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Harrison's 19th Ed > Fluid And Electrolyte Disturbances > Flashcards

Fluid And Electrolyte Disturbances Flashcards

1
Q

Dopamine

A

Natriuretic effect

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2
Q

Aldosterone

A

Activates Na Cl reabsorption within aldosterone-sensitive distal nephron

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3
Q

Mannitol

A

Filtered by glomeruli

Not reabsorbed in proximal tubule

Causes osmotic diuresis

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4
Q

Acetazolamide

A

Inhibit proximal tubular Na Cl absorption via inhibition of carbonic anhydrase

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5
Q

Trimethoprim and pentamidine

A

Inhibit distal tubular Na reabsorption through amiloride sensitive ENaC channel

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6
Q

Daily fecal fluid loss

A

100-200 ml/day

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7
Q

Insensible losses

A

500-650 ml/day

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8
Q

Hypovolemia and
Hypochlormeic alkalosis due to vomitting diarrhea or diuretics

What is the expected urine na?

A

> 20

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9
Q

Renal causes of hyponat

Expected Urine Na?

A

> 20

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10
Q

Inhibits renal concentrating activity, thiazides or loop diuretics?

A

Loop (blunts countercurrent mechanism)

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11
Q

Cerebral salt wasting

A

Hypovolemic hyponat
UNa > 20 (inappropriate natriuresis)

Assoc w: 
SAH 
TBI 
Craniotomy 
Encephalitis 
Meningitis
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12
Q

Hypervolemic hyponat with Urine Na > 20

A

Acute or chronic renal failure

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13
Q

Primary vs secondary AI in terms of volume status and Na levels?

A

Primary- hypovolemic hyponat

Secondary- euvolemic hyponat

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14
Q

Most common cause of euvolemic hyponat?

A

SIADH

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15
Q

Other causes euvolemic hyponat?

A 
Glucocorticoid deficiency 
Hypothyroidism
Stress
Drugs 
SIADH
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16
Q

Class of drugs which most commonly cause SIADH

A

SSRIs

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17
Q

Most common malignancy assoc w SIADH

A

Small cell lung Ca

18
Q

Symptomatic hyponat at levels..

A

<125

19
Q

Overly rapid Na correction

A

> 8-10 in 24 hrs

> 18 in 48 hrs

20
Q

ODS presentation

A 
Paraparesis / quadriparesis
Dysphagia 
Dysarthria
Diplopia 
Locked in syndrome 
LOC
21
Q

AVP agonist

A

Desmopressin

22
Q

Most common manifestation of hypernatremia

A

Altered mental status

23
Q

Correction of acute hypernat

A

Rate of 1mM/hr

24
Q

Nephrogenic vs central DI in response to DDAVP

A

Nephrogenic - less than 50% increase in Urine osmolality pr <150 mOsm/kg from baseline

25
Q

Nephrogenic DI causes

A

Genetic mutations
Hypercalcemia
Hypokalemia
Drugs (lithiumn ifosfamide, antiviral agents)

26
Q

Major K channels that mediate its secretion

A

ROMK - mediate bulk of K secretion

Flow sensitive big Potassium (BK) channel

27
Q

Increase in distal delivery of Na and distal flow rate: effect on K?

A

Enhance K secretion —> hypokalemia

28
Q

Decrease distal delivery of Na, effect on K?

A

Blunts ability to excrete K —> hyperkalemia

29
Q

Aldosterone effects on K

A

Increases activity of ENaC—> K secretion —> hypoK

30
Q

Possible treatment for TTP

A

Propanolol 3mg/kg

31
Q

Urine calcium in hiazide diuretics vs loop diuretics

A

HYPERcalciuria in LOOP diuretics

HYPOcalciuria in THIAZIDE diuretics

32
Q

Liddle syndrome

A 
Autosomal dominant 
Gain in function mutation in ENaC
Severe hypertension + hypokalemia 
Unresponsive to spironolactone 
Sensitive to amiloride
33
Q

Hypokalemic alkalosis

Loss of function of TALH

A

Bartter’s

34
Q 
Hypokalemic alkalosis 
Loss of function of DCT segments 
Chondro calcinosis (abnormal deposition of CPPD in joints) 
Hypomagnesemia
Marked hypocalciuria
A

Gittleman’s syndrome

35
Q

ECG changes with K <2.7 mmol/L

A

Broad flat T waves
ST depression
QT prolongation

36
Q

Same clinical manif with Liddle’s syndrome but

Responds to spironolactone

A

SAME (syndrome of apparent mineralocorticoid excess)

37
Q

Reduction of serum K by 2.0 mM results in loss of ____ mmol of total K stores

A

400-800 mmol

38
Q

ECG changes in hyperkalemia

A

Tall peaked T waves - 5.5-6.5
Loss of p waves 6.5-7.5
Widened qrs 7.0-8.0
Sine wave pattern > 8.0

39
Q

Effect of hypercalcemia in px taking digoxin

A

Potentiates cardiac toxicity of digoxin

40
Q

Effect of Calcium gluc

A

Effect starts in 1-3 mins,
Lasts 30-60 mins

May repeat if no ECGchanges (hyperkalemia)

41
Q

Glucose insulin solution

A

Effect begins 10-20 mins
Peaks 30-60 mins
Lasts 4-6 hrs

If cbg > 200-250 , hold D5W

42
Q

Beta blockers for hyperkalemia

A 
Albuterol 10-20 mg 
Inhaled over 10 mins
Effect starts at 30 mins 
Peak at 90 mins 
Lasts for 2-6 hrs

Harrison's 19th Ed (13 decks)

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