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Endocrine > Water and sodium balance > Flashcards

Water and sodium balance Flashcards

1
Q

Where sodium goes water follows

A

Where sodium goes water follows

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2
Q

What hormone regulates water balance?

A

ADH

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3
Q

Where is water found in the body?

A

All body compartments and can move freely between them.

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4
Q

What does ADH do?

A

Increases water reabsorption in renal tubules

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5
Q

What causes ADH release?

A

Increasing osmolality

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6
Q

How is urine conc measured?

A

Osmolality

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7
Q

What does a high osmolality indicate?

A

Conce urine

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8
Q

What does a low osmolality indicate?

A

Dilute urine

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9
Q

What are the extremes of urine osmolality range?

A

40 and 1200

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10
Q

What hormone controls Na balance?

A

Aldosterone

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11
Q

What is the physiological range of Na?

A

135-145 mmol/l

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12
Q

What fluid compartment is Na mainly found in?

A

ECF

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13
Q

How does aldosterone work?

A

Causes reabsorption of Na in renal tubules and lose K instead.

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14
Q

How is aldosterone regulated?

A

RAAS

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15
Q

Explain RAAS

A

Renin released from kidneys in response to drop in BP
Renin converts angiotensinogen to angiotensin I
ACE converts angiotensin I to angiotensin II
Angiotensin II causes release of aldosterone from adrenal glands

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16
Q

What are the two major fluid compartments in the body and what are their volumes?

A

Extracellular fluid- 14L

Intracellular fluid- 28L

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17
Q

What are the two components of the ECF and what are their volumes?

A

Plasma- 3.5L

Interstitial fluid- 10.5L

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18
Q

What are the two pathologies of Na/water?

A

Hyponatraemia

Hypernatraemia

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19
Q

What two things can cause hyponatremia?

A

Low Na

High fluids

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20
Q

What two things can cause hypernatremia?

A

High Na

Low fluids

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21
Q

When is hyponatraemia serious?

A

<120 mmol/L

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22
Q

When is hypernatraemia serious?

A

> 160 mmol/L

23
Q

When might a normal range of sodium be serious?

A

If it changes fast

24
Q

What effect does decreasing Na have on fluid compartments?

A

Decrease ECF only. Large drop as only lost from here.

25
Q

What can cause Na decrease?

A

Reduced Na intake
Na loss in vomiting/diarrhoea, burns, kidney damage
Addison’s disease

26
Q

How does low sodium present?

A 
Tachycardia
Dry membranes 
Sunken eyes
Loss of consciousness
Decreased urine output and BP
27
Q

How do you treat a low sodium?

A

Give sodium

28
Q

What effect does increasing fluid have on fluid compartments?

A

Small increase in all as it spreads throughout body.

29
Q

What can cause a fluid increase?

A

Increased fluid intake (compulsive drinking)

Decreased fluid loss- SIADH (V common)

30
Q

How do you treat a high fluid?

A

Fluid restrict

31
Q

How do you diagnose high fluid?

A

Someone with low sodium who doesn’t look dehydrated

32
Q

What effects does increasing sodium have on fluid compartments?

A

Large increase in ECF as fluid gain restricted to here only.

33
Q

What can cause high sodium levels?

A

Increased Na intake
Near drowning in salt water
poisoning with salt

34
Q

How does high sodium present?

A

Coughing, SOB, tiredness, pulmonary oedema, pleural effusion, weak heart, ascites, oedema

35
Q

How do you treat high sodium?

A

Remove sodium with loop diuretics

36
Q

What effects does decreasing fluid have on fluid compartments?

A

Small decrease in whole body volume as lost from whole body

37
Q

What causes low fluid levels?

A

Increased fluid loss (DI) or decreased fluid intake

38
Q

How do you treat low fluid levels?

A

Give water- as 5% dextrose to maintain osmolality so don’t damage RBC
Collides- Plasma expanders

39
Q

What is pseudohyponatremia?

A

Increase in blood proteins and lipids reduces apparent blood volume and sodium when they’re actually normal.

40
Q

When should you suspect pseudohyponatremia?

A

If have really low sodium but no clinical features.

41
Q

What is syndrome of inappropriate ADH?

A

Release of ADH in response to low blood volume when actually have enough fluid

42
Q

What regulates ADH release?

A

Blood osmolality

Hypovolemia/hypotension

43
Q

What happens in SIADH?

A

Fluid leaks out of vessels due to lack of albumin
BP drops
ADH released to restore volume
Cycle continues

44
Q

How do you treat SIADH?

A

Loop diuretics to lose fluid and Na

45
Q

What happens to plasma osmolality during an abnormal water deprivation test?

A

Increases due to fluid loss

46
Q

Why is it better to undertreat than overtreat with desmopressin?

A

Because overtreatment can lead to very dangerous side effects

47
Q

How can glucose cause pseudohyponatremia?

A

By drawing water into extracellular compartments therefore diluting Na content

48
Q

How do you calculate normal urea production?

A

1ml/kg/hr

49
Q

What is classed as polyuria?

A

More than 50% greater than normal urine production

50
Q

How do you calculate osmolality?

A

2[Na+K]+Glucose+Urea

51
Q

What are some endocrine causes of hypertension?

A

Cushing’s
Conn’s
Phaeocytocratoma
Acromegaly

52
Q

What is another cause of SIADH?

A

Patho too much ADH release

Ectopic ADH production- SCLC

53
Q

How does SIADH present?

A

Low Na and K
Oedema
High BP

54
Q

How do you treat SIADH?

A

Treat underlying cause
Fluid restrict
Loop diuretics

Endocrine (23 decks)

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