follows sodium all the way through tubular fluid to the _______

A

Blood

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25
Q

What moves sodium out and potassium in?

A

Sodium/potassium ATPase* 

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26
Q

Both sodium (+) and __________ Move into the cell together. 

A

Chloride (-)

Both monovalent

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27
Q

Bicarbonate can be _____________ and reabsorbed. 

A

Recycled

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28
Q

What does the adrenal cortex make?

A

Aldosterone (Steroid hormone)

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29
Q

What is the most abundant NPN?

A

Urea***

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30
Q

What are some NPN products?

A

-urea (Most abundant!)
-Creatine
-Uric acid
-and others 

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31
Q

What is the source of urea?

A

Ammonia NH3 (Processed by the liver) 

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32
Q

Urea cycle happens only in the ________.

A

Liver

(Ammonia —> urea —> Excreted) 

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33
Q

Urea can _________ pass through the glomerulus. 

A

Easily

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34
Q

Creatine is proportional to ____________. 

A

Muscle mass

(Be careful about data interpretation of this*)

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35
Q

Urea cannot be used for a GFR because? 

A

It is reabsorbed

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36
Q

What three characteristics are needed before a value can be used for GFR?

A

-stable
-Filter through
-No reabsorption

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37
Q

Increased uric acid can sometimes, but not always, be a clue for what?

A

Cancer

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38
Q

What does GFR stand for?

A

Glomerulus filtration rate

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39
Q

Where does filtration happen?

A

Glomerulus 

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40
Q

What controls aquapourin, water channels?

A

ADH (vasopressin) 

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41
Q

What part of the loop of Henlee will the osmolarity be back to normal?

A

The top of the ascending loop of Henlee

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42
Q

Where is urine the most concentrated?

A

The bottom of the distal loop of Henlee 

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43
Q

What connects proximal and distal tubules? 

A

Loop of Henle 

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44
Q

This completes small adjustments to achieve electrolyte and acid base homeostasis

A

DCT

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45
Q

DCT is under control of ____________.

A

Aldosterone and ADH

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46
Q

This stimulates sodium reabsorption and potassium secretion that will increase BP

A

Aldosterone

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47
Q

Aldosterone is regulated primarily by what mechanism?

A

Renin-angiotensinogen mechanism
-and by ACTH

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48
Q

What does the sympathetic nervous system stimulate?

A

Kidney’s juxtaglomerular cells to release renin 

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49
Q

What produces renin?

A

Kidney’s juxtaglomerular cells

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50
Q

What does renin activate? And where?

A

Angiotensinogen in liver 

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51
Q

What does angiotensinogen create?

A

Angiotensinogen I 

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52
Q

What converts angiotensin one to angiotensin two? 

A

ACE (Angiotensin converting enzyme)

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53
Q

Where is ACE found?

A

The surface of the lung and kidney endothelium

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54
Q

What does angiotensin 2 do?

A

Constricts smooth muscles of vessels and increases blood volume (by sodium and water reabsorption) 

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55
Q

What effect does angiotensin II have on the kidneys?

A

Helps the body keep sodium and water 

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56
Q

What effect does angiotensin II have on the adrenal cortex?

A

Stimulates the adrenal cortex to make aldosterone —-> Keep sodium and water and decreases potassium

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57
Q

What effect does angiotensin II have on the posterior pituitary gland?

A

Causes it to release ADH (Vasopressin) That helps the body retain water

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58
Q

What is the goal of the RAAS (Renin – angiotensin – aldosterone – system)?

A

To manage blood pressure especially when it drops. This is done by angiotensin II 

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59
Q

What are the two main overall effects of angiotensin II?

A

Increase blood volume and blood pressure

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60
Q

What does renin act on?

A

Angiotensinogen (produced by liver)

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61
Q

What will increase with decreased renal perfusion pressure and sodium levels?

A

Renin

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62
Q

Which ion is intracellular and which one is extracellular?

A

Extracellular- sodium
Intracellular-potassium 

(3 sodium out and 2 potassium in, More water out) 

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63
Q

What moves sodium out and potassium in? (One cation in and one cation out)

A

ATPase***

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64
Q

What moves into the cell WITH sodium?

A

Chloride Cl-

(Sodium is the driving force) 

65
Q

-filters blood to form filtrate
-Consist of capillary tough surrounding Bowmans capsule (Extended end of renal tubule?)
-Supplied by and afferent arterial and efferent arteriole

A

Glomerulus 

66
Q

What cells is the capillary tuff composed of?

A

*endothelial cells
*Mesangial cells (Modify smooth muscle, Can contract and relax so blood flow can be regulated)

67
Q

What is the important function of Mesangial cells?

A

•They can modify smooth muscle by relaxing or contracting so blood flow can be regulated***

• phagocytic function- Take up molecules that block the space between the filter cells so filtration can continue*

68
Q

What is the glomerulus impermeable to? 

A

Molecules and cells greater than 66 kg Dalton 

69
Q

What is the threshold glucose level?

A

180 (units?)

70
Q

-reabsorbs most (75 to 80%) of Filtrate volume; Water, HCO3, sodium) 
-All glucose up to threshold
-Almost all amino acids, vitamins, proteins
-Varying amounts of urea, uric acid
-Varying amounts of ions (Mg2+, Ca2+,P, K+)
-Some secretion at this location (Secretes H+, K+, NH3, and drugs

A

Proximal convoluted tubule (In renal cortex)

71
Q

The GFR can tell you the renal __________.

A

Function

72
Q

Albumin is _____ Kilodaltons and has a ______ charge. 

A

66, negative (things can attach to it like Na+) 

73
Q

Filtration rate is _____ml/min

A

130

74
Q

Hypothalamus hormones are stored in the…

A

Posterior pituitary gland

75
Q

Where is ATH made? And where is it Stored and released from?

A

Hypothalamus

Posterior pituitary gland

76
Q

What does the anterior pituitary do?

A

Make hormones 

77
Q

What are the Surveillance functions of the hypothalamus?

A

- detect O2 levels
- Detect osmolarity

78
Q

The loop of Henley facilitates reabsorption of _____, ______, ______. 

A

H2O, Na, Cl 

79
Q

The descending limb of the loop of Henle is highly permeable to ______ And passively enters the medulla. 

A

Water

80
Q

Urine is highly concentrated at what part of the loop of Henle? 

A

In the bottom of the loop

81
Q

The ascending limb of the loop of Henley is relatively _________ To water, but actively reabsorbs…..

A

Impermeable 

Na+ and Cl- diluting the urine in the tubular lumen

82
Q

-completes small adjustments to achieve electrolyte and acid-base homeostasis
-Under the control of aldosterone and ADH

A

Distal convoluted tubule

83
Q

The distal convoluted tubule is under the control of…

A

Aldosterone and ADH 

84
Q

What gets increased when there is a decrease renal perfusion pressure and sodium levels 

A

Renin (acts on angiotensinogen in liver) 

85
Q

What can make the renin aldosterone system go up?

A

Decrease filtration and decrease sodium filtration

86
Q

The renin angiotensin mechanism is connected to what systems? 

A

Para and sympathetic Nervous systems

87
Q

-Final site for concentration or dilution of urine
-ADH controls water permeability
-ADH increases tubular permeability to water, increasing water reabsorption

A

Collecting duct (Collecting tubule) 

88
Q

ADH (vasopressin) controls water permeability of the collecting tubule by expression of….

A

Aquaporin channels

89
Q

What are the functions of the renal system? 

A

• homeostasis of body water
• Regulation of fluid and electrolyte balance
• Regulation of acid-base balance
• excretion of waste products of protein metabolism

90
Q

The renal system excretes surplus of unwanted substances like…

A

-water
-Electrolytes
-Excessive glucose
-Drugs
-Some proteins

91
Q

The kidney is an ___________ gland.

A

Endocrine

92
Q

What is the threshold value of glucose?

A

180 mg/dL

93
Q

What is the primary metabolic organ? The second?

A

Liver, kidneys 

94
Q

Why can both the liver and the kidneys do glucogenesis?

A

They both have glucose-5-Phosphate

95
Q

Phosphorylation, attaches protein to phosphate (ATP) 

A

Kinase???

96
Q

Enzyme to detach phosphate. Dephosphorylation (?) 

A

Phosphatase (in liver and kidneys) 

97
Q

Phorterlace?

A

…

98
Q

Detach or attach hydrogen

A

Dehydrogenase

99
Q

Three reasons why water is important?

A

-blood pressure to maintain brain functioning
-Biochemical reaction (Enzymes)
-Entra and extra cellular functioning

100
Q

What is the percentage of water to total body weight?
Intracellular water?
Extracellular water? 

A

60%

2/3
1/3

101
Q

Water that is enclosed by epithelial membranes. Not counted in the total body water

A

Transcellular water. Ex: Pleural fluid, humor and I, CSF, GUI, etc.

102
Q

What influences the distribution of water in the various Compartments of the body? 

A

The concentration of the ions

Na+/Cl- > HCO3+ > K+, Ca+, Mg2+ 

103
Q

What are three major components of the Nurohormonal regulation mechanism for body sodium and water?

A

-Renin
-Angiotensinogen
-Aldosterone

104
Q

What are the natriuretic peptides?

A

-ANP (Type A from the atrium)
-BNP (Type B from the ventricle)
-CNP (Type C Brain vascular endothelial cells renal tubule) 
-Urodilation (kidney)

105
Q

Natriuretic peptide that increases offloading of water, vasodilator

A

ANP

106
Q

 what is important for CHF diagnosis? 

A

Increased BNP

107
Q

What is average heart rate?

A

70 bpm

108
Q

What measurement is proportional to vasculature width? 

A

Peripheral resistance

109
Q

CO=

A

HR x SV*

110
Q

MAP =

A

CO x PR*

111
Q

SV =

A

EDV - ESV*

112
Q

The amount of blood that can be pumped in one minute

A

Cardiac output (CO)
-around 4900ml 

113
Q

Is osmolarity is osmolality more more thermodynamically stable?

A

Osmolality

114
Q

of particles/kg of water

A

Osmolality*** absolute data
(evaluation of kidneys in fluid and electrolyte balance) 

115
Q

of particles/ L

A

Osmolarity

-Govern the solvent movement across membrane

116
Q

This is an indicator of the kidneys ability to conserve water

A

Urine osmolality

117
Q

What is the most general target electrolyte?

A

Sodium (Na+) 

118
Q

What is the normal values for sodium (Na+) 

A

135-145 mEq/L or mmol/L (because they are monovalent?) 

This is plasma concentration 

119
Q

Normal values for potassium K+? 

A

3.5-5 mEq/L or mmol/L in plasma

120
Q

what value is considered mild hyperkalemia?

(K+)

A

> 5.5 mM

121
Q

Value is considered severe hyperkalemia? 

A

> 7.5 mM

122
Q

Value is considered hypokalemia? 

A

< 3.5 mM

123
Q

-maintains intracellular fluid volume
-Important and neuromuscular excitability, cardiac contraction (Normal values are essential to life) 

A

K+

124
Q

H+ and _____ can swap inside and outside cell to maintain pH levels by hydrogen ion concentration

A

K+

125
Q

What are the normal values for chloride (Cl-)? And where is this ion mostly found?

A

98-106 mEq/L or mmol/L

Major extracellular anion

126
Q

What is the hamburger shift?

A

Chloride shift with bicarbonate (swap?)

127
Q

 bicarbonate is a major ___________ anion.  primarily involved in acid base balance in carbonic acid dissociation

A

Extracellular

128
Q

What are the three forms of carbon in the body? 

A

HCO3-, H2CO3, CO2

129
Q

What is the normal value for total CO2?
HCO3-?

A

22-29 mEq/L
22-26 mEq/L

130
Q

More than _____ % Of the carbon in the body is in the HCO3 form under normal conditions

A

60

(at a pH of 7.4 it’s H2CO3) 

131
Q

What ions contribute to anion gap? 

A

All charged molecules contribute not just the major ones

132
Q

When measuring the anion gap what ions are used? 

A

Cations: Na+, K+
Anions: Cl-, and CO2/HCO3-

133
Q

How do you calculate the anion gap with and without potassium?***

A

• (Na + K) - (Cl + HCO3) = about 15 mmol/L (10-20)

•(Na) - (Cl + HCO3) = about 12 mmol/L (7-16)

134
Q

What is the anion gap for metabolic acidosis? 

A

30 mmol/L or higher!

135
Q

Calculating the anion gap is useful in assessing….

A

The accuracy of measured electrolyte results or signifying disease process (Metabolic acidosis) 

136
Q

What should be done if you get an abnormal anion gap measurement?

A

Repeating of electrolyte measurements before reporting

137
Q

What is the typical cause of an increased anion gap?

A

Increased Or decrease of unmeasured anions (like Lactic acid) 

138
Q

What are three types of water and balances that cause a water deficit?

A

-diabetic acidosis (Osmotic Diuresis)
-Normal sodium Water imbalance
-Sodium imbalance


139
Q

What are possible causes of water imbalance with normal sodium levels?

A

-dehydration: Water deficit
-adipsia (No sensation of thirst), Hypothalamic disorder
-Diabetes insipidus

140
Q

The term used when a patient has no sensation of thirst

A

Adipsia

141
Q

What are the two types of diabetes insipidus?

A

-Central: A.k.a. pituitary diabetes-ADH is not being released from pituitary gland
-Nephrogenic: Hypothalamus and pituitary function properly but kidneys do not respond to ADH

142
Q

What can cause water imbalance by excess water and normal sodium levels?

A

-massive water intake usually psychiatric
-Excessive production of ADH (SIADH) 

143
Q

Excess water but with sodium imbalance is usually due to…

A

Excess water with edema usually resulting from increased sodium

144
Q

What causes plasma volume to increase, causing hypertension and cardiac overload and edema? 

A

Excess sodium (hypernatremia)

145
Q

Hypernatremia (Excess sodium) Could result from…

A

Congestive heart failure, liver disease, renal disease, Renal nephrotic syndrome, Hyperaldosteronism (cushings)***, severe dehydration, nasogastric feeding of high-protein with not enough fluids 

146
Q

Why could renal disease cause excess sodium (Hypernatremia)?

A

No filtration is happening (sodium stays in plasma due to decreased GFR)

147
Q

What is the disease associated with hyperaldosteronism?

A

Cushing’s syndrome*** (Need to know!) 

148
Q

What are the three main diseases associated with excess sodium (Hypernatremia)?

A

• renal disease
• Renal nephrotic syndrome
• hyperaldosteronism (cushings)

149
Q

What is the number one function of the liver?

A

Protein synthesis

(can activate RAAS too) 

150
Q

Sodium depletion (Hyponatremia)
Can be caused by…

A

-Hypoaldosteronism (Addison’s disease)***
-renal reabsorption disease
-Diabetes mellitus
-polyuria 

151
Q

Potassium excess (hyperkalemia) Is fatal if it is over _____ mmol/L. Why?

A

7.5

Interferes with depolarization and resting membrane potential goes down?

152
Q

Increase plasma levels (Hyperkalemia) Is seen in what diseases?

A

-hypoaldosteronism-adrenal insufficiency (Addison’s disease)
-Renal failure
-acidosis (increase in H+)
-Cellular breakdown (Potassium gets leaked out)*
-Insulin deficiency*

153
Q

What can cause potassium depletion (Hypokalemia)? 

A

-vomiting, diarrhea
-Cushing syndrome (Hyperaldosteronism)
-renal absorptive disease
-Metabolic alkalosis
-Insulin access

154
Q

Insulin can move potassium _______ cells.

A

Into

155
Q

This generally coexists with hypernatremia

A

Hyperchloremia (Increase chloride)

156
Q

Generally coexist with hyponatremia

A

Hypochloremia

157
Q

What is an exception when there is normal sodium levels with abnormal chloride levels?

A
  • metabolic acidosis- Increased chloride And decreased bicarbonate
    * metabolic acidosis- Decreased chloride but increased bicarbonate

***”chloride shift” 

158
Q

Evaluation of electrolyte balance may be examined in what specimens?

A

-serum/plasma of Electrolytes
-Urine measurement Of electrolytes
-Serum/urine osmolarity

159
Q

Sweat electrolytes is mostly ___________.

A

Chloride

(cystic fibrosis Screening —> Sweat chloride) 

Clinical Chemistry 1 (9 decks)

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