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T2 - Phase 2 - Systems Modules (II) > Renal - Calcium, Sodium, and Potassium > Flashcards

Renal - Calcium, Sodium, and Potassium Flashcards

1
Q

What does calcium bind on the parathyroid glands to inhibit PTH synthesis?

A

Calcium sensing receptors (CaSR)

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2
Q

Chronic kidney disease may cause _________ of the parathyroid glands.

A

Chronic kidney disease may cause hyperplasia of the parathyroid glands.

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3
Q

Why may chronic kidney disease result in hyperparathyroidism?

A

Decreased serum calcium

+

increased serum phosphate

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4
Q

Serum osmolality is mainly decided by what three serum substances?

A

Sodium;

BUN;

glucose

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5
Q

Serum osmolality = _____ (Na) + (BUN) / _____ + (glucose) / _____,

A

Serum osmolality = 2 (Na) + (BUN) / 2.8 + (glucose) / 18,

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6
Q

True/False.

Total body water dictates total body sodium.

A

False.

Total body sodium dictates total body water.

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7
Q

What is the major determinant of extracellular fluid volume?

A

Serum sodium

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8
Q

Changes in what ECF ion will affect the resting potential of contractile cells?

A

K+

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9
Q

Changes in what ECF ion will affect the threshold potential of contractile cells?

A

Ca2+

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10
Q

______kalemia causes muscle weakness.

A

Hypokalemia causes muscle weakness.

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11
Q

______kalemia causes arrhythmias due to more frequent cardiac action potentials.

A

Hyperkalemia causes arrhythmias due to more frequent cardiac action potentials.

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12
Q

Epinephrine moves potassium _______ (into/out of) the cells.

A

Epinephrine moves potassium into the cells.

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13
Q

Beta blockers moves potassium _______ (into/out of) the cells.

A

Beta blockers moves potassium out of the cells.

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14
Q

The majority of K+ is reabsorbed in what part of the nephron?

A

The PCT

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15
Q

When K+ is depleted, more is reabsorbed in the ___________.

A

When K+ is depleted, more is reabsorbed in the collecting duct.

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16
Q

K+ excretion is dependent on (and fine-tuned by) ____________ K+ secretion.

A

K+ excretion is dependent on (and fine-tuned by) collecting duct K+ secretion.

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17
Q

Sustained disorders of potassium are usually _________ in origin.

A

Sustained disorders of potassium are usually renal in origin.

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18
Q

True/False.

Hyperkalemia is often associated with hyperaldosteronism.

A

False.

Hypokalemia is often associated with hyperaldosteronism.

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19
Q

Sustained hyperkalemia is often associated with what?

A

Renal failure

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20
Q

Increased distal sodium delivery and aldosterone __________ K+ secretion/wasting.

A

Increased distal sodium delivery and aldosterone increase K+ secretion/wasting

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21
Q

True/False.

Certain antibiotics can prevent potassium excretion and cause hyperkalemia.

A

True.

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22
Q

If a patient has hyperkalemia and EKG changes, the most important first step is to stabilize the ______________ via administration of ______________.

A

If a patient has hyperkalemia and EKG changes, the most important first step is to stabilize the cardiac membrane via administration of calcium gluconate.

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23
Q

A very ill patient with elevated potassium levels is found to have moderate blood on urinary dipstick with only one RBC / field on light microscopy.

What explains this presentation?

A

Rhabdomyolysis

(the moderate blood identified is actually hemoglobin!)

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24
Q
A

C.

(leading to overactive ENaC, aka Liddle syndrome)

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25
Q

Urine at an osmolarity of _________ mOsm/Kg H2O is considered ~100% dilute.

A

Urine at an osmolarity of < 100 mOsm/Kg H2O is considered ~100% dilute.

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26
Q

Urine at an osmolarity of _________ mOsm/Kg H2O is considered ~100% concentrated.

A

Urine at an osmolarity of > 1200 mOsm/Kg H2O is considered ~100% concentrated.

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27
Q

Reabsorption is still isotonic in which part of the nephron?

A

The PCT

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28
Q

Someone with hyponatremia would typically have a ____ serum osmolality (____tonic).

A

Someone with hyponatremia would typically have a low serum osmolality (hypotonic).

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29
Q

What is here described:

A high serum osmolality (hypertonic) due to hyperglycemia. Think of this hyponatremia as hyperosmotic hyponatremia secondary to hyperglycemia.

A

Translocational hyponatremia

(not a ‘true’ hyponatremia – a relative hyponatremia)

30
Q

What is here described:

A normal serum osmolality (isotonic) with associated hyponatremia due to elevated lipids or proteins (note: can be viral particles). Think of this hyponatremia as a hyponatremia secondary to hyperglycemia.

A

Isotonic hyponatremia

(pseudohyponatremia)

31
Q

Translocational hyponatremia is due to elevated serum __________.

A

Translocational hyponatremia is due to elevated serum glucose (a hyperosmotic, relative hyponatremia).

32
Q

Pseudohyponatremia (isotonic hyponatremia) is due to elevated serum __________.

A

Pseudohyponatremia (isotonic hyponatremia) is due to elevated serum lipids or proteins (a relative hyponatremia).

33
Q

Hyponatremia with hypoosmolar serum is typically due to an elevation of which hormone?

A

ADH

34
Q

A patient presents with a hypervolemic hyponatremia. Urine osmolality is < 100 mOsm/Kg, indicating low ADH.

Name two behaviors and/or conditions that could cause this presentation.

A

(1) Poor sodium/protein intake (e.g. tea and toast diet; beer potomania; etc.)
(2) Psychogenic polydipsia
* (Either way, the solvent : solute ratio is greatly elevated.)*

35
Q

If someone has true hyponatremia with a urine osmolality of _______ mOsm / Kg, think tea and toast diet, beer potomania, or primary psychogenic polydipsia. These are all disorders with too little solute and/or too much solute + __________ (preserved / decreased) ADH secretion.

A

If someone has true hyponatremia with a urine osmolality of < 100 mOsm / Kg, think tea and toast diet, beer potomania, or primary psychogenic polydipsia. These are all disorders with too little solute and/or too much solute + decreased ADH secretion.

36
Q

If someone has true hyponatremia with a urine osmolality ______ mOsm / Kg, recognize ADH is present, and we need to determine volume status.

A

If someone has true hyponatremia with a urine osmolality > 100 mOsm / Kg, recognize ADH is present, and we need to determine volume status.

37
Q

How does SIADH present in terms of volume status and serum sodium levels?

A

Euvolemic hyponatremia

38
Q

Euvolemic hyponatremia is a sign of what disorder?

A

SIADH

39
Q

Hypernatremia is almost always due to a lack of what?

A

Water

40
Q

Diabetes Insipidus will have what serum sodium presentation?

A

Normal or high

41
Q

Psychogenic polydipsia will have what serum sodium presentation?

A

Low

42
Q

A patient presents with altered mental status, a BP of 130/80 mmHg, a RR of 20, a serum sodium of 125 mEq/L, a urine osmolality of 600 mOsm/kg.

What is the most likely cause of this person’s hyponatremia?

A. SIADH

B. Decreased ECF volume

C. Heart failure

A

A. SIADH

(often associated with small cell carcinomas — check for 40-year smoking history)

43
Q

What substance is released by the body with the primary goal of decreasing serum phosphorus?

A

FGF23

44
Q

What is the primary goal of FGF23?

A

To decrease serum phosphorus

45
Q

What is tertiary hyperparathyroidism?

A

Excessive PTH secretion that is no longer regulated

(often due to chronic secondary hyperparathyroidism which results in hyperplastic, nodular parathyroid glands)

46
Q

Name a calcinomimetic that can be administered to decrease PTH secretion.

A

Cinacalcet

47
Q

True/False.

Oral paracalcitol (calcitriol) can be used to increase serum PTH levels.

A

False.

Oral paracalcitol (calcitriol) can be used to decrease serum PTH levels.

48
Q

Which will not tend to raise serum calcium or phosphates levels, cinacalcet or paracalcitol?

A

Cinacalcet

(a calcimimetic; vs. paracalcitol, a synthetic calcitriol)

49
Q

What type of medication can be used to decrease serum phosphate in an isolated manner?

A

Phosphate-binders

50
Q

Elevated serum calcium and phosphorus are associated with what main cardiovascular issue?

A

Vascular calcification

51
Q

Hyperkalemia makes resting membrane potentials _______ (more/less) negative.

Hypokalemia makes resting membrane potentials _______ (more/less) negative.

A

Hyperkalemia makes resting membrane potentials less negative.

Hypokalemia makes resting membrane potentials more negative.

52
Q

How does NaCl reabsorption increase K+ excretion?

A

By creation of a negative lumen

(Na+ reabsorption happens much faster than Cl-)

53
Q

What are the most common causes of hypokalemia?

A

Renal or GI loss

54
Q

Describe urine K+ levels in each of the following scenarios:

Hyperglycemia - _________

Diarrhea - _________

A

Describe urine K+ levels in each of the following scenarios:

Hyperglycemia - Increased

Diarrhea - Decreased

55
Q

Describe urine K+ levels in each of the following scenarios:

Vomiting - _________

A

Describe urine K+ levels in each of the following scenarios:

Vomiting - Increased (secondary hyperaldosteronism)

56
Q

Describe urine K+ levels in each of the following scenarios:

Laxatives - _________

Diuretics - _________

A

Describe urine K+ levels in each of the following scenarios:

Laxatives - Decreased

Diuretics - Increased

57
Q

Acidosis is associated with _______kalemia.

Alkalosis is associated with _______kalemia.

A

Acidosis is associated with hyperkalemia.

Alkalosis is associated with hypokalemia.

58
Q

Proximal RTA (type II) and distal RTA (type I) are associated with hypokalemia in the presence of ___________ blood pressure.

A

Proximal RTA (type II) and distal RTA (type I) are associated with hypokalemia in the presence of normal or low blood pressure.

59
Q

Proximal RTA refers to a type ____ RTA.

A

Proximal RTA refers to a type II RTA.

60
Q

Distal RTA refers to a type ____ RTA.

A

Distal RTA refers to a type I RTA.

61
Q

What effect do Gitelman’s or Bartter’s syndrome have on blood pressure?

A

Normal or decreased

62
Q

Gitelman’s syndrome mimics the effects of what medication class?

A

Thiazide diuretics

63
Q

Bartter’s syndrome mimics the effects of what medication class?

A

Loop diuretics

64
Q

Hypokalemia in the presence of hypertension typically indicates what type of disorder?

A

Hyperaldosteronism

(either primary/low-renin or secondary/high-renin)

65
Q

Liddle’s syndrome is associated with hypokalemia in the presence of _________ blood pressure.

A

Liddle’s syndrome is associated with hypokalemia in the presence of elevated blood pressure.

66
Q

Tumor lysis syndrome is associated with an abrupt increase in which serum contents?

A

Potassium;

uric acid;

phosphate

(decreased calcium)

67
Q

Aldosterone deficiency is associated with a type ____ RTA.

A

Aldosterone deficiency is associated with a type IV RTA.

68
Q

What drug can be used as a potassium-binder in patients with hyperkalemia?

A

Kayexalate

69
Q

Sustained hyperkalemia is always due to a ________ cause.

A

Sustained hyperkalemia is always due to a renal cause.

70
Q

What is the mainstay of treatment for hypernatremia?

A

Hydration

T2 - Phase 2 - Systems Modules (II) (22 decks)

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