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Urinary Block > Water, Sodium, Potassium > Flashcards

Water, Sodium, Potassium Flashcards

1
Q

How is ICF estimated clinically?

A

plasma sodium

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2
Q

How is ECF volume estimated clinically?

A

physical exam; edema, crackles, JVD

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3
Q

Abnormal plasma sodium indicates a disorder with what?

A

water balance

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4
Q

Abnormal ECF volume indicates a disorder with what?

A

Na+ balance

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5
Q

Under what conditions is ECF not based on sodium?

A

SIADH, pure water loss

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6
Q

What is the mechanism of hypertonic hyponatremia?

A

Solutes pulling ICF into the serum, diluting sodium

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7
Q

What is the cause of hypotonic hyponatremia when Uosm<100?

A

polydypsia (too much water)

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8
Q

What are the causes of hypotonic hyponatremia when Uosm>100 and UNa>40?

A

SIADH, hypothyroid, glucocorticoid deficiency

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9
Q

What are the causes of hypotonic hyponatremia when Uosm>100 and UNa<20 with hypovolemia?

A

burns, diarrhea, vomiting

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10
Q

What are the causes of hypotonic hyponatremia when Uosm>100 and UNa<20 with hypervolemia?

A

CHF, Cirrhosis, Nephrosis

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11
Q

What is the cause of pseudohyponatremia?

A

high lipids or proteins reducing plasma volume

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12
Q

How is pseudohyponatremia diagnosed?

A

Osmolal gap >10mOsm/Kg

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13
Q

What are the causes of hypertonic hyponatremia?

A

hyperglycemia, mannitol, glycine, sorbitol, sucrose

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14
Q

What is the treatment for symptomatic hyponatremia?

A

3% saline

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15
Q

What is the effect of rapid correction of hyponatremia?

A

Osmotic Demyelination Syndrome

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16
Q

In water diuresis polyuria, what separates diabetes insipidus form primary polydipsia?

A

DI: hypernatremic
polydipsia: hyponatremic

17
Q

What test separates central DI from nephrogenic DI?

A

NPO - desmopressin. If urine is still dilute, DI is nephrogenic

18
Q

What is the effect of rapid correction of hypernatremia?

A

cerebral edema

19
Q

How much fluid must accumulate in the interstitium before edema is apparent?

A

2.5-3.0 L

20
Q

What are the two pathways of fluid retention in nephrotic syndrome?

A

hypoalbuminemia reduces osmotic pressure; kidneys retain more sodium

21
Q

What is nephrotic syndrome?

A

> 3.5g/hr protein excretion with hypoalbuminemia, edema, lipiduria, and dyslipidemia

22
Q

Acidosis leads to what change in K+?

A

hyperkalemia

23
Q

Alkalosis leads to what change in K+?

A

hypokalemia

24
Q

What is the effect of aldosterone on K+?

A

secretion from the principal cells

25
Q

What are the five stimulants of K+ secretion?

A

high plasma K+, aldosterone, dietary K+, increased tubular flow rate, negative charge in the tubule

26
Q

What are the two inhibitors of K+ secretion?

A

ACEi/ARB, tubular damage

27
Q

What are the two mechanisms of hyperkalemia?

A

redistribution, decreased excretion

28
Q

What stimulates the movement of K+ from ECF to ICF?

A

insulin, beta2-agnosts, alkalosis, anabolism

29
Q

What stimulates the movement of K+ from ICF to ECF?

A

insulin deficiency, high tonicity, cell injury, beta-blockers, alpha-agonists, drugs, mineral acidosis

30
Q

Why does mineral acidosis cause hyperkalemia but not organic acidosis?

A

Cl- can’t cross cell membranes freely, but organic anions can

31
Q

What factors impair K+ excretion?

A

positive charge in tubule, decreased flow/Na to the CCD, decreased aldosterone

32
Q

What causes pseudohyperkalemia?

A

hemolysis, tourniquet time, thrombocytosis

33
Q

What are the causes of hyperkalemic distal RTA?

A

anything that interferes with ENaC action (RAAS)

34
Q

What EKG changes are seen in hyperkalemia?

A

peak-T waves

35
Q

Why is Ca2+ given in hyperkalemia?

A

it raises the threshold potential in myocytes to counter the rise of membrane potential from K

36
Q

What is the treatment for hyperkalemia?

A

IV-Ca, insulin, albuterol, bicarb if acidotic, dialysis, cation exchange, K-trapping resin

37
Q

What are the causes of hypokalemia?

A

intracellular redistribution, inadequate intake/GI loss, urinary loss

38
Q

What does urine K/createnine ratio measure?

A

normalizes the amount of K+ lost in the urine

39
Q

What is a normal urine K/creatinine ratio?

A

13-15

Urinary Block (8 decks)

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