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Renal > IVF and Diuretics > Flashcards

IVF and Diuretics Flashcards

1
Q

What are relative amounts of sodium, chloride, and glucose in D5 water?

A

0 ions, mostly glucose

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2
Q

What are relative amounts of sodium, chloride, and glucose in normal saline?

A

equal amounts of Na and Cl, no glucose

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3
Q

What are relative amounts of sodium, chloride, and glucose in half normal saline?

A

equal sodium and chloride (half of normal saline) and zero glucose

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4
Q

What are relative amounts of sodium, chloride, and glucose in lactated ringers? what else is there?

A

slightly more sodium than chloride, no glucose. also contains lactate, potassium, and calcium

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5
Q

Where will IV fluids go when administered?

A

intravascular space

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6
Q

Is “normal” saline actually hypertonic or hypotonic?

A

hypertonic, slighlty

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7
Q

for the proverbial 70 kg person, what is the minimum water needed per day?

A

2500 cc per day

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8
Q

If a person needs 2500 cc of water per day minimum, what is the rate of IV fluids to meet this need?

A

100 cc/ hour

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9
Q

What is something to always keep in mind if you are rehydrating someone with normal saline?

A

they are getting a LOT of sodium

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10
Q

Why is acetazolamide a poor diuretic?

A

it works on the PCT, so the rest of the nephron does a really good job compensating for its action and not that much changes in sodium handling

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11
Q

How does acetazolamide work?

A

it prevents bicarbonate absorption, which prevents sodium absoprtion via the cotransporter

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12
Q

When is acetazolamide used as a diuretic, most commonly?

A

metabolic alkalosis diuresis

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13
Q

What is frequently co administered along with a loop diuretic to treat hyperkalemia and hypercalcemia?

A

normal saline

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14
Q

Other than hypertension, when can thiazide diuretics be used preventatively?

A

to prevent calcium stones

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15
Q

Why can a high sodium diet, non-K sparing diuretics or IVF with saline all cause hypokalemia?

A

in the principal cells of the CCD, sodium and potassium are handled in opposite directions - sodium absorption causes potassium loss

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16
Q

Does the kidney mainly excrete volatile or non volatile acids?

A

non volatile (those from metabolism, diet and intestinal losses)

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17
Q

How are steady state and zero balance related?

A

they both mean that input and output are equal (in reference to kidney excretion)

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18
Q

What is a normal acid production from a protein based diet?

A

1 mEq/kg per day

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19
Q

What are the 3 processes that protect the body from acute increases in blood acid?

A

(1) the extra cellular and intracellular buffers act to neutralize excess H+ and thus prevent changes in pH induced by an acid load,
(2) Alveolar ventilation increases to eliminate CO2 rapidly and more efficiently,
(3) the plasma HCO3- concentration is held within narrow limits by the regulation of renal H+ excretion

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20
Q

What is the immediate first step in controlling acute increases in acid?

A

buffering by HCO3 in the blood

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21
Q

What is the second step (in minutes) to buffering acute acid increases?

A

Within several minutes, the respiratory compensation begins, resulting in hyperventilation, a decrease in the
PCO2, and therefore an increase in the pH toward normal

22
Q

What are the third (2 to 4 hours) step in buffering acute acid increases?

A

Within 2 to 4 hrs, the intracellular buffers (primarily proteins and organic phosphates) and bone provide further buffering, as H+ ions enter the cells in exchange for intracellular K+ and Na+.

23
Q

When is the corrective renal response to an acute acid load complete?

A

it begins on the first day and is done within 4 to 6 days

24
Q

Is the renal response more quick in acid or base increases?

A

base - excess bicarb is excreted very quickly in the urine

25
Q

What are the most important acid base transporters at the level of the individual cell?

A

Na/H exchanger and Cl-HCO3 exchanger

26
Q

What are the two urinary buffers?

A

NH4+, titratable acids, and organic anions

27
Q

What is the major titratable acid in urine?

A

H2PO4-, because the pKa of the urine and high rate of excretion

28
Q

What are the 3 steps of ammonium excretion?

A

(1) NH4 is produced, primarily in the early proximal tubular cells; (2) Luminal NH4+ is partially reabsorbed in the thick ascending limb and the NH3 then recycled within the renal medulla; and
(3) the medullary interstitial NH3 reaches high concentrations that allow NH3 to diffuse into the tubular lumen in the medullary collecting tubule where it is trapped as NH4+ by
secreted H+.

29
Q

What is the first step in ammonium excretion?

A

(1) NH4 is produced, primarily in the early proximal tubular cells;

30
Q

What is the second step in ammonium excretion?

A

(2) Luminal NH4+ is partially reabsorbed in the thick ascending limb and the NH3 then recycled within the renal medulla;

31
Q

What is the 3rd and final step in ammonium excretion?

A

(3) the medullary interstitial NH3 reaches high concentrations that allow NH3 to diffuse into the tubular lumen in the medullary collecting tubule where it is trapped as NH4+ by
secreted H+.

32
Q

What mediates NH4+ secretion?

A

the Na/H antiporter, which can also transport NH4+ in place of H

33
Q

What is the main base excreted in a western diet?

A

citrate

34
Q

What is the most effective chelator of calcium in the urine?

A

Citrate is a urinary base and represents the main mode of base excretion under normal circumstances. In addition to its impact on overall base excretion, the 1:1 Ca+2: Citrate-3 complex has a very high association constant and solubility. The latter properties render citrate the most effective chelator of calcium in the urine, which prevents its precipitation with phosphate and oxalate.

35
Q

Where is citrate reabsorbed?

A

the proximal tubule by Na dependent dicarboxylic acid symporter

36
Q

What effect does metabolic acidosis have on citrate metabolism?

A

In the face of metabolic acidosis there is an adaptive increase in uptake and metabolism of citrate within the proximal tubule. This reduces the excretion of base in the urine and helps maintain acid-base status during metabolic acidosis, since the increased reabsorption of citrate is equivalent to a decrease in base excretion.

37
Q

What is the major fraction of proximal tubular bicarb reabsorption dependent on?

A

The major fraction of proximal tubular HCO3- reabsorption
occurs as a result of H+ secretion via the Na+/H+ antiporter located in the apical membrane of the cells. Consequently, factors that regulate Na+ homeostasis alter HCO3- reabsorption secondarily.

38
Q

What effect does ECF expansion have on bicarb reabsorption?

A

expansion of the ECF, which inhibits

proximal tubular Na+ reabsorption, also decreases the reabsorption of HCO3-.

39
Q

When ECF is decreased, what happens to bicarb reabsorption?

A

enhanced

40
Q

What hormone is an important regulator of bicarb in the CCD?

A

aldosterone

41
Q

What effect does aldosterone have on bicarb reabsorption?

A

Aldosterone
stimulates H+ secretion by the intercalated cells of the collecting duct. This effect reflects both the direct action of the hormone on the intercalated cell and an indirect effect via aldosterone stimulation of Na+ reabsorption by the principal cell. Na+ reabsorption by the principal cells of the collecting duct produces a lumen-negative transepithelial voltage. When Na+ reabsorption is stimulated by aldosterone, the magnitude of the lumen-negative voltage is increased. This, in turn, favors α-intercalated cell H+ secretion.

42
Q

How does aldosterone stimulate intercalated cell H secretion?

A

stimulates synthesis of H+ ATPase pumps and their insertion

43
Q

What effect does metabolic acidosis have on bicarb absorption? acid?

A

Metabolic Acidosis Stimulates bicarbonate absorption and acid excretion

44
Q

What effect does respiratory acidosis have on bicarb absorption? acid?

A

Respiratory Acidosis Stimulates bicarbonate reabsorption and acid excretion

45
Q

What effect does metabolic alkalosis have on bicarb absorption? acid?

A

Reduces bicarbonate reabsorption and acid excretion

46
Q

What effect does respiratory alkalosis have on bicarb absorption? acid?

A

Reduces bicarbonate reabsorption and acid excretion

47
Q

What effect does volume contraction have on bicarb absorption? acid?

A

Stimulates bicarbonate reabsorption and acid excretion

48
Q

What effect does volume expansion have on bicarb absorption? acid?

A

Reduces bicarbonate reabsorption and acid excretion

49
Q

What effect does aldosterone have on bicarb absorption? acid?

A

Stimulates bicarbonate reabsorption and acid excretion

50
Q

What effect does hypokalemia have on bicarb absorption? acid?

A

Stimulates bicarbonate reabsorption and acid excretion

51
Q

What effect does Angiotensin II have on bicarb absorption? acid?

A

Stimulates bicarbonate reabsorption and acid excretion

Renal (28 decks)

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