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nephrology > Body fluids, Edema and IV fluids > Flashcards

Body fluids, Edema and IV fluids Flashcards

1
Q

Isotonic Loss

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A
  • No change
  • Decrease
  • No change
  • Increase
  • Increase
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2
Q

Isotonic Gain

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A
  • No change
  • Increase
  • No change
  • Decrease
  • Decrease
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3
Q

Hypotonic Loss

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A
  • Increase
  • Decrease
  • Decrease
  • Increase
  • Increase
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4
Q

Hypotonic Gain

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A
  • Decrease
  • Increase
  • Increase
  • Decrease
  • Decrease
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5
Q

Hypertonic Loss

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A
  • Decrease
  • Decrease
  • Increase
  • Increase
  • No change (???)
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6
Q

Hypertonic Gain

Body Osmolality, ECF volume, ICF volume, RAAS response, ADH response

A
  • Increase
  • Increase
  • Decrease
  • Decrease
  • No change (???)
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7
Q

Isotonic Loss

Causes

A
  • Hemorrhage
  • Diarrhea
  • Vomiting
  • Isotonic urine
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8
Q

Isotonic Gain

Causes

A
  • Isotonic saline

- Hyperaldosteronism

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9
Q

Hypotonic Loss

Causes

A
  • Dehydration
  • Alcoholism
  • DI
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10
Q

Hypertonic Loss

Causes

A

Adrenal insufficiency

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11
Q

Hypertonic Gain

Causes

A
  • Salt ingestion
  • Hypertonic saline
  • Mannitol
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12
Q

Hypotonic Gain

Causes

A
  • Hypotonic saline
  • Water intoxication
  • SIADH
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13
Q

Aldosterone

Regulators

A
  • Plasma angiotensin II (stimulate release)

- Plasma K+ (stimulate release)

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14
Q

ADH

Regulators

A
  • Plasma osmolality (directly related)

- Blood pressure/volume (inversely related)

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15
Q

Renin

Regulators

A
  • Perfusion pressure to the kidneys (inversely related)
  • Sympathetic stimulation to the kidneys (direct effect via beta-1 receptors)
  • Na+ delivery to macula densa (inversely related)
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16
Q

Starling Equation

A
  • Qf = k [(Pc + Oif) - (Pif + Oc)]
  • Qf is fluid movement
  • k is filtration coefficient
  • P is hydrostatic pressure
  • O is oncotic pressure
  • c is capillary
  • if is interstitium
17
Q

Capillary hydrostatic pressure

Regulators

A
  • Blood flow (regulated by arteriole)
  • Venous pressure
  • Blood volume
18
Q

Interstitial oncotic pressure

Regulators

A

Interstitial protein concentration (regulated by lymphatics)

19
Q

Capillary oncotic pressure

Regulators

A

Capillary protein concentration

20
Q

Interstitial hydrostatic pressure

Regulators

A

Lymphatic flow

21
Q

Filtration Coefficient

Regulators

A

Capillary permeability

22
Q

Peripheral Edema

Primary Causes

A
  • Increased capillary hydrostatic pressure (Pc)
  • Increased interstitial oncotic pressure (Oif)
  • Decreased capillary oncotic pressure (Oc)
  • Increased capillary permeability (k)
  • Lymphatic obstruction/removal (lymphedema)
23
Q

Increased capillary hydrostatic pressure (Pc)

Causes

A
  • Marked increase in blood flow like vasodilation in a given vascular bed
  • Increasing venous pressure like venous obstruction or HF
  • Elevated blood volume (Na+ retention) like in HF
24
Q

Increased interstitial oncotic pressure (Oif)

Causes

A
  • Thyroid dysfunction (elevated mucopolysaccharides in the interstitium that act as osmotic agents resulting in fluid accumulation)
  • Lymphedema
25
Q

Decreased capillary oncotic pressure (Oc)

Causes

A
  • Liver failure

- Nephrotic syndrome

26
Q

Increased capillary permeability (k)

Causes

A
  • Circulating agents like tumor necrosis factor-alpha (TNF-alpha), bradykinin, and histamine
  • Cytokines related to burn trauma
27
Q

Lymphatic obstruction/removal (lymphedema)

Causes

A
  • Filarial (W. bancrofti [elephantiasis])
  • Bacterial lymphangitis (streptococci)
  • Trauma
  • Surgery
  • Tumors
28
Q

Pulmonary Edema

Causes

A
  • Cardiogenic (elevated Pc) associated with increased pulmonary wedge pressure
  • Non-cardiogenic (adult respiratory distress syndrome [ARDS] due to increased permeability) that can be due to sepsis, bacterial pneumonia, trauma and gastric aspirations. Pulmonary wedge pressure is normal or low
29
Q

Volume of Distribution

A
  • V = A / C
  • V: volume of compartment to be measured
  • A: amount of tracer
  • C: concentration of tracer in the compartment to be measured
30
Q

Tracers used to measure Plasma

Characteristics, Examples

A
  • It should not cross the capillary membranes

- Albumin

31
Q

Tracers used to measure ECF

Characteristics, Examples

A
  • It should cross the capillary membranes but not the cell membranes
  • Inulin, mannitol, sodium and sucrose
32
Q

Tracers used to measure Total body water

Characteristics, Examples

A
  • It should cross both the capillary and cell membranes

- Tritiated water and urea

33
Q

Blood volume

Calculation

A
  • Blood volume = plasma volume / (1 - hematocrit)

- 7% of body weight in kgs

34
Q

Angiotensin II

Effects

A
  • Direct vasoconstrictive effect
  • Increases aldosterone secretion
  • Increases ADH release from posterior pituitary
  • Increases thirst
  • Increases Na+ reabsorption in the proximal tubule
35
Q

Cortisol

Factoids

A
  • Zona fasciculata/reticularis
  • Steroid
  • Catabolic
  • Immunosuppression
  • Increase appetite
36
Q

Cortisol

Effects on Metabolism

A
  • Increases lipolysis
  • Increases protein degradation
  • Increases gluconeogenesis
37
Q

Cortisol

Permissive effects

A
  • Enhances catecholamines effect on alpha receptors (vasculature) and beta receptors (especially in lung and liver)
  • Enhances effects of glucagon
38
Q

Cortisol

Other effects

A
  • Anti-inflammatory effect by stimulating Lipocortin synthesis which is a phospholipase A2 inhibitor
  • Increases bone breakdown by increasing RANK-L and decreasing OPG
  • Binds to mineralocorticoids receptors (Aldosterone-like)

nephrology (7 decks)

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