Fluid and Electrolytes/Acid Base Flashcards
1
Q
major determinant of LV filling volume, CO, MAP
A
intravascular volume
2
Q
diagnostic hallmark of decrease EABV
A
Urine sodium < 15
3
Q
principal anion lost in diarrhea
A
bicarbonate
4
Q
acid base in diarrhea
A
hyperchloremic acidosis
5
Q
acid base in diuretics, bartter, Gitelman
A
hypokalemic alkalosis
6
Q
K and acid base in adrenal insufficiency
A
hyperkalemia and met acidosis
7
Q
urine parameters in hypovolemia
A
u.spg > 1.020, Una < 10, Uosm > 400 mOsm/Kg
Feureia of hypvolemia with diuretics less than 30-35%
Fena of hypovolemia less than 1%
8
Q
clilnical detection of edema occurs when interstitial fluid is
A
>2 to 3 L
9
Q
sine qua non for Na and water retention in cirrhosis with portal hypertension
A
intrasinusoidal hypertension > 12 mmHg
halmark of fluid retention in cirrhosis peripheral arterial vasodilation with vasoconstriction
treatment of choice for HRS liver transplantation
10
Q
standard of care for heart failure
A
B blocker
11
Q
daily insensible water loss 8-10 ml/kg
A
8-10 ml/kg
12
Q
primary determinant of free water excretion in regulation of H20
A
ADH
13
Q
most important stimulus of AVP secretion
A
hypertonicity, oncotic pressure of plasma
absolute level of Posm at which a person develops a conscious urge to drink osmotic thirst threshold
Osmotic thirst threshold 295 mOsm/kg/H20
14
Q
lack of osmoreceptors that regulate thirst and impaired osmoregulation of AVP
A
osmoreceptor dysfunction
hallmark of osmoreceptor dysfunction abnormal thirst response
15
Q
enzyme enhanced in gestational DI
A
oxycytocinase and vasopressinase
16
Q
resistance of ADH due to defect within the kidney
A
nephrogenic DI
17
Q
most common cause of drug induced NDI
A
lithium
18
Q
characteristic clinical symptom of DI
A
polyuria, polydipsia
19
Q
solute excretion rate in solute diuresis
A
> 15 mOsm
20
Q
diabetes insipidus central vs nefrogenico
A
fluid deprivation test
21
Q
increase in U Osm after vasopressin
A
CDI
22
Q
<10% increase in Uosm after vasopressin
A
NDI
23
Q
drug of choice for acute and chronic CDI
A
desmopressin
24
Q
paradoxic antidiuretic effect in NDI
A
Thiazide
25
major comploication of desmopressin
hyponatremia
26
hyponatremia, normal osm
pseudohyponatremia, factitious hyponatremia
27
potent stimulus to AVP secretion
volume depletion
28
most common of hospitalized hyponatremia
SIADH
Uosm in sIADH \> 100 mOsm/Kg H20
29
most common malignancy with sIADH
bronchogenic Ca and small cell lung cancer
30
Na increase in 100 ml hypertonic saline
2 to 4 mmol/L
31
most dreadful complication in acute hyponatremia
brain herniation
32
allowable increase in Na in 24 hours in high risk ODS
8 mmol/L
33
max daily rate of increase in Na
10-12 mmol/L
34
TTKG 2-3
redistributive hypokalemia
35
TTKG\>4
renal K wasting
36
Urine K/Crea signifying poor dietary intake
\< 13 meq/g Crea
37
Most common cause of hypokalemia in hospitalized
GI losses, diuretics, hypomagnesemia
38
renal compression by subscapular mass or hematoma causing increase in renin
page kidney
39
unusual presentation of renal artery stenosis and renal ischemia
hyponatremic hypertensive syndrome + hypokalemia
40
Familial Hyperaldosteronism Type I
Glucocorticoid remediable hyperaldosteronism
41
suppresion of aldosterone after dexamethasone suppression test: FH I
\< 4 ng/dL
42
Findings in primary hyperaldosteronism after saline loading test
UNa \> 200 mmol/day, Ualdo \> 33 mmol/day
43
PAC in PA
\> 277 pmol/L
44
preferred surgical management for APA or PAH
laparoscopic adrenalectomy
45
Most common cause of hyperKalemia in the ER
Renal Failure
46
combined alpha and betablocker common to cause hyperkalemia
Labetalol
47
most common cause of adrenalitis in hiv disease
cmv
48
loss of function mutation in mineralocorticoid receptor: unc in aldosterone, ang II and renin; Asymptomatic in adulthood
Pseudohypoaldosteronism (PHA-1) autosomal dominant
49
recessive form of pha-1, mutation
EnaC
50
PHA-II, gain of function in NCC
Gordon syndrome
51
Htn, hyperK, Nagma, suppressed pra and aldosterone, hypercalciuria reduced bone density
Gordon syndrome
52
Tx Gordon syndrome
Thiazide
53
first line drug in Er management of hyperkalemia
Calcium IV
54
vasoconstrictor of choice for liver cirrhosis
terlipressin
55
most constant and reliable medication to induce redistribution of K
Insulin with glucose
56
transporters affected by B agonists
Na K ATPase and NKCC1
57
preferred mode when rapid correction of hyperkalemic episode is desired
Hemodialysis
58
low plasma K can alter the rate of tissue metabolism, decrease tissue oxygen consumption, promoting arteriolar constriction, reduce efficiency of hd
Solandt Effect
59
Excess of this hormone is responsible for hyperca of malignancy
PTHrp
60
Most common cause of hypercalcemia in hospitalized patients
Malignancy
61
Most common cause of hypercalcemia in outpatient clinic
PHPT
62
positive family history, hypercalcemia at a young age, low Uca
Familial hypocalciuric hypercalcemia
63
excessive and incompletely regulated secretion of pth with hypercalcrmia and hypophosphatemia
primary hyperparathyroidism
64
Cause of PhPT in 80-85% of cases
Parathyroid adenoma
65
classic bone lesion in phpt
osteitis fibrosa cystica
66
standard therapy for phpt
surgery
67
most popular and most sensitive technique to localize pth glands
sestamibi scanning
68
endocrine tumors in 2 of 3: Parathyroid gland, pituitary gland, enteropanxreatic tissue; most common form of familial phpt
MEN1
69
syndrome of heritable predisposition to medullary thuroid carcinoma, pheochrokocytoma and phpt
Men 2A
70
glycoprotein that inhibits wnt b catenin signaling
sclerostin
71
fully humanized monoclonal antibody that prevents bunding of rank to rankl
denosumab
72
most common granulomatous disease with hypercalcemia
sarcoidosis
73
most effective therapy for hypercalcemia in hematologic malignancies
glucocorticoids
74
most common causes of hypocalcemoa in the nonacute setting
hypoparathyroidisn, hypomagnesemia, ckd and vitamin d deficiencies
75
pth resistance with short stature, round face, mental retardation, brachydactyly, lack of phosphaturic response to parathyroid extract
albright hereditart osteodystrophy
76
php with complete resistance to effects if pth
PHP-1
77
php without hypocalcemia and endocrine dysfunction
pseudohypoparathyroidism
78
php with reduced phosphaturic response to pth but normal increase in urinary camp levels
php-2
79
most common cause of acquired hypoparathyroidism in adults
surgical removal or damage to the pth glands
80
prolonged hypocalcemia after parathyroidectomy
hungry bone or recalcification syndrome
81
best indicator of vitamin d status
25 (OH)D
82
tumor lysis
hyperphos, hyperuric
hypocalcemia
83
best test of overall magnesium status
magnesium tolerance test
84
FeMg suggestive of magnesium wasting
\>24 mg per day
85
earliest manifestation of hypermg
hypotension
86
rare autosomal recessive disorder characterized by hyperphos and progressive deposition pf ca phos crystals
familial tumor calcinosis
87
acquired paraneoplastic syndrome of kidney phos wasting - hypophos, normal serum calcium, pth levels, low calcitriol, decreased bone mineralization
tumor induced osteomalacia
88
First line of defense against acid or base
buffers
second line of defense against acid base respiratory system
3rd line of defense renal
89
major buffer system in the body
CO2/Hco3
90
most common cause of drug induced respiratory alkalosis
salicylates
91
surrugate for ammonium excretion
urine anion gap
92
principal defect in acidification of advanced renal failure
reduced ammoniagenesis, impaired NH4 accumulation
93
most common cause of acquired pRTA
multiple myeloma
94
most common drug causing of acquired pRTA
ifosfamide
95
acid base in fanconi syndrome
chronic hyperchloremic metabolic acidosis
96
Type 1 RTA
classical distal RTA
97
Type 2 RTA
proximal RTA
98
hallmark of cDRTA
hypokalemia distal RTA
99
reliable marker for cDRTA
nephrocalcinosis
100
Type 4 RTA
hyperkalemic RTA
HIPOALDOSTERONISMO=
principal= nefropatia diabetica
tbm associado a =cni, aines, nefrite intersticial cronica, e glomerulonefrite aguda
suspeitar em casos de hipercalemia sem etiologia aparente
101
glucocorticoid and mineralocorticoud deficiency
addison's disease
102
most common congenital adrenal defect
21 hydroxylase deficiency
103
most frequently associated renal disease with hyporeninimic hypoaldosteronism
DM nephropathy and tubulointerstitial disease
104
drugs that inhibits EnaC
amiloride, triamterene
105
inhibited by cyclosporine and tacrolimus
Na K ATPase, ROMK channel,enac
106
target hco3 concentration
\> 22 meq/L
107
PHA-2
Gordon syndrome
108
most common lactic acidosis
L-lactic
most widely reported drug that can cause lactic acidosis metformin
109
lactic acidosis from tissue hypoperfusion
Type A
110
most common cause of type A acidosis
bowel ischemia
111
treatment for salicylate activated charcoal
activated charcoal
treatment for ethylene glycol fomepizole
112
mutation in Bartter Syndrome
NKCC2
113
Gitelman
NCC DCT
114
Gitelman vs Barter
hypocalciuria and hypomagnesemia for Gitelman
115
mutation in Liddle
Enac principal cells CCD
116
diabetes insipidus central
destruicao dos neuronios da neurohipofise ou mutacoes do adh
diminuicao da liberacao do adh
117
diabetes insipidus gestacional
atividade excessiva da vasopressinase placentaria
quebra o adh
118
treatment of gestational DI
vasopressin
119
RESPOSTA A DESMOPRESSINA
OSMOLARIDADE URINARIA aumenta menos de 15%para um valor menor que \<300 mosmol/kg = di nefrogenico completo
osm urinaria aumenta de 15 a 45% para um vamor \<300 = di nefrogenico parcial
osm urinaria mais que dobra \>100% = di central completo
osm urinaria aumenta 15-100 % para um valor \> 300 = di central parcial
minimo ou sem aumento e valor \>300 = nao diagnostico
quando é nao diagnostico é pq é polidipsia primaria ou di central parcial
120
diabetes insipidus nefrogenico
resistencia a acao do adh no nefron
121
acidose metabolica
AG= na -cl+bic = 10 +-2
\> 12- anion gap aumentado
AG corrigido = AG calculado + 2,5 x (valor de referência da albumina – albumina mensurada)
GOLDMARK=
Glicois, oxoprolina,l-lactato, d-lactato, metformina, metanol,
aas, renal, kad
paraldeido,cetoacidose alcoolica, jejum
tto= reversao das causas base
gap osmolar
2xna +glicose/18 +ureia /6
delta/delta.
Colocando de forma matemática (variação do AG) / (variação do bicarbonato) = 1 é o normal (ou seja, variações iguais).
Como assumimos valor normal do ânion gap como 10 e do bicarbonato como 24, temos que:
(AG calculado – 10) / (24 – HCO3–medido ) = 1
Se esse cálculo resultar em \< 1, quer dizer que o denominador (bicarbonato) variou muito em relação ao numerador (AG). Portanto, possivelmente há acidose metabólica com AG elevado e acidose metabólica hiperclorêmica coexistindo.
Se o resultado é \> 2, quer dizer que apesar de o AG ter variado, o bicarbonato variou muito pouco. Uma explicação para isso é que junto com a acidose metabólica de AG elevado, há uma alcalose metabólica (algo que causou um relativo aumento no HCO3–, evitando que ele caia proporcionalmente ao aumento do AG).
122
acidose metabolica com ag normal ou hipercloremica
diarreia ou rta
ag urinario se ag negativo = diarreia
