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Electrolytes Flashcards

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1
Q

What happens when there’s a 1-2% increase in Na or a 10% decrease in blood volume?

A

osmoreceptors in the hypothalamus sense the change–> vasopressin secreted from posterior pituitary–> enhances H2O resorption in renal CDs

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2
Q

Na is a major determinant of intra or extracellular osmolality?

A

extra

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3
Q

incr in BP–> sensed by ______–> impulses to the ____ to inhibit ____ release and decrease ___ resorption in the distal nephron

A

incr in BP–> sensed by arterial and atrial baroreceptors–> impulses to the hypothalamus to inhibit vasopressin release and decrease Na resorption in the distal nephron

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4
Q

What happens when there is a decrease in BP to stimulate an increase in resorbed water in the kidneys?

A

decr in BP–> sensed by juxtaglomerular cells–> activate RAAS by secreting renin–> renin cleaves angiotensinogen to angiotensin I–> angiotensin I converted to angiotensinogen II by ACE–> angiotensinogen triggers release of aldosterone from the adrenals, secretion of vasopressin, and stimulates thirst

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5
Q

What are the actions of angiotensinogen II?

A

triggers release of aldosterone from the adrenals, secretion of vasopressin, and stimulates thirst

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6
Q

T or F: All hyperNa animals are hyperosmolar

A

T

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7
Q

What is the normal ECF osmolality?

A

300 mOsm/kg

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8
Q

What are effective osmoles?

A

osmoles that contribute to tonicity

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9
Q

What are examples of effective osmoles?

A

glucose, EG, propylene glycol

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10
Q

T or F: BUN is a strong effective osmole

A

F- BUN is an osmole but doesn’t cornice to tonicity b/c can freely diffuse across membranes

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11
Q

What is an example of a hypertonic rumens where BUN actually contributes to hypertonicity and is an effective osmole?

A

urea toxicosis

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12
Q

T or F: Hypoosmolar pts always have hypoNa.

A

T

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13
Q

T or F: HypoNa pts always are hypoosmolar.

A

F (if concurrent hyperglycemia)

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14
Q

What are 3 scenarios where you may have hyponatremia without a decrease in osmolality?

A
  1. Pseudohyponatremia when indirect potentiometry and flame photometry are used and Na is measured in plasma and not just plasma H2O
  2. Marked hyperlipemia or hyperproteinemia displaces the plasma H2O
  3. Translocational hypoNa: concurrent hyperosmolality from some other substance (glucose, EG, mannitol, etc)
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15
Q

HypoNa in a normovol patient indicates…

A

increased total body Na

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16
Q

HypoNa in a dehydrated patient indicates…

A

Na and H2O are being lost together but Na loss is > H20; indicates severe total body Na deficit

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17
Q

HypoNa in a pt with ascites or edema indicates…

A

H2O is accumulating faster than Na can increase; tuna is normal to increased

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18
Q

HyperNa in a dehydrated pt indicates…

A

H2O loss w/o Na loss, tbNa is normal and ECF volume is decreased

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19
Q

HyperNa in a normovol pt indicates…

A

increase in tuna (usually excess salt w/o access to water)

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20
Q

What are 3 mechanisms of hypoNa?

A
  1. excess water diluting out Na
  2. endogenous shifts
  3. losing Na in excess of H2O
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21
Q

What are 3 causes of renal Na loss leading to hypovolemic hypoNa?

A
  1. proximal tubule dysfx–> less Na resorption
  2. Addisons
  3. osmotic diuresis (DM)
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22
Q

What are 3 main causes of non-renal Na loss leading to hypovolemic hypoNa?

A
  1. GI (diarrhea or vomiting)
  2. 3rd spacing (ruptured bladder, peritonitis, chylothorax)
  3. cutaneous (sweating in horses)
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23
Q

What are 4 causes of excessive water intake causing euvolemic hypoNa?

A
  1. PD
  2. SIADH
  3. Antidiuretics
  4. hypotonic fluid admin
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24
Q

What are 4 causes of volume overload leading to hypervolemic hypoNa?

A
  1. CHF
  2. Liver disease
  3. nephrotic syndrome
  4. advanced (oliguric/anuric) renal failure
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25
What are 5 reasons for low Na:K?
1. addisons 2. renal/urinary tract disease 3. GI dz/parasitism 4. body cavity effusions 5. repeated chylothorax drainage
26
Chloride is an anion or cation?
anion
27
Chloride is primarily in the ECF or ICF?
ECF
28
How can hyperCl be related to secretory acidoses?
when you lose bicarb, you retain Cl to stay electroneutral
29
What are 5 conditions that you might lose bicarb and have a resulting hyperCl?
1. diarrhea 2. saliva loss in cattle 3. vomiting 4. renal loss with proximal or distal tubular acidosis 5. chronic respiratory alkalosis (there's a decr in renal conservation of bicarb)
30
What can cause an artificial increase in chloride?
halides (bromide or iodide)
31
What is the corrected Cl formula?
Corr Cl= Normal Na/measured Na x measured Cl
32
K is primarily and intra or extracellular ion?
intra
33
Is K an anion or cation?
cation
34
Which species have normally high intracellular K?
Horses, pigs, primates
35
___-___% of K is excreted in the kidneys. Where is the rest excreted?
90-95%, 5-10% excreted in colon
36
What are the 3 major mechanisms of hyperK?
decreased renal excretion shift from ICF to ECF artifactual
37
What are the 3 major mechanisms of hypoK?
decreased intake increased excretion/loss shift from ECF-> ICF
38
What are 7 causes of decreased renal excretion as a cause of hypoK?
renal failure (anuric/oliguric in SA, polyuric in horses) urethral obstruction ruptured urinary bladder ill bitches in late pregnancy addisons high doses of TMS hypovolemia (3rd spacing, GI dz/whipworms)
39
What are 7 causes of intercellular shifts leading to hyperK?
``` Metabolic acidosis (nonunion gap) Insulin deficiency Cellular damage Hyperosmolality Secretory diarrhea HYPP Oleander tox ```
40
What are 6 causes of artifactual hyperK?
``` K leaks out after blood draw Blood clotting Hemolysis contamination of sample with EDTA delayed serum removal thrombocytosis ```
41
What are 5 renal causes of hypoK?
``` CRF Distal renal tubular acidosis postobstructive diuresis DKA diuretics ```
42
What are 3 major mechanisms of increased excretion/loss of K causing hypoK?
``` GI loss (vomiting/diarrhea) Renal Hyperaldosteronism ```
43
What are 5 causes of intercellular shifts leading to hypoK?
excess insulin glucose infusion met alkalosis pain, sepsis, trauma (catecholamine indued) admin of alkalinizing fluid in acidotic patient
44
What are the main ECF cations?
Na, K, Ca, Mg
45
What are the main ECF anions?
Cl, HCO3, plasma proteins, organic acid ions, phosphate, sulfate
46
What is the anion gap?
The difference between unmeasured anions (Na + K) and cations (Cl - HCO3) (more anions unmeasured than cations)
47
Ca, P, and Mg are higher in the intra or extra cellular fluid?
ICF
48
Calcitonin is made by _____.
thyroid parafollicular C cells
49
PTH is made by ____.
parathyroid gland chief cells
50
How does calcitonin decrease serum Ca and P?
inhibits bone and kidney resorption
51
What are PTH's effects on Ca and P?
increases Ca (increases Ca resorption from bone and kidney) and decreases P (phosphaturic and decreases renal P resorption)
52
What is active Vit D's effect on Ca and P?
increases both by increasing their absorption from the GI
53
______ is made in the liver and metabolized to calcidiol--> goes to ____ in response to PTH to become _____.
Cholecalciferol is made in the liver and metabolized to calcidiol--> goes to kidneys in response to PTH to become calcitriol (active Vit D).
54
iCa is ____% of total Ca.
50%
55
``` Typical patterns in primary hyperparathyroidism: PTHrp- PTH- Ca- P- ```
PTHrp- normal/decr PTH- incr Ca- incr P- decr unless dehydrated
56
``` Typical patterns in hypercalcemia of malignancy: PTHrp- PTH- Ca- P- ```
PTHrp- incr PTH- decr Ca- incr P- decr unless dehydrated
57
Typical pattern in primary hypoPTHism Ca- P- PTH-
Ca- decr P- incr PTH- decr
58
What are 3 ways that diet can play a role in hypoCa?
malabsorptive disease Vit D def cantharidiasis
59
What 2 electrolyte abnormalities can lead to hypoCa? secondarily?
hypoMg | hyperK
60
What is the mechanism for hypoCa caused by hypoMg? What is an example of a condition that causes this?
hypoMg--> decr PTH secretion & actin--> decr Ca | Grass tetany
61
What are 2 diseases that can cause hypoCa secondary to hyperP?
renal failure | nutritional secondary hyperPTHism (excess P in diet or low Ca:P ratio)
62
P is excreted mainly through the ____ in SAs but not in cows-- they excrete mainly in the ____.
P is excreted mainly through the kidneys in SAs but not in cows-- they excrete mainly in the GI.
63
What are the 3 main mechanisms of hyperP?
decreased excretion/GFR increased load redistribution from bone or ICF to ECF
64
What are 3 causes of decreased excretion of P causing hyperP?
CRF dehydration GI obstruction in cattle (can't excrete like they normally do in GI)
65
What are 4 causes of increased P load causing hyperP?
high P diet EG poisoning hypervit D phosphate enema
66
What are 3 causes of hyperP that are from redistribution from bone or ICF to ECF fluid?
``` osteolytic lesions cell injury (acute tumor lysis, acute myopathies) acidosis (decreases cell uptake of P) ```
67
What are 3 causes of hormonal imbalances leading to hypoP?
primary hyperPTHism hypovit D pariparturient hypoCa
68
What are 5 causes of hypoP due to increased renal excretion/decreased resorption?
``` defects in prox tubules (fanconis) diuresis DKA- diuresis and phosphate used as buffer for excreted acids CRF in horses hyperPTHism ```
69
What are 3 causes of hypoP due to decreased intestinal absorption?
prolonged anorexia or low P diet vomiting, diarrhea, malabsorptive disease hypovitD
70
What are 3 causes of hypoP due to redistribution of ECF to ICF?
``` insulin admin resp alkalosis (CO2 out of cell, P in) accelerated metabolism (P needed for cell fx) ```
71
Mg is mainly intra or extra cellular?
intra
72
What % of Mg is ionized/free?
70%
73
HypoMg can lead to decreases in what other 2 electrolytes?
K & Ca
74
What are 2 causes of hypoMg due to increased loss?
GI in SAs (malabsorption or diarrhea) | kidneys in SAs (diuresis & renal disease)
75
What are 2 major diseases in large animals that involve hypoMg?
grass tetany | milk tetany
76
What is the mechanism of grass tetany?
grass tetany--> eat lush pastures high in K & low in Mg--> high K blocks Mg absorption in rumen
77
Between non diluted/direct and diluted/indirect measurements of electrolytes, which is not affected by increases in the non-aqueous phase (by lipemia or hyperproteinemia)?
nondiluted/direct
78
Between non diluted/direct and diluted/indirect measurements of electrolytes, which is affected by increases in the non-aqueous phase (by lipemia or hyperproteinemia)?
diluted/indirect
79
Most chemistry analyzers use non diluted/direct or diluted/indirect to measure electrolytes?
diluted/indirect
80
What are the 4 major unmeasured anions in health?
albumin phosphates sulfates small organic acids (lactic, BHB)
81
What are the 4 major unmeasured cations in health?
Ca Mg y-globs some abx
82
What are 3 causes of decreased anion gap?
hemodilution, hypoalb, increase in some cations (Ca)
83
What is the SID formula?
SID= cations that dissociate at body pH - anions that dissociate at body pH
84
Increased SID indicates-
met alkalosis
85
Decreased SID indicates-
met acidosis
86
Why would producers feed an acidifying diet to pre parturient cows?
acidosis will cause more Ca to be in the ionized fraction-- used to prevent milk fever
87
What is DCAD? How is it used? What is the formula?
Dietary cation anion difference (Na + K) - (Cl - SO4) Impt in choosing diet for preparturient cows-- want a food with a DCAD
88
What 2 opposing forces determine pH during exercise?
lactic acidosis | hyperventilation and decreased pCO2 (alkalosis)
89
What electrolyte changes do horses usually get during exercise due to sweating?
mild-severe hypoK, hypoCl, usually mild hypoNa

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