Wolff Hyper-Hypokalemia Hyper-Hyponatremia Renal Flashcards
1
Q
routine dietary intake of this cation would increase its plasma levels to the toxic range if not for a means for rapid redistribution into cells
A
potassium
2
Q
type of metabolic alkalosis seen with thiazide and loop diuretics secondary to K+ loss
A
hyperchloremic
3
Q
this of body is monitored by special sensors in the brain, cannot be eye-balled but instead approx clinically by summing things that are measured (or measured directly via colligative properties of vapor point elevation or freezing point depression)
A
osmolality
4
Q
characterizes the on and off-rate for drugs such as spironolactone that decrease protein expression with disappearance of existing proteins each having their own half-life (hours, days) to see the effects
A
slow
5
Q
adverse effect associated with administration of tolvaptan for >30 days
A
hepatotoxicity
6
Q
whether extracellular or intracellular, means that too much sodium is in this compartment (water compartment); extracellular location is a common indication for a loop diuretic
A
edema
7
Q
prototype for the non-peptide V2 receptor antagonists that can be used judiciously to treat euvolemic and hypervolemic hyponatremia if unresponsive to other measures; causes water excretion w/o solute excretion
A
conivaptan
8
Q
class of drugs that interferes with renin secretion and the ability of diuretics to cause a diuresis
A
NSAIDs
9
Q
abuse of this can cause extra-renal K+ losses leading to hypokalemia that can occur +/- concurrent metabolic acidosis
A
laxative
10
Q
invasive means for treating life-threatening hyperkalemia
A
dialysis
11
Q
increased by a step change in daily sodium intake
A
body weight
12
Q
potential adverse effect of spironolactone use by females
A
hirsutism
13
Q
caused by loop and thiazide diuretics, increases the risk of gout
A
hyperuricemia
14
Q
contraindication for loop diuretics and not a good time to start thiazide diuretics
A
pregnancy
15
Q
positive inotrope used in HF whose toxicity is increased by loop diuretic-induced K+ loss
A
digoxin
16
Q
RTA with hypokalemia due to, for example, autoimmunity leading to fibrosis with impaired function in the cortical collecting duct
A
Type 1
17
Q
among the neuromuscular manifestations of hypokalemia
A
constipation
18
Q
occurs in liver disease due to impaired synthesis of plasma proteins and increased portal venous pressure, reason to administer loop diuretics
A
ascites
19
Q
can cause hyperkalemia
A
tissue necrosis
20
Q
tablets that are a treatment for hypovolemia hyponatremia
A
NA K2Cl
21
Q
suggestive clues include hypovolemic hypernatremia, hypokalemia with metabolic alkalosis, significant urinary Cl- loss despite low plasma levels
A
hyperaldosteronism
22
Q
hypo- and hyper- mean respectively that there is too much or too little water diluting the body’s sodium content
A
natremia
23
Q
identified the forces that determine the net magnitude and direction of fluid movement across capillary barriers
A
starling
24
Q
part of the coma cocktail, it is also often administered along with other agents to patients presenting with hyperkalemia
A
glucose
25
tablets that are a treatment for hypovolemic hyponatremia
salt
26
consequence of treating hyponatremia too rapidly
osmotic demyelination
27
well known toxicity of loop diuretics
ototoxicity
28
osmotic pressure is the driving force for water movement across this
cell membrane
29
organ that doesn't have space for its cells to swell due to hyponatremia, lack of space leads to symptoms of encephalopathy and possible uncal herniation +/- death
brain
30
abbr. for hormone released by posterior pituitary whose receptor-mediated water-retaining effects are blocked by the vaptans
ADH
31
caused by a lack of ADH secretion or a failure of the kidneys to respond to it leads to euvolemic hypernatremia
diabetes insipidus
32
surprising consequence of hyperkalemia, occurs because hyperkalemia increases K+ conductance in SA nodal tissue enough to cause membrane hyperpolarization; other regions of heart do become hyperexcitable so arrhythmias likely
bradycardia
33
ion that exchanges with cellular K+ during acid-base maintenance and/or compensation; reason acidosis can cause hyperkalemia
hydrogen
34
occurs when K+ (and Cl-) are lost in urine due to, for example, diuretics; cells donate K+ while taking up H+ (and leaving behind HCO3-) in an effort to maintain hypokalemic plasm K+ levels closer to normal
metabolic alkalosis
35
blocks ENaC channels in the principal cells of the connecting tubule and and collecting duct, similar to amiloride
triamterene
36
gliflozin class of drugs lowers circulating glucose levels in diabetes by blocking its reabsorption in proximal tubule... this causes polyuria as does diabetes itself cuz glucose excreted in urine functions as this type of diuretic
osmotic
37
not a good time to take a loop or thiazide diuretic given the typical duration of action
bed time
38
potential adverse effect of spironolactone use by males
gynecomastia
39
hyperkalemic/most common form of renal tubular acidosis, caused by lack of aldosterone or failure to respond to it
type 4
40
when this is less than about 30 ml/min, thiazides no longer work but loop diuretics still work when treating HTN; can be cause of hyperkalemia when <~ 5 ml/min
GFR
41
hormone whose levels decrease in response to a dietary sodium load to help facilitate its renal elimination
aldosterone
42
hormone principally responsible for cellular uptake of K+, can cause hypokalemia with normal acid-base balance
insulin
43
problematic with diuretics presumably in part cuz of urgent need to urinate
non-adherence
44
type of acids that have less of an effect on plasma K+ than, for example, hydrochloric or sulfuric acids
organic
45
slowing the progression of this is a reason for continued administration of expensive tolvaptan
APKD
46
interval widened by hyperkalemia
QRS
47
loop diuretic that can be used by patients with sulfa allergy
ethacrynic acid
48
channel responsible for Mg2+ distal convoluted tubule, can compensate somewhat when Mg2+ reabsorption is blocked in TAL by loop diuretics but down-regulates in presence of thiazides leading to more profound Mg2+ loss in urine
TRPM6
49
class of diuretics acting in the collecting duct to block Na+/K+ exchange, useful to counterbalance an adverse effect of loop and thiazide diuretics
K+ sparing
50
cells in the collecting duct that are the primary target of K+ sparing diuretics
principal cells
51
diuretic that blocks epithelial Na+ channels in principal cells of the collecting duct, effects are rapid when compared to spironolactone
amiloride
52
characteristic of urine excreted with maximally effective doses of furosemide, irrespective of plasma ADH levels
isotonic
53
nephron location where osmotic diuretics and carbonic anhydrase inhibitors exert their effects; increasing or decreasing the fraction of the filtered load absorbed here is a primary determinant of Na+ excretion
proximal tubule
54
ionized form of this divalent cation is a crucial cofactor in many biological processes, plasma levels are maintained in normal range by regulation of reabsorption through TRPM6 channels in DCT in a poorly understood manner; both loop and thiazide diuretics cause it to be lost in urine, especially thiazides
magnesium
55
3% NaCl is an example of this type of solution that causes cells to shrink, can be used to treat acute severe hyponatremia
hypertonic
56
receptors that sense body Na+ content via measurement of effective blood volume
stretch
57
can be a hidden source of excessive K+ intake
antibiotics
58
co-transporter in the DCT that acts to further dilute the tubular fluid; target of thiazide diuretics
NaCl
59
example of an osmotic diuretic administered in gram quantities to help eliminate excess intracellular volume (eg. causing elevated intracranial pressure), now often supplanted by hypertonic saline
mannitol
60
substance that promotes free water clearance
aquaretic
61
broad characterization of diuretics that includes thiazides, loop diuretics, carbonic anhydrase inhibitors and osmotic diuretics
K+ losing
62
likelihood of formation from calcium in the urinary pelvis is increased by loop diuretics and decreased by thiazide diuretics due to their differing effects on its reabsorption
stones
63
membrane potential that is determined by extracellular K+ levels
resting
64
failure of this to treat hyponatremia in symptomatic hospitalized patients is an indication for vaptans
fluid restriction
65
refers to factors such as Ang II, ANP, and SNS activity that modify the intrinsic renal relationship between arterial pressure and Na+ excretion
extrinsic
66
irrespective of whether hypo- or hyper-natremia, if this word applies the rate of correction must be slow
chronic
67
means plasma levels <1.7 mg/dL, often coexists with hypokalemia and hypocalcemia; contributes to clinical signs such as muscle weakness, tremors, tetany, seizures, parasthesias, nystagmus, torsades de pointes
hypomagnesemia
68
this clearance is 0 when urine is isotonic, positive when urine is dilute, and negative when urine is hypertonic; negative means the water in which urinary solute was dilute has been returned to body to dilute to lower plasma osmolality
free water
69
a potassium salt formed with this bicarbonate precursor can be administered to a person with hypokalemia and acidosis
acetate
70
thirst, tenting of skin, sunken eyes and oliguria are signs of this, ultimately a more powerful stimulus of ADH release than increases in plasma osmolality
hypovolemia
71
predictable consequence of severe hypokalemia, diabetes insipidus, and vaptan administration
polyuria
72
V2 agonist used to treat central diabetes insipidus
DDAVP
73
syndrome that is a cause of type 2 RTA due to impaired ability to reabsorbed filtered bicarb in the proximal tubule
Fanconi
74
nephron cells that can change their phenotype and are normally associated with the maintenance of acid-base balance, they are also a target of thiazide diuretics
intercalated
75
ability impaired in the kidney by loop diuretics, Bartter syndrome, and hypokalemia (here presumably due to need for K+ by Na+ K+ 2Cl- cotransporter) resulting in polyuria and nocturia
concentrating
76
chicory, dandelion leaves, fennel, goldenseal, and others are diuretics of this type of alternative medicine with generally uncharacterized MOAs and uncertain efficacy
herbal
77
loss of this in excess of water is why loop and thiazide diuretics can cause hyponatremia
sodium
78
substance that promotes excretion of urine, potential cause of hypovolemic hyponatremia
diuretic
79
causes include anything that interferes with normal renin secretion or Ang II generation or the actions of Ang II or aldosterone
hyperkalemia
80
prototypical loop diuretic
furosemide
81
refers to the channels directly blocked by amiloride and triamterene in collecting duct cells
ENaC
82
real European form of this contains sweet glycrrhizic acid which dose-dependently potentiates aldosterone effects and increases systolic BP
licorice
83
common term for diuretic class with "high-ceiling" effects exerted in the TAL
loop
84
its blockade of carbonic anhydrase causes a sodium bicarb diuresis with hyperchloremic acidosis; principal uses include urinary alkalinization to hasten elimination of weak acid toxins (eg. aspirin), treatment of metabolic alkalosis, acute mountain sickness and glaucoma
acetazolamide
85
healthy way to transiently raise extracellular K+ levels
exercise
86
common cause of hypervolemic hyponatremia
heart failure
87
caused by cell lysis in a collection of blood samples
pseudo-hyperkalemia
88
this of Na+ increases as BP increases
urinary output
89
refers to the fact that RBF and GFR are maintained approx. constant at MAP of ~100 mmHg +/- 40 cuz of myogenic mechanism and tubuloglomerular feedback
autoregulation
90
selective non-peptide V2 receptor antagonist that can be cautiously administered orally to patients with persistent hyponatremia despite use of initial therapies
tolvaptan
91
typical route for KCl administration to a person with hypokalemia
oral
92
administered to raise the threshold potential when people present with hyperkalemia
calcium
93
receptors in collecting duct that mediate the response to ADH (aka arginine vasopressin) leading to insertion of aquaporin 2 water channels in luminal membrane for water reabsorption
V2
94
a large volume of this in plasma can cause pseudo-hyponatremia
lipid
95
with worsening hyperkalemia, may have muscle twitching/weakness and numbness/prickling sensation gave way to this type of paralysis
flaccid
96
whether excreting a maximally dilute or maximally concentrated urine, the elimination of this is approx. unchanged
solute
97
becomes prominent in severe hypokalemia
U wave
98
K+ excretion is increased when this is increased in the distal nephron
tubular fluid flow rate
99
disease that causes hyperkalemia despite adequate GFR
Addison's
100
administering a 5% solution of this is ultimately equivalent to infusing approx. that volume of distilled water
dextrose
101
recent episodes of this can give rise to hyponatremia, hypokalemia, hypovolemia, and metabolic alkalosis with renal retention of K+ and Na+ (eg. <20 and 30 mEq/L respectively)
vomiting
102
aldosterone antagonist with greater selectivity than spironolactone, also much more expensive
eplerenone
103
cause of euvolemic hyponatremia
SIADH
104
major pathway for Mg2+ reabsorption in TAL, Ca2+ is also reabsorbed here in addition to its major reabsorption via this pathway in proximal tubule
paracellular
105
cause of hyperosmolar hyponatremia
hyperglycemia
106
volume expanded by infusion of 0.9% NaCl solution
extracellular
107
class of diuretics with medium Na+ losing ability due to effects that include blockade of a transporter in distal convoluted tubules; treatment for nephrogenic diabetes insipidus
thiazide
108
hypo- or hyper- means there is too little or too much Na+ in the body
volemia
109
0.45% NaCl solution is an example of this type of solution that causes cells to swell, can be administered to treat hypernatremia
hypotonic
110
hypovolemic form of this sign of neglect in nursing home
hypernatremia
111
glomerulotubular ___ refers to forces acting across proximal tubular epithelium that result in proportional rather than absolute amounts of ~isotonic fluid reabsorption from the proximal tubule
balance
112
classical aldosterone antagonist, its effects in the principal cells of the collecting duct cause it to act as K+ sparing diuretic
spironolactone
113
means plasma Na+ concentration is <135 mEq/L; seen in 15-20% of hospitalized patients, it is the most common electrolyte abnormality seen in clinical practice
hyponatremia
114
consuming this decreases ADH secretion
alcohol
115
refers to form of diabetes insipidus when kidney fails to respond to ADH
nephrogenic
116
along with massive, this adjective characterizes the fluid removal response to loop diuretics
rapid
117
administration of this to treat bipolar disorder is the most common cause of nephrogenic diabetes insipidus, treated with amiloride
lithium
118
means of plasma K+ concentration is <3.5(ish), hyperpolarizes most cell membranes; can be used by K+ losing diuretics
hypokalemia
119
generic term for the portion of the nephron that increases K+ reabsorption when plasma levels are low
distal
