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Physiology Part 2 > Lec46_Na_Handling > Flashcards

Lec46_Na_Handling Flashcards

1
Q

Are salt and water regulated together or independently?

A

independently

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2
Q

What general thing regulates water balance?

A

ADH [which responds to plasma osmolarity and volume status]

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3
Q

What general thing regulates salt balance?

A

volume [by things that responds to changes in blood volume]

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4
Q

What 4 things regulated Na?

A
  • aldosterone
  • ANP
  • sympathetics
  • angiotensin II
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5
Q

What regulates K?

A

adrenal cortex –> aldosterone release which causes K secretion from principal cells

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6
Q

what regulates pCo2/pO2?

A

chemoreceptors –> changes in ventilation

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7
Q

What regulates Ca?

A

Ca-sensing receptor on parathyroid hormone [PTH]

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8
Q

What regulates cortisol?

A

pituitary feedback

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9
Q

What are 3 things that increase Na in body? What are they released in response to?

A

Aldosterone
Sympathetic nerves
Angiotensin II

  • they are responding to changes in MAP or body volume not Na level
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10
Q

What percent of serum osmolality does Na and counter ion account for?

A

97% [280 of 300ish]

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11
Q

What will increasing plasma Na do to H2O in vasculature?

A
  • increasing plasma Na moves H2O into vasculature

- leads to decreases H2O excretion

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12
Q

What is normal serum K?

A

4 mEq/L

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13
Q

What is normal serum Hgb?

A

15 g/dL

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14
Q

What is normal serum Na?

A

140 mEq/L

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15
Q

Does serum Na measure concentration or total Na level?

A

concentration

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16
Q

Does the body see serum Na?

A

No – it just sees serum osmolarity

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17
Q

What is normal Na handling after you ingest a lot of Na?

A
  • ingest Na
  • increase serum Na
  • increase plasma osmolarity
  • get compensatory mech to restore normal osmolarity
18
Q

What are the 2 initial compensation mech for increased Na [increased osmolarity] in plasma?

A
  • increased ADH –> increase water retention

- thirst –> increase water intake

19
Q

What are 6 specific compensatory mech for increased blood volume?

A
  1. higher BP: increased RBF and same GFR –> causes lower FF
  2. Higher NaCl sensed at macula densa: causes decreased renin realse and thus decreased angiotensin II and aldosterone
  3. less Na reabsorbed in collecting duct
  4. decreased oncotic pressure in PTC so less favorable gradient for H2O reabsorption
  5. less Na reabsorbed in principal cells
  6. increased ANP
20
Q

What is net result of compensatory mech responsible for increased blood volume?

A
  • increase water and Na excretion to return to normal BV
21
Q

What happens to plasma osmolarity, ADH, water balance, volume status, urinary salt excretion when excessive Na ingestion?

A

plasma osm: initial increase
ADH: initial increase
water balance: initial increased intake [thirst]
volume status: hypervolemia
urinary salt excretion: increased [to return normal V]

22
Q

How much Na secretion when you are hypovolemic?

A
  • excrete little Na because you are trying to retain volume of H2O that comes with it
  • increased RAA, decreased ANP, increased sympathetics
23
Q

What are ADH and RAA levels in hypovolemia?

A
  • ADH and RAA both eleveated
24
Q

What is treatment for hypovolemic hypernatremia?

A
  • replace slat and water to fix hypovolemia and electrolyte imbalance
  • ex. give normal saline
25
Q

What does hypovolemic hypernatremia mean?

A
  • salt deficit but even bigger H2O deficit
26
Q

Do people with access to water become hypernatremic

A

very rarely

27
Q

What is normal handling of water ingestion?

A
  • ingest water
  • get decrease in serum Na conc
  • decrease plasma osmolality
  • ADH release suppressed
    dilute urine excreted
28
Q

What is minimum urine osmolatiry?

A

50 mosm/L with no ADH

29
Q

What is max amount of maximally dilute urine you can excrete per day?

A

16 L water/day

30
Q

If you ingest more than 16 L/day of water without ingesting osmoles how much urine will you excrete?

A
  • you will excrte 16 L of urine

- you will retain water beyond that

31
Q

If you are hypervolemic will you retain or secrete Na?

A

secrete Na regardless of hyper vs hypo natremia

  • because you sense high volume which causes you to want to get rid of salt/water
32
Q

If you consume a bunch of water why aren’t you necessarily hypertensive or swollen?

A
  • the increased water you consume doesn’t necessarily stay into the vasculature
33
Q

How do you get mOsm from Na conc of blood?

A

mOsm is [Na]*2

ex. Na = 115 mEq/L, mosm = 2*115 = 230 mOsm/L

34
Q

How much of water is in intercellular space?

A

60%

35
Q

How much of water is in interstitial space?

A

32%

36
Q

How much of water is in blood volume?

A

8%

37
Q

What is source of side effect confusion in excess water intake?

A
  • get extra water
  • some of that water goes into cells to equalize osmolarity
  • brain is in skull so brain starts to swell like everywhere else but there is no space for it to happen
  • get cerebral edema
38
Q

What is primary polydipsia?

A
  • too much water intake in excess of consumed salt

- get hypervolemic, hyponatremic, secrete lots of Na in urine

39
Q

What is treatment for primary polydipsia?

A

water restriction [maybe also hypertonic saline]

40
Q

What is euvolemia?

A

too much water, normal salt

- primary polydipsia

41
Q

What is hypovoluemia?

A

too little water but even lower salt

- GI/kidney loss

42
Q

what is hypervolemia?

A

too much water and salt but more water than salt

- CHF, cirrhosis

Physiology Part 2 (19 decks)

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