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Renal Week 1 > Disorders of Water Balance > Flashcards

Disorders of Water Balance Flashcards

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1
Q

what is the equation to estimate the ICF volume?

A

it is inversely related to the effective osmolality

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2
Q

how do we estimate the ECF volume?

A

by physical exam…edema means its up…low BP and high heart rate and less capillary flow mean ECF is down

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3
Q

what is the ECF volume usually directly related to?

A

sodium balance

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4
Q

what are two situations where ECF volume is not directly related to sodium load?

A

dehydration…still have normal sodium

SIADH

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5
Q

when you have a hypotonic hyponatremia situation, what must you look at osmolality or tonicity to check to see if levels are low?

A

osmolality

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6
Q

in a hypotonic situation should you have ADH or not?

A

NO want to get rid of water

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7
Q

in a hypotonic situation…what should be looked at first to let you know if ADH is there or not?

A

urine osmolality

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8
Q

in hypotonic situation…what urine osmolality means you have ADH there? is this normal?

A

urine osmolality above 100

NO

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9
Q

in a hypotonic situation…what urine osmolality means ADH is not there? is this normal?

A

less than 100 mOsm

normal

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10
Q

after figuring out patient is hypotonic hyponatremic and has urine mOsm over 100…what decision is next?

A

volume status…are they hypovolemic/hyper or euvolemic

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11
Q

in a hypotonic hyponatremic state…when you are also hypovolemic…why does ADH function?

A

because hypovolemic means you need fluid and that trumps the hypotonic or natremia problems

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12
Q

in a hypotonic hyponatremic hypovolemic state…what will concentration of the urine sodium be? why?

A

it will be less than 20 mEq/L
this is because the RAAS system is activated from the hypovolemic state and leads to aldosterone placing more ENaC channels

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13
Q

name three common hypovolemic, hyponatremic hypotonic states

A

burns
diarrhea
vomiting

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14
Q

what are three causes of a hypervolemic hyponatremic hypotonic state?

A

CHF, cirrhosis and nephrosis

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15
Q

why does a hypervolemic state lead to hyponatremia and hypotonicity?

A

RAAS still activated and so is ADH…so you get lots of water absorption and increased Na absorption but higher rate of water absorption

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16
Q

why is RAAS and ADH still working in hypervolemic state?

A

decreased effective arterial blood volume

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17
Q

what will the urine sodium concentration be in a hypervolemic hyponatremic hypotonic state?

A

less than 20 mEq/L

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18
Q

if patient is euvolemic, hyponatremic, and hypotonic what do we consider as the cause?

A

SIADH

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19
Q

what is SIADH?

A

syndrome of inappropriate ADH release

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20
Q

in hypovolemic or hypervolemic states with hyponatremia and hypotonicity the urine sodium is low at less than 20 mEq, but the urine is still concentrated…what is causing this?

A

the urea that is still in there… cause ADH doesnt get as much urea out as water

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21
Q

why does SIADH lead to high urine conc of sodium?

A

because the RAAS system is not activated

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22
Q

name the 6 classes of SIADH causes

A 
pulmonary disorder
exercise
drugs
miscellaneous 
tumors
CNS disorders
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23
Q

what is the drug to remember that causes SIADH?

A

ecstasy

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24
Q

name four miscellaneous causes of SIADH

A 
HIV infection 
pain
post op
nausea
stress
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25
what is the most common tumor that leads to SIADH?
small cell lung cancer
26
what is pseudohyponatremia?
when it looks like you have hyponatremia but really you don't
27
what is the usual cause of pseudohyponatremia?
high triglycerides or proteins in the blood
28
will pseudohyponatremia be hypotonic, hyper or iso?
isotonic
29
what is the cause of hypertonic hyponatremia?
increases serum osmolality from another molecule
30
what is the cutoff between chronic versus acute hyponatremia?
acute is less than 48 hours and chronic is longer than 48 hours
31
which is worse and more likely to show symptoms...acute or chronic hyponatremia?
acute
32
what do you treat acute hyponatremia with?
3%saline
33
how to treat hypovolemic hypotonic hyponatremia?
give fluids...isotonic saline
34
how to treat hypervolemic hypotonic hyponatremia?
treat cause and restrict fluid and Na+ | diuretics
35
name three steps to treat SIADH hypotonic hyponatremia?
correct cause fluid restriction 3%saline
36
what happens if you give way too much sodium too fast to try and correct hyponatremia? what is the name of the syndrome?
get high conc of Na in the serum and fluid will rush out of cells..in brain this can be especially problematic causes osmotic demyelination syndrome
37
what is osmotic demyelination syndrome?
when myelin cells degenerate because the hypnatremic state was fixed too rapidly with sodium
38
how high is sodium to classify as hypernatremia?
145 mEq/L
39
what are the three changes that can lead to hypernatremia?
decreased ECF volume with hypotonic fluid loss pure water loss but normal ECF volume increased ECF volume with hypertonic fluid increase
40
give two examples of extra renal ECF volume loss that causes hypernatremia
vomit/diarrhea without H2O replacement
41
give two examples of renal losses of ECF volume that can cause hypernatremia
osmotic or solute diuresis | diuretics
42
explain how solute diuresis can lead to hypernatremia
you have excess solute of something that needs to be secreted and the water follows it out, leaving behind lower water levels with same sodium levels so sodium concentration is high
43
what are the two types of pure water loss that can lead to hypernatremia?
renal and extra renal losses
44
give two examples of extra renal pure water loss that can lead to hypernatremia
skin and lungs
45
in extra renal water loss with hypernatremia...will osmolality of urine be high or low?
high
46
renal loss of pure water leading to hypernatremia is often caused by what?
diabetes insipidus
47
in diabetes insipidus...what are the two types? what molecule is affected?
central or nephrogenic ADH
48
with pure water loss from renal issue leading to hypernatremia...will the urine osmolality be high or low?
low
49
in hypernatremia with increased ECF volume...what are the two possible causes?
increased sodium intake | increased mineralocorticoid
50
what mineralocorticoid increases and causes hypernatremia with increased ECF?
aldosterone
51
what will hypernatremia from increased sodium intake lead to in a patient?
polyuria...trying to pee off the increased sodium
52
how much urine production to be diagnosed with polyuria?
over 3 L a day
53
if you have polyuria and urine osmolality is low...what are the two possible causes?
diabetes insipidus | primary polydipsia
54
how do we differ between diabetes insidious and primary polydipsia?
diabetes insipidus will have hypernatremia | primary polydipsia will have hyponatremia
55
if you have polyuria with high urine osmolality...what is the cause of the polyuria?
osmotic or solute diuresis
56
what is a test to do to determine if patient has diabetes inspidus or primary polydipsia?
water deprivation test
57
with water deprivation...how does primary polydipsia urine osmolality change?
osmolality will increase to above 600
58
with water deprivation...how does diabetes insipidus urine osmolality change?
it stays below 200
59
if you find out you have diabetes insipidus...what can you give to determine if it is central or nephrogenic? what are the results of each?
desmopressin central. ..urine osmolarity increases to 600 nephrogenic. ..urine osmolarity stays low around 200
60
if you give rapid correction of hypernatremia...what can occur?
cerebral edema

Renal Week 1 (8 decks)

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