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MD4003 > U&E's > Flashcards

U&E's Flashcards

1
Q

Is water mainly intracellular or extracellular?

A

Intracellular

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2
Q

Is sodium mainly intracellular or extracellular?

A

Extracellular

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3
Q

Is potassium mainly intracellular or extracellular?

A

Intracellular

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4
Q

Give 2 examples of how you could loose an isotonic fluid?

A
  1. Haemorrhage

2. Fistula fluid

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5
Q

Describe the loss of isotonic fluids?

A
  • Loss from ECF
  • No change in sodium
  • No fluid redistribution
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6
Q

Give an example of how you could loose a hypotonic fluid?

A

Insensible loss (dehydration)

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7
Q

Describe the loss of hypotonic fluids?

A
  • Greater loss from ICF than ECF
  • Small increase in sodium
  • Fluid redistribution between ECF & ICF
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8
Q

Give an example of how you could gain isotonic fluids?

A

Saline drip

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9
Q

Describe the gain of isotonic fluids?

A
  • Gain is to ECF
  • No change in sodium
  • No fluid redistribution
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10
Q

Give 2 examples of how you could gain hypotonic fluids?

A
  1. Water

2. Dextrose

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11
Q

Describe the gain of hypotonic fluid?

A
  • Greater gain to ICF than ECF
  • Small decrease in sodium
  • Fluid redistribution between ECF & ICF
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12
Q

List 3 physiological compensatory mechanisms?

A
  1. Thirst
  2. ADH
  3. Renin / Angiotensin system
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13
Q

List 3 therapeutic compensatory mechanisms?

A
  1. IV therapy
  2. Diuretics
  3. Dialysis
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14
Q

What is the simple test to ascertain ADH status?

A
  • Measure plasma & urine osmolality. If Urine > Plasma = ADH active
  • Measure plasma & urine urea. If Urine&raquo_space; Plasma = water retention
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15
Q

What is the Renin-angiotensin system activated by?

A

Reduced intra-vascular volume (IVV) ie. sodium depletion or haemorrhage

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16
Q

What is the simple test to ascertain renin-angiotensin system?

A
  • Measure plasma & urine sodium

- If Urine <10mmol/L = R/A/A active

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17
Q

What happens if you replace 2L of lost isotonic fluid with hypotonic fluid?

A
  • Fall in sodium

- Fluid redistribution

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18
Q

What happens if you replace 2L of lost isotonic fluid with isotonic fluid?

A
  • No change in sodium

- No fluid redistribution

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19
Q

What happens if you replace 3L of hypotonic fluid with hypotonic fluid?

A
  • Sodium is restored

- Fluid redistribution

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20
Q

What happens if you replace 3L of hypotonic fluid with isotonic fluid?

A
  • Sodium slightly increased

- No fluid redistribution

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21
Q

What is urea?

A

Normal breakdown product of protein metabolism

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22
Q

Describe how Urea is important to monitor?

A
  • In dehydration often first to show change

- Sodium and urea concentrations will often parallel each other during fluid correction

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23
Q

When is urea usually elevated?

A
  • CCF
  • Shock
  • MI
  • Severe burns
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24
Q

What is creatinine?

A

Breakdown product of protein and muscle

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25
Q

What happens to urea and creatinine during loss of renal function?

A
  • Decreased filtered volume

- Increased plasma urea & creatinine

26
Q

What is GFR?

A

(Glomerular Filtration Rate) is the volume of fluid passing through the glomerulus, in a given period of time

27
Q

What does a decrease in GFR usually precede?

A

Renal failure in all forms of progressive kidney disease

28
Q

What is GFR influenced by?

A
  • Renal perfusion pressure
  • Renal vascular resistance
  • Glomerular damage
  • Post- glomerular resistance
29
Q

What is eGFR based on?

A

Creatinine

30
Q

What are the 3 possible diagnosis’s for hypovolaemia and >20 urine sodium levels?

A
  1. Diuretics
  2. Addison’s
  3. Sodium losing nephritis
31
Q

What are the 3 possible diagnosis’s for hyponatraemia, hypovolaemia and <20 urine sodium levels?

A
  1. Vomiting
  2. Diarrhoea
  3. Skin loss
32
Q

What are the 2 possible diagnosis’s for hyponatraemia with oedema?

A
  1. CCF cirrhosis

2. Nephrosis

33
Q

What are the 3 possible diagnosis’s for hyponatraemia, euvolaemic with >20 urine sodium levels?

A
  1. SIADH
  2. Drugs
  3. CRF
34
Q

What are the 3 possible diagnosis’s for hyponatraemia, euvolaemic with <20 urine sodium levels?

A
  1. Stress
  2. Post surgery
  3. Hypothyroid
35
Q

Does plasma potassium reflect the body potassium?

A

NO! Small proportion of total potassium is in the plasma

36
Q

How is the total body potassium determined?

A

By total cell mass

37
Q

Describe the relationship between potassium and hydrogen ions?

A
  • Exchange across cell membrane

- Both bind to negatively charger proteins

38
Q

What happens to potassium during acidosis?

A

Moves out of cells –> Hyperkalaemia

39
Q

What happens to potassium during alkalosis?

A

Moves into cells –> Hypokalaemia

40
Q

What are the 3 artifactual causes of hyperkalaemia?

A
  1. Delay in sample analysis
  2. Haemolysis
  3. Drug therapy- excess intake
41
Q

What are the 2 renal causes of hyperkalaemia?

A
  1. Acute renal failure

2. Chronic renal failure

42
Q

What are the 2 mineralocorticoid dysfunctional causes of hyperkalaemia?

A
  1. Adrenocortical failure

2. Mineralocorticoid resistance ie. spironolactone

43
Q

What is the cell death cause of hyperkalaemia?

A

Cytoxic therapy

44
Q

What are the 5 treatments for hyperkalaemia?

A
  1. Correct acidosis if this is the cause
  2. Stop unnecessary supplements/intake
  3. Give glucose & insulin (drives K into cells)
  4. Ion exchange resins (GIT K binding)
  5. Dialysis
45
Q

What are the 3 increased urine loss causes of potassium depletion?

A
  1. Diuretics/osmotic diuresis
  2. Tubular dysfunction
  3. Mineralocorticoid excess
46
Q

What are the 3 GIT loss causes of potassium depletion?

A
  1. Vomiting
  2. Diarrhoea/laxatives
  3. Fistulae
47
Q

What are the 2 hypokalaemia without depletion causes?

A
  1. Alkalosis

2. Insulin/ glucose therapy

48
Q

What does acute potassium depletion changes in ICF/ECF ratios cause?

A
  • Lethargy
  • Muscle weakness
  • Heart arrhythmias
49
Q

What does chronic potassium losses from the ICF cause?

A
  • Lethargy
  • Muscle weakness
  • Heart arrhythmias
  • Polyuria
  • Alkalosis
  • Vascular & gut problems
50
Q

What signs in the history could suggest potassium depletion?

A
  • Diarrhoea, vomiting, drugs (diuretics, digoxin)
  • Symptoms of lethargy / weakness
  • Cardiac arrythmias
51
Q

What signs in the electrolyte investigation could suggest potassium depletion?

A
  • Hypokalaemia

- Alkalosis (raised HCO3)

52
Q

What are the 2 possible treatments of potassium depletion?

A
  1. Oral- 48mmol/day & diet

2. IV- <20mmol/L

53
Q

In what 4 cases would you monitor plasma potassium regularly?

A
  1. Diuretic therapy
  2. Digoxin use
  3. Compromised renal function
  4. In support of IV resuscitation (eg DM Ketacidosis)
54
Q

What would the U&E’s appear like in intra-renal failure?

A
  • Increased creatinine
  • Increased urea
  • Increased K
  • Increased H
  • Decreased HCO3
  • Metabolic acidosis
55
Q

Describe the U&E’s of hypovolaemia/dehydration?

A
  • Increased urea
  • Increased creatinine
  • Increased haematocrit
  • Decreased urine volume
56
Q

What is Addison’s disease?

A

Primary adrenocortical insufficiency

57
Q

Describe the electrolytes in Addison’s disease?

A
  • Decreased Na
  • Increased K
  • Increased Ca
58
Q

What is Cushing’s syndrome?

A

Excess plasma cortisol

59
Q

Describe the electrolytes in Cushing’s syndrome?

A
  • Increased Na
  • Decreased K
  • Decreased Ca
60
Q

Describe the electrolytes in Conn’s syndrome?

A
  • Increased/Normal Na

- Decreased K

61
Q

What can cause increased urea, but normal creatinine?

A
  • Dehydration
  • GI haemorrhage
  • High protein diet

MD4003 (22 decks)

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