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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
Q

[creatinine in plasma]

A

1.5 mg/dl

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26
Q

[bilirubin in plasma]

A

0.5 mg/dl

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27
Q

[bile salts in plasma]

A

Trace amounts

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28
Q

Plasma-interstitial water distribution forces

A
  • forces that move fluid in/out of caps
    • cap/interstitial hydrostatic
    • cap/interstitial oncotic
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29
Q

Intracellular-extracellular water distribution

A
  • controlled by osmotic effect of Na and Cl across membrane

- water moves across membrane in or out to keep ICF isotonic with ECF

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30
Q

1 osmole

A

1 mole of particles (6.02x10^23) in solution

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31
Q

Plasma mOsm

A

301.8

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32
Q

Interstitial mOsm

A

300.8

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33
Q

Intracellular mOsm

A

301.2

  • higher than interstitial due to Donnan effect
  • more protein inside of cell
34
Q

Osmotic pressure of 1 mOsm

A
  1. 3 mmHg

- small change in [solute] will shift large volume of H2O creating large fluid shifts

35
Q

Isotonic solution

A
  • won’t upset osmotic balance

- 0.9% NaCl

36
Q

Crenate / Crenation

A
  • Cell shrivels up
37
Q

Osmolarity difference - Intracellular vs extracellular

A
  • 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
Q

Adding NS to patient

A
  • 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
Q

Adding hypertonic solution to patient

A
  • 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
Q

Assumed normal mOsm/L

A

280

41
Q

Adding hypotonic solution to patient

A
  • ECF osmolarity < ICF osmolarity…water moves from ECF to ICF
  • Overall decrease in osmolarity
  • ECF volume increases
  • ICF volume increases
  • Do practice problems*
42
Q

Nutrient solutions for patient

A
  • 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
Q

Plasma [Na]

A
  • 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
Q

Hypernatremia

A

High plasma Na

45
Q

Hyponatremia via Na loss from ECF

A
  • Low plasma Na
  • decrease in ECFV
  • Increase in ICFV

Causes

  • diarrhea/vomiting
  • diuretic overdose
  • renal disease
  • Addison’s disease
46
Q

Hyponatremia via excess water to ECF

A
  • decrease plasma [Na]
  • Increase ECFV
  • Increase ICFV

Causes:

  • excess water retention
  • excess ADH
47
Q

Consequences of Hyponatremia

A
  • 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
Q

Hypernatremia via water loss from ECF

A
  • increased plasma [Na]
  • decrease ECFV
  • decrease ICFV

Causes:

  • No ADH…very dilute urine
  • excess sweating
49
Q

Hypernatremia via excess Na to ECF

A
  • increased plasma [Na]
  • increased ECFV
  • decreased ICFV

Causes:
- excess aldosterone (reabsorb H2O and Na…but more Na)

50
Q

Consequences of Hypernatremia

A
  • cells shrink
  • not as common as hypo
  • need 158-160 mEq/L
  • slow correction best
51
Q

Intracellular edema

A

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
Q

Extracellular edema

A

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
Q

Big picture renal function

A
  • 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
Q

3 types of gradients

A
  • osmotic
  • electrical
  • solute
55
Q

More specific renal functions

A
  • 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
Q

amino acid metabolism waste

A

Urea

57
Q

Muscle creative waste

A

Creatinine

58
Q

Nucleic acid waste

A

Uric acid

59
Q

Hemoglobin break down waste

A

Bilirubin

60
Q

Renal response to Na intake

A
  • able to respond to huge differences in Na intake with small changes to ECFV or [Na]
  • also true for most other electrolytes
61
Q

Kidney / lung and body buffer systems

A
  • Lungs remove CO2
  • Kidneys control [bicarb] and [H]
  • Kidneys only way to remove sulfuric/phosphoric acid
    • byproducts of protein metabolism
62
Q

RBC production

A
  • kidneys secrete erythropoietin (almost all)
    • stimulate RBC production when hypoxic
  • Severe renal disease leads to severe anemia due to lack of erythropoietin
63
Q

Glucose and kidneys

A
  • when fasting…glucose from amino acids

- can make large amounts

64
Q

Structure of kidneys

A

look at two diagrams in slides

65
Q

What % of CO is RBF

A
  • 22% (1100 mls/min based on 5L/min)
66
Q

Glomerular capillaries

A
  • High pressure - 60 mmHg
  • inside Bowman’s capsule
  • high rate of fluid filtration
67
Q

Peritubular capillaries

A
  • Low pressure - 13 mmHg
  • high rate of reabsorption
  • surrounds nephron tubules
  • controller of afferent/efferent arteriole resistance
68
Q

How many nephrons do we have

A
  • 1,000,000
  • > 40 YO….lose 10% per year
    • older more prone to hypertension
69
Q

Structure of nephron

A

look at diagram in slides

70
Q

Cortical nephrons

A
  • mostly in cortex
  • not much thin loop…mostly thick
  • 70-80% of all nephrons
  • look up basic functions in book
71
Q

Juxtamedullary Nephrons

A
  • mostly in medulla
  • long segments of thin loop
  • 20-30% of nephrons
  • look up basic functions in book 325-326
72
Q

Filling/emptying of bladder

A
  • micturation (nervous) reflex empties it

- ANS spinal cord reflex w/ brain stem input

73
Q

Detrusor muscle

A
  • smooth muscle of bladder

- surrounds bladder

74
Q

Trigone area of bladder

A
  • very smooth area inside bladder

- contains openings from ureters

75
Q

Internal sphincter of bladder

A
  • tone hold urine in (smooth muscle)
76
Q

External sphincter of bladder

A
  • skeletal muscle
  • voluntary control
  • conscious prevention of urination
77
Q

Pelvic nerve

A
  • primary innervation of bladder
  • sensory and motor
    • sensory: from posterior urethra / initiate reflex
    • motor: are parasympathetic
78
Q

Pudendal nerve

A
  • innervate skeletal muscle fibers of external sphincter

- voluntary control

79
Q

Pain nerves of bladder

A
  • supply ureters

- can hold in urine up to a point….then ANS overrides voluntary control

80
Q

Transport of urine into bladder

A
  • 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
Q

Micturition reflex

A
  • 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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