Clinical Examples

Question 1

Conn syndrome can cause hypertension/hypotension

Answer 1

Hypertension

Question 2

If you are given a patient’s plasma creatinine, urine flow, and urine creatinine, could you calculate their GFR?

Answer 2

Yes, but if their urine creatinine was given to you in a value of mg/day, you’d have to change it to mg/min HINT HINT

Question 3

Conn’s syndrome will cause excessive _________ release

Answer 3

Aldosterone

Question 4

Conn’s syndrome will cause an increased _____ retention and an increased ________ excretion

Answer 4

Na+ retention

K+ excretion

Question 5

Conn’s Syndrome will cause an ECF (expansion/contraction)

Answer 5

Expansion

You’re retaining a ton of salt, and water follows salt

Question 6

Why would Conn syndrome cause an alkalosis?

Answer 6

Because all the extra aldosterone, in addition to increasing Na+ retention, will stimulate H+-ATPase in the α-intercalated cells of the distal tubule. This will increase the secretion of H+ and the return of HCO3 to the plasma

Question 7

Is Conn Syndrome a cancer?

Answer 7

Yes, it doesnt care about the persons acid-base status or whatever

Question 8

Why might Conn syndrome cause muscle weakness?

Answer 8

The hypokalemia

will hyperpolarize the membranes and make it harder to fire

Question 9

Why isn’t renin elevated in Conn Syndroe?

Answer 9

Because you will be volume EXPANDED (retaining too much Na+)

RAS responds to volume contractions

Question 10

Why would you see these signs in someone in DKA:

Hypotension

Sunken eyes

Decreased skin turgor

Rapid HR

Answer 10

Volume depletion

Question 11

Why would someone in Diabetic Ketoacidosis have a super low bicarb?

Answer 11

Because of the production of all of the ketones!! (Causes FIXED ACID production which eats up all the bicarb!)

This would also increase the anion gap….

Question 12

Why does someone in DKA have super deep and rapid Kussmaul’s respirations?

Answer 12

Its the lungs trying to blow off more CO2 to compensate for the metabolic acidosis

Question 13

Why does someone in DKA have an elevated anion gap?

Answer 13

Due to the production of Ketoacids (fixed acids: acetoacetic acid, β-OH-butyric acid)

This depletes HCO3 with no increases in Cl-

Anion gap= Na- Cl- HCO3

Question 14

Why does someone in DKA urinate all the time?

Answer 14

Their glucose transporters are overwhelmed, so glucose spills out into the urine causing osmosis diuresis (causing an increased Cosm as well)

Question 15

WHY is someone in DKA HYPERkalemic?

Answer 15

Low insulin and hyper osmolality promotes K+ efflux from cells

Question 16

Your patient in DKA is volume depleted and hyperosmotic. What hormones do you expect to be high?

Answer 16

Volume depletion: Renin, angiotensin II, aldosterone

Hyperosmotic: ADH

Question 17

Your patient in DKA is volume depleted and hyperosmotic. Which hormone will LOWER than normal?

Answer 17

ANP (which is released in high pressure states)

TEST QUESTION HE SIAD THIS IS A TEST Q!!**

Question 18

If someone is in metabolic alkalosis, what will happen to their breathing rate?

Answer 18

Decreased

Trying to increase CO2 aka acid

Question 19

Your patient is in a metabolic alkalosis due to excessive vomiting. However, her body is MAINTAINING it. What does this mean?

Answer 19

The volume contraction caused the activation of RAAS!

Angiotensin II stimulated NHE in the proximal tubule which therefore increases HCO3- reabsorption

Aldosterone stimulated the secretion of H+ via the H+ATPase from α-intercalated cells and K+ from principal cells.

Question 20

Why is the patient who is in metabolic alkalosis from vomiting for 3 days straight also HYPOkalemic?

Answer 20

The volume contraction stimulated aldosterone, which increases alkalosis and K+ loss from the principal cells in the distal tubule

Question 21

How do you treat the patient who is in metabolic alkalosis due to vomiting for 3 days straight and whose body is now maintaining her alkalosis?

Answer 21

Give her saline and she will be all better

This type of metabolic alkalosis responds to saline