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Fluid-electrolyte physio Flashcards

1
Q

what is formula for fluid balance

A

input-output

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2
Q

what is main predictor of water volume in ECF

A

Na, as water follows Na

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3
Q

what happens when add isotonic solution to body

A

adds ECF volume and ICF stays the same

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4
Q

4 consequences of dec. ECF vol

A
  1. low plamsa vol
  2. low blood volume
  3. low CO
  4. low BP
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5
Q

major consequence to high ECF volume

A

pulmonary edema

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6
Q

how does added isotonic solution dist in ECF

A

1:3 plasma to ISF

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7
Q

how does ISF volume change when change plasma vol? (2)

A

via changes in both hydrostatic and plasma oncotic pressure

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8
Q

what happens in hypoalbumenemia

A

ECF vol stays the same, but movement from plasma to ISF

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9
Q

how does body sense Na and ECF balance

A

via changes in effective arterial volume

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10
Q

what is effective arterial volume

A

volume of blood in arterial tress that is effectively perfusing tissues

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11
Q

what are sensors of effective arterial volume

A

baroreceptors (sense stretch)

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12
Q

where are baroreceptors located

A
  1. central arteries
  2. renal afferet art.
  3. cardiac atria and vents
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13
Q

4 possible responses to baroreceptors

A
  1. SNS
  2. RAAS system
  3. ADH
  4. atrial naturetic peptide - to lower
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14
Q

3 main functions of angiotensin 2

A
  1. art. contstriction
  2. renal Na absorption, both direct and via adlosterone
  3. increased thirst and ADH
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15
Q

3 effects of Ang2 induced eff arteriole constriction

A
  1. incr glom cap pressure
  2. changes in peritubular cap. factors
  3. net effect of wasted out, but Na kept in
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16
Q

3 pathologies of chronic RAAS activity

A
  1. atheriosclerois
  2. cardiac remodelling
  3. renal scarring post-injury
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17
Q

what is typical Na intake in a day

A

150mmol

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18
Q

what is neg Na balance

A

intake less than output

19
Q

5 places Na can be lost

A
  1. skin - sweat and burn oozes
  2. GI - diarrhea or vomiting
  3. kidneys
  4. 3rd space
  5. bleeding
20
Q

3 causes of too much Na from kidneys

A
  1. diuretics (that inhib Na absrob)
  2. glucose diuresis - after diabted mellitus
  3. renal tubular disease
21
Q

what are 3rd space losses

A

fluid that is not in intravasuclr or interstitum - major surg, crush injury

22
Q

2 renal responses to hypovolemia

A
  1. hypotension and renal vasoconstrict. - lower GFR

2. incr. renal Na absorb (Ang, SNS)

23
Q

manifestations of Na loss

A
  1. fatigue
  2. hypotension - may only be postural
  3. tachy
  4. cold sweaty skin (SNS activ)
  5. low urine
  6. circ. shock
24
Q

treatment of volume depletion

A
  1. treat underlying cause

2. give fluids - isotonic

25
what is pos. Na balance
intake more than excrete
26
what happens when increase Na intake
1. will increase Na in ECF (more volume) | 2. eventually get Na excretion to equal, but never lose the ECF vol
27
how is high ECF vol sensed
baroreceptors
28
3 ways body tries to fix ECF vol increase
1. lower Na reabsorb (Ang2, aldo, SNS) 2. release naturetic peptide 3. pressure naturesis
29
2 potential problems with Na excretions
1. primary renal prob - failure, nephrotic synd | 2. failure in signalling - heart failure, cirrosis
30
what happens in renal falure
low GFR - can't get out Na
31
3 mechanisms in nephrotic syndrome
1. protenuria>hypoalbumenemia>edema 2. protenuria>activation of eNaC>more Na reabsorbtion 3. proteinuria>hypoalbumenemia>increase LDL production>hypercholesterolemia
32
what is effect of heart failure
1. low CO | 2. leads to Na retention to react to low arterial volume, because volume is all in veins
33
how does cirrosis affect Na balance
1. scar liver 2. portal hypertenion > blood pools in vessels 3. low effective art. volume
34
how much edema is detectable
3L
35
2 main effects of Na high
1. hypertension | 2. edema (esp. pulmonary)
36
treatment of high Na balnce (3)
1. reduce intake 2. increase Na out 3. treat underlying issue
37
site of action and mech of acetazolamide
site: PCT mech: carbonic anhydrase inhib
38
site of action and mech of furosamide
site: ALOH mech: inhibs Nak2Cl
39
site of action and mech of hydrochlorothiazide and metazone
site: DCT mech: inhib NaCl transporter
40
site of action and mech of spironolactone
site: CCD mech: aldosterone antagonist
41
site of action and mech of amiloride
site: CCD mech: Na channel blocker
42
4 places drugs can work on the RAAS
1. renin inhibitor 2. ACE inhib 3. aldosterone antagonist 4. angiotensin receptor blocker
43
4 clinical uses of RAAS antagonists
1. hypertension 2. CHfailure 3. renal disease 4. after MI

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