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PY6020 > Fluid & Electrolyte Balance > Flashcards

Fluid & Electrolyte Balance Flashcards

1
Q

What factors can be observed via measurements of Na+/K+/Cl-/HCO3-?

A

Fluid, electrolyte status and urine function

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2
Q

How is water secretion by the kidneys controlled?

A

It is controlled by ADH (anti-diuretic hormone), which is secreted from the posterior pituitary glands depending on the osmolarity of the body.

  • Increased salt conc. in blood (high osmolality) = ADH secreted (increasing water reabsorption)
  • Low osmolality (blood being more diluted) = ADH switched off
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3
Q

What are normal Na+ levels in the blood?

A

135-145 mmol/L

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4
Q

How can Na+ be excreted?

A

Via kidneys, sweat, gut and vomiting

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5
Q

Which 2 substances regulate urinary Na+ output?

A
  • Aldosterone - causing Na+/H2O retention

- Atrial natriuretic peptide (ANP) - secreted by the heart to increase Na+ urinary excretion

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6
Q

Describe the RAAS process and the end result of this system.

A
  1. Liver produces angiotensin & kidneys produce the enzyme renin
  2. This produces angiotensin I
  3. Lungs produce angiotensin converting enzyme (ACE), which converts angiotensin I into angiotensin II
  4. Angiotensin II binds to the adrenal glands of the kidneys to stimulate aldosterone production
  5. Aldosterone works on:
    - The heart
    - The kidneys (increase Na+/H2O retention and K+ excretion)
    - Blood vessels (vasoconstriction)
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7
Q

What is hyponatremia, and what causes it?

A

It is low Na+ levels in the body caused by vomiting, burns, diarrhoea, Addison’s disease (low aldosterone levels so Na+ not retained), or inappropriate ADH secretions

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8
Q

What happens to cells during hyponatremia?

A

Water moves from extracellular fluid (ECF) to intracellular fluid (ICF) to restore osmotic pressure of the cells

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9
Q

What are the symptoms of hyponatremia?

A
  1. Nausea
  2. Lethargy
  3. Reduced consciousness
  4. Headaches
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10
Q

What are the clinical signs of hyponatremia?

A
  1. Decreased urinary output
  2. Hypotension
  3. Increased pulse
  4. Decreased skin turgor
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11
Q

Which 2 drugs are associated with hyponatremia?

A

Lithium and SSRIs

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12
Q

What is hypernatremia, and what causes it?

A

It is high Na+ levels in the body caused by low water intake, excess water loss, diabetes insipidus (no ADH), sweating, over-infusion of saline/salts

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13
Q

How does hypernatremia form concentrated urine?

A

High Na+ levels induces a higher osmotic pressure.

This increases urea in the ECF of cells, which forms concentrated urine. ADH is then released.

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14
Q

What are the symptoms of hypernatremia?

A
  1. Thirst
  2. Dry mouth
  3. Weakness
  4. Loss of skin turgor
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15
Q

What are normal K+ levels in the blood?

A

3.5-5mmol/L

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16
Q

What type of electrolyte is K+?

A

It is an excitation electrolyte so used for e.g. muscle health

17
Q

Which protein stimulates the uptake of K+ in cells?

A

Insulin

18
Q

What occurs in acidosis in relation to K+ & H+?

A

During acidosis, K+ is displaced by H+ and increases, causing hyperkalaemia

19
Q

What can cause hyperkalaemia?

A
  1. Renal failure
  2. Addisons disease
  3. Hormonal effects - e.g. low insulin
  4. Excess K+ supplements
  5. Excess of K+ sparing diuretics
20
Q

How can hyperkalaemia be treated?

A
  1. Bicarbonate infusion
  2. Insulin - to increase K+ cellular uptake
  3. Salbutamol
21
Q

Why is hyperkalaemia known as an medical emergency?

A

Because it can effect cardiac/skeletal muscles

22
Q

What causes hypokalaemia?

A
  1. GI losses
  2. Renal failure
  3. Alkalosis
  4. High aldosterone levels - Conn’s syndrome
  5. Drug induced - e.g. diuretics, corticosteroids
23
Q

Which specific drug increases in toxicity during hypokalaemia?

A

Digoxin.

24
Q

Which protein can affect Ca2+ levels in the body?

A

Albumin, because it carries Ca2+

25
Q

What 2 substances control Ca2+ homeostasis in the body?

A
  1. Vitamin D

2. Parathyroid hormone (PTH) - secreted from parathyroid glands in response to low unbound Ca2+ levels

26
Q

What is the difference between osteoclasts and osteoblasts?

A
  1. Osteoclasts - shed Ca2+ from the bone to provide for the body
  2. Osteoblasts - puts Ca2+ into the bone
27
Q

What is the effect of PTH in terms of Ca2+ in the body?

A

It increases osteoclastic reabsorption and increases renal reabsorption of Ca2+ - this all increases Ca2+ levels in the body

28
Q

This equation is used for which types of patients specifically?

Corrected calcium (mmol/L) = total measured calcium + 0.02 (40-albumin)

A

Patients with low albumin levels

29
Q

What can cause hypocalcaemia?

A
  1. Renal disease
  2. Vitamin D deficiency
  3. Hypoparathyroidism
30
Q

What are the early symptoms of hypocalcaemia?

A

Numbing/tingling sensation of fingers, due to muscular disturbances.

31
Q

How is hypocalcaemia managed?

A

Ca2+ supplements.

32
Q

What can cause hypercalcaemia?

A
  1. Vitamin D overdose
  2. Bone diseases
  3. Hyperparathyroidism
33
Q

Which drug class is used to treat hypercalcaemia?

A

Bisphosphonates - they bind to Ca2+ in the bone to retain it

PY6020 (22 decks)

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