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My Own Renal Biochem > Disorders Of Water And Electrolyte Metabolism > Flashcards

Disorders Of Water And Electrolyte Metabolism Flashcards

1
Q

Plasma osmolality

A

2x Na plasma in mmol

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2
Q

When is body in water balance

A

Water intake= water output

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3
Q

Homeostasis of water and electrolytes maintained by

A

Kidney
Water transport
Ion transport

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4
Q

Biochemical factors regulating water and electrolyte balance

A 
Thirst mechanism
Antidiuretic hormone
RAAS system
Aldosterone
ANP
Kinins
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5
Q

Thirst mechanism

A

Lack of water->increased comc or osmolarity of plasma->stimulation of thirst centre in hypothalamus->to drink water-> water in body regulated

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6
Q

ADH mechanism

A

Lack of water in body->release of ADH->works on collection duct-> increases its permeability to water-> reabsorption of water-> scanty concentrated urine

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7
Q

RAAS mechanism kick in?

A

When volume and pressure of blood is lost. Ie from hearmmorhage, vomiting, diarrheal . Mechanisms that lead to drop in BP

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8
Q

Where is vasopressin secreted from?

A

Posterior pituitary

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9
Q

RAAS mechanism?

A

Decreased BP->stimulation of receptors in juxtaglerular apparatus->release of renin->formation of angiotensin 2->contriction of afferent arteriole->restoration of BP as pressure increases.

Angiotensin 2 can also release aldosterone->causes reabsortiom of sodium amd water-> lowers irine output

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10
Q

Aldosterone

A

Increases k+ losses im urine

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11
Q

Hyperkalemia

A

Induces release of aldosterone

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12
Q

Aldosterone

A

Acts on distal comvoluted tubule

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13
Q

Adh and osmolality

A

Increased osmolality induces adh production

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14
Q

Thirst mechanism and adh mechanism

A

Are responses to increased osmolality and just water is enough to solve problems since electrolytes are present

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15
Q

What is atrial natriuretic peptide

A

Cardiac hormone released by right atrium in response ro increased bp

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16
Q

Anp and raas

A

Anp opposes raas system and suppresses renin aldosterone and adh

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17
Q

Anp stimulayes excretion of

A

Sodium and water

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18
Q

Anp

A

Causes vasodilation and decreased vascular resistance

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19
Q

Kinins

A

Proteins in blood that lowers bp.

Increases sodium and water excretion

Causes inflammation

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20
Q

Dehydration caused by

A

No water intake
Excessive loss of fluid
Water deficiency condition
Disturbance of body electrolytes

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21
Q

Types of dehydration

A

Primary
Seconday
Mixed

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22
Q

Primary dehydration

A

This is due to loss of water.

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23
Q

Causes of primary dehydration

A 
Ill patients who cant eat
Mental patients who wont drink
Shipwrecked
Coma patients
Defect to hypothalamus 
Renal tubular disorder-no reabsorption
Diabetes insipidus
24
Q

Why may bp be normal in primary dehydration

A

Ecf depletion of water-> drawing of warer from icf-> ecf volume kept fairly constant

25
Q

PD clinical manifestations?

A

Dry tongue
Pinched face
Oliguria
Acute nephrotic necrosis

26
Q

PD Management

A

Water ro drink

5% iv glucose

27
Q

Mixed dehydration

A

Fluid tonicity and volume in both ecf and icf reduced

Most common type of dehydration

28
Q

Manifestations of mixed type dehydration

A

Feeling of thirst
Low bp
Oliguria
High blood urea

29
Q

Md management

A

Nacl and 5% glucose in 1:1

30
Q

Secondary dehydration

A

Occurs when fluids of high nacl are lost.

Ie sweat,gi fluids

31
Q

Causes of md

A 
Excessive sweating
Vomiting ,diarrhea
Addisons dx (low aldosterone, na excretion increased)
Excessive use of Diuretics
Aspiration of gi fluid
32
Q

Events in secondary dehydration

A

Loss of electrolyte->Na conc in IF and plasma reduces->decreased osmolarity in if and plasma->water moves into intracellular space->cells swelling-> comvulsions,coma, death.

Aldoaterone function reduced

33
Q

Sd manifestations

A 
No thirst
Patient listless 
Convulsions 
Anorexia,nausea
Cramps in thigh, abdomen
Sunken eyes
Inelastic skin
Low bp
Low gfr
34
Q

Management

A

0.9% nacl

35
Q

Overhydration

A

Intake or retainment of too much water

36
Q

Causes of over hydration

A

Excessive administration of parenteral fluids
Renal failuire(can excrete)
Hypersecretion of adh which can also be caused by anesthesia and narcotics
Excessive aldosterone secretion

37
Q

Management of over hydration

A

No drink

Hypertonic saline

38
Q

Hyponatremia

A

Na less than 130meq/l

39
Q

Hypernattrmia

A

> 145meq/l

40
Q

Hypokalemia

A

<3.5meq/l

41
Q

Hyperkalemia

A

> 5.1meq/l

42
Q

Conditions of water imbalance

A

Edema
Diabetes insipidus
Addisons dx
Cushions dx

43
Q

Types of di

A

Central- problem with adh deficiency

Nephrogenic- problem with kidneys or insensitivity to adh

44
Q

Diagnosis of di

A

Dilite urine with decreased osmolarity
Decreased specific gravity
Fluid deprivation test( despite deprivation urine volume is constant)
Electrolyte conc in serum amd urine

45
Q

Treatment of di

A

Desmopressin

46
Q

Addisons dx

A

Defect in adrenal glands which results in low aldosterone $cortisol->increased excretion of water

47
Q

Biochemical manifestations in addisons

A

Hyperkalemia
Hypercalcemia
Hypoglycemia
Hyponatremia

48
Q

Manifestations of addisons dx

A 
Low bp
Convulsions
Confusion
Psychosis
Syncope
Slurred speech
49
Q

Diagnosis of addisons

A 
Blood calcium 
glucose
 electrolytes
Acth stimulating test
Cortisol
50
Q

In acth stimulating test?

A

Using of synthetic acth hormone- TETRACOSIDE to induce increased cortisol levels. If not,gland is not working

51
Q

Management of addisons dx

A

Iv glucocorticoids-Hydrocortisone,Prednisolone

Iv saline wih glucose

Oral doses of fludrocortisone

52
Q

Cusions syndrome

A

Overactivity of adrenal glands. Increased aldosterone x cortisol

53
Q

Biochemical alterations

A

Hypokalemia
Hypocalcemia
Hyperglycemia
Hypernattemia

Ised for diagnosis

54
Q

Manifestation of cusions

A 
Depression 
Moon face
High bp
Insomnia 
Weight gain
Excessive sweating
55
Q

Management of cusions

A

Surgical removal in adrenal adenomas
Drugs-ketoconazole,metyrapone, inhibit cortisol synthesis
Glucocorticoid inhibitor- mifepristone

My Own Renal Biochem (7 decks)

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