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Endocrine > Sodium and water balance > Flashcards

Sodium and water balance Flashcards

1
Q

How does ADH work?

A

Causes water to be reabsorbed from the renal tubules
Increased ADH results in a small volume of concentrated urine
Decreased ASH results in a large volume of dilute urine

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2
Q

How is urine conc measured?

A

Urine osmolality
Concentrated urine = high osmolality
Dilute urine = low osmolality

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3
Q

What is mineralocorticoid activity?

A

The effects of steroids on sodium balance - refers to sodium reabsorption in renal tubules in exchange for potassium/hydrogen

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4
Q

What steroids have mineralocorticoid activity?

A

Aldosterone

Cortisol

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5
Q

What occurs with high levels of mineralocorticoids?

A

Sodium gain and vice versa

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6
Q

What is the normal conc levels?

A

135-145 mmol/mol

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7
Q

What is the equation for sodium?

A

Na+ = mmol Na+/ ILH2O

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8
Q

What can cause hyponatraemia?

A

Low sodium

Water retention

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9
Q

What can cause hypernatraemia?

A

High sodium

Water loss

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10
Q

What is the relative concs of sodium in and out of the cell?

A

140mmol/mol in the interstitial fluid

4 mmol/mol in the intracellular compartment

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11
Q

Where can water be lost from?

A

All body compartments. Loss/gain of water is from/to the whole body

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12
Q

Where can sodium be lost and gained from?

A

Confined to the ECF - pump in the plasma membrane

Sodium loss or gain is solely from/to the ECF

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13
Q

What does water follow?

A

Sodium - if you gain/lose sodium from the ECF then you will lose/gain water with it

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14
Q

What will happen if the ECF volume is too high?

A

The kidneys will secrete more Na and therefore you will lose water

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15
Q

What are the symptoms of low sodium?

A 
Postural decrease in BP
Increased pulse
Dry mucous membranes
Sunken eyeballs
Decreased skin turgor
Decreased consciousness
Decreased urine output
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16
Q

What are the symptoms of hypernatraemia?

A 
Coughing
Tiredness
SOB
Pulmonary oedema
Heart failure
Ankle oedema
Ascites
17
Q

What causes increased sodium loss?

A

Adrenal glands
Gut - N+V, IBD fistula
Skin - burns, TEN
Reduced sodium intake

18
Q

What can cause a decreased water excretion?

A

SIADH

19
Q

What can cause an increased sodium level?

A

Some IV meds
Near-drowning
Malicious

20
Q

What can cause an increased water loss?

A

Diabetes insipidus

Decreased water intake - very young and old

21
Q

How can you give sodium to a patient?

A

Form of saline

Can give dioralyte in D+V

22
Q

Why do you not give pure water IV?

A

Red blood cells would lyse

Give 5% dextrose

23
Q

What compartments with dextrose enter?

A

Plasma
Interstitial fluid
Intracellular fluid compartment

24
Q

What compartments will saline enter?

A

Plasma

Interstitial fluid

25
Q

What constitutes a low and high sodium?

A

Less than 120 mmol/L

Over 160 mmol/L

26
Q

What are the symptoms of abnormal sodium levels?

A 
Altered consciousness
Confusion 
Nausea
Vomiting
Fitting
27
Q

What are the 2 stimuli for ADH release?

A

Osmotic

Non-osmotic (disease)

28
Q

What are examples of non-osmotic stimuli of ADH release?

A

Hypovolaemia
Hypotension
Pain
N+V

29
Q

What forces act on the capillary for fluid balance?

A

Hydrostatic inside the capillary pushing fluid out

Oncotic on the outside pushing fluid into the capillary

30
Q

What does oedema signify?

A

An effective circulating volume depletion - an altered balance of starling forces at capillary level

31
Q

What is high in an oedematous patient?

A

Too much sodium and water

32
Q

How is oedema treated?

A

Loop diuretics - loss of sodium and water

33
Q

What electrolyte balance will addisons disease present with?

A

Low sodium and high potassium

Increased pigmentation

34
Q

Why does addisons disease result in low sodium and increased potassium?

A

Adrenal insuffience so lack of mineralocorticoud activity

Can’t retain sodium in kidneys so lose sodium and water from ECF

35
Q

Why are patients pigmented in addisons?

A

Excess ACTH from pituitary which is degraded by proteases exposing MSH

36
Q

What controls sodium and water?

A

Mineralocorticoid activity retains sodium

ADH release and action retains water

Endocrine (35 decks)

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