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Renal II Med 215 > Fluid and Electrolyte Disturbance (Na, K) > Flashcards

Fluid and Electrolyte Disturbance (Na, K) Flashcards

1
Q

What are the major EC and IC molecules?

A

Extracellular:

  • Na+
  • Cl-

Intracellular:

  • Proteins
  • K+
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2
Q

What is the overarching causes of extracellular edema?

A
  1. Increased capillary hydrostatic pressure
  2. decreased plasma proteins
  3. increase capillary permeability
  4. Blocked lymph return
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3
Q

What are the common causes of increased capillary hydrostatic pressure?

A
  1. Excess kidney retention of salt and water
  2. high venous pressure
  3. decreased arteriolar resistance
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4
Q

What causes decreased plasma proteins (leading to extracellular edema)?

A
  1. Loss of protein in urine (nephrotic syndrome)
  2. loss of protein from skin (burns, wounds)
  3. failure to produce proteins (liver disease, malnutrition)
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5
Q

What causes blockage of lymph return?

A
  1. Infections (filarial, nematodes)
  2. Cancer
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6
Q

What factors work to prevent extracellular edema?

A
  • Interstitium has low compliance (doesn’t expand easily)
  • lymphatic flow can increase 10-50 fold
  • protein wash out happens quickly in interstitium making retaining water in the interstitium harder
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7
Q

What are the two main causes of intracellular edema?

A
  1. depression of metabolic systems of tissues
  2. lack of adequate nutrition to the cells

too little EC Na+ or too much water are other factors

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8
Q

What in the body measures sodium content?

A

stretch receptors that sense effective vascular volume

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9
Q

What are two clinical causes that lead to hypoosmolality and cellular swelling?

A
  • SIADH - impaired ability to excrete water
  • Minearalocorticoid deficiency - impaired ability to keep Na+
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10
Q

Differentiate a -natremia problem from a -volemia problem

A
  • natremia
  • Concerned with Na+ concentration, but the problem is how much water is present
  • volemia
  • problem with Na+ content
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11
Q

Delivery of solute to the juxtaglomerular apparatus is sense by the ________ __________

A

Macula densa

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12
Q

What are the three sodium transporters found in the proximal tubule on the apical membrane (between the cell and lumen)?

A
  1. Na+/H+ exchanger
  2. Na+ w/: aa, organic solute, or glucose cotransporter
  3. Cl-/anion exchange
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13
Q

what are the major regulatory hormones of the proximal tubule?

A
  • Angiotensin II
  • Epinephrine
  • Norepinephrine
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14
Q

What are the major regulatory hormones of the late distal tubule and collecting duct?

A
  • Aldosterone
  • Atrial Natriuretic Peptide
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15
Q

Explain what happens in response to an increase in effective circulating volume

A

Decrease in Sympathetic input:

  • Increase GFR
  • increase ANP (heart)
  • decrease ADH (brain)
  • Less: Renin, angiotensin II, aldosterone
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16
Q

Describe why your body might have a lowered effective circulating volume, but have a high total body sodium?

A

in CHF the brain sense it’s not getting enough blood so it stimulates retention of sodium. However, the problem lies in the mechanical inability of the heart not the volume within the vasculature.

Other Conditions:

  • cirrhosis (extrarenal cause)
  • severe nephrotic syndrome (renal cause)
17
Q

What is Conn syndrome?

A

same thing as primary hyperaldosteronism

18
Q

Define the values associated with hypernatremia and hyponatremia

A

Hypernatremia: plasma [Na+] > 145 mEq/L

Hyponatremia: plasma [Na+] < 135 mEq/L

Again, because we’re talking about concentration this is a water problem, concentration heavily determined by water volume present

19
Q

What’s normal blood osmolality?

A

285 - 295 mOsm/kg

Quick formula: 2 x [Na+]plasma

20
Q

What is the two major stimulators for ADH release from the posterior pituitary?

A
  • High plasma osmolality
  • Lowered blood volume/pressure
21
Q

Increased thirst is correlated with…

A
  1. increased osmolarity
  2. decreased BV/BP
  3. increased angiotensin II
  4. dryness of mouth
22
Q

What kind of hyponatremia is caused by SIADH?

A

euvolemic hyponatremia

23
Q

What are the hyponatremic symptoms

A

Stupor/coma

Anorexia, nausea, vomiting

Lethargy

Tendon reflexes decreased

Limp muscles (weakness)

Orthostatic hypotension

Seizures/headache

Stomach cramping

24
Q

How would you treat a patient with moderate symptoms of hyponatremia Such as nausea, confusion, disorientation, and altered mental status?

A

level 2

  • Vaptans (aquaretics) or hypertonic NaCl
  • Fluid restriction
25
Q

How would you treat a patient with severe symptoms of hyponatremia such as vomiting, seizures, obtundation, respiratory distress, and coma?

A

Level 3

  • Hypertonic NaCl
  • Fluid restriction or vaptan (aquaretic)
26
Q

What must you be cautious when correcting chronic hyponatremia?

A

Too rapid of a correction of hyponatremia can result in osmotic demyelination syndrome (locked-in syndrome)

27
Q

Classic tumor producing vasopressin ectopically causing SIADH?

A

Oat-cell carcinoma

28
Q

Where is hypernatremia commonly seen?

A
  • nursing home neglect
  • traveling in the desert w/o enough water (southwest US)
  • individuals living at home alone who fall
29
Q

What are causes of hypervolemic hypernatremia?

A
  • Primary hyperaldosteronism
  • cushing syndrome
30
Q

What are the symptoms of hypernatremia?

A

Twitching, tremors, hyperreflexia

Restlessness, irritable, confusion (due to brain cell shrinkage)

Intense thirst, dry mouth, decreased urine output

Pulmonary and peripheral edema

31
Q

What things cause potassium to enter a cell?

A
  • Insulin
  • aldosterone deficiency
  • alkalosis
  • β2-agonist (Epi)
32
Q

What is the major stimulus for aldosterone secretion?

A

hyperkalemia

33
Q

What is a major cause of hyperkalemia?

A

pseudohyperkalemia due to lysed RBCs while taking a blood sample

34
Q

What are the signs and symptoms associated with hypokalemia?

A

Neuromuscular (most prominent manifestation)

  • Skeletal muscle weakness
  • smooth muscle weakness (ileus, constipation)

Cardiovascular

  • Ventricular arrhythmias
  • hypotension
  • cardiac arrest

Renal (impaired concentrating ability)

  • Polyuria and nocturia

Metabolic —> hyperglycemia

35
Q

What are the main causes of metabolic alkalosis due to hypokalemia?

A
  • Vomiting
  • bartter syndrome (pt has a normal BP)
  • hyperaldosteronism (pt has high BP)
  • mineralcorticoid excess (pt has high BP) - licorice
36
Q

What are the main signs/symptoms of Hyperkalemia?

A

Cardiac:

  • Tall T waves
  • Bradycardia

Neuromuscular:

  • Numberless, weakness
  • flaccid paralysis
37
Q

What are medications that can cause hyperkalemia?

A

ACEI and ARBs

38
Q

How do we treat Hyperkalemia?

A
  • IV calcium (counteracts cardiac symptoms)

redistribute K+ into cells:

  • Insulin and glucose (best)
  • albuerol (also works)

Facilitate K+ elimination:

  • K+ losing diuretic
  • dialysis
  • cation exchange resin
39
Q

what parameters define hypokalemia and hyperkalemia?

A

Hypokalemia: < 3.5 mEq/L

Hyperkalemia: > 5.5 mEq/L

Renal II Med 215 (3 decks)

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