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556 - Physiology & Pathophysiology II > Exam 6 - Fluid Compartments & Urine Formation > Flashcards

Exam 6 - Fluid Compartments & Urine Formation Flashcards

1
Q

Why kidneys are important

A
  • maintaining constant and appropriate volumes and composition of body compartments
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2
Q

Normal fluid intake

A

2300 mls / day

  • ingested fluids: 2100 mls
  • oxidation of carbs: 200 mls
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3
Q

Fluid output

A

2300 mls/day

  • urine: 1400 mls
  • Insensible loss via respiratory/skin: 700 mls
  • sweat: 100 mls
  • feces: 100 mls
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4
Q

Total body fluid

A

Male: 60% of body weight
Female: 50% of body weight (more fat)

  • decreases with age
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5
Q

ECF

A
  • 20% of weight
  • 1/3 of total water volume
  • Interstitial = 75%
  • Plasma = 25%
  • Transcellular fluid = 1-2 L
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6
Q

ICF

A
  • 40% of weight
  • 2/3 of water volume
  • cell composition very consistent
    • 100 trillion cells
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7
Q

Gibbs-Donnan Equilibrium

A
  • how ions are distributed on either side of semi-permeable membrane….with non-permeable ions on one side

At equilibrium:

  • product of diffusible ions EQUAL
  • sum of all cations = sum of anions…on each side

Produces:
- different [ ] of ions on each side w/o need for pump mech

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8
Q

[Na]

A

In: 10 mEq/L
Out: 142

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9
Q

[K]

A

In: 140 mEq/L
Out: 4

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10
Q

[Ca]

A

In: 0.0001 mEq/L
Out: 2.4 mEq/L

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11
Q

[Mg]

A

In: 58 mEq/L
Out: 1.2

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12
Q

[Cl]

A

In: 4 mEq/L
Out: 103

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13
Q

[PO4]

A

In: 75 mEq/L
Out: 4

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14
Q

[HCO3]

A

In: 10 mEq/L
Out: 28

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15
Q

[Protein]

A

In: 40 mEq/L
Out: 5

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16
Q

[Glucose]

A

In: 0-20 mEq/L
Out: 90

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17
Q

pH

A

In: 7.0
Out: 7.4

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18
Q

[phospholipids in plasma]

A

280 mg/dl

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19
Q

[cholesterol in plasma]

A

150 mg/dl

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20
Q

[fat in plasma]

A

125 mg/dl

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21
Q

[glucose in plasma]

A

100 mg/dl

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22
Q

[urea in plasma]

A

15 mg/dl

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23
Q

[lactic acid in plasma]

A

10 mg/dl

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24
Q

[uric acid in plasma]

A

3 mg/dl

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25
[creatinine in plasma]
1.5 mg/dl
26
[bilirubin in plasma]
0.5 mg/dl
27
[bile salts in plasma]
Trace amounts
28
Plasma-interstitial water distribution forces
- forces that move fluid in/out of caps - cap/interstitial hydrostatic - cap/interstitial oncotic
29
Intracellular-extracellular water distribution
- controlled by osmotic effect of Na and Cl across membrane | - water moves across membrane in or out to keep ICF isotonic with ECF
30
1 osmole
1 mole of particles (6.02x10^23) in solution
31
Plasma mOsm
301.8
32
Interstitial mOsm
300.8
33
Intracellular mOsm
301.2 - higher than interstitial due to Donnan effect - more protein inside of cell
34
Osmotic pressure of 1 mOsm
19. 3 mmHg | - small change in [solute] will shift large volume of H2O creating large fluid shifts
35
Isotonic solution
- won't upset osmotic balance | - 0.9% NaCl
36
Crenate / Crenation
- Cell shrivels up
37
Osmolarity difference - Intracellular vs extracellular
- quickly corrected....within seconds - but takes time for equilibrium to be reached throughout entire body Causes: - water ingestion - dehydration - diarrhea - massive sweating or fluid loss via kidneys - CPB
38
Adding NS to patient
- No change in ECF osmolarity - Expand ECF volume by amount added - within 15 min...75% of volume will end up in interstitial....causes edema
39
Adding hypertonic solution to patient
- ECF osmolarity will increase - [ECF] > [ICF]....water from ICF to ECF - Overall increase in osmolarity - ECF volume increases (more than volume added) - water added + water shift - ICF volume decreases * do practice problems*
40
Assumed normal mOsm/L
280
41
Adding hypotonic solution to patient
- ECF osmolarity < ICF osmolarity...water moves from ECF to ICF - Overall decrease in osmolarity - ECF volume increases - ICF volume increases * Do practice problems*
42
Nutrient solutions for patient
- glucose most common....but...patients normally high glucose on CPB - isotonic or nearly to (or given slow to keep equilibrium) - as nutrients metabolized, water left over.... - removed via kidneys
43
Plasma [Na]
- Na and Cl make up 90% of solute in ECF - big controllers of osmolarity - 142 mEq/L - [Na] and osmolarity go hand in hand
44
Hypernatremia
High plasma Na
45
Hyponatremia via Na loss from ECF
- Low plasma Na - decrease in ECFV - Increase in ICFV Causes - diarrhea/vomiting - diuretic overdose - renal disease - Addison's disease
46
Hyponatremia via excess water to ECF
- decrease plasma [Na] - Increase ECFV - Increase ICFV Causes: - excess water retention - excess ADH
47
Consequences of Hyponatremia
- Cell swelling (bad in brain) - Headache, nausea, lethargic, disoriented - if [ ] falls to 115-120 - seizures - coma - brain damage - death - Brain tries to move ions from cells to ECF - don't treat too quick...10-12 mmol/L over 24 hrs - most common electrolyte disorder (25%)
48
Hypernatremia via water loss from ECF
- increased plasma [Na] - decrease ECFV - decrease ICFV Causes: - No ADH...very dilute urine - excess sweating
49
Hypernatremia via excess Na to ECF
- increased plasma [Na] - increased ECFV - decreased ICFV Causes: - excess aldosterone (reabsorb H2O and Na...but more Na)
50
Consequences of Hypernatremia
- cells shrink - not as common as hypo - need 158-160 mEq/L - slow correction best
51
Intracellular edema
Causes: - hyponatremia - decreased cell metabolism - less Na/K pump activity...Na into cell...less Na out - no nutrition to cells - inflammation - cell membrane permeability goes up...Na into cell
52
Extracellular edema
Causes: - leakage of fluid from plasma to interstitial - failure of lymphatics to return fluid from interstitial to vascular system *look at causes on page 297*
53
Big picture renal function
- control volume/composition of body spaces - keep homeostatic environment - by controlling [Na] - Rid body of wastes produced by body or ingested - FILTER plasma into tubules - REABSORB much of the filtrate back to blood - SECRETE substances from blood into tubules - usually active process - substances secreted or NOT reabsorbed are excreted in urine
54
3 types of gradients
- osmotic - electrical - solute
55
More specific renal functions
- water and electrolyte balance - Osmolality and electrolyte [ ] - regulation of BP - regulation of acid-base balance - prevent acidosis/alkalosis - on CPB...acidosis more common...we control respiratory
56
amino acid metabolism waste
Urea
57
Muscle creative waste
Creatinine
58
Nucleic acid waste
Uric acid
59
Hemoglobin break down waste
Bilirubin
60
Renal response to Na intake
- able to respond to huge differences in Na intake with small changes to ECFV or [Na] - also true for most other electrolytes
61
Kidney / lung and body buffer systems
- Lungs remove CO2 - Kidneys control [bicarb] and [H] - Kidneys only way to remove sulfuric/phosphoric acid - byproducts of protein metabolism
62
RBC production
- kidneys secrete erythropoietin (almost all) - stimulate RBC production when hypoxic - Severe renal disease leads to severe anemia due to lack of erythropoietin
63
Glucose and kidneys
- when fasting...glucose from amino acids | - can make large amounts
64
Structure of kidneys
*look at two diagrams in slides*
65
What % of CO is RBF
- 22% (1100 mls/min based on 5L/min)
66
Glomerular capillaries
- High pressure - 60 mmHg - inside Bowman's capsule - high rate of fluid filtration
67
Peritubular capillaries
- Low pressure - 13 mmHg - high rate of reabsorption - surrounds nephron tubules - controller of afferent/efferent arteriole resistance
68
How many nephrons do we have
- 1,000,000 - >40 YO....lose 10% per year - older more prone to hypertension
69
Structure of nephron
*look at diagram in slides*
70
Cortical nephrons
- mostly in cortex - not much thin loop...mostly thick - 70-80% of all nephrons - *look up basic functions in book*
71
Juxtamedullary Nephrons
- mostly in medulla - long segments of thin loop - 20-30% of nephrons - *look up basic functions in book 325-326*
72
Filling/emptying of bladder
- micturation (nervous) reflex empties it | - ANS spinal cord reflex w/ brain stem input
73
Detrusor muscle
- smooth muscle of bladder | - surrounds bladder
74
Trigone area of bladder
- very smooth area inside bladder | - contains openings from ureters
75
Internal sphincter of bladder
- tone hold urine in (smooth muscle)
76
External sphincter of bladder
- skeletal muscle - voluntary control - conscious prevention of urination
77
Pelvic nerve
- primary innervation of bladder - sensory and motor - sensory: from posterior urethra / initiate reflex - motor: are parasympathetic
78
Pudendal nerve
- innervate skeletal muscle fibers of external sphincter | - voluntary control
79
Pain nerves of bladder
- supply ureters | - can hold in urine up to a point....then ANS overrides voluntary control
80
Transport of urine into bladder
- Renal calyces are pacemaker for peristalsis of urine down into bladder - more stretch of calyces = more peristalsis - parasympathetic enhance peristalsis - sympathetic inhibit peristalsis - Detrusor muscle prevents back-flow by constricting down on ureters
81
Micturition reflex
- volume/bladder pressure directly prop. - positive feedback...more stretch....stronger contractions - stronger and stronger over time...can only prevent emptying for so long...eventually inhibitor signals to external sphincter - urination happens when inhibitory signals > voluntary signals sent to external sphincter

556 - Physiology & Pathophysiology II (8 decks)

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