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House Clinical Pathology > WATER AND ELECTROLYTE METABOLISM > Flashcards

WATER AND ELECTROLYTE METABOLISM Flashcards

1
Q

WATER DISTRIBUTION

Total Body Water: ___L

_____% of body weight in men

_____% of body weight in women

A

42

60

55

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2
Q

WATER DISTRIBUTION

§____% is in ICF. ___L
§____% is in ECF. ___L
§ __% is in plasma: ____L: interstitial: ___L

A

66; 28

33; 14

8; 3.5; 11

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3
Q

Electrolyte Composition: between ECF and ICF

Which has more sodium
Which has more potassium
Which has more calcium
Which has more magnesium

A

Ecf
ICF
Ecf
ICF

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4
Q

Electrolyte Composition: between ECF and ICF

Which has more chloride
Which has more bicarbonate
Which has more proteins
Which has more phosphates
Which has more sulfates

A

Ecf
Ecf
ICF
ICF
Ecf

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5
Q

Anion gap in normal health=____-___mmol/l

A

6-20

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6
Q

Formula for Anion gap= _____________________

A

(Na+K)-(Cl+HC03)

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7
Q

Water distribution

Water is freely permeable through ECF and ICF depending on ________ of these compartments.

Except in the _____ , where the osmotic concentrations of these compartments are _____

A

osmotic contents

kidney

equal

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8
Q

Water distribution

ECF osmolality-_____-_____mOsmol/kg of water

A

282-295

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9
Q

Arginine vasopressin (ADH)

§ Specialised cells in the ________ sense the differences between their ———- and that of the _____ and adjust the secretion of AVP from the ————-

A

hypothalamus

osmolality; ECF

posterior pituitary gland.

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10
Q

Arginine vasopressin (ADH)

§ A rising ECF osmolality (promotes or switches off?) secretion of AVP a declining osmolality (promotes or switches off?) AVP.

A

Promotes

Switches off

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11
Q

Arginine vasopressin (ADH)

AVP causes _____ to be retained by the ____ with (increase or reduction?) of urine production.

A

water

kidneys

Reduction

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12
Q

Planning fluid therapy:asssessing the patient
Take History!

§ cardiac or renal disease, liver disease.
§ Vomiting or diarrhea
§ Nausea, headache, confusion
§ Fever, nasogastric suction, surgical drains, fistulae, artificial ventilation.

A

🍻

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13
Q

Clinical Assessment
Examination

§ Plasma volume-____,_____,____,______.

§ The interstitial volume- check for ______

§ Intracellular volume - (easy or difficult?) to assess clinically: so, look for evidence of ______ dysfunction like _____,______

A

BP, pulse, JVP, CVP

oedema

Difficult

cerebral

drowsiness, coma.

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14
Q

SODIUM DISTRIBUTION

70kg man-Total body sodium- _____mmol

___% of this is exchangeable

% not exchangeable- incorporated in _____ and has a (slow or fast?) turn over.

A

3700

75

25; bone

Slow

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15
Q

SODIUM DISTRIBUTION

Most of exchangeable volume is found in the ________ fluid

§ reference interval : ____-____mmol/L

A

extracellular

135-145

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16
Q

SODIUM DISTRIBUTON

____mmol/day-___mmol/day in Western diets. Intake=output

Most Na is excreted in the _____. But also _____ and ______.(____mmol/L).

A

100; 300

kidneys

Sweat and faeces; 5

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17
Q

SODIUM DISTRIBUTON
In disease , GIT loss is very important as children die of water and sodium loss in _____________.

A

infantile diarrhea

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18
Q

SODIUM DISTRIBUTON

Urinary sodium output is regulated by;
§____________
§____________

A

Aldosterone

Atrial Natriuretic peptide

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19
Q

Sodium excretion

Aldosterone ___eases urinary sodium excretion by _____________ at the expense of _____________________ ions.

A

decr

increasing sodium reabsorbtion in the renal tubules

potassium and hydrogen

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20
Q

Sodium excretion

Aldosterone secretion is stimulated by ____eased ECF volume.

A

decr

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21
Q

Sodium excretion

Cells of the ____ apparatus sense decrease in BP and secrete ____

A

JG

renin

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22
Q

angiotensin is gotten from ________

aldosterone is gotten from _______

A

Liver

Zona glomerulosa of adrenal cortex

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23
Q

Sodium excretion: Atrial Natriuretic peptide

Polypeptide hormone secreted by ______ of the _______ of the ——-

A

cardiocytes

right atrium; heart

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24
Q

Sodium excretion: Atrial Natriuretic peptide

It ____eases urinary sodium excretion

A

incr

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25
Q

Regulation of Volume of sodium

Amount of Na in _____ determines what its volume will be.

A

ECF

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26
Q

Regulation of Volume of sodium

__________ and _______ interact to maintain normal volume and concentration of ECF

A

Aldosterone and AVP

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27
Q

HYPONATRAEMIA

(Rise or Fall?) in plasma Na below the reference range of ____-_____mmol/L.

A

Fall

135-145

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28
Q

HYPONATRAEMIA

Can either be ______ or _______

A

Oedematous

Non oedematous

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29
Q

HYPONATRAEMIA caused by Congestive cardiac failure

Oedematous or Non oedematous ?

A

Oedematous

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30
Q

Oedematous HYPONATRAEMIA leads to a reduced _________

A

effective blood volume

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31
Q

HYPONATRAEMIA caused by Nephrotic syndrome

Oedematous or Non oedematous ?

A

Oedematous

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32
Q

HYPONATRAEMIA caused by SIAD

Oedematous or Non oedematous ?

A

Non oedematous

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33
Q

HYPONATRAEMIA caused by renal failure

Oedematous or Non oedematous ?

A

Non oedematous

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34
Q

HYPONATRAEMIA caused by compulsive water drinking

Oedematous or Non oedematous ?

A

Non oedematous

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35
Q

HYPONATRAEMIA caused by both water and sodium overload

Eg: by ______________

Treatment is by : _______ and ———-

A

inappropriate iv saline

diuretcs and fluid restriction.

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36
Q

Hyponatraemia due to sodium loss from GIT or Urine.

GIT LOSS

§ Vomiting-______
§______
§ _______ Fistula

A

pyloric stenosis

Diarrhoea

Enterocutaneous

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37
Q

Hyponatraemia due to sodium loss from GIT or Urine.

§ URINARY LOSS

§_______ deficiency- _____ disease

§_______ antagonists- _______ or _____

A

Aldosterone; Addisons

Aldosterone

Spironolactone or triamterine

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38
Q

Hyponatraemia due to Na loss

If Na and water are lost

There would be a Reduction in blood volume which gives rise to ________ ——- secretion overriding the osmotic control mechanism which leads to ________ and hyponatraemia.

A

non osmotic

AVP

Water retention

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39
Q

Hyponatraemia due to Na loss

Diagnosis of hyponatraemia- ____tension
and _____cardia

Treatment is correction of Na loss

A

hypo

tachy

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40
Q

SIAD - ___________________

(Oedematous or Non oedematous?) hyponatraemia

A

Syndrome of inappropriate antidiuresis

Non oedematous

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41
Q

Hyponatraemia: SIAD

(Elevated or depressed?) prices total body sodium level

Hyponatraemic, _____tensive, _____ glomerular filtration rate and a ____ serum urea and creatinine.

A

Normal

normo

normal

normal

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42
Q

Hyponatraemia: SIAD

This syndrome is encountered in many situations:- infections, malignancy, trauma,carcinoma of the ____,___ injury.

Drug induced eg __________

A

Lungs; head

thiazide diuretics.

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43
Q

In SIAD, there is _______________ stimulation and if they are exposed to excess water load eg oral or iv fluids they become ____natraemic.

A

non osmotic AVP

Hypo

44
Q

SIAD

Triggered by Non –osmotic stimuli which include;
___________

Nausea and vomiting

______

A

Reduction in circulating blood volume

Pain

45
Q

SIADH secretion

In SIADH, there is a continued _____ despite the (low or high?) plasma sodium concentration because _____ is maintained by ______ and there is therefore no ______ stimulus to stimulate ________ secretion.

A

natriuresis

Low ; plasma volume

water retention ; hypovolaemic

aldosterone

46
Q

Hyponatraemia with natriuresis can also occur in ______ failure and in
______ disorders and they must be excluded before a diagnosis of SIADH can be made.

A

adrenal

renal

47
Q

Water intoxication should always be considered as a possible cause of a confusional state

T/F

48
Q

natriuresis = ______eased sodium excretion and _____eased sodium reabsorption

49
Q

Water Overload

Hyponatremia in patients (with or without?) oedema, who have (low, high or normal ?) serum urea and creatinine, and blood pressure have water overload.

This is treated by _________

A

Without

normal

fluid restriction.

50
Q

HYPERNATRAEMIA

CAUSES-

______ depletion

__________ depletion,eg_______, Excess _______, ______ in children

excess sodium ______ or ____: eg taking ______ to correct _____

A

water

water and sodium; diabetes mellitus

sweating; diarrheoa

intake or retention

Sodium bicarbonate; acidosis

51
Q

HYPERNATRAEMIA

Clinical Presentation- ______in water loss and indications of ________ in Na retention- Increased ______ and _____

A

dehydration

fluid overload

JVP and pulmonary oedema.

52
Q

HYPERNATRAEMIA

MANAGEMENT. Due to water loss, give ________ (slowly or rapidly ?) or __% dextrose (slowly or rapidly?)

A

oral fluids

Slowly

5

Slowly

53
Q

diabetes insipidus causes _____ natremia

54
Q

diabetes mellitus causes _____natremia
.

55
Q

Conn’s syndrome causes ______natremia

56
Q

Cushing’s syndrome causes ______natremia

57
Q

POTASSIUM HOMOESTASIS

§ Total body potassium: _____ mmol

§____% intracellular, ___% extracellular

58
Q

POTASSIUM HOMOESTASIS

§ Output: variable. Mainly by the ______

§ Excretion dependent on _________

A

kidneys

glomerular filtration

59
Q

POTASSIUM HOMOESTASIS

Important factor of potassium excretion regulation in urine is the ____________

____% lost in faeces

A

plasma potassium concentration.

5

60
Q

Serum potassium

____% of total body potassium is in the ECF

Conc.___-___ mmol/L.

A

2

3.5 – 4.5

61
Q

Serum potassium

Varies greatly with shift in ________

A

intracellular potassium.

62
Q

Serum potassium

Reciprocal relationship between potassium and ______ ions

In metabolic _____ the opposite occurs.

A

Hydrogen

Acidosis

63
Q

Potassium ECF levels vary much in response to water loss or retention.

T/F

A

F

It doesn’t

64
Q

Cellular uptake of potassium stimulated by ______.

65
Q

Serum potassium

Despite its low conc in the ECF potassium determines the ___________ of cells.

A

resting membrane potential

66
Q

Serum potassium

Changes in potassium concentration makes excitable cells like nerve and muscle cells to respond differently to stimuli.

T/F

67
Q

Serum potassium

In particular because ____ is mainly muscle and nerve, very low potassium and very high potassium may have life threatening effects.

68
Q

POTASSIUM DEPLETION AND HYPOKALAEMIA

Hypokalaemia means serum potassium levels (more or less?) than ___ mmol/L

69
Q

POTASSIUM DEPLETION AND HYPOKALAEMIA

Clinical effects of hypokalaemia include severe ______, ____reflexia, cardiac ______ , and cardiac arrest at less than 3mmol/L

A

weakness

hypo

arrhythmias

70
Q

POTASSIUM DEPLETION AND HYPOKALAEMIA

ECG changes include __________ and _________ and increased sensitivity to ______.

A

flattened T waves

prominent U wave

digoxin

71
Q

Causes of hypokalaemia

GIT losses – _______ ,________,_______

A

vomiting, diarrhoea, fistula

72
Q

Causes of hypokalaemia

Renal losses – from renal disease, _____ therapy or increased _____ production (_____ Syndrome)

A

diuretic

aldosterone

Conns

73
Q

Causes of hypokalaemia

Drug induced –_________ and ______.

A

thiazide diuretics

corticosteroids

74
Q

Causes of hypokalaemia

Alkalosis causes a shift of potassium from the ______ to the _____

A

ECF to the ICF

75
Q

Cabenoxolone has ______corticoid activity

76
Q

Treatment of hypokalaemia

§_____ potassium supplements
§ ________ potassium

A

Oral

Intravenous

77
Q

Intravenous potassium should not be given faster than ____mmol/h and must be given under monitoring with ECG

78
Q

Hyperkalaemia means potassium levels (lesser or greater?) than ____ mmol/L

79
Q

_________ is the commonest and most serious electrolyte emergency encountered in clinical practice

A

HYPERKALAEMIA

80
Q

Clinical Features of hyperkalemia

Muscle ______

ECG changes include _______ and ______

A

weakness

widened QRS complex,

peaked T waves

81
Q

Above __ mmol/L of serum potassium there is a serious risk of cardiac arrest

82
Q

Causes of hyperkalaemia

Renal failure – the kidneys cannot _________ due to a ___________

Mineralocorticoid deficiency –_____ Disease, patients on antagonists of _______ like _______ and ______

A

excrete a large load of potassium

very low glomerular filtration

Addison’s; aldosterone

spironolactone or triamterene

83
Q

Causes of hyperkalaemia

(Alkalosis or Acidosis?)

Potassium released from ______ cells

______ increase in hemolysed serum

A

Acidosis

damaged

Artefactual

84
Q

Treatment of hyperkalaemia

Infusion of ______ and _____ to move potassium ion into the cells

Infusion of ________ given to counter the effects of hyperkalaemia

A

insulin and glucose

calcium gluconate

85
Q

Treatment of hyperkalaemia

Dialysis

Cation exchange resin like _______

A

resonium A

86
Q

SOURCES OF HYDROGEN IONS IN THE BODY

§ ________nmol/L is reference range

87
Q

SOURCES OF HYDROGEN IONS IN THE BODY

<____and >____nmol/L is not compatible with life.

§ Known as pH in the past. (pH ___-____)

A

20

120

7.35-7.45

88
Q

SOURCES OF HYDROGEN IONS IN THE BODY

§ ________: Especially ——— of the _____ containing _______ of proteins ingested as food.

As dissolved ______ in blood.

A

Metabolism

oxidation; sulphur

amino acids

Carbon dioxide

89
Q

BUFFERING OF HYDROGEN IONS

A buffer is a solution of the ____ of a _______ which is able to bind ________

A

salt

weak acid

hydrogen ions.

90
Q

BUFFERING OF HYDROGEN IONS

A buffer (temporarily or permanently?) mops up any excess hydrogen ions which are produced.

A

temporarily

91
Q

Buffers

Blood buffers include:- _______,_______,_______

Urinary buffers include:_______ and ______ buffers.

A

bicarbonate, haemoglobin, proteins

phosphate and ammonium

92
Q

The permanent way in which the body gets rid of hydrogen ions is through _______ bound to ______

A

renal excretion

urinary buffers.

93
Q

Arterial blood gas values
§ H+-35 -46nmol/ L
§ Bicarbonate-22-30mmol/L
§ PCO2-4-6kP (36-46mmHg)
§ PO2-11-15kP (85-105 mmHg)

A

Are we really learning this?!!

94
Q

DISORDERS OF HYDROGEN ION HOMOEOSTASIS

§ Metabolic disorders are those which directly cause a change in __________

§ Respiratory disorders affect directly _____

A

bicarbonate concentration.

PCO2

95
Q

METABOLIC ACIDOSIS

•H is _______

• bicarbonate is ______

A

high or normal

always low.

96
Q

METABOLIC ACIDOSIS

§_____ disease
§______ ketoacidosis
§_______ acidosis

A

Renal

Diabetic

Lactic

97
Q

RESPIRATORY ACIDOSIS

•H is usually _________________

•PCO2 is __________

A

high or within the reference range
always raised.

98
Q

RESPIRATORY ACIDOSIS

.
§ In chronic cases, (H+) settles to a new steady state in which the compensation is (minimal or maximal?) .

99
Q

RESPIRATORY ACIDOSIS
Can be caused by:

Airways _____, respiratory centre ______, ____ disease, neuromuscular disease like ————.

Extrapulmonary thoracic disease like _______

A

obstruction

depression

lung; poliomyelitis

flail chest

100
Q

RESPIRATORY ALKALOSIS

Common or Not common ?

usually acute conditions which occur when _____ is over stimulated or is no longer ___________

A

Not common

respiration; subject to feedback control.

101
Q

Other causes of respiratory alkalosis

•________ overventilation

•Hysterical ________
§ Raised _________

A

Mechanical

overbreathing

intracranial pressure.

102
Q

hypoxia causes (respiratory or metabolic?) (alkalosis or acidosis?)

A

respiratory alkalosis

103
Q

METABOLIC ALKALOSIS

H is ______

bicarbonate is _________

A

depressed

always raised.

104
Q

METABOLIC ALKALOSIS

Respiratory compensation results in _____________

A

elevated PCO2

105
Q

METABOLIC ALKALOSIS

Commonest cause is _________

But can also be caused by ______ suction, _____ syndrome

A

prolonged vomiting.

Nasogastric

Conns

House Clinical Pathology (45 decks)

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