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Year 4 ACC > U&Es > Flashcards

U&Es Flashcards

1
Q

On average, what is the normal concentration of Na+ found in plasma?

A

142mmol/L

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2
Q

What is the normal potassium concentration in the body?

A

4mmol/L

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3
Q

What is the average concentration of bicarbonate in the body?

A

26-30mmol/L

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4
Q

What % of a men and women respectively is made up of water?

A

60% men

55% women

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5
Q

Of the water in the body, what % is extracellular and what % is intracellular?

A

65% intracellular

35% extracellular

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6
Q

What is oedema?

A

An increase in interstitial fluid

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7
Q

What are the causes of oedema? (4)

A
  1. Increased hydrostatic pressure e.g. sodium and water retention in cardiac failure
  2. Reduced oncotic pressure e.g. as a result of nephrotic syndrome with hypoalbuminaemia
  3. Obstruction to lymphatic flow
  4. Increased permeability of the blood vessel wall e.g. at a site of inflammation, cytokines lead to an increase in vascular permeability
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8
Q

Which electrolyte is primarily involved in the maintenance of effective circulating volume?

A

Sodium

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9
Q

Where are the two types of volume receptors found? (2)

A
  1. Extrarenal : in the large vessels near the heart
  2. Intrarenal : in the afferent renal arteriole, which controls the renin-angiotensin system via the juxtaglomerular apparatus
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10
Q

What is produced by the atria in the heart that responds to a rise in blood pressure?

A

Atrial natriuretic peptide (ANP) –> leads to an increase in sodium excretion

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11
Q

How does extracellular volume increase?

A

Either as a result of increased sodium and water absorption, or due to impaired excretion by the kidney.

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12
Q

What are the pathological causes of increase extracellular volume?

A
  1. Cardiac failure (reduced cardiac output and impaired perfusion of the volume receptors)
  2. Nephrotic syndrome
  3. Cirrhosis
  4. Sodium retention (drug induced e.g. NSAIDs)
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13
Q

What are the signs of interstitial volume overload? (4)

A
  1. Ankle oedema
  2. Pulmonary oedema
  3. Pleural effusion
  4. Ascites
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14
Q

What are the signs of intravascular volume overload? (3)

A
  1. Raised JVP
  2. Cardiomegaly
  3. Raised arterial pressure
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15
Q

What is the main form of treatment for increased extracellular volume?

A

Diuretics

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16
Q

What is the cause of volume depletion? (3)

A
  1. Haemorrhage (external or internal)
  2. Plasma loss in burns
  3. Loss of salt and water from the kidneys, GI tract or skin
17
Q

What are the symptoms/signs of volume depletion?

A
  1. Thirst
  2. Nausea
  3. Postural dizziness/hypotension
  4. Peripheral vasoconstriction
  5. Tachycardia
18
Q

In severe burns or peritonitis, what needs to be replaced primarily?

A

Plasma

19
Q

What is hyponatraemia in mmol/L?

A

Serum sodium <135mmol/L

20
Q

What are the causes of hyponatraemia?

A
  1. Relative water excess (most common cause)

2. Salt loss in excess of water e.g. diarrhoea

21
Q

How is it possible to determine if the hyponatraemia is a result of hypovolaemic hyponatraemia or just fluid loss as opposed to salt loss?

A

Hypovolaemic hyponatraemia would should a low urinary sodium level, as the kidneys would be trying to retain/conserve NaCl, whereas if there is true salt loss, the urinary levels of sodium would be elevated.

22
Q

What is the cause of hyponatraemia resulting from water excess in the majority of patients?

A

An overgenerous infusion of 5% glucose into post-operative patients

23
Q

In patients with which diseases is hyponatraemia a common occurrence? (hint: same as oedema patients) (3)

A
  1. Cardiac failure
  2. Nephrotic syndrome
  3. Cirrhosis
24
Q

What is the cause of hyponatraemia in patients with no evidence of fluid excess/oedema? (3)

A
  1. Syndrome of inappropriate ADH secretion (SIADH)
  2. Addison’s disease
  3. Hypothyroidism
25
Q

What is the treatment for hyponatraemia? (4)

A
  1. Treat the underlying cause
  2. Restrict water intake to 500-1000mL/day
  3. Correct magnesium and potassium deficiency
  4. If experiencing fits/coma:
    • hypertonic saline 3% (513mmol/L) at a rate of 1- 2mL/kg/h
    • furosemide
26
Q

Why is important not to correct sodium concentration too rapidly?

A

It can lead to severe neurological syndrome - central pontine myelinolysis

27
Q

How is hypernatraemia quantified?

A

Serum sodium > 145mmol/L

28
Q

What is the cause of hypernatraemia?

A

Almost always result of reduced water intake

29
Q

What are the symptoms/signs of hypernatraemia? (3)

A
  1. Confusion
  2. Nausea and vomiting
  3. Fever
30
Q

Is potassium predominantly intra or extra cellular?

A

Intracellular (only 2% extracellular)

Year 4 ACC (11 decks)

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