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CC2 > Kidneys, Water Balance and Electrolytes 1 > Flashcards

Kidneys, Water Balance and Electrolytes 1 Flashcards

Lecture

1
Q

major site of water reabsorption

A

proximal tubule

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2
Q

how is water filtered and reabsorbed

A

through osmosis

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3
Q

it reabsorbs ions more than water

A

loop of henle

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4
Q

if ions are reabsorbed than water in the loop of henle what happens to the medulla and tubular fluid

A

medulla - concentrated
tubular fluid - diluted

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5
Q

it controls the insertion of aquaporin water that are necessary for water reabsorption in the collecting duct

A

ADH

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6
Q

ADH Synonym

A

Vasopressin, argipressin, or arginine vasopressin (AVP)

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7
Q

makes ADH

A

Posterior pituitary

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8
Q

looped blood vessels which maintain the concentrated nature of the medullary interstitium

A

Vasa recta

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9
Q

most ideal substance for glomerular filtration rate

A

INULIN or LOTHALAMATE (lo)

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10
Q

considered as the reference method and most accurate test for glomerular filtration rate

A

Clearance of Inulin

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11
Q

measure of its solute/water ratio (amount of dissolved particles)

A

osmolality of body fluid

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12
Q

best method to determine maximal concentration and dilution of urine

A

urine osmolality

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13
Q

major extracellular cation

A

chloride

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14
Q

measures the effective renal plasma flow (ERPF) in the absence of tubular functional impairment

A

Para aminohippurate clearance

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15
Q

most common substance used to assess secretory function of renal tubules

A

PAH clearance

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16
Q

reference method for ERPF

A

PAH clearance

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17
Q

Normal range of PAH clearance

A

600-700 ml/min

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18
Q

2 important properties of ECF

A

ECF volume and ECF osmolality

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19
Q

directly dependent on the sodium content

A

ECF volume

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20
Q

regulated by the levels of sodium and associated anion, glucose, urea, and proteins

A

ECF osmolality

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21
Q

conditions that stimulates juxtaglomerular (IG) cells of the kidneys to release renin

A

hyponatremia, hypotension or potassium increase in blood (hyperkalemia)

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22
Q

pure water loss or deficit

A

dehydration

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23
Q

leads to increased ECF osmolality

A

dehydration

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24
Q

Osmolality: blood diluted = __________

A

decrease osmolality

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25
Q

Osmolality: blood concentrated = ___________

A

increased osmolality

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26
Q

explain the mechanism of dehydration on plasma or ECF volume

A

in dehydration, it has less effect on the plasma or ECF volume since the body easily compensates for the fluid loss by recruiting water from ICF

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27
Q

pure water loss _________total body water but the __________ remains normal

A

pure water loss lowers total body water but the total body sodium remains normal

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28
Q

has greater effect on ECF or plasma volume

A

Water and sodium loss

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29
Q

it takes place especially in isotonic fluid loss

A

hypovolemia

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30
Q

what are the different types of water and sodium losses and its associated condition/happenings/symptoms

A
  1. hypernatremic dehydration - water and food deprivation, excessive sweating, osmotic diuresis
  2. normonatremic dehydration - vomiting, diarrhea
  3. hypernatremic dehydration - diuretic therapy, salt-wasting renal disease, adrenocortical insufficiency
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31
Q

excessive intake of water and reabsorption of water

A

overhydration

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32
Q

major determinant of plasma osmolality

A

sodium

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33
Q

the only fluid compartment that is accesible for analysis

A

plasma

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34
Q

essential at the tissue-interstial fluid interface where they provide the colloid osmotic pressure (oncotic pressure)

A

Proteins

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35
Q

normal values of serum osmolality

A

285-319 mOsmol/kgH2O

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36
Q

seen in polydipsia

A

hypoosmolality

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37
Q

seen in excessive water loss

A

serum hyperosmolality

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38
Q

measures urine osmolality using osmometer or cryoscope

A

osmometry

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39
Q

refers to difference between the calculated osmolality using the equation (lowr) and the measured osmolality using any direct method (higher)

A

delta osmolality

40
Q

this is used to evaluate acute ill or comatose patients

A

DELTA OSMOLALITY

41
Q

delta osmolality: values considered a poor prognosis

A

> 40 mOsmol/kgH2O

42
Q

cause of increased delta osmolality

A

PEA:
Poison
Ethanol Overdose
Azotemia

43
Q

caused by toxic alcohols, mannitol, and lorazepam infusions

A

osmolol gaps

44
Q

it causes large osmolar gap but does not cause an anion gap metabolic acidosis

A

isopropyl alcohol

45
Q

refer to the renal failure index and the fractional sodium excretion, respectively.

A

RFI and FeNa

46
Q

used to differentiate between pre-renal and renal
cause of acute renal failure.

A

RFI and FeNa

47
Q

RPL FeNa 1.0

A

pre-renal failure

48
Q

RFI/FeNa >2.0

A

parenchymal renal failure e.g., acute tubular necrosis

49
Q

evaluates the concentration and diluting ability of
kidneys

A

OSMOL CLEARANCE

50
Q

what does osmol clearance measures

A

measure the amount of water cleared from the plasma resulting in urine that has the same osmolality as the plasma

51
Q

for concentration and dilution ability of the kidneys and it is calculated as the difference between the total urine
volume and the osmol clearance.

A

FREE WATER CLEARANCE

52
Q

positive free water clearance

A

urine is diluted compared to serum

53
Q

negative free water clearance

A

urine is concentrated compared to serum

54
Q

plasma osmolality is increased during?

A

Dehydration
Alcohol intoxication
Diabetes insipidus
Hypercalcemia
Administration of osmotically active drugs [e.g.,
mannitol]

55
Q

plasma osmolality is decreased during?

A

Water intoxication (polydipsia)
Inappropriate retention of water in the kidney (SIADH and ectopic secretion of ADH)
In bronchogenic cancer lymphosarcoma

56
Q

indirect measure of ADH content

A

OVERNIGHT WATER DEPARTMENT TEST

57
Q

explain the steps involved in overnight water department test and what happens in patient with ADH deficiency and normal ADH response.

A

1.Water is withheld from the patient for 8 hours.
2. A series of timed blood and urine samples is then obtained as well as the weight of the patient.
3. Osmolalities of the samples are determined.
4. Patients with ADH deficiency: should show increasing serum osmolality and decreasing urine osmolality over the time tested.
5. Patients with normal ADH responses should not have weight losses greater than 3% and the decrease in water intake should stimulate the release of ADH.

58
Q

functions of electrolytes:

A

Maintenance of osmotic pressure and hydration e.g., sodium

Buffering functions e.g., HCO,

Activators in enzyme reactions e.g., Mg

Normal neuromuscular excitability e.g., Ca

Redox reaction (electron transport) e.g., Fe

59
Q

refers to the difference between the sums of the concentrations
of the principal cations (e.g., Na and K) and of the principal anions (e.g., Cl and HCO3-).

A

ANION GAP

60
Q

can be used in the quality control of automated analyzers.

A

anion gap

61
Q

An abnormal anion gap in healthy individuals
suggests an___________________.

A

instrument problem

62
Q

NV:
AG= Na-(Cl + HCO3-)

A

7-14 mmol/L

63
Q

NV:
AG = (Na + K)-(CI + HCO3-)

A

10-18 mmol/L

64
Q

anion gap is increased in:

A

Ketoacidosis (starvation or diabetes)

Uremia

Methanol

Aspirin or ethylene glycol poisoning (lots of acid metabolites produced), severe dehydration

Lactic acidosis

65
Q

anion gap is decreased in:

A

multiple myeloma
instrument error
protein error

66
Q

most abundant cation in the extracellular fluid. It accounts for about 92% of the osmotically active solutes in the plasma.

A

SODIUM

67
Q

main functions of sodium

A

water pull e.g., osmotic
activity of extracellular fluid

blood volume regulation,

neuromuscular excitability.

68
Q

level of sodium is regulated by:

A
  1. diet
  2. kidney
  3. RAA
  4. Atrial natriuretic factor (ANF)
69
Q

normal value of sodium in the ECF and ICF:

A

extracellular fluid is 135-145 mmol/L

intracellular fluid 4-10 mmol/L

70
Q

seen in dehydration, azotemia, burns, diarrhea, vomiting, salt-losing nephropathies excessive use of diuretics, congestive heart failure, and SIADH(syndrome of inappropriate antidiuretic hormone hypersecretion).

A

Hyponatremia

71
Q

seen in excessive sweating, diarrhea and renal loss and diabetes insipidus. May also be iatrogenic such as use of certain diuretics.

A

Hypernatremia

72
Q

a colorimetric method test involves combining sodium with zinc uranyl acetate to produce sodium uranyl acetate precipitate.

A

Albanese-Lein

73
Q

Addition of water to the sodium uranyl acetate precipitate produces ________________

A

produces a yellow solution.

74
Q

major intracellular cation and 20 times greater in concentration inside the cells than outside.

A

POTASSIUM

75
Q

Normal values of potassium in serum samples

A

3.8-5.0 mmol/L.

76
Q

elevated levels of potassium
(>7.5 mmol/L) can

A

inhibit irritability of muscles, including the heart that may lead to paralysis or cessation of heartbeat

77
Q

Low serum potassium (<3.0 mmol/L) may cause

A

increase muscle irritability and cause cessation of the heartbeat during systole.

78
Q

primary organ responsible for controlling extracellular
potassium

A

kidney

79
Q

minor regulator of potassium homeostasis.

A

gut

80
Q

where potassium is secreted in
exchange of sodium under the influence of aldosterone.

A

colon and the rectum

81
Q

hydrogen ions tend to be secreted in preference to the potassium resulting in hyperkalemia.

A

Acidosis

82
Q

fewer hydrogen ions are available for excretion. As a result potassium secretion is favored. Hydrogen ions also move from the intracellular fluid
to the ECF while potassium moves from the ECF to
the ICF.

A

Alkalosis

83
Q

during acidosis, what happens to potassium and hydrogen ions

A

Potassium moves into the extracellular fluid as
hydrogen ions are buffered into the cells.

84
Q

during alkalosis, what happens to potassium and hydrogen ions

A

Hydrogen ions move from the intracellular fluid to the ECF while potassium moves from the ECF to the ICF.

85
Q

normal serum concentrations of potassium

A

3.5 to 5.5 mmol/L.

86
Q

major extracellular anion

A

chloride

87
Q

decreased bicarbonate is
accompanied by a high chloride.

A

during metabolic acidosis

88
Q

selectively admits all halogen ions but only bromide can possibly cause interference.

A

Chloride: ISE method

89
Q

The membrane of the chloride ISE is a composite of ______ and _________

A

silver sulfide and silver chloride.

90
Q

provides an accurate measure of the time of the current flow or, when properly calibrated, can give a direct read-out of the chloride concentration.

A

coulometric-amperometric method.

91
Q

coulometric-amperometric method synonym

A

Cotlove titrator or chloridometer.

92
Q

used in some semi-automated chloride analyzers

A

Zall color reaction

93
Q

color that will occur as the next drop of mercuric nitrate is added as chloride ions are combined

A

colorless or faint pink
to violet.

94
Q

the reagent in Zall color reaction contains __________ and _________

A

mercuric tioiocyanate and
ferric nitrate

95
Q

Normal value of CSF chloride

A

115-132 mmol/L.

96
Q

normal serum chloride concentration

A

98 to
108 mmol/L.

CC2 (3 decks)

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