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Renal > SM 199 > Flashcards

SM 199 Flashcards

1
Q

What are the recommended sodium intake values for men and women?

A

Both are recommended 1500mg

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2
Q

What is the normal value for Na?

A

140

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3
Q

What is the normal value for Cl?

A

102

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4
Q

What is the normal value for BUN?

A

10-20

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5
Q

What is the normal value for K?

A

4.0

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6
Q

What is the normal value for HCO3?

A

24

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7
Q

What is the normal value for Cr?

A

1.0

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8
Q

What is the normal value for Glucose?

A

60-100

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9
Q

What percent of total body weight is water?

A

60%

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10
Q

What fraction of total body water is intracellular water?

A

2/3 of total body water (ergo 40% of total body weight is ICF)

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11
Q

What fraction of total body water is extracellular water?

A

1/3 of total body water (ergo 20% of total body weight is ECF)

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12
Q

What portion of ECF is intravascular?

A

1/4 of ECF (ergo 5% of total body weight is plasma)

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13
Q

What potion of ECF is extravascular?

A

3/4 of ECF (ergo 15% of total body weight is interstitial fluid)

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14
Q

What component of body water is sensed and regulated by the Kidney?

A

Intravascular ECF = plasma = regulated by kidney

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15
Q

Is the barrier between the blood and interstitial fluid permeable?

A

Yes

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16
Q

Is the barrier between the interstitial fluid and ICF permeable?

A

No

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17
Q

What is the main ion in the ECF?

A

Sodium

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18
Q

What should you give if you want to treat dehydration?

A

Give D5W

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19
Q

What should you give if you want to treat volume depletion?

A

Give sodium containing fluid like Normal Saline or Lactate Ringers

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20
Q

How do volume depletion and dehydration differ?

A

Volume depletion refers to poor perfusion of an organ, while dehydration refers to a lack of water

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21
Q

Why can pure water not be administered?

A

Pure water is hypotonic to the cells and would cause cell lysis

Need to use a solution around serum osmolality

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22
Q

What is the equation and normal range for serum osmolality?

A

Serum Osmolality = 2*Na + BUN/2.8 + Glucose/18

Normal range = 285 - 295

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23
Q

How many grams of Dextrose are in D5W, and at what osmolarity?

A

In 1L water, 5% Dextrose = 50gm of Dextrose

Corresponds to osmolarity of 278

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24
Q

How does D5W deliver sugar?

A

The Dextrose is metabolized by the body, leaving only water to be distributed among compartments

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25
Q

How does adding D5W change ICF and ECF, and why?

A

Adding 1L of D5W results in 667mL in the ICF and 333mL in the ECF

D5W is essentially just water and distributes where the water is normally partitioned among the body (2/3 ICF and 1/3 ECF)

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26
Q

Does adding D5W add water to the plasma?

A

Yes, but < 100mL if 1L of D5W was added

1L of D5W sends 333mL to the ECF, of which 1/4 goes to the plasma and 3/4 to the Interstitial Fluid

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27
Q

How many grams of Saline are in Normal Saline, and what is the osmolarity?

A

Normal Saline = 0.9% Saline, so in 1L of water 9g of Saline

9g of Saline corresponds to an osmolarity of 308, of which the osmolarity of sodium is 154 and the osmolarity of chloride is 154

28
Q

What is normal saline used for?

A

Normal Saline is used to expand the extracellular compartment

29
Q

How does Normal Saline distribute between the ECF and ICF?

A

Adding 1L of Normal Saline results in all 1L going to the ECF and 0L going to the ICF, because the solution is mostly isotonic (308 NS is almost the same as 290 for ICF)

30
Q

Does Normal Saline significantly effect the plasma?

A

Yes, if 1L of NS is given the plasma will expand by 250mL because NS is isotonic and all of the solution goes to the ECF, where 1/4th is sent to the Plasma and 3/4th to the interstitial space

31
Q

How does Half Normal Saline distribute?

A

Half Normal Saline can be thought of as 50% pure water and 50% Normal Saline

32
Q

What are lactated ringers?

A

A “physiologic” solution preferred by surgeons because it contains Sodium, Chloride, Potassium, Calcium and Lactate which resembles the blood

33
Q

How do Lactated Ringers distribute between the ECF and ICF?

A

90% of Lactated Ringers goes to the ECF, while 10% goes to the ICF

34
Q

Which solution should be administered to maintain CO?

A

Lactated Ringers or Normal Saline, because that stays in the blood and can raise blood pressure

35
Q

What are insensible losses?

A

Insensible losses are water losses that are unavoidable and require water to replace

36
Q

What are sources of insensible losses?

A

Urine, Skin, Respiratory Tract, Stool which set the minimum water needs for a person

37
Q

What determines the rate of fluid administration when giving IVF?

A

If a patient is hemodynamically unstable, give a bolus over a short time

If a person is stable, a slower rate is acceptable to compensate for fluid loss

38
Q

What should be given if a person is volume deplete and why?

A

If a person is volume deplete, give NS or Lactated Ringers to restore ECF

39
Q

What should be given if a person is euvolemic and hyperosmotic?

A

If a person is euvolemic, their total blood volume is ok, so there is no need to raise ECF

If a person is hyperosmotic, they are dehydrated and lack water in the ICF, so give D5W

40
Q

What should be given if a person is hypovolemic and hyperosmotic?

A

In this scenario, restore volume first to maintain Cardiac Output and give Normal Saline or Lactated Ringers, and then give D5W later

41
Q

What is diuresis?

A

Producing more urine

42
Q

What is natriuresis?

A

Promoting salt excretion

43
Q

Why is the PCT not a good target for diuretics?

A

The PCT is not a good target for diuretics because other parts of the nephron will compensate for the sodium loss with increased reabsorption

44
Q

What is the common PCT diuretic?

A

Acetazolamide, a carbonic anhydrase inhibitor

45
Q

How does Carbonic Anhydrase work in the Kidneys, and why is it a diuretic target?

A

CA promotes the absorption of Bicarb and Sodium, and is targeted by Acetazolamide which results in less Sodium reabsorption and less bicarbonate reabsorption, as well as less H+ secretion

46
Q

What metabolic derangement can Acetazolamide cause?

A

Acetazolamide can cause less H+ secretion leading to a Non-Gap acidosis

47
Q

What type of acidosis does Acetazolamide cause?

A

A non-AG acidosis

48
Q

What inhibits the NKKC transporter and where?

A

Loop diuretics like furosemide inhibit the NKKC transporter in the TALH

49
Q

What are side effects of loop diuretics?

A

Volume depletion, ototoxicity, hypokalemia, hypocalcemia, and hypomagnesemia

50
Q

Which type of diuretic causes ototoxicity?

A

Hearing issues can be caused by loop diuretics because the NKKC channel has analogs in the inner ear

51
Q

Why do loop diuretics cause hypocalcemia, hypokalemia, and hypomagnesemia?

A

Hypokalemia = increased Na deliver to the CD results in a stronger driving force for K secretion

Hypocalcemia and Hypomagnesemia = loss of K leak results in the loss of a lumen-positive potential, which means there is no driving force for Mg and Ca paracellular absorption

52
Q

Which type of diuretic is used for rapid diuresis of volume overload?

A

Loop diuretics like Furosemide

53
Q

Which type of diuretic requires BP and lab followup in 1 week?

A

Loop diuretics, because they are powerful

54
Q

Why are Loop Diuretics so powerful?

A

Loop diuretics block Na and Cl reabsorption in the TALH, disrupting blood pressure via Na reabsorption losses as well as by weakening the medullary ionic gradient

As a result, the Kidney loses some of it’s ability to concentrate urine and reabsorb water, because less Na and Cl is being reabsorbed and transported into the interstitium

55
Q

Which class of diuretics inhibits the Na-Cl symporter, and where?

A

Thiazides like HCTZ inhibit the NaCl symporter in the DCT, lowering Sodium reabsorption

56
Q

Why is hypercalcemia a potential side effect of Thiazide diuretics?

A

Hypercalcemia can occur because the intracellular sodium deceases due to inhibition of the Na/Cl symporter, which potentiates the Na/Ca exchanger (less intracellular Na allows for more entry of Na from the outside and therefore more Ca efflux into the bloodstream)

57
Q

What are side effects of thiazide diuretics?

A

Thiazides can cause: impotence, hypokalemia, hyponatremia, hypercalcemia

58
Q

What is the first line diuretic of choice?

A

Thiazides normally

59
Q

What are the K sparing diuretics and why are they called that?

A

K sparing diuretics impede potassium excretion in the CD, hence the name

Triamterene, Amiloride, Spironolactone, Eplerenone

60
Q

Which K sparing diuretics inhibit eNaC?

A

Amiloride and triamterene inhibit eNaC, preventing Na reabsorption across the apical membrane of the CD and disrupting the negative lumen potential needed for K excretion

61
Q

Which K sparing diuretics inhibit the Mineralocorticoid Receptor?

A

Spironolactone and Eplenerone, which prevent Aldosterone from binding and therefore inhibit K excretion and well as Na reabsorption

62
Q

Why is the collecting tubule a good target for diuretics?

A

Since the Collecting Tubule is farther along the nephron, there is no chance for compensation - it is a site of “fine tuning”

63
Q

What are side effects of Amiloride and Triameterene?

A

Hyperkalemia, nasuea

64
Q

What are side effects of Spironolactone?

A

Hyperkalemia, gynecomastia

65
Q

What are side effects of Eplenerone?

A

Hyperkalemia, NO gynecomastia

66
Q

How do Spironolactone and Eplenerone differ?

A

Spironolactone can cause gynecomastia and is cheap, while Eplenerone does not cause gynecomastia but is more expensive

67
Q

When should a K sparing diuretic be given?

A

Second line to further diurese someone and prevent hypokalemia

Renal (19 decks)

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