Fluid and Electrolytes/Acid Base Flashcards
Principal cation in the ECF
Na
Principal cation in the ICF
K
major determinant of LV filling volume, CO, MAP
intravascular volume
diagnostic hallmark of decrease EABV
Urine sodium < 15
principal anion lostin diarrhea
bicarbonate
acid base in diarrhea
hyperchloremic acidosis
acid base in diuretics, bartter, Gitelman
hypokalemic alkalosis
K and acid base in adrenal insufficiency
hyperkalemia and met acidosis
urine parameters in hypovolemia (3)
u.spg > 1.020,
Una < 10,
Uosm > 400 mOsm/Kg
Fena of hypovolemia
less than 1%
FeNa of hypvolemia with diuretics
less than 30-35%
mainstay for volume replacement
crystalloids isotonic 0.9%
fluid of choice for burns/trauma
colloids
clilnical detection of edema occurs when interstitial fluid is
> 2 to 3 L
sine qua non for Na and water retention in cirrhosis with portal hypertension
intrasinusoidal hypertension > 12 mmHg
halmark of fluid retention in cirrhosis
peripheral arterial vasodilation with vasoconstriction
standard of care for heart failure
B blocker
vasoconstrictor of choice for liver cirrhosis
terlipressin
a-adrenergic agonist inhibits release of glucagon, no effect on renal fxn
ocreotide
treatment of choice for HRS
liver transplantation
daily insensible water loss
8-10 ml/kg
primary determinant of free water excretion in regulation of H20
AVP
most important stimulus of AVP secretion
2
hypertonicity, oncotic pressure of plasma
most sensitive osmoreceptor cells
anterior hypothalamus
absolute level of Posm at which a person develops a conscious urge to drink
osmotic thirst threshold
Osmotic thirst threshold
295 mOsm/kg/H20
rare autosomal recessive causing DI, DM, optic atrophy, deafness
Wolfram syndrome
primary osmoreceptors controlling AVP secretion and thirst
anterior hypothalamus
lack of osmoreceptors that regulate thirst and impaired osmoregulation of AVP
osmoreceptor dysfunction
hallmark of osmoreceptor dysfunction
abnormal thirst response
enzyme enhanced in gestational DI
2
oxycytocinase and vasopressinase
treatment of gestational DI
vasopressin
resistance of ADH due to defect within the kidney
nephrogenic DI
most common cause of drug induced NDI
lithium
characteristic clinical symptom of DI
polyuria, polydipsia
solute excretion rate in solute diuresis
> 15 mOsm
differentiate CDI and NDI
fluid deprivation test
increase in U Osm after vasopressin
CDI
<10% increase in Uosm after vasopressin
NDI
drug of choice for acute and chronic CDI
desmopressin
paradoxic antidiuretic effect in NDI
Thiazide
major comploication of desmopressin
hyponatremia
hyponatremia, normal osm
pseudohyponatremia, factitious hyponatremia
potent stimulus to AVP secretion
volume depletion
most common of hospitalized hyponatremia
SIADH
Uosm in sIADH
> 100 mOsm/Kg H20
most common malignancy with sIADH
bronchogenic Ca and small cell lung cancer
Na increase in 100 ml hypertonic saline
2 to 4 mmol/L
treatment of choice for depletional hyponatremia
isotonic saline
most dreadful complication in acute hyponatremia
brain herniation
allowable increase in Na in 24 hours in high risk ODS
8 mmol/L
max daily rate of increase in Na
10-12 mmol/L
TTKG 2-3
redistributive hypokalemia
TTKG>4
renal K wasting
Urine K/Crea signifying poor dietary intake
< 13 meq/g Crea