Deck 2 Flashcards
(48 cards)
What are the 3 layers of the adrenal gland?
GFR
Glomerulosa: Aldosterone controls Na balance (outer layer)
Fasciulata: Cortisol (middle layer)
Reticularis: produces androgen/estrogen (inner layer)
Cushing’s Syndrome:
S/s related to cortisol excess
Cushing’s disease:
cushing’s syndrome caused specifically by pituitary incr ACTH secretion
What are EXOGENOUS causes of Cushing’s syndrome
Iatrogenic - long term high dose corticosteroid use
What are ENDOGENOUS causes of Cushing’s syndrome
Cushing's Disease (70%) Ectopic ACTH (15%) Adrenal Tumor (15%)
What is the lung cancer that is an endogenous cause of cushing’s syndrome
Small Cell Lung Cancer secreting ACTH
What are the Clinical Presentations of Cushing’s Syndrome:
- Redistribution of Fat
- central obesity
- moon facies
- buffalo hump
- supraclavicular fat pads - catabolism of protein
- wasting (thin) of extremities
- prox muscle weakness
- increased infections
- skin atrophy
- hyperpigmentation - Hypertension
- Androgen excess (hirsutism)
How do you diagnose Cushing’s syndrome?
- Low-dose dexamethasone suppression test
- Incr 24hr urinary free cortisol levels
- Incr salivary cortisol levels
What would you expect CMP lab results to be if a patient is in Addison’s crisis?
HYPOnatremic
HYPOglycemic
HYPERkalemic
HYPERcalcemic
How do you treat someone in Addison’s crisis:
- IV normal saline for Hypovolemia (D5NS if hypoglycemic)
- Replenish Sodium
- Give K-exylate to decrease potassium
- Florinef (to replace aldosteron)
- if known addisons = hydrocortisone
- if undiagnosed = dexamethasone
At what serum glucose level, does glucose start spilling into the urine?
180mg/dL.
-normally the kidney reabsorbs nearly all glucose, the renal threshold for glucose is 180mg/dL.
Where in the kidney (nephron) does Acetazolamide work?
-the proximal tuble
What is the primary function of the proximal tubule?
-reabsorption of vital substances
Where does Mannitol work in the nephron?
-proximal tuble
What substances are reabsorbed in the proximal convoluted tubule?
- 75% Na
- glucose
- Amino acids
- most bicarbonate (HCO3)
- Chloride
- 75-90% of H2O
The Thick Ascending Limb (TAL) of Loop of Henle is IMPERMEABLE to H20, but absorbs what substances?
Actively reabsorbs: Na+, K+, & Cl-
Indirectly reabsorbs Mg+ & Ca+
Where do diuretics like furosemide, bumetanide, ethacrynic acid, & torsemide work in the kidney?
Furosemide, Bumetanide, Ethacrynic acid, and torsemide are all examples of Loop Diuretics.
Loop Diuretics work in the Thick Ascending Limb of the Loop of Henle.
What is the MOA for Loop Diuretics?
They work on the Thick Ascending Limb, to inhibit the reabsorption of solutes.
When Na+, Cl-, K+, Mg+ and Ca+ are not reabsobed, a person becomes:
Hyponatremic
Hypochloremic > incr. biocarb reabsorption >met. alkalosis
Hypokalemic
Hypocalcemic
Hypomagnesemic
Concentrated urine means:
1. physiologically what is happening? 2. resulting in a solute to H2O ratio? 3. High or low specific gravity?
Something is happening in the kidneys causing solutes (Na, K, Cl, Ca, Mg, glucose) to not be reabsorbed into the body…thus causing increased amounts being excreted through the urine & decreased amount in the blood.
more solute > H2O ratio.
concentrated urine = high specific gravity
What does Dilute Urine mean?
- What is happening physiologically?
- what is the solute to H2O ratio?
When urine is more dilute it means there is a physiologic process occurring in the kidneys increasing the amount of solutes (Na, K, Cl, Ca, Mg, glucose) that are being reabsobed.
Where do chlorothiazide, chlorthalidone, HCTZ, indapamide, methyclothiazide, and metolazone work in the kidney?
chlorothiazide chlorthalidone HCTZ indapamide methyclothiazide metolazone are all examples of Thiazide Diuretics they work on: the cortical-diluting segment of the ascending loop of Henle
What is the MOA of Thiazide Diuretics?
inhibits sodium and chloride reabsorption in the cortical-diluting segment of the ascending loop of Henle
Where does Angiotensin II act on the kidneys?
What does it cause?
Proximal Tubules
Causing Incr. Na & H2O reabsorption.
Where does Aldosterone work in the Kidneys?
What does it do?
Collecting Duct, (Distal)!
Incr. reabsorption of Na+ in exchange for decr. reabsorption of K+ & H+
