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Renal > Water, Calcium, Phosphate Biochem > Flashcards

Water, Calcium, Phosphate Biochem Flashcards

1
Q

Exogenous sources of water

A 
Drinking water (1000-1500mL) 
Food 
 Metabolic water (400ml)
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2
Q

Functions of water

A

Reactant - hydrolytic rxns

Transportation of nutrients and waste hormones etc

Regulates body temp

Solvent

Digestion

Lubricant

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3
Q

Body water output

A

Kidney
Skin Evaporation
Exhalation from lungs
Feces

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4
Q

What is an electrolytes

A

Substance that’s when is dissolved in solution dissociates into ions

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5
Q

Main electrolytes in intracellular compartment

A

Potassium
magnesium
phosphorus

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6
Q

Main electrolytes in extracellular compartment

A

Sodium
chlorite
bicarbonate

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7
Q

Sodium concentration in extracellular fluid

A

140 mEq/L

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8
Q

Concentration of chloride in extracellular fluids

A

103 mEQ

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9
Q

Total amount of cations and anions

A

155 and 155

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10
Q

Amount of potassium in intracellular fluid

A

150 mEq/L

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11
Q

Amount of phosphorus in intracellular

A

140 meq/l

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12
Q

Total onions and cations in intracellular Street

A

195 and 195

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13
Q

Most abundant electrolytes in extracellular fluid

A

Sodium

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14
Q

Essential electrolytes for not normal membrane accessibility for nerve impulse

A

Potassium

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15
Q

Electrolytes that regulates osmatic pressure and assist in regulation of acid-base balance

A

Chloride

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16
Q

Electrolytes that promotes nerve impulse and muscle contraction or relaxation

A

Calcium

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17
Q

Electrolytes that plays a role in carbohydrates and proteins metabolism storage and use of intracellular energy neural transmission

A

Magnesium

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18
Q

What is diffusion

A

Movement of particles down a concentration gradient

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19
Q

What is osmosis

A

Movement of water across a membrane from less concentrated solution to a more concentrated

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20
Q

What is osmolarity

A

Number of moles per liter of solution

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21
Q

What is osmolality

A

Number of moles per kilogram of solvent

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22
Q

Plasma osmolality formula

A

2 x plasma Na

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23
Q

Active transport

A

Movement is absolute across the membrane which requires transporters and energy expenditure

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24
Q

What is filtration

A

Transfer of water and salute through a membrane from a region of high pressure to a region of low pressure

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25
Q

Healthy body amount of water taken in and out every day

A

2100 milliliters

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26
Q

How is solutes homeostasis maintained

A

Ion transport
water movements
kidney function

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27
Q

Why are you a chemical mechanism that helps regulate water and electrolyte balance

A 
The neural mechanism- thirst mechanism
Antidiuretic hormone  
vasopressin
raas
aldosterone
Atrial natriuretic peptide
Kinins
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28
Q

How is thirst mechanism helpful in water electrolyte balance

A

Low plasma volume
So high osmotic pressure because high solite concentration
What are drawn from cells to plasma

Cellular dehydration which activates thirst center located in hypothalamus
Dryness of mouth and pharynx
Feeling of thirst and then person drinks water

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29
Q

Where is the antidiuretic hormone produced

A

In the hypothalamus

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30
Q

Where is the antidiuretic hormone stored

A

In the pituitary gland

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31
Q

What is the mechanism of ADH

A

Hi osmolality in plasma
ADH secretion promoted
ADH act on Renal collecting tubule which promotes reabsorption of water by renal tubules
Low urine output

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32
Q

When does RAAS works

A

When blood volume and blood pressure are low

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33
Q

Raas mechanism

A

Decrease blood pressure or blood volume
kidney releases renin
Renin activates Angiotensinogen produced by the liver to form angiotensin I
Angiotensin I is converted to angiotensin II by angiotensinogen converting enzyme produced by the lung
Angiotensin II leads to vasoconstriction which increases blood pressure and formation of aldosterone by adrenal cortex which increases water reabsorption

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34
Q

Aldosterone action

A

Increase rate of reabsorption of sodium and chloride
Retains water
increases potassium loss through urine

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35
Q

ANP action

A

Released when high blood pressure in atria
suppresses renin level
decreases release of aldosterone
decreases ADH release
stimulates excretion of sodium and water
reduces vascular resistance by causing vasodilation

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36
Q

Kinins action

A

Cause inflammation
affect blood pressure
increases salt and water excretion

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37
Q

Organs involved in water and electrolytes Balance

A 
Hypothalamus 
pituitary gland 
kidneys 
liver 
the lungs 
adrenal glands 
cardiac tissue
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38
Q

Water electrolytes conditions

A

Dehydration

overhydration

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39
Q

What is dehydration

A

Outputs of water exceeds the water intake which causes reduction of body water below normal level

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40
Q

Basic causes of dehydration

A

No ingestion of water

excessive loss of body fluids

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41
Q

Types of dehydration

A

Primary dehydration with pure water depletion
Secondary dehydration with pure salt depletion
Mixed dehydration with both water and electrolytes depletion

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42
Q

Causes of primary dehydration

A

Ill patients a week patient who can’t Ingests water
mental patients who refuses to drink water,
Coma person
Person lost in desert or shipwrecked
Hypothalamus defect
renal tubular disorder
diabetes insipidus

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43
Q

Main cause of pure water depletion

A

Lack of water intake

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44
Q

Clinical manifestation of pure dehydration

A

Dry tong
pinched faces
oligouria
Low urine volume

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45
Q

Management of pure dehydration

A

Water to drink by mouth
5% glucose by IV
Should never give isotonic saline

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46
Q

Most common type of dehydration

A

Mixed dehydration

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47
Q

Causes of mixed dehydration

A

Severe vomiting or diarrhea

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48
Q

Manifestation of mixed dehydration

A

Feeling of thirst
low blood pressure
increase blood urea
urinary output low

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49
Q

Management of mixed dehydration

A

Mixture of saline and 5% glucose in 11 proportion

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50
Q

Secondary dehydration causes

A 
Excessive sweating 
GIT loss of fluids during VOMITING and diarrhea 
continuous aspiration of G.I. fluids 
Addison’s disease 
vigorous use of diuretics
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51
Q

Manifestation of secondary dehydration

A 
Absence of thirst
  apathetic
 listless 
hallucinations 
confusion 
anorexia
 nausea 
cramps in thigh abdominal and respiratory muscles
 Sunken eyes 
 inelastic skin
 low blood pressure 
decreased GFR and excretion
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52
Q

Management of secondary dehydration

A

Administration of isotonic solution normal saline

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53
Q

General causes of overhydration

A

Excess water intake
water retention
Excessive administration of Parenteral fluids
Hyper secretion of ADH
administration of narcotics anesthesia which causes secretion of ADH
excess aldosterone conn syndrome

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54
Q

Manifestation of overhydration

A

Headache
nausea
Incoordination of movements
delirium

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55
Q
A

Withholding drinking fluids

administration of hypertonic saline IV

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56
Q

Edema definition

A

Excess fluid accumulates in interstitial compartment as response to inflammation, injury, pregnancy, medications

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57
Q

Causes of edema

A

High hydrostatic pressure
Low plasma oncotic pressure
Increased capillary membrane permeability

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58
Q

Reasons for high hydrostatic pressure in edema

A

Venous obstruction
Lymphedema ,
Cardiac heart failure
Renal failure

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59
Q

Low plasma oncotic pressure causes

A

Liver failure
Malnutrition
Burns

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60
Q

Increased capillary membrane permeability causes

A

Inflammation

Sepsis

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61
Q

Types of edema

A

Generalized edema
Organ specific edema
Cutaneous pitting edema
Non pitting edema

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62
Q

Generelized edema defintion and causes

A

Fluid accumulation that affects entire body

CHF
Cirrhosis
Kidney disease
Leg Veins damages 
Severe Protein deficiency
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63
Q

Pitting edema causes

A

Pregnancy
Standing or sitting too long
Side of effects of some drugs

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64
Q

Consequences of edema

A 
Water and electrolytes imbalance
Impaired blood flow 
Slow healing 
High risk of infections
Pressures over bony prominences
Impaired organ fucntiôn
65
Q

Treatment of edema

A

Treat underlying conditions

Reduce salt amount

66
Q

What is diabete insipidus

A

Endocrine disorder where theres ADH insuffiency affecting water and electrolyte imbalance

67
Q

Manifestation of dibates insipidus

A

Excretion of large amounts of severely dilute urine

Excessive thirst

68
Q

Incidence of diabetes insipidis

A

3/100,000

69
Q

Types of diabetes insipidus

A

Central DI

Nephrogenic DI

70
Q

Central DI

A

Vasopressin and ADH deficiency

71
Q

Nephrogenic DI

A

Kidney or nephron dysfunction

They can be insensitive to ADH

72
Q

Manifestation of DI

A 
Polyuria
Dilute urine
Polydypsia
Dehydration
Electrolyte imbalance
73
Q

Diagnosis of DI

A

Urine osmolarity
Urine specific gravity
Elevtrolyte concentration in serum and urine
Fluid deprivation test

74
Q

Treatment of DI

A

Desmopressin which is analog of vasopressin
Given intranasal or orzl
Only works for central DI

75
Q

Addisons disease

A

Autoimmune and endocrine disorder with hypoadrenocorticism

76
Q

Cause of addison disease

A

Defect or insuffiency of adrenal glands

77
Q

Incidence of addisons disease

A

1/100,000

78
Q

Biochemical alterations in addisons disease

A

Hypoglycemia
Hyponatremia
Hyperkalemia
Hypercalcemia

79
Q

Addisons disease manifestation

A 
Low BP
Syncope 
Confusion
Psychosis
Slurred speech
Severe lethargy 
Convulsions
80
Q

Diagnosis of addisons disease

A

Blood electrolytes of sodium and potassium
Blood glucose
Blood calcium
Blood cortisol levels
ACTH Stimulation test With Synthetic pituitary ACTH ( tetracosactide
)

81
Q

Addisons disease treatment

A 
Iv of glucocorticoids
Hydrocortisone tablets 
Prednisone tablets 
Iv saline solution with dextrose or glucose
Fludrocortisone acetate oral
82
Q

Cushings syndrome

A

Overactivity of adrenal glands causing excess aldosterone and cortisol

83
Q

Incidence of cushing syndrome

A

1/100,000

84
Q

Biochemical alterations in cushings syndrome

A

Hyperglycemia
Hypernatremia
Hypokalemia
Hypocalcemia

85
Q

Manifestation of cushing syndrome

A 
High BP 
Weight gain 
Central obesity 
Buffalo hump
Moon face 
Insomnia
Excess sweating
Depression 
Anxiety
86
Q

Diagnosis of cushing syndrome

A

Blood electrolyte level of sodiul and potassium
Blood glucose
Blood calcium
Blood cortisol

87
Q

Manageemnt of cushing syndrome

A

Surgical removal if due to adrenal adenomas
Ketoconazole Or metyrapone shich inhibits cortisol levels
Mifepristone which is antagonist of glucocorticoid type II recept

88
Q

How does stress play into water and electrolyte imbalance

A

Stress acts on hypothalamus which increase release of ACTH from anterior pituitary which leads to high cortisol and aldosterone and releass of ADH from posterior pituitary
Both increase watee retention

89
Q

Blood Diagnostic test ro check fluid and electrolytes imbalance

A 
Serum electrolytes 
Serum creatinine (0.6-1.5 mg/ dl)
Blood urea and BUN (8-20 mg/dl) 
Serum osmolality 
Serum albumin ( 3.5-5.5 g /dl)
Serum hematocrit ( 40-54% for men and 38-47 for women )
90
Q

Urine investigations to do when checking for water elctrolytes imbalances

A 
Urine pH 
Urine specific gravity
Urine osmolality 
Urine creatinine clearance 
Urine sodium 
Urine potassium
91
Q

Les la contrition of ionic form of calcium and Phosphates

A

1.3mM FOR BOTH

92
Q

Functions of calcium

A 
Cell signaling 
second messenger 
neurotransmitter 
hormone release 
exocytosis of proteins 
muscle contraction 
blood clotting 
bio mineralization
93
Q

Serum presentation of ionic calcium

A

2.2-2.6 mM

94
Q

Serum concentration of ionic phosphates

A

0.7 -1.4mM

95
Q

Serum concentration of ionic magnesium

A

0.8 -1.2mM

96
Q

Organs that play in important role in calcium metabolism

A

Skeleton
G.I. tract
kidney

97
Q

What are the Calcitropic hormones

A

Parathyroid hormone
calcitonin
vitamin D (1, Dihydroxycholecalciférol)
Parathyroid hormone related protein

98
Q

Different form of circulating calcium in the body

A 
Potein bound calcium ( inactive, not excreted)
ionized calcium (free and active )
complexed calcium ( complexed with phosphate , bicarbonate, citrate )
99
Q

When do you have negative calcium balance

A

When the output is higher than the intake of calcium

100
Q

What disease can be caused by negative calcium balance

A

Osteoporosis

101
Q

What is positive calcium balance

A

When intake of calcium is higher than the output

102
Q

When do you have a positive calcium balance

A

During growth

103
Q

Is calcium essential or not essential

A

Essential so cannot synthesize it

104
Q

What happens when the concentration of calcium is low

A

PTH stimulated which increases parathyroid hormone levels
Parathyroid hormone acts on bone to release calcium which increases level of serum calcium level
Parathyroid hormone acts on the kidney to release vitamin D which releases calcium and increases calcium level

105
Q

Where is parathyroid hormone synthesized

A

In the four parathyroid glands

106
Q

What is the action of calcium level on parathyroid hormone secretion

A

Parathyroid hormone increases when low calcium and decreases when high calcium

107
Q

Action of parathyroid hormone on bones

A

Stimulates resorption and release of calcium in the ECF

108
Q

Action of parathyroid hormones on kidney

A

Increase calcium reabsorption and phosphate excretion through GPCR in distal tubule

Stimulate transcription of one alpha hydroxylase for vitamin D activation in kidney vitamin D then increases calcium and phosphate absorption

109
Q

Composition of Bones

A

67% inorganic compounds hydroxyapatite, amorphous calcium phosphates
33% organic components called osteoid with
- 28% type one Collagen
- 5% of non-collagen structural proteins
- growth factors
- cytokines

110
Q

Osteoblasts function

A 
 Bone formation
synthesis of matrix proteins 
Type one collagen 
Osteocalcin
 mineralization 
activation of osteoclasts via RANKL production
111
Q

Functions of osteoclasts

A

Bone resorption
degradation of proteins by enzymes
acidification
RANK activated by RANKL and differentiation to osteoclasts

112
Q

Bone remodeling process

A

Osteoclasts dissolve bone through large multi nucleated giant cells
osteoblasts produce bone through parathyroid hormone vitamin D cytokines
growth factors
osteoblasts become encased and become osteocytes

113
Q

In the renal system 80% of the absorption of calcium occurs at

A

Proximal tubal and is PTH independence

114
Q

Calcitonin action

A

Inhibits osteoclast Mediated bone resorption which decreases serum calcium
promotes renal excretion of calcium

115
Q

Which hormone is a potential treatment for hypercalcemia

A

Calcitonin

116
Q

Where is vitamin D dependent calcium absorption more important
Duodenum? Jejunum?ileum?

A

Dudodenum

Best in acidic conditions

117
Q

What disease is caused when vitamin D deficient

A

Rickets

118
Q

What can cause rickets

A

Inadequate intake of vitamin D

absence of sunlight

119
Q

Most prominent clinical effects of vitamin D deficiency

A

Osteomalacia

120
Q

What causes vitamin D resistant rickets

A

Deficiency of renal one alpha hydroxylase

121
Q

Function of parathyroid hormone related protein

A

Physiological role in lactation
Hormone for mobilization or transfer of calcium to the milk
important in fetal development
important in development of hypercalcemia of malignancy

122
Q

Causes of hypocalcemia

A

Hypoparathyroid level due to postoperative conditions could beat idiopathic or postradiation

Non-parathyroid cause due to vitamin D deficiency ,malabsorption ,liver disease ,kidney disease ,vitamin D resistance

PTH resistance due to pseudo hypoparathyroidism

123
Q

Symptoms and signs of pseudo hypoparathyroidism

A 
Hypocalcemia 
hyperphosphatemia 
short stature 
round face 
short thick neck 
obesity 
Enamel hypoplasia
shortening of the metacarpals 
Autosomal dominant resistance to parathyroid hormone
124
Q

Cause of pseudo hyperparathyroidism

A

50% efficiency of GPC are in all cells and not due to parathyroid glands not working

125
Q

Treatment of pseudohypo parathyroidism

A

Vitamin D and calcium

126
Q

Signs and symptoms of hypercalcemia

A

Neurologic (lethargy drowsiness depression confusion which can lead to coma or death )
neuromuscular (muscle weakness, hypotonia, decreased reflexes )
cardiac arrhythmias
bones (ache, pain, fracture)

127
Q

CommonCauses of hypercalcemia

A

Malignant disease like lung cancers
hyperparathyroidism
vitamin D toxicity

128
Q

Uncommon causes of hypercalcemia

A

Renal failure
sarcoidosis
multiple myeLoma

129
Q

triad of complaints in hyperparathyroidism

A

Bone
Stones
Abdominal groans

130
Q

Biochemistry of hyperparathyroidism

A

Hypercalcuria
Hypophosphatemia
Hyperphosphaturia

131
Q

What is primary hyperparathyroidsm

A

Calcium excretion higher than calcium intake
Bone replaced with connective tissue
Lesiosn on forehead and maxilla

132
Q

When is treating hypercalcemia of malignancy useful

A

When hypercalcemia not life threatening

Treatment can improve way of life

133
Q

Treatment of hypercalcemia of malignancy

A

Biphosphonates to inhibit osteoclastic activity

NaCl iv whhen more than 3.00mM ca2+

134
Q

What is osteoporosis

A

Reduction in bone mineral density and matrix compared to age and sex norms

135
Q

Most common metabolic disease of bone

A

Osteoporosis

136
Q

Risk factors to osteoporosis

A 
Gender => male more than females 
Race => blacks more the whites 
Genetics (estrogen receptor, type I collagen gene, vitamin D receptor gene )
Gonadal steroids deficiency 
Less Growth hormone 
No Calcium intake in case of deficit 
Lack of Exercise
137
Q

Age of peak bone mass

A

30

138
Q

Treatment to decrease in bone mass, osteoporosis

A

Exercise , activity
Calcium intake (1000-1500mg/day)
Estrogen treatment => inhibit osteoclastic activity
Bisphophonates => inhibits osteoclasts
Calcitonin
Vitamin D
Parathyroid hormone => expensive and need constant injections

139
Q

Normal serum phosphorus level

A

2.5-4.5mg/100ml

140
Q

When calcium high , phosphate is …

A

Low

141
Q

Hypophosphetemia

A

Less than 2.5 mEq/L

142
Q

Causes of hypophosphetemia

A

Overzealous intake of simple carbohydrates
Severe protein calorie malnutrition
Anorexia, alcoholism

143
Q

Hypophosphatemia clinical manisfestations

A 
Muscle weakness
Seizures
Coma 
Irritability 
Fatigue
Confusion 
Numbness
144
Q

Management of hypophosphatemia

A 
Prevention 
IV phosphorus when severe
Prevention of infection 
Monitor phosphorus level 
Increase oral intake of phosphorus rich food
145
Q

Food rich in phosphorus

A 
Milk 
Milk products 
Whole grains
Organ meats 
Nuts 
Fish
146
Q

Hyperphosphatemia

A

More than 4>5mEq/L

147
Q

Causes of hyperphosphatemia

A

Renal failure
Chemotherapy
Hypoparathyroidism
High phosphate intake

148
Q

Clinical manifestations of hyperphosphatemia

A

Tetany
Mucle weakness
Looks like hypocalcemia

149
Q

Intervention for hyperphosphatemia

A

Treat underlying conditions

Avoid food rich in phosphorus

150
Q

Normal magnesium serum level

A

1.5 - 2.4 mEq/L

151
Q

Hypomagnenesemia

A

Less than 1.5 mEq/L

152
Q

Causes of hypomagnesemia

A 
Chronic alcoholism 
Diarrhea 
Disruption of small bowel function
TPN 
DKA
153
Q

Clinical manifestations of hypomegnesemia

A 
Neuromuscular irritability 
Tousseau sign 
Positive chvostek 
EKG chnges , long QRS , depressed ST segment , cardiac dysrrhyrtmias 
Hypocalcemia , hypokalemia 
Starved
Seizures
Tetany 
Anorexia 
Rapid heart rate 
Vomiting 
Emotional lability 
Deep tendon reflex
154
Q

General interventions for hypomagnesemia

A 
IV magnesium 
Calcium gluconate if hypocalcemia 
Monitor dysphagia 
Soft foods 
Vital signs monitoring
155
Q

Food high in magnesium

A 
Green vegetables 
Nuts
Legumes
Seafood 
Chocolate
156
Q

Hypermagnesemia

A

More than 2.4mEq/L

157
Q

Causes of hypermagnesemia

A

Renal failure
Untreated DKA
Excessive use of antacids and laxatives

158
Q

Clinical manifestations of hypermagnesemia

A 
Flushed face 
Skin warmth 
Mild hypotension
Heart block 
Cardiac arrest 
Muscle weakness
Paralysis
ECG changes - bradycardia, hypotension 
Nausea vomiting
Lethargy
159
Q

Intervention for hypermagnesemia

A

Monitor magnesium levels , RR, cardiac rythm
Increase fluids
IV calcium in emergencies

Renal (16 decks)

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