Fluid and Electrolytes/Acid Base Flashcards
(139 cards)
1
Q
Principal cation in the ECF
A
Na
2
Q
Principal cation in the ICF
A
K
3
Q
major determinant of LV filling volume, CO, MAP
A
intravascular volume
4
Q
diagnostic hallmark of decrease EABV
A
Urine sodium < 15 (or urine chloride ?)
5
Q
principal anion lost in diarrhea
A
bicarbonate
6
Q
acid base in diarrhea
A
hyperchloremic acidosis
7
Q
acid base disorder in diuretics, bartter, Gitelman
A
hypokalemic alkalosis
8
Q
K and acid base disorder in adrenal insufficiency
A
hyperkalemia and met acidosis (lack of aldosterone leading to hyperK)
9
Q
urine parameters in hypovolemia (3)
A
u.spg > 1.020,
Una < 10,
Uosm > 400 mOsm/Kg
10
Q
Fena of hypovolemia
A
less than 1%
11
Q
FeNa of hypvolemia with diuretics
A
less than 30-35%
12
Q
mainstay for volume replacement
A
crystalloids isotonic 0.9%
13
Q
fluid of choice for burns/trauma
A
colloids
14
Q
clilnical detection of edema occurs when interstitial fluid is
A
> 2 to 3 L
15
Q
sine qua non for Na and water retention in cirrhosis with portal hypertension
A
intrasinusoidal hypertension > 12 mmHg
16
Q
halmark of fluid retention in cirrhosis
A
peripheral arterial vasodilation with vasoconstriction
17
Q
standard of care for heart failure
A
B blocker
18
Q
vasoconstrictor of choice for liver cirrhosis
A
terlipressin
19
Q
a-adrenergic agonist inhibits release of glucagon, no effect on renal fxn
A
Octreotide
inhibiting insulin secretion from the pancreas thus preventing persistent hypoglycemia
20
Q
treatment of choice for HRS
A
liver transplantation
21
Q
daily insensible water loss
A
8-10 ml/kg
22
Q
primary determinant of free water excretion in regulation of H20
A
AVP
23
Q
most important stimulus of AVP secretion
2
A
hypertonicity, oncotic pressure of plasma
24
Q
most sensitive osmoreceptor cells
A
anterior hypothalamus
25
absolute level of Posm at which a person develops a conscious urge to drink
osmotic thirst threshold
26
Osmotic thirst threshold
295 mOsm/kg/H20
27
rare autosomal recessive causing DI, DM, optic atrophy, deafness
Wolfram syndrome
28
primary osmoreceptors controlling AVP secretion and thirst
anterior hypothalamus
29
lack of osmoreceptors that regulate thirst and impaired osmoregulation of AVP
osmoreceptor dysfunction
30
hallmark of osmoreceptor dysfunction
abnormal thirst response
31
enzyme enhanced in gestational DI
oxycytocinase and vasopressinase
32
treatment of gestational DI
vasopressin
33
resistance of ADH due to defect within the kidney
nephrogenic DI
34
most common cause of drug induced NDI
lithium
35
characteristic clinical symptom of DI
polyuria, polydipsia
36
solute excretion rate in solute diuresis
> 15 mOsm/kg body water/day
In solute diuresis, the kidneys excrete a high volume of urine containing a large amount of solutes, with a daily solute excretion rate exceeding 750-1000 mOsm/day (or >15 mOsm/kg body water/day). This is due to the presence of non-reabsorbable solutes in the tubule fluid, preventing water reabsorption and leading to increased urine volume
37
differentiate CDI and NDI
fluid deprivation test
38
increase in U Osm after vasopressin
CDI
39
<10% increase in Uosm after vasopressin
NDI
40
drug of choice for acute and chronic CDI
desmopressin
41
paradoxic antidiuretic effect in NDI
Thiazide
42
major comploication of desmopressin
hyponatremia
43
hyponatremia, normal osm
pseudohyponatremia, factitious hyponatremia
44
potent stimulus to AVP secretion
volume depletion
45
most common of hospitalized hyponatremia
SIADH
46
Uosm in sIADH
> 100 mOsm/Kg H20
47
most common malignancy with sIADH
bronchogenic Ca and small cell lung cancer
48
Na increase in 100 ml hypertonic saline
2 to 4 mmol/L
49
treatment of choice for depletional hyponatremia
isotonic saline
50
most dreadful complication in acute hyponatremia
brain herniation
51
allowable increase in Na in 24 hours in high risk ODS
8 mmol/L
52
max daily rate of increase in Na
10-12 mmol/L
53
TTKG 2-3
redistributive hypokalemia
54
TTKG>4
renal K wasting
55
Urine K/Crea signifying poor dietary intake
< 13 meq/g Crea
56
Most common cause of hypokalemia in hospitalized
GI losses, diuretics, hypomagnesemia
57
renal compression by subscapular mass or hematoma causing increase in renin
page kidney
58
unusual presentation of renal artery stenosis and renal ischemia
hyponatremic hypertensive syndrome + hypokalemia
59
Familial Hyperaldosteronism Type I
Glucocorticoid remediable hyperaldosteronism
60
suppresion of aldosterone after dexamethasone suppression test: FH I
< 4 ng/dL
61
Findings in primary hyperaldosteronism after saline loading test
UNa > 200 mmol/day, Ualdo > 33 mmol/day
62
PAC in PA
> 277 pmol/L
63
preferred surgical management for APA or PAH
laparoscopic adrenalectomy
64
Most common cause of hyperKalemia in the ER
Renal Failure
65
Ingestion of K rich clay
Geophagia
66
Ingestion of burnt matchstick
Cautopyreiophagia
67
combined alpha and betablocker common to cause hyperkalemia
Labetalol
68
most common cause of adrenalitis in hiv disease
cmv
69
loss of function mutation in mineralocorticoid receptor: unc in aldosterone, ang II and renin; Asymptomatic in adulthood
Pseudohypoaldosteronism (PHA-1) autosomal dominant
70
recessive form of pha-1, mutation
EnaC
71
PHA-II, gain of function in NCC
Gordon syndrome
72
Htn, hyperK, Nagma, suppressed pra and aldosterone, hypercalciuria reduced bone density
Gordon syndrome
73
Tx Gordon syndrome
Thiazide
74
first line drug in Er management of hyperkalemia
Calcium IV
75
most constant and reliable medication to induce redistribution of K
Insulin with glucose
76
transporters affected by B agonists
Na K ATPase and NKCC1
77
preferred mode when rapid correction of hyperkalemic episode is desired
Hemodialysis
78
low plasma K can alter the rate of tissue metabolism, decrease tissue oxygen consumption, promoting arteriolar constriction, reduce efficiency of hd
Solandt Effect
79
Excess of this hormone is responsible for hyperca of malignancy
PTHrp
80
Most common cause of hypercalcemia in hospitalized patients
Malignancy
81
Most common cause of hypercalcemia in outpatient clinic
PHPT
82
positive family history, hypercalcemia at a young age, low Uca
Familial hypocalciuric hypercalcemia
83
excessive and incompletely regulated secretion of pth with hypercalcrmia and hypophosphatemia
primary hyperparathyroidism
84
Cause of PhPT in 80-85% of cases
Parathyroid adenoma
85
classic bone lesion in phpt
osteitis fibrosa cystica
86
standard therapy for phpt
surgery
87
most popular and most sensitive technique to localize pth glands
sestamibi scanning
88
endocrine tumors in 2 of 3: Parathyroid gland, pituitary gland, enteropanxreatic tissue; most common form of familial phpt
MEN1
89
syndrome of heritable predisposition to medullary thuroid carcinoma, pheochrokocytoma and phpt
Men 2A
90
glycoprotein that inhibits wnt b catenin signaling
sclerostin
91
fully humanized monoclonal antibody that prevents bunding of rank to rankl
denosumab
92
most common granulomatous disease with hypercalcemia
sarcoidosis
93
most effective therapy for hypercalcemia in hematologic malignancies
glucocorticoids
94
most common causes of hypocalcemoa in the nonacute setting
hypoparathyroidisn, hypomagnesemia, ckd and vitamin d deficiencies
95
pth resistance with short stature, round face, mental retardation, brachydactyly, lack of phosphaturic response to parathyroid extract
albright hereditart osteodystrophy
96
php with complete resistance to effects if pth
PHP-1
97
php without hypocalcemia and endocrine dysfunction
pseudohypoparathyroidism
98
php with reduced phosphaturic response to pth but normal increase in urinary camp levels
php-2
99
most common cause of acquired hypoparathyroidism in adults
surgical removal or damage to the pth glands
100
prolonged hypocalcemia after parathyroidectomy
hungry bone or recalcification syndrome
101
best indicator of vitamin d status
25 (OH)D
102
tumor lysis
hyperphos, hyperuric
| hypocalcemia
103
best test of overall magnesium status
magnesium tolerance test
104
FeMg suggestive of magnesium wasting
>24 mg per day
105
earliest manifestation of hypermg
hypotension
106
rare autosomal recessive disorder characterized by hyperphos and progressive deposition pf ca phos crystals
familial tumor calcinosis
107
acquired paraneoplastic syndrome of kidney phos wasting - hypophos, normal serum calcium, pth levels, low calcitriol, decreased bone mineralization
tumor induced osteomalacia
108
First line of defense against acid or base
buffers
109
major buffer system in the body
CO2/Hco3
110
second line of defense against acid base
respiratory system
111
3rd line of defense
renal
112
most common cause of drug induced respiratory alkalosis
salicylates
113
surrugate for ammonium excretion
urine anion gap
114
principal defect in acidification of advanced renal failure
reduced ammoniagenesis, impaired NH4 accumulation
115
most common cause of acquired pRTA
multiple myeloma
116
most common drug causing of acquired pRTA
ifosfamide
117
acid base in fanconi syndrome
chronic hyperchloremic metabolic acidosis
118
Type 1 RTA
classical distal RTA
119
Type 2 RTA
proximal RTA
120
hallmark of cDRTA
hypokalemia distal RTA
121
reliable marker for cDRTA
nephrocalcinosis
122
Type 4 RTA
hyperkalemic RTA
123
glucocorticoid and mineralocorticoud deficiency
addison's disease
124
most common congenital adrenal defect
21 hydroxylase deficiency
125
most frequently associated renal disease with hyporeninimic hypoaldosteronism
DM nephropathy and tubulointerstitial disease
126
drugs that inhibits EnaC
amiloride, triamterene
127
inhibited by cyclosporine and tacrolimus
Na K ATPase, ROMK channel
128
target hco3 concentration
> 22 meq/L
129
PHA-2
Gordon syndrome
130
most common lactic acidosis
L-lactic
131
lactic acidosis from tissue hypoperfusion
Type A
132
most common cause of type A acidosis
bowel ischemia
133
most widely reported drug that can cause lactic acidosis
metformin
134
treatment for salicylate
activated charcoal
135
treatment for ethylene glycol
fomepizole
136
mutation in Bartter Syndrome
NKCC2
137
Gitelman
NCC DCT
138
Gitelman vs Barter
hypocalciuria and hypomagnesemia for Gitelman
139
mutation in Liddle
Enac principal cells CCD
