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Nefrologia PT > Fluid and Electrolytes/Acid Base > Flashcards

Fluid and Electrolytes/Acid Base Flashcards

1
Q

major determinant of LV filling volume, CO, MAP

A

intravascular volume

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2
Q

diagnostic hallmark of decrease EABV

A

Urine sodium < 15

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3
Q

principal anion lost in diarrhea

A

bicarbonate

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4
Q

acid base in diarrhea

A

hyperchloremic acidosis

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5
Q

acid base in diuretics, bartter, Gitelman

A

hypokalemic alkalosis

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6
Q

K and acid base in adrenal insufficiency

A

hyperkalemia and met acidosis

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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%

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8
Q

clilnical detection of edema occurs when interstitial fluid is

A

>2 to 3 L

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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

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10
Q

standard of care for heart failure

A

B blocker

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11
Q

daily insensible water loss 8-10 ml/kg

A

8-10 ml/kg

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12
Q

primary determinant of free water excretion in regulation of H20

A

ADH

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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

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14
Q

lack of osmoreceptors that regulate thirst and impaired osmoregulation of AVP

A

osmoreceptor dysfunction

hallmark of osmoreceptor dysfunction abnormal thirst response

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15
Q

enzyme enhanced in gestational DI

A

oxycytocinase and vasopressinase

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16
Q

resistance of ADH due to defect within the kidney

A

nephrogenic DI

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17
Q

most common cause of drug induced NDI

A

lithium

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18
Q

characteristic clinical symptom of DI

A

polyuria, polydipsia

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19
Q

solute excretion rate in solute diuresis

A

> 15 mOsm

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20
Q

diabetes insipidus central vs nefrogenico

A

fluid deprivation test

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21
Q

increase in U Osm after vasopressin

A

CDI

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22
Q

<10% increase in Uosm after vasopressin

A

NDI

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23
Q

drug of choice for acute and chronic CDI

A

desmopressin

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24
Q

paradoxic antidiuretic effect in NDI

A

Thiazide

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25
Q

major comploication of desmopressin

A

hyponatremia

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26
Q

hyponatremia, normal osm

A

pseudohyponatremia, factitious hyponatremia

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27
Q

potent stimulus to AVP secretion

A

volume depletion

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28
Q

most common of hospitalized hyponatremia

A

SIADH

Uosm in sIADH > 100 mOsm/Kg H20

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29
Q

most common malignancy with sIADH

A

bronchogenic Ca and small cell lung cancer

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30
Q

Na increase in 100 ml hypertonic saline

A

2 to 4 mmol/L

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31
Q

most dreadful complication in acute hyponatremia

A

brain herniation

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32
Q

allowable increase in Na in 24 hours in high risk ODS

A

8 mmol/L

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33
Q

max daily rate of increase in Na

A

10-12 mmol/L

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34
Q

TTKG 2-3

A

redistributive hypokalemia

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35
Q

TTKG>4

A

renal K wasting

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36
Q

Urine K/Crea signifying poor dietary intake

A

< 13 meq/g Crea

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37
Q

Most common cause of hypokalemia in hospitalized

A

GI losses, diuretics, hypomagnesemia

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38
Q

renal compression by subscapular mass or hematoma causing increase in renin

A

page kidney

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39
Q

unusual presentation of renal artery stenosis and renal ischemia

A

hyponatremic hypertensive syndrome + hypokalemia

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40
Q

Familial Hyperaldosteronism Type I

A

Glucocorticoid remediable hyperaldosteronism

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41
Q

suppresion of aldosterone after dexamethasone suppression test: FH I

A

< 4 ng/dL

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42
Q

Findings in primary hyperaldosteronism after saline loading test

A

UNa > 200 mmol/day, Ualdo > 33 mmol/day

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43
Q

PAC in PA

A

> 277 pmol/L

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44
Q

preferred surgical management for APA or PAH

A

laparoscopic adrenalectomy

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45
Q

Most common cause of hyperKalemia in the ER

A

Renal Failure

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46
Q

combined alpha and betablocker common to cause hyperkalemia

A

Labetalol

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47
Q

most common cause of adrenalitis in hiv disease

A

cmv

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48
Q

loss of function mutation in mineralocorticoid receptor: unc in aldosterone, ang II and renin; Asymptomatic in adulthood

A

Pseudohypoaldosteronism (PHA-1) autosomal dominant

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49
Q

recessive form of pha-1, mutation

A

EnaC

50
Q

PHA-II, gain of function in NCC

A

Gordon syndrome

51
Q

Htn, hyperK, Nagma, suppressed pra and aldosterone, hypercalciuria reduced bone density

A

Gordon syndrome

52
Q

Tx Gordon syndrome

A

Thiazide

53
Q

first line drug in Er management of hyperkalemia

A

Calcium IV

54
Q

vasoconstrictor of choice for liver cirrhosis

A

terlipressin

55
Q

most constant and reliable medication to induce redistribution of K

A

Insulin with glucose

56
Q

transporters affected by B agonists

A

Na K ATPase and NKCC1

57
Q

preferred mode when rapid correction of hyperkalemic episode is desired

A

Hemodialysis

58
Q

low plasma K can alter the rate of tissue metabolism, decrease tissue oxygen consumption, promoting arteriolar constriction, reduce efficiency of hd

A

Solandt Effect

59
Q

Excess of this hormone is responsible for hyperca of malignancy

A

PTHrp

60
Q

Most common cause of hypercalcemia in hospitalized patients

A

Malignancy

61
Q

Most common cause of hypercalcemia in outpatient clinic

A

PHPT

62
Q

positive family history, hypercalcemia at a young age, low Uca

A

Familial hypocalciuric hypercalcemia

63
Q

excessive and incompletely regulated secretion of pth with hypercalcrmia and hypophosphatemia

A

primary hyperparathyroidism

64
Q

Cause of PhPT in 80-85% of cases

A

Parathyroid adenoma

65
Q

classic bone lesion in phpt

A

osteitis fibrosa cystica

66
Q

standard therapy for phpt

A

surgery

67
Q

most popular and most sensitive technique to localize pth glands

A

sestamibi scanning

68
Q

endocrine tumors in 2 of 3: Parathyroid gland, pituitary gland, enteropanxreatic tissue; most common form of familial phpt

A

MEN1

69
Q

syndrome of heritable predisposition to medullary thuroid carcinoma, pheochrokocytoma and phpt

A

Men 2A

70
Q

glycoprotein that inhibits wnt b catenin signaling

A

sclerostin

71
Q

fully humanized monoclonal antibody that prevents bunding of rank to rankl

A

denosumab

72
Q

most common granulomatous disease with hypercalcemia

A

sarcoidosis

73
Q

most effective therapy for hypercalcemia in hematologic malignancies

A

glucocorticoids

74
Q

most common causes of hypocalcemoa in the nonacute setting

A

hypoparathyroidisn, hypomagnesemia, ckd and vitamin d deficiencies

75
Q

pth resistance with short stature, round face, mental retardation, brachydactyly, lack of phosphaturic response to parathyroid extract

A

albright hereditart osteodystrophy

76
Q

php with complete resistance to effects if pth

A

PHP-1

77
Q

php without hypocalcemia and endocrine dysfunction

A

pseudohypoparathyroidism

78
Q

php with reduced phosphaturic response to pth but normal increase in urinary camp levels

A

php-2

79
Q

most common cause of acquired hypoparathyroidism in adults

A

surgical removal or damage to the pth glands

80
Q

prolonged hypocalcemia after parathyroidectomy

A

hungry bone or recalcification syndrome

81
Q

best indicator of vitamin d status

A

25 (OH)D

82
Q

tumor lysis

A

hyperphos, hyperuric
hypocalcemia

83
Q

best test of overall magnesium status

A

magnesium tolerance test

84
Q

FeMg suggestive of magnesium wasting

A

>24 mg per day

85
Q

earliest manifestation of hypermg

A

hypotension

86
Q

rare autosomal recessive disorder characterized by hyperphos and progressive deposition pf ca phos crystals

A

familial tumor calcinosis

87
Q

acquired paraneoplastic syndrome of kidney phos wasting - hypophos, normal serum calcium, pth levels, low calcitriol, decreased bone mineralization

A

tumor induced osteomalacia

88
Q

First line of defense against acid or base

A

buffers

second line of defense against acid base respiratory system

3rd line of defense renal

89
Q

major buffer system in the body

A

CO2/Hco3

90
Q

most common cause of drug induced respiratory alkalosis

A

salicylates

91
Q

surrugate for ammonium excretion

A

urine anion gap

92
Q

principal defect in acidification of advanced renal failure

A

reduced ammoniagenesis, impaired NH4 accumulation

93
Q

most common cause of acquired pRTA

A

multiple myeloma

94
Q

most common drug causing of acquired pRTA

A

ifosfamide

95
Q

acid base in fanconi syndrome

A

chronic hyperchloremic metabolic acidosis

96
Q

Type 1 RTA

A

classical distal RTA

97
Q

Type 2 RTA

A

proximal RTA

98
Q

hallmark of cDRTA

A

hypokalemia distal RTA

99
Q

reliable marker for cDRTA

A

nephrocalcinosis

100
Q

Type 4 RTA

A

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
Q

glucocorticoid and mineralocorticoud deficiency

A

addison’s disease

102
Q

most common congenital adrenal defect

A

21 hydroxylase deficiency

103
Q

most frequently associated renal disease with hyporeninimic hypoaldosteronism

A

DM nephropathy and tubulointerstitial disease

104
Q

drugs that inhibits EnaC

A

amiloride, triamterene

105
Q

inhibited by cyclosporine and tacrolimus

A

Na K ATPase, ROMK channel,enac

106
Q

target hco3 concentration

A

> 22 meq/L

107
Q

PHA-2

A

Gordon syndrome

108
Q

most common lactic acidosis

A

L-lactic

most widely reported drug that can cause lactic acidosis metformin

109
Q

lactic acidosis from tissue hypoperfusion

A

Type A

110
Q

most common cause of type A acidosis

A

bowel ischemia

111
Q

treatment for salicylate activated charcoal

A

activated charcoal

treatment for ethylene glycol fomepizole

112
Q

mutation in Bartter Syndrome

A

NKCC2

113
Q

Gitelman

A

NCC DCT

114
Q

Gitelman vs Barter

A

hypocalciuria and hypomagnesemia for Gitelman

115
Q

mutation in Liddle

A

Enac principal cells CCD

116
Q

diabetes insipidus central

A

destruicao dos neuronios da neurohipofise ou mutacoes do adh

diminuicao da liberacao do adh

117
Q

diabetes insipidus gestacional

A

atividade excessiva da vasopressinase placentaria

quebra o adh

118
Q

treatment of gestational DI

A

vasopressin

119
Q

RESPOSTA A DESMOPRESSINA

A

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
Q

diabetes insipidus nefrogenico

A

resistencia a acao do adh no nefron

121
Q

acidose metabolica

A

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
Q

acidose metabolica com ag normal ou hipercloremica

A

diarreia ou rta

ag urinario se ag negativo = diarreia

Nefrologia PT (112 decks)

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