Fisiopato Parcial 1 Flashcards

Question

Polidipsia

Answer 1

demasiado sed

Answer 2

sintomatica/verdadera (estimulado por deshidratación celular por aumento de la osmolalidad EC + Disminución de la volemia + angiotensina II) falsa compulsivo

Answer 3

Diabetes mellitus is a disorder of blood glucose regulation, which results from a deficiency in the action of the hormone insulin. This may be due to autoimmune destruction of the insulin-secreting cells of the pancreas (type 1 diabetes mellitus) or it may result from a problem in the responsiveness of tissues to insulin, known as insulin resitance (type 2 diabetes mellitus). With either disorder, the result is hyperglycemia, or high levels of glucose in the plasma. In a diabetic that has hyperglycemia, the filtered load of glucose (amount of glucose filtered) can exceed the capacity of the kidney tubules to reabsorb glucose, because the transport proteins become saturated. The result is glucose in the urine. Glucose is a solute that draws water into the urine by osmosis. Thus, hyperglycemia causes a diabetic to produce a high volume of glucose-containing urine. Diabetes Insipidus tambien resulta en perdida de agua por deficiencia de ADH (neurogenico) o falta de respuesta a ADH (nefrogenico)

Answer 4

nivel aumenta en respuesta a volumen sanguíneo baja pression sanguínea baja)

Answer 5

actua sobre tubulos aumentando reabsorción de sodio, estrecha (constricts) vasos sanguíneos renales, reduce TFG, enlentece flujo sangineo renal Na+ filtra menos y se reabsorbe mas.

Answer 6

Sintetizado por celulas en nucleo supraoptico y paraventricular @ hipotálamo --> posterior pituitary gland (neurohipófisis) almacena aquí --> circulación Forma aquaporina 2 --> aumenta permeabilidad y reabsorcion para agua

Answer 7

released by the pituitary in response to sensors that detect an increase in blood osmolality or decrease in blood volume

Answer 8

increased glomerular capillary filtration coefficient increased blood flow into glomerulus increased glomerular capillary hydrostatic pressure increased arterial pressure increased resistance of efferent arterioles (constriction) decreased resistance of afferent arterioles (dilation) Endothelial-derived nitric oxide Prostaglandins

Answer 9

dilutional hyponatremia. no edema + headaches Urine osmolality is high and serum osmolality is low. Urine output decreases despite adequate or increased fluid intake. Hematocrit and the plasma sodium and BUN levels are all decreased because of the expansion of the ECF volume.

Answer 10

deficit de agua, tobaco, antipsicoticos

Answer 11

``` anfotericina B demeclociclina etanol foscarnet litio antagonistas de la morfina ```

Answer 12

``` antineoplasicos (vincristina y ciclofosfamida) carbamazepina clorpropamida clofibrato anestesicos generales narcoticos (morfina y meperidina) nicotina AINES antipsicoticos fenotiacinicos inhibidores selectivos de la recaptacion de serotonina diureticos tiacidicos (clorotiazida) tiotixeno (antipsicotico) antidepresivos triciclicos ```

Answer 13

acetato de desmopresina, clorpropamida los dos tipos responden a ii. Diuréticos tiazidicos (hidroclorotiaziada) – aumentan excreción de sodio, disminuyendo la TFG y aumenta reabsorción de agua en Tubulo proximal

Answer 14

Inadequate Fluid intake (trauma, impaired thirsts) Excessive GI fluid lossis (diarrea, vomito) Excessive Renal Losses (terapia diuretica, hiperglicemia, addisons disease) excessive skin loss (fever, burns) third space losses (intestinal obstruction, edema, ascitis)

Answer 15

the adrenal glands are underactive, resulting in a deficiency of adrenal hormones A deficiency of aldosterone in particular causes the body to excrete large amounts of sodium and retain potassium, leading to low levels of sodium and high levels of potassium in the blood. The kidneys are not able to retain sodium easily, so when a person with Addison disease drinks too much water or loses too much sodium, the level of sodium in the blood falls, and the person becomes dehydrated. Severe dehydration and a low sodium level reduce blood volume and can lead to shock

Answer 16

perdida de peso (mas de 8% severo) Compensatory increase in ADH (decrease urine) Aumento de osmolalidad (sed, aumento en Ht + BUN) increased urine osmolality fiebre Disminuye volumen vascular (hipotension, tachycardia, shock) Disminuye volumen EC (sunken eyes and soft eyeballs) Impaired temperature regulateion (elevated T) hipotension postural

Answer 17

inadequate sodium and water elimination (fallo cardiaco, fallo renal, aumento de niveles de corticosteroids, hiperaldoseronism, enfermdedad de cushing, fallo hepatico() Excessive Na+ ingestion (dieta) Excessive fluid intake

Answer 18

are produced in the adrenal cortex of vertebrates as well as the synthetic analogues of these hormones. Glucocorticoids such as cortisol control carbohydrate, fat and protein metabolism, and are anti-inflammatory by preventing phospholipid release, decreasing eosinophil action and a number of other mechanisms.[1] Mineralocorticoids such as aldosterone control electrolyte and water levels, mainly by promoting sodium retention in the kidney.

Answer 19

A common blood test, the blood urea nitrogen (BUN) test reveals important information about how well your kidneys and liver are working. A BUN test measures the amount of urea nitrogen that's in your blood. Here's how your body typically forms and gets rid of urea nitrogen: Your liver produces ammonia — which contains nitrogen — after it breaks down proteins used by your body's cells. The nitrogen combines with other elements, such as carbon, hydrogen and oxygen, to form urea, which is a chemical waste product. The urea travels from your liver to your kidneys through your bloodstream. Healthy kidneys filter urea and remove other waste products from your blood. The filtered waste products leave your body through urine. A BUN test can reveal whether your urea nitrogen levels are higher than normal, suggesting that your kidneys or liver may not be working properly.

Answer 20

Excess cortisol interacts with mineralocorticoid receptors leading to: Sodium retention causing hypertension (in 70-80%). Potassium loss: hypokalemic alkalosis in 20% of cases

Answer 21

Aumento de peso Aumento de volumen intesticial (edema) Aumento de volumen vascular (venous distenstion, full pulse, dispnea por edema pulmonar)

Answer 22

275-295m | Osm/kg

Answer 23

Hipertonica por hiperglucemia hipovolemic Hipotonica hiponatremia (+) pueder ser : hipovolemica (mas Na+ se pierde que agua) euvolemica (SIADH) hipervolemica (por trastornos que causan edema --> liberacion de ADH)

Answer 24

``` hipovolemia ingestion de soluciones sin sodio perdida GI diureticos enfermedad de addison ```

Answer 25

``` aumenta ADH trauma SIADH diurticos deficiency de glucocorticoide hipotiroidismo polidipsia psicogenico ejercicio MDMA ```

Answer 26

fallo cardiaco fallo hepatico fallo renal

Answer 27

hiperflicemia

Answer 28

serum sodium 280mOsmo/kg cramps, weakness, headache depresion, personality changes, lethhargy, coma (agua entra a neuronas) anorexia, nausea, vomito, diarrea aumenta IC --> fingerprint edema

Answer 29

perdida de agua excessiva (diarrea aguada, sweating, increased respirations, diabetes insipidus) decreased water intake (trauma, impaired thirs) excessive sodium intake (ocean drowning)

Answer 30

Na+ > 145 aumento de Ht y BUN high urine specific gravity Sed, aumento de ADH --> polidipsia, oliguria, anuria Deshidratacion IC --> dry skin, decreased tissue turgor, rough tongue, disminucion de salivacion and lacrimacion Agua sale de neuronas (cefalea, agitation, disminucion de reflejos, convulsiones , coma Deshidratacion EC, tacicardia, weakpulse, hipotension, vascular collapse

Answer 31

50mEq/kg (K+)

Answer 32

50-100mEq 40-60 se elimina en heces

Answer 33

osmolalidad de suero, trastornos acido-base, insulina, estimulacion beta-adrenergica, ejercicio

Answer 34

insulina | adrenalina

Answer 35

hipolarizacion, potencial de membrana de reposo mas positivo closer to threshold prolonged depolarization that can decrease excitability. more rapid repolarization

Answer 36

PMR mas negativo = hiperpolarizacion y se aleeje del umbral para que se produzca la excitacion Thus, it takes a greater stimulus to reach threshold and open the sodium channels that are responsible for the action potential slower repolarization

Answer 37

inadequate intake (dieta, inconsciencia) excessive renal loss (terapia diuretica, fallo renal, increased mineralocorticoid levels, hiperaldosteronism, tx con corticosteroid drugs) excessive GI losses (vomit, diarrea) transcompartmental shift (beta-adrenergic agonist, insulina, alkalosis)

Answer 38

poliuria orina no concentrada polidipsia anorexia, nausea, vomito constipation, muscle fatigue, cramps, paresthesias, paralisis hipotension postural, cambios en ECG, disrithmias confusion, depresion alkalosis metabolica takicardia y disrimias

Answer 39

thiazide diuretics metabolic alkalosis magnesium deplesion (causes renal K+ wasting) aumento en aldosterona + cortisol Cortisol binds to aldosterone receptors and exerts aldosterone-like effects on potassium elimination. Other rare, genetic disorders that can also result in hypokalemia are the Bartter, Gitelman, and Liddle syndromes.

Answer 40

PR prolongado ST depression T flattened U prominante U>T Hypokalemia reduces the permeability of the cell membrane to potassium tasa de repolarizacion prolongada, perioodo refractorio prolongada bradicardia

Answer 41

excessive ingestion release from IC (trauma, burns, extreme excercise, siezures) inadequate elimination (fallo renal, enfermedad de addison, potassium-sparing diuretics, tx with ACE inhibitors or ARBs)

Answer 42

suero > 5mEq nausea, vomito , cramps, diarrea paresthesia, weakness, cramps, dizziness cambios en ECG (more cardiac than neurological)

Answer 43

peaked T waves shortened !T widened QRS PR interval prolonged P waves disappear

Answer 44

Calcium antagonizes the potassium-induced decrease in membrane excitability, restoring excitability toward normal. The protective effect of calcium administration is usually short-lived (15 to 30 minutes), and it must be accompanied by other therapies to decrease the ECF potassium concentration Sodium bicarbonate, b-adrenergic agonists (nebulized albuterol) or insulin distributes K+ into ICF and decreases ECF (IV insulin + glucose)

Answer 45

unidos a proteinas (40%) o ionizados libres (50%) complejado con citrato, fosfato, sulfato (10%)

Answer 46

excitacion neuromuscular y cardiaco, reacciones enzimaticas, contraccion del musculo, liberacion de hormonas, NTs, mensajeros quimicos, contractilidad cardiaca, coagulacion

Answer 47

PTH y renal, alteraciones en albumina + pH

Answer 48

tubulo distal convoluted: PTH, Vitamina D, thiaziade diuretics, fosfato, glucosa, e insulina regulan aqui

Answer 49

Perdida de habilidad de movilizar calcio del hueso (hipoparatiroidismo, resistencia a PTH, hipomagnesemia) Perdida anormal de calcio por riñones (fallo renal + hiperfosfatemia) decreased intake or absorption (malabsorcion, deficiencia de vitamina D, fallo de activacion de vitamina D por fallo hepatico o renal) Aumento de unión con proteínas o chelation --> mas proporciones de calcio en forma noionizado (aumento en pH, aumento en AGs, transfusion de sangre citrado) Sequestracion por tejidos blandos (pancreatitis aguda)

Answer 50

pH acido disminuye union de calcio con proteína --> aumentando Ca2+ ionizado (plasma calcio total no cambia) pH alkalino aumenta union con proteina --> tetany

Answer 51

Tetany is a symptom characterized by muscle cramps, spasms or tremors. These repetitive actions of the muscles happen when your muscle contracts uncontrollably caused by low levels of calcium in the body

Answer 52

AGs aumentan union de calcio con albumina elevados por estres, heparina, beta-adrenergic drugs (epinefrina, isoproterenol, NE) y alcohol

Answer 53

elevación de AGlibres, epinefrina, glucagón, hormona de crecimiento , y adrenocortocotropic hormone

Answer 54

calcio en suero osteomalacia, bone pain, deformities + fractures Muscle cramps, pins and needle sensation around the mouth/lips, and unexplained bruising while abdominal spasms and hyperactive reflexes are more likely consequences of low calcium levels personality changes ventricular arrythmias Hypocalcaemia may be evidenced by personality changes and neuromuscular irritability along with tremors, choreiform movements, and positive Chvostek or Trousseau signs. Cardiovascular manifestations include tachycardia, hipotension, and ventricular dysrhythmias.

Answer 55

a. Ca2+ se une con acidos grasos libres liberados por lipolisis en el páncreas --> soaps + removing Ca2+ de la circulación

Answer 56

taping face below temple @ nervio VII --> spasm of lip, nose face = +

Answer 57

aumenta de absorcion intestinal (excessive Ca en dieta, excessive vitamin D, milk-alkali syndrome) Aumento de Resorcion Osea (aumento de PTH, neoplasias, immobilizacion prolongada) falta de eliminacion de calcio (diureticos thiazide, terapia con lithium) de malignancy (PTH suppresed)

Answer 58

suero > 10.5mg/dL inabilidad de concentrar orina (poliuria, polidipsia, dolor, fallo renal, calculos renales) (anorexia, nausea, vomito, constipation) disminucion en excitibilidad neuromuscular (debilidad musculoar, atrocity, ataxia) osteopenia, osteoporosis lethargy, cambios en personalidad, coma hipertension QT shortening with atrioventricular block on ECG Polydipsia, polyuria, anorexia, lethargy, and stupor

Answer 59

ingestion excesiva de calcio (leche) _ antacidos absorbables

Answer 60

lithium, thiazide diuretics

Answer 61

85% en hueso 14% iC 1% EC

Answer 62

organica (90% de fosforo IC - acidos nucleicos, fosfolipidos, ATP) inorganica (principal forma circulante - el que se mide en laboratorio)

Answer 63

Formación de hueso Esencial para procesos metabólicos Formación de ATP + enzimas usadas en metabolismo de glucosa, grasa, y proteína Comonente de celulas (acidos nucleico, fosfolípidos, ) Amortiguador @ EC + ecreccion renal de H+ Delivery de Oxigeno por GR depende de fosforo organico en ATP y 23DPG Función de GBs y plaquetas

Answer 64

magnesio, calcio, alumino

Answer 65

NO ! todo se filtra

Answer 66

disminucion de absorcion intestinal (antacids = calcio y aluminum, diarrea, ausencia de vitamina D) aumento de eliminacion renal (alkalosis, hiperparatiroidismo, diabetic ketoacidosis, renal tubular absorption defects) Malnutricion + IC shifts (alcoholismo, total parenteral hiperalimentation, insulina)

Answer 67

Phosphate is necessary for the normal function of platelets and the excretion of hydrogen ions that contribute to acidosis. Phosphate replacement would be unlikely to resolve ascites and cardiac anomalies, Neural Manifestations Intention tremor Ataxia Paresthesias Confusion, stupor, coma Seizures Muscle weakness Joint stiffness Bone pain Osteomalacia Blood Disorders Hemolytic anemia Platelet dysfunction with bleeding disorders Impaired white blood cell function

Answer 68

Antacidos que contienen aluminum hydroxide, alimunim carbonate, and calcium carbonate se unen con fosfato --> perdida en heces

Answer 69

laxatives and enemas IC --> EC shift por (trauma, heat stroke, seizures, rhabdomiolisis, deficiencia de K+) fallo renal, hipoparatiroidismo

Answer 70

suero >4.5 en adultos y mas de 5.4 en ninos dismiucion de calcio en suero (paresthesias, tetania) hipotension , arrithmias

Answer 71

50-60% stored en hueso 39-49% en celulas del cuerpo 15-30% se puede intercambiar con EC 1% EC 20-30% unido a proteína (EC)

Answer 72

1.8-3mg/dL

Answer 73

Cofactor en reacciones (generación ATP de ADP, replicación, tramscripcion, tradducion) Metaboloismo Bomba ATPasa Estabilización de membrana Conducion de nercvio Trasnporte ion Actividad de canales de Ca2+ y K+ Smooth muscle relaxant – anticonvulsante trata eclampsia en embarazadas agente neuroprotector para infantes

Answer 74

difunction de absorcion (alcoholismo, malnutricion, malabsorcion, dieta alta en calcio sin magnesio) perdida de Mg por terapia diuretica, hiperparatiroidismo, hiperaldosteronismo, diabeteic ketoacidosis,

Answer 75

Serum magnesium level below 1.8 mg/dL (0.75 mmol/L) Personality change Athetoid or choreiform movements Nystagmus Tetany Positive Babinski, Chvostek, Trousseau signs Tachycardia Hypertension Cardiac arrhythmias

Answer 76

ingestion excessiva (para tratamiento de preeclampsia) fallo renal, glomerulonefriis disminuyen excreccion

Answer 77

mg en suero > 3mg/dL lethargia, hiporeflexia, confusion, coma, hipotension, arritmias

Answer 78

Formerly called toxemia, preeclampsia is a condition that pregnant women develop. It is marked by high blood pressure and a high level of protein in the urine. Preeclamptic women will often also have swelling in the feet, legs, and hands. a result of a placenta that doesn't function properly no cure

Answer 79

hipercalcemia + eclampsia

Answer 80

@ pelvis renal: calculos renales, necrosis papilar @ ureter: calculos, embarazo, tumores que comprimen ureter, trastornos congenitos @ vejiga/uretra : CA, calculos, trastornos congenitas

Answer 81

sales de calcio, acido urico, magnesimu ammonium phosphate, cystine

Answer 82

Mg+ citrato

Answer 83

calcio (oxalate and phosphate - 75-80%) mg ammonium phosphate (struvite) (15%) uric acid (urate-7%) cystine

Answer 84

@ ph alta --> calcium phosphate @ pH baja --> calcium oxalata hipercalcemia, hipercalcuria, immobilizacion, hiperparatiroidismo, intoxicacion con vitamina D, diffuse bonde disease, milk-alkali syndrome, hiperoxaluria, oxalate crystals from ethylene glycol, vitamin C abuse, Crohn disease

Answer 85

urea splitting infeccion por bugs ureasa positivo (proteus, staph, kliebsella) that hydrolisan urea --> ammonia --> urine alkalinization UTIs aumento de pH

Answer 86

pH 5.5 high purine diet low urine volume, arid climates, acidic pH hiperuricemia (gout) leukemia

Answer 87

low pH cistinuria (genetico , trastrono de metabolismo de AAs)

Answer 88

trata underlying condition increase fluid intake thiazide diuretics + citrate dieta sin oxalate

Answer 89

tratar UTI (eradicacion de infecion ) acidify orina increase fluid intake surgical removal of stone

Answer 90

increase fluid intake allopurinol for hyperuricosuria alkalinzation of urine

Answer 91

increase fluid intake | alkalinzation of urine

Answer 92

debilita los huesos y aumenta la posibilidad de fracturas.

Answer 93

Insidious, parcial, complete, unilateral, bilateral

Answer 94

Anormalidades congenitales, calculi urinaria (stones), embarazo, hiperplasa prstatica benigna, scar tissue de infección + inflmacion, tumores, trastronos neurológicos,

Answer 95

Stasis of urine (stoppage of flow) --> infeciones y pierdras Dilatación progressiva de ducto colectores renales y estructuras tubulares  destrucion + atrofia del tejido renal

Answer 96

in stagnant alkaline urine

Answer 97

dilatacion de pelvis renal + calyces por obstruccion de tracto urinario (calculos renales, CA cervical, trauma en ureter, retroperitoneal fibrosis, vesicoureteral reflux) only impairs renal function if bilateral causa compression atrophy of renal cortex and medulla

Answer 98

Silent, or pain complete Bilateral= (below the level of the ureterovesical junction): olguria (less urine ) + anuria parcial: fallo renal, perdida de habilidad de concentrar orina --> poliuria , nocturia Hipertensión

Answer 99

solo afectan algunos glomérulos

Answer 100

compromete todos los glomérulos + todas las partes

Answer 101

solo comprometen un segmento especifico de cada glomérulo

Answer 102

solo afectan cel. Mesangiales

Answer 103

Lesión por anticuerpos que reaccionan contra antígenos glomerulares fijos Lesión por immunocomplejos atrapados en la membrana glomerular

Answer 104

Proliferativos: aumento en componentes celulares Escleroticos: aumento en componentes no celulares Membranosos: aumento en espresor de pared capilar

Answer 105

- Proceso inflamatoria producida por reacción inmune que se desencadena cuando los complejos inmunes circulantes quedan atrapados en la membrana capilar glomerular. - se observa proliferación de las celulas endoteliales que tapizan los capilares glomerulares y de las celulas mesangiles - La membrana capilar se edematiza y se torna permeable a las proteínas plasmáticas y celulas de la sangre --> proteinuria , hematuria - Disminuye TFG --> oliguria - Aumenta retención de Na+ y H2O  hipertensión y edema azotemia Deposición de IgG, IgM y C3 --> aparencia granular en tincion Inmunocomplejos en ninos se resuelve

Answer 106

- Prolif. Focal + segmentaria de cel. Glomerulares + reclutamiento de monocitos y macrófagos  estructuras en forma de medialuna que obliteran espacio de Bowman linear causada por sindrome de goodpasure mal pronostico

Answer 107

antricuerpos contra MBG y membrana basal alveolar Hemorragia pulmonar anemia ferropenica glomerulonefritis Goodpasture syndrome is a form of glomerulonephritis; treatment includes plasmapheresis to remove circulating anti-GBM antibodies and immunosuppressive therapy to inhibit antibody production.

Answer 108

aumento de permeabilidad glomerular Proteinuria masiva (>3.5 g/dia) Hipoalbuminemia The pathophysiology of the nephrotic syndrome involves damaged glomeruli becoming increasingly permeable to protein, allowing more protein into the glomerular filtrate. Massive proteinuria results, leading to hypoalbuminemia. Generalized edema, which is the hallmark of nephrotic syndrome, results from the loss of colloidal osmotic pressure of the blood with subsequent accumulation of fluid in the interstitial tissues.

Answer 109

causa mas frecuente de sinfrome nefrotico in whites Engrosamiento difuso de MBG y capilares por immunocomplejos granular Causas:- Idiopático o asociado con anti-fosfolipasa A2 receptor, drogas (AINES) infecciones, SLE, tumores, alteraciones metabolicas 50% --> fallo renal

Answer 110

- Perdida difusa/fusion de los podocitos Niños Causa desconocido (infecion, immunizacion, linfoma de hodkin) Respuesta excelente a tratmiento con corticoesteroides

Answer 111

- Esclerosis segmental y hyalinosis Hipertensión perdida de funcion renal causa mas comun de sind. nerfrotico en hispanos y afroamericanos causas: - Idiopático , ↓ O2 en sangre, VIH, abuso de drogas IV, secundario, obesidad, tx IFN

Answer 112

causa sind. nefritico Deposito de IgA en mesangio --> proliferación mesangial --> inflamación infecion respiratorio + gastroenteritis o asintomatico hematuria (2-6 dias) no tx Immunoglobulin A (IgA) nephropathy (Buerger disease) is a primary glomerulonephritis characterized by the presence of glomerular IgA immune complex deposits. It can occur at any age, but most commonly occurs with clinical onset in the second and third decades of life. It is more common in males than in females and is the most common cause of glomerular nephritis in Asians. There is no satisfactory treatment for IgA nephropathy.

Answer 113

``` ninos vasculitis de vasos pequentos erupcion palpable artralgias dolor abdominal, ``` asociado con IgA nefropatia sindrome nefrotico, nefritico o combinado recuperacion

Answer 114

Defecto hereditario de MBG por mutacion en tipo IV colágeno -->thinning and splitting of glomerular basement membrane --> fallo renal defectos en ojos oidos hematuria proteinuria glomerulonefritis Heavy microscopic hematuria, proteinuria, and sensorineural deafness and eye disorders are characteristic of Alport syndrome. This symptomatology is less characteristic of systemic lupus erythematosus glomerulonephritis, Henoch-Schönlein purpura nephritis, or immunoglobulin A nephropathy.

Answer 115

``` Tipo I: normal Tipo II: proliferación mesangial Tipo III: proliferación focal y segmental Tipo IV: proliferación difusa Tipo V: proliferación membranosa ```

Answer 116

thicenking of glomerular capillary basement membrane + diffuse increase in mesangial matrix ; this impinges on capillary lumen reducing glomerular filtration

Answer 117

4. Nodular glomerulosclerosis nodular deposition of hyaline in mesangial portion of glomerulus --> obliteration in nodular glomerulosclerosis, also known as Kimmelstiel-Wilson syndrome, there is nodular deposition of hyaline in the mesangial portion of the glomerulus. As the sclerotic process progresses in the diffuse and nodular forms of glomerulosclerosis in many cases, early changes in glomerular function can be reversed by careful control of blood glucose levels. Control of high blood pressure and smoking cessation are recommended as primary and secondary prevention strategies in persons with diabetes

Answer 118

urinary albumin excretion of 30 to 300 mg in 24 hours (predicts future diabetic nephropathies)

Answer 119

sclerotic changes in renal arterioles and small arteries, referred to as benign nephrosclerosis --> bilateral, kidneys smaller, narrowed arterioles, thicken and scarring, --> less blood flow to nephron -->patchy tubular atrophy, interstitial fibrosis

Answer 120

AGUDA --> edema intersticial CRONICA --> fibrosis intersticial, atrofia, infiltrado mononuclear; primeros asintomaticos causan imbalancia de fluido + electrolitos

Answer 121

defectos tubulares en reabsorción de HCO3- o excreccion de H+ --> acidosis metabolica

Answer 122

I (distal, ph >5.5) = defecto en secrecion de H+ --> no new HCO3- generated asociado con hipokalemia II (proximal pH se elimina en orina asociado con hipokalemia --> aumenta riesgo de hipofosfatemic rickets IV ( hiperkalemic pH 5.5) - dificiencia de aldosterona o resistencia , hiperkalemia, no se elimina H+

Answer 123

(wilsons disease) asociado con proximal renal tubular acidosis defecto en reabsorcion de glucosa, AAs, fosfato, y acido urico --> retraso de crecimiento, rickets, osteomalacia, metabolismo anormal de vitamina D + acidosis

Answer 124

infección de parénquima de rinon + pelvis renal Aguda y cronica

Answer 125

affects cortex UTI superior, catherter, cesicouretral reflux, embarazo white cell casts disuria, fever, costovertebral tenderness, nausea, vomiting can cause renal papillary necrosis in px with diabetes or px with obstructtion tx: antibioticos Manifestations of acute pyelonephritis include pain, frequency, urgency, dysuria, nausea, and vomiting. s.

Answer 126

from reccurent pielonefritis aguda scarring + deformation of calyxes renales Chronic rather than acute pyelonephritis is often caused by hypertension, while most cases are caused by ascending bacteria, not systemic infections. Scarring is more commonly a result of chronic pyelonephritis

Answer 127

acute interstitial renal inflamation piuria (eosinofilia) , azotemia, fiebre, rash, hematuria, costovertebral angle tenderness, or asintomatico 1-2 semanas after drogas: diureticos, penicilin derivatives, sulfonamides, rifampin, AINes) 50% fallo renal

Answer 128

1. Fuera del peritoneal cavity @ back of upper abdomen | T12 a L3

Answer 129

en corteza exterior

Answer 130

porque HCO3- has lag entry across blood-brain barrier

Answer 131

respiratorio

Answer 132

1. Excreccion de H+ de acidos metabolisados 2. Reabsorpcion de HCO3- filtrado 3. Produccion de HCO3- liberada en sangre

Answer 133

SI, 4300mEq/dia | y se reabsorbe

Answer 134

ammonia NH3 = lipid solube and can diffuse across collecting duct cells Once in the tubular fluid, NH3 combines with secreted H+ to form NH4+. NH4+ is not lipid soluble, and thus is trapped in the tubular fluid and excreted in urine.

Answer 135

aguda --> edema interstical y cronica --> fibrosis intersticial, atrofia, infiltrado mononuclear

Answer 136

imbalancia de fluido y electrolitos

Answer 137

H2CO3 (hecho de CO2 + HCO3-) contribuye a pH sanguineo

Answer 138

volatile (en equilibrio) H2CO3 eliminado por polmon Nonvolatile (fijados) (sulfuric, HCl,, eliminados por rinon)

Answer 139

15,000mmol

Answer 140

un base leve con su acido conjugado o vice versa trades a strong acid for weak or strong base for weak

Answer 141

como gas en plasma (10%) -->pulmon como bicarbonato en GRs cuando hay exceso de CO2; en GRs (70%) (anhidrasa carbonica convierte H2CO3 en H+ + HCO3-(goes into plasma); H+ + Hb 20% carbaminohemoglobina – CO2 en GRs que queda + Hb para formar HbCO2

Answer 142

amortiguadores químicas (bicarbonato , proteínas, H+/K+ transcellular ) pulmones que eliminan Co2 riñones que eliminan H+ y reabsorbe/genera HCO3-

Answer 143

40% H+ se cambia por Na+ y K+ @ superficie de hueso --> liberación de CaCO3 + NaHCO3 al espacio EC puede amortiguar acidos Provoca demineralizacion del hueso y predispone a formación de cálculos renales por aumento en excreción urinario de calcio.

Answer 144

disminucion de PCO2

Answer 145

respiratorio

Answer 146

Excreccion de H+ de acidos metabolisados 2. Reabsorpcion de HCO3- filtrado 3. Produccion de HCO3- liberada en sangre

Answer 147

85%-90% de secreción de H+ y reabsorción de HCO3- occure aqui H+ secretado se combina con HCO3- filtrado --> H2CO3 --> CO2 + H2O (catalizado por anhidrasa carbonica) -->crusan membrana luminal y entran celula tubular --> adentro de la celula las reacciones occuren en reversa --> CO2 + H2O (catalizado por anhidrasa carbonica) --> H2CO3 --> HCO3- + H+. HCO3- se reabsorbe en sangre con Na+ y H+ secretado , comienza de nuevo

Answer 148

4.5 (en este pH secreccion de H+ stops)

Answer 149

fosfato ammonia

Answer 150

transporte activo reabsorbe K+ y secreta H+ (@ hipokalemia) plasma K+ --> eliminacion de H+ y vice versa

Answer 151

Normally, Cl− is absorbed along with Na+ throughout the tubules. In @ tubulo colector influye secreccion de H+ indirectamente por secreccion de K+ y reabsorcion de Na+ Sodium absorption generates a more lumen-negative potential that drives both potassium secretion by principal cells as well as proton secretion by type A intercalated cells. entonces hiperaldosteronismo --> alkalosis metabolica

Answer 152

cuando hay deplecion de volumen , rinones substituyen HCO3- por Cl- aumentando absorcion de HCO3-

Answer 153

por disminucion en Cl- hay un aumento excesso en reabsorcion de HCO3-

Answer 154

aumento de Cl- disminuye HCO3- y pH

Answer 155

venous normal = 24-31mEq/L arterial = 22-2mEq/

Answer 156

metabolico (altera HCO3-) y respiratorio (altera PCO2)

Answer 157

diminuye pH, ventilación y aumento de PCO2 (>45mmHg) compensacion renal: mas H+ excrecion y mas reabsorcion de HCO3- (acute = 0.1, chronic 0.3) accompanied by renal adaptation with a more marked increase in plasma HCO3– and a lesser decrease in pH. Her pH is likely below 7.35, and the likely renal response involves the reabsorption of HCO3– and secretion of H+. Excess

Answer 158

aumenta pH, por aumento de ventilación y disminución en PCO2 (

Answer 159

se redistribuye lejos de la corteza hacia la médula. Esta redistribución del flujo sanguíneo disminuye la filtración glomerular mientras se mantiene la capacidad de concentración de la orina de los riñones, un factor que es importante durante las condiciones tales como choque

Answer 160

(120/80) BP es 88/53 = hipotension

Answer 161

60 to 100 beats a minute

Answer 162

12 to 20 breaths

Answer 163

Mesangial cells possess phagocytic properties and remove macromolecular materials that enter the intercapillary spaces. Mesangial cells also exhibit contractile properties in response to neurohumoral substances and are thought to contribute to the regulation of blood flow through the glomerulus. Mesangial hyperplasia and increased mesangial matrix occur in a number of glomerular diseases

Answer 164

The proximal tubule secretes exogenous organic compounds such as penicillin, aspirin, and morphine. Many of these compounds can be bound to plasma proteins and are not freely filtered in the glomerulus. Therefore, excretion by filtration alone eliminates only a small portion of these potentially toxic substances from the body.

Answer 165

El aumento de la actividad simpática causa la constricción de la arteriolas aferentes y eferentes y por lo tanto una marcada disminución en el flujo sanguíneo renal. La estimulación simpática intenso puede producir disminuciones en el flujo sanguíneo renal y la TFG marcada. Sustancias humorales, incluyendo la angiotensina II, ADH, y endotelinas, producen vasoconstricción del flujo sanguíneo renal.

Answer 166

A common side effect of thiazide diuretics is increased potassium losses in the urine, which may necessitate potassium supplementation. Aldosterone antagonists, loop diuretics, and osmotic diuretics are less likely to induce hypokalemia. Thiazide diuretics increase the loss of potassium in urine. Because calcium is actively reabsorbed in the distal convoluted tubule, it is likely that her calcium level will go up, especially if she takes it for a long time.

Answer 167

Twenty-four–hour urine tests are often used to quantify the amount of substances, such as proteins, that an individual's kidneys are spilling. Single urine samples are able to assess more parameters than just the presence of bacteria, and they are sufficient in quantity to detect numerous substances such as glucose.

Answer 168

Increased creatinine and BUN are associated with abnormalities in renal function, as is the presence of glucose in a urine sample

Answer 169

disminucion de pH y HCO- (

Answer 170

aumento de pH y HCO3- (>26mEq/l) compensacion respiratorio: disminucion de ventilacion aumento de PCO2 (0.7) compensacion renal: disminucion de excreccion de H+ y reabsorcion de HCO3-

Answer 171

excess metabolic acids (increased anion gap) (excessive production of metabolic acids, lactic acidosis from strenuous excercise, diabetic ketoacidosis, alcoholic ketoacidosis, starvation, poisoning)(impaired elimination of metabolic acids por fallo renal) excessive HCO3- loss (normal anion gap) (loss of intestinal secretions, diarrea, renal losses por renal tubular acidosis, carbonic anhydrase inhibitors, hypoaldosteronism) Increased chloride levels (normal anion gap) (excessive reabsorption of Cl- by kidney, heavy alcohol use and renal failure are associated with acidosis.

Answer 172

disminuye pH HCO3- (primario) disminuye PCO2 (compensatorio) disminuye anorexia, nausea, dolor abdominal, vomito lethargy, confusion, coma, depresion of vital functions decreaesed heart rate, arrythmias decreaseled alertness warm flushed skin bone disease COMPENSACION: Kussmaul breathing (increased rate and depth of respiration) hiperkalemia, orina acido, increased ammonia in urine

Answer 173

in RTA only tubular function is compromised vs. both tubular and glomerular funciont

Answer 174

excessive gain of HCO3- or alkali (acetate, lactate, citrate) Excessive loss of H+ (vomiting, K+ deficit, hiperaldosteronismo, milk-alkali syndrome) Increased HCO3- Retention (loss of Cl-) Volume contraction (diuretics) Ingestion of bicarbonate, gastric suction, and vomiting are causes of metabolic alkalosis.

Answer 175

pH increased HCO3- (primary) increased PCO2 (compensatory) increased confusion, hyperactive reflexes, tetany, convulsions hipotension, arrithymias ``` respitory acidosis (decreased rate) ``` increased urine pH

Answer 176

depression of respiratory center (drug overdose, trauma) Lung disease (asma, emfisema, edema,etc) Obstrucion (paralisis de musculus respiratorios, trauma, obesidad, paralisis, kyphoscoliosis) breathing aire with high CO2 content

Answer 177

pH decreased PCO2 (primary) increased HCO3- (compensatory) increased dilation of cerebral cessels, depresion, headache, behavior changes, tremors, paralysis, coma skin warm and flushed Carbon dioxide readily crosses the blood–brain barrier, exerting its effects by changing the pH of brain fluids. Elevated levels of CO2 produce vasodilation of cerebral blood vessels, causing headache, blurred vision, irritability, muscle twitching, and psychological disturbances acid urine accompanied by renal adaptation with a more marked increase in plasma HCO3– and a lesser decrease in pH. Her pH is likely below 7.35, and the likely renal response involves the reabsorption of HCO3– and secretion of H+. Excess

Answer 178

Aguda: rapid rise in PCO2 arterial >45mmHg, with minimal increase in plasma HCO3-, and large decrease in pH

Answer 179

ventialcion excessiva (anxiety, hypoxia or lung disease with reflex ventilation, stimulation of respiratory center, elevated blood ammonia, salicylate toxicity, enceefalitis, fiebre, mechanical ventialtion)

Answer 180

pH increased PCO2 (primario) decreased HCO3- (compensatory) decreased constriction of cerebral vessels and increased neuronal excitiability, dizziness, panic, tetany, numbness and tingling of fingers and toes, +++ Chvostek and Trousseau signs Seizures arritmias Renal compensation for respiratory alkalosis involves decreased bicarbonate reabsorption

Answer 181

3%-5% sodium chloride 10% dextrose in water

Answer 182

0.9% NaCl 5% dextrose

Answer 183

0.45% NaCl o 0.33% NaCl

Answer 184

Ascites is characterized by an accumulation of fluid in the transcellular component of the ECF, not ICF.(Third-spacing) The fluid is not categorized as belonging to the plasma component of the ECF.

Answer 185

Right-sided heart failure, burns, and low levels of plasma proteins are all associated with the development of edema.

Answer 186

Desmopressin acetate (DDAVP)

Answer 187

Elevated blood glucose levels, dry mucous membranes, and severe projectile vomiting

Answer 188

NO Regular insulin infusion, rate dependent on lab values Feedback:The administration of sodium bicarbonate, -adrenergic agonists, or insulin distributes potassium into the ICF compartment and rapidly decreases the ECF concentration

Answer 189

esta presente @ piel o intestino se concentra @ higado se transporta a kidney se produce calcitriol absorcion de calcio del intestino aumenta

Answer 190

The bisphosphonates (e.g.,pamidronate, zoledronate), which act mainly by inhibiting osteoclastic activity, provide a significant reduction in calcium levels with relatively few side effects. Calcitonin also inhibits osteoclastic activity. Gallium nitrate is highly effective in the treatment of severe hypercalcemia associated with malignancy. Prednisone, a corticosteroid, inhibits bone resorption.

Answer 191

low calcium levels

Answer 192

Increased CO2 levels, an increased anion gap, and a base deficit are all associated with an acidotic state. Base excess, low oxygen, high potassium, high ammonia, and decreased anion gap would not suggest acidosis

Answer 193

Feedback:A unique form of lactic acidosis, called D-lactic acidosis, can occur in persons with intestinal disorders that involve the generation and absorption of D-lactic acid. D-lactic acidosis can occur in persons with jejunoileal bypass, in which there is impaired reabsorption of carbohydrate in the small intestine. Persons with D-lactic acidosis experience episodic periods of metabolic acidosis often brought on by eating a meal high in carbohydrates. Manifestations include confusion, cerebellar ataxia, slurred speech, and loss of memory. They may complain of feeling (or may appear) intoxicated.

Answer 194

Ethylene glycol is found in products ranging from antifreeze and deicing solutions to carpet and fabric cleaners. It tastes sweet and is intoxicating—the factors that contribute to its abuse potential. A lethal dose is approximately 100 mL. It is rapidly absorbed from the intestine, making treatment with either gastric lavage or syrup of ipecac ineffective. Fomepizole, with specific indications for ethylene glycol poisoning, was recently approved by the U.S. Food and Drug Administration

Answer 195

The salicylates cross the blood–brain barrier and directly stimulate the respiratory center, causing hyperventilation and respiratory alkalosis. The blood pressure is at normal range, and the urine output is normal or excessive depending on fluid intake. Bilateral crackles (fluid) in the lungs `are usually a sign of heart failure.

Answer 196

metabolico

Answer 197

IV KCl solucion

Answer 198

ventilacion mecanico

Answer 199

Respiratory alkalosis is seen as a treatment with the ventilator with intubated people experiencing high intracranial pressure (ICP) in order to attempt to lower the ICP.

Answer 200

Renal hypoplasia, cystic dysplasia, and horseshoe kidney are more common diagnoses in infants. Renal cell carcinoma is not a congenital condition or one that often manifests in infancy.

Answer 201

Pregnancy, BPH, renal calculi, and neurogenic bladder are all identified contributors to urinary obstructions.

Answer 202

hipofosfatemia | hipomagnesemia

Answer 203

dolor y hidroureter, distention of distal ureter

Answer 204

Excruciating pain in the flank and upper outer quadrant of the abdomen that radiates to the bladder area Classic ureteral colic is manifested by acute, intermittent, and excruciating pain in the flank and upper outer quadrant of the abdomen on the affected side. The pain may radiate to the lower abdominal quadrant, bladder area, perineum, or scrotum in the man

Answer 205

Individuals with calcium oxalate stones often need to avoid high-oxalate foods like nuts, cocoa, and chocolate. Extracorporeal shock-wave lithotripsy treatment may be used to fragment larger renal calculi. It would not be necessary to avoid calcium intake, and fluid intake should encouraged, not curbed. Medications can reduce the potential for stone formation but are not a common treatment modality

Answer 206

In its most dramatic form, the acute nephritic syndrome is characterized by sudden onset of hematuria, variable degrees of proteinuria, diminished GFR, oliguria, and signs of impaired renal function. Inflammatory processes damage the capillary wall. This damage to the capillary wall allows RBCs to escape into the urine and produce a decrease in GFR. Extracellular fluid accumulation, hypertension, and edema develop because of the decreased GFR.

Answer 207

membranous glomerulonephritis is the most common cause of primary nephrosis in adults, most commonly those in their sixth or seventh decade. It is treated with corticosteroids.

Answer 208

``` Cl- = 100 HCO3= 24 ``` 124

Answer 209

disminucion de 1.2 mmHg pCO2

Answer 210

aumento de 0.7mmHgpCO2

Answer 211

aguda: aumenta 1 mEq/l HCO3- Cronica: aumenta 3.5 mEq/l HCO3-

Answer 212

aguda: disminuye 2 mEq/l HCO3- cronica: disminuye 5 mEq/l HCO3-

Answer 213

metanol, uremia, diabetic, pildoras, iron, lactic acidosis, etilen glicol, salicilatos anion gap

Answer 214

40*** pCO2 = 1.5(HCO3) + 8 (+/-2) if close together = acidosis metabolica + alcalosis resp. compensatorio (pCO2 = 16, HCO3=5, pH=7.11)

Answer 215

renina responde a cambios en presion arterial, TFG, y # de Na+ en filtrado

Answer 216

(>16mEq/L) Presence of unmeasured metabolic anion Diabetic ketoacidosis Alcoholic ketoacidosis Lactic acidosis Starvation Renal insufficiency Presence of drug or chemical anion Salicylate poisoning Methanol poisoning Ethylene glycol poisoning

Answer 217

Loss of bicarbonate Diarrhea Pancreatic fluid loss Ileostomy (unadapted) Chloride retention Renal tubular acidosis Ileal loop bladder Parenteral nutrition (arginine, histidine, and lysine)

Answer 218

``` Increased Capillary Pressure Increased vascular volume Heart failure Kidney disease Premenstrual sodium retention Pregnancy Environmental heat stress Thiazolidinedione (e.g., pioglitazone, rosiglitazone) therapy Venous obstruction Liver disease with portal vein obstruction Acute pulmonary edema Venous thrombosis (thrombophlebitis) Decreased arteriolar resistance Calcium channel–blocking drug responses Decreased Colloidal Osmotic Pressure Increased loss of plasma proteins Protein-losing kidney diseases Extensive burns Decreased production of plasma proteins Liver disease Starvation, malnutrition Increased Capillary Permeability Inflammation Allergic reactions (e.g., hives) Malignancy (e.g., ascites, pleural effusion) Tissue injury and burns Obstruction of Lymphatic Flow Malignant obstruction of lymphatic structures Surgical removal of lymph nodes ```

Answer 219

Normal: starts at rest goes up and down a lil below resting and back to resting Hyperkalemia: closer to threshold potential, farther up from resting membrane potential, doesn’t go all the way back down to it Hypokalemia: starts below resting goes up down way below resting and back up way below as well Normally, potassium leaves the cell during the repolarization phase of the action potential, returning the membrane potential to its normal resting value. Hypokalemia produces a decrease in potassium efflux that prolongs the rate of repolarization and lengthens the refractory period. The U wave normally may be present on the ECG but should be of lower amplitude than the T wave. With hypokalemia, the amplitude of the T wave decreases as the U-wave amplitude increases.

Answer 220

Bone 99%, 1% ICF, 0.1—0.2% ECF (ECF divides into 50% free, 10% complexed, 40% protein bound)

Answer 221

immunodeficiency virus (HIV) infection is an established cause of SIADH (e.g., related to associated infections, tumors, drugs). Its 5 cardinal features  Hypotonic hyponatremia  Natriuresis (excretion of sodium in the urine)  High urine osmolality and low plasma osmolality  Absence of edema and volume depletion  Normal renal, adrenal, and thyroid function

Answer 222

hypercalcemia is a common complication of malignancy. Some tumors destroy the bone, but others produce humoral agents that stimulate osteoclastic activity, increase bone resorption, or inhibit bone formation. 80% of patients with hypercalcemia of malignancy produce PTH-related protein (PTH-rP). PTH and PTH-rP have marked homology, or structural similarity, at their amino terminal ends, with 8 of the first 13 amino acids in the same positions. This homology results in both PTH and PTH-rP binding to the same receptor (PTH/PTH-rP receptor). PTH-rP is produced by several tumors, including cancers of the lung, breast, kidney, head and neck, and ovary. Your answer should include that the following additional tests may also be completed:  Tests for renal function: BUN, creatinine, urine specific gravity  Tests of bone density in regard to osteoporosis  Tests for cardiac involvement: ECG, blood pressure  Tests for hydration levels: electrolytes Tests for serum PTH levels to rule out hyperparathyroidism

Answer 223

On a mixed diet, pH is threatened by the production of strong acids (sulphuric, hydrochloric, and phosphoric) mainly as the result of protein metabolism. These strong acids are buffered in the body by chemical buffer bases, such as extracellular fluid (ECF) bicarbonate (HCO3−).

Answer 224

7.4 pH = 6.1 + log10 (ratio HCO3–: H2CO3) Metabolic acidosis with a HCO3−:H3CO3 ratio of 10:1 and a pH of 7.1. Respiratory compensation lowers the H3CO3 to 0.6 mEq/L and returns the HCO3−:H3CO3 ratio to 20:1 and the pH to 7.4. Respiratory alkalosis with a HCO3−:H3CO3 ratio of 40:1 and a pH of 7.7. Renal compensation eliminates HCO3−, reducing serum levels to 12 mEq/L, returning the HCO3−:H3CO3 ratio to 20:1 and the pH to 7.4. Normally, these compensatory mechanisms are capable of buffering large changes in pH but do not return the pH completely to normal

Answer 225

This equation is utilized for explaining the calculation of pH. It should be noted that it is the ratio rather than the absolute values for bicarbonate and dissolved CO2 that determines the pH. For example, when the ratio is 20:1 (bicarbonate to carbon dioxide), the serum pH equals 7.4. Plasma pH decreases when the ratio is less than 20:1, and it increases when the ratio is greater than 20:1. In this stated scenario, the pH is 7.1 and the reported serum bicarbonate is 12 mEq/L. Utilizing Figure 40.2, the ratio is 10:1, and the decreased pH is documented. Calculating for PCO2, the value would be 40.

Answer 226

Carbon dioxide (CO2) diffuses from the blood or urine filtrate into the tubular cell, where it combines with water in a carbonic anhydrase (CA)–catalyzed reaction that yields carbonic acid (H2CO3). The H2CO3 dissociates to form H+ and HCO3−. The H+ is secreted into the tubular fluid in exchange for Na+. The Na+ and HCO3− enter the ECF. (ATP, adenosine triphosphate.)

Answer 227

The monohydrogen phosphate ion (HPO42–) enters the renal tubular fluid in the glomerulus. An H+ combines with the HPO42– to form H2PO4− and is then excreted into the urine in combination with Na+.

Answer 228

The pH of tubular urine decreases along the proximal convoluted tubule, rises along the descending limb of the Henle loop, falls along the ascending limb, and reaches its lowest values in the collecting ducts. Ammonia (NH3 + NH4) is chiefly produced in proximal tubule cells and is secreted into the tubular urine. NH4 is reabsorbed in the thick ascending limb and accumulates in the kidney medulla. NH3 diffuses into acidic collecting duct urine, where it is trapped as NH4. H+ and NH3+ secreted @ PT @ ascending thick: na reabsorbed,NH4+ reabsorbed H+ secreted (NH4+, Na, 2Cl- cotransport) H+ secreted @ collecting duct: H+ secreted, NH3 as well  NH4+ excreted

Answer 229

Normal anion gap = 12 Acidosis anion gap = 25 ( low bicarbonate – like 14) = excess organic acids Acidosis anion gap: 12, high chloride leves,  low bicarbonate The anion gap in acidosis due to excess metabolic acids and excess plasma chloride levels. Unmeasured anions such as phosphates, sulfates, and organic acids increase the anion gap because they replace bicarbonate. This assumes there is no change in sodium content.

Answer 230

K+ depletion from vomiting -->HCO3- reabsorption @ intercalated cells only??!/ -->alkalosis metabolica EC fluid depletion DECREASES GFR : increases renin release , aldosterone increases HCO3- reabsorption, (electrical gradient) --> alkalosis also DGFR decreases HCO3- filtration --> alkalosis Vomit -->Cl depleted absorbs HCO3- reabsorbed --> alkalosis

Answer 231

as acidosis progresses, the skin vessels become less responsive to sympathetic stimulation and lose tone. Acidosis depresses neuronal excitability and decreases binding of calcium to plasma proteins so that more free calcium is available to decrease neural activity. This results in a decreased level of consciousness, stupor, and ultimately, coma.

Answer 232

Circulating anti-GBM antibodies with linear GBM staining for IgG with lung hemorrage --> good pasutre without lung hemorrage --> anti-GBM glomerulonefritis

Answer 233

Glomerular immune complex localization with granular capillary wall and/or mesangial staining IgA dom and no vasculitis --> IgA nefropathy IgA dom + systemic vasculitis --> henoch-schonlein purpura SLE --> leupus nefritis Acutre strep --> acute glomerulonefritis thick capillary walls and endocapullary hypercelularity (acute post strep glomerulonefritis) subepithelial dense deposits --> membranous glomerulopathy other

Answer 234

Circulating ANCA with paucity of glomerular immunoglobulin staining without lung hemorrage ----> ANCA glomerulonephritis vascultis with no asma or granulomas --> microcopic polyangitis granulomas no asma --> wegener granulomatosis eosinophilia, asma, granulomas --> churg strauss syndrome

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