W2- electrolyte management

Question 1

what can ACEi/ spirnolactone/NSAIDS cause

Answer 1

hyperkalemia

Question 2

what can insulin deficiency/ resistance cause

Answer 2

hyperkalemia

Question 3

what are the phyical manifestations of hyperkalemia

Answer 3

Cardiac arrhythmias

Muscular weakness

Ascending paralysis

Ileus

Death

Question 4

what can increased fluid osmolarity cause

Answer 4

hyperkalemia

Forces water out of the cell which then makes the intracellular content of K high, it then shifts extracellularly to equilibrate

Question 5

how do you treat hyperkalemia

Answer 5

Iv calcium – stabilize myocardium

Insulin

Glucose

Beta agonist

Sodium polystyrene therapy- increase fecal excretion

Saline

Hemodialysis

Question 6

what effect does hyperkalemia have on aldosterone secrection

Answer 6

upregulates it

Question 7

what can acidosis cause

Answer 7

hyperkalemia the H ions can decrease the Na/k pumps

Question 8

what can an upregulation in B adrenergic/ NE cause

Answer 8

hypocalemia because they stimulate uptake into the cells

Question 9

what can aldosterone deficiency cause

Answer 9

hyperkalemia

Question 10

what can increased aldosterone cause and how

Answer 10

hypokalemia

K shift into cells, causes renal secretion( by causing active resorption of Na in principle cells. Na/K pump in exchange secretes K) and upregulates ROMK/BK channels in principle cells

Question 11

what drives potassium secrection into filtrate

Answer 11

Basolateral Na/K antiporter brings K in. then as the intracellular K is high it passively diffuses into filtrate with the gradient created by Na/k. the luminal membrane also has high permeability for K due to ROMK and BK channels

Question 12

what are the physical manifestations of hypokalemia

Answer 12

often asymptomatic - Well tolerated in otherwise healthy PTs

fatigue

weakness

Muscle necrosis

Paralysis

impairment of respiratory function

Can also cause arrthymias in PTs with heart failure, cardiac ischemia or LVH. It can also increase BP when sodium intake is not restricted

Question 13

what effect does increased tubular flow/ volume expansion or Na excess have on K secrection

Answer 13

increases it and upregulates BK channels

Question 14

how do you treat hyperkalemia

Answer 14

Oral potassium

Potassium salts

Potassium sparing diuretics

Question 15

what can insulin overdose cause

Answer 15

hypokalemia

Question 16

what is the most important site for potassium reabsorption

Answer 16

principle cells of the late distal tubules and the cortical CD

Question 17

what change in potassium can renal failure induce

Answer 17

hyperkalemia

Question 18

what can mg depletion cause

Answer 18

hypokalemia

Question 19

what can loop diuretics and thiazide diuretics cause

Answer 19

hypokalemia

Question 20

what can exercise cause

Answer 20

hyperkalemia