HY Arrows Flashcards
(133 cards)
Pt has high aldosterone. What are the arrows for serum Na+, K+. pH, bicarbonate, and CO2?
- Increase Na+, decrease K+. increase pH, increase bicarbonate, increase CO2
- All arrows go the same direction except potassium.
- acts on the cortical collecting duct up regulating Na/K ATPase pump.
- metabolic alkalosis with respiratory compensation
What type of acidosis would you see with low aldosterone?
Non anion gap metabolic acidosis with respiratory compensation
Pt is given an ACE inhibitor, what change will this cause in renin, AT1, AT2, and aldosterone?
- Increase renin, increase angiotensin 1, decrease angiotensin 2, decrease aldosterone
Pt is given an ARB, what change will this cause in renin, AT1, AT2, and aldosterone?
- increase renin, increase AT1, increase AT2, decrease aldosterone
What is the alternate medication to give to avoid the anti-androgenic effects of spironolactone?
Eplerenone
Pt is given enalapril, what will happen to LV after load, systemic arteriolar diameter, renal afferent arteriolar diameter and renal efferent arteriolar diameter?
- Decrease LV after load, increase systemic arteriolar diameter, no change in afferent diameter, increase efferent diameter
*AT2 is a potent vasoconstrictor of peripheral arterioles, especially renal efferent arterioles. This increases filtration fraction and maintains GFR in the setting of reduced renal blood flow.
Young female with abdominal bruit and BP of 160/100. What are the arrows for Na+, K+. pH, bicarbonate, and CO2?
- increase Na+, decrease K+, increase pH, increase bicarbonate, increase CO2.
*Dx: Fibromuscular displasia, tunica media proliferation. Results in decreased renal perfusion inducing renin secretion by JGC which activates RAAS.
*Hint: same arrows for high aldosterone
74M + hyperpigmentation of the forearms + eosinophils 23% + 6 mo hx of fatigue + BP 100/60. What are the arrows for Na+, K+. pH, bicarbonate, CO2, and ACTH?
- Decrease Na+, increase K+, decrease pH, bicarbonate, CO2, and increase ACTH
*Dx: Addison disease (primary hypoadrenalism). Mc etiology is autoantibodies against 21-hydroxylase in the adrenal cortex - Aldosterone and cortisol is low.
- remember POMC is the precursor to both ACTH and alpha-MSH so thats why hyperpigmentation.
45M + one year Hx of fatigue and darkening of skin of forearms + BP 100/60, exogenous ACTH is administered and shows marginal increase in cortisol levels. Prior to administration of ACTH, what are the arrests for serum ACTH, eosinophils, Na+, K+, pH, bicarbonate, and CO2?
- Increase ACTH, increase eosinophils, decrease Na+, increase K+, decrease pH, decrease bicarbonate. decrease CO2.
- Dx: Addison disease. ACTH stimulation to diagnose.
*Low cortisol and aldosterone
39F + 20 yr hx of RA managed with NSAIDS, prednisone, methotrexate, and infliximab. She has Cushinoid appearance. What are the arrows for her ACTH and cortisol levels?
- Decrease ACTH and cortisol
*Prednisone is not the same as cortisol, it’s only a glucocorticoid analogue. - The decree in ACTH and cortisol in the setting of exogenous glucocorticoids is exceedingly high yield for USMLE.
13M + 3 days ago treated for meningococcal septicemia + now has BP 80/50. What are the arrows for serum aldosterone, cortisol, ACTH, K+, Na+, bicarb, pH, and CO2?
- Decrease serum aldosterone, decrease cortisol, increase ACTH, increase K+, decrease Na+, decrease bicarb, decrease pH, and decrease CO2.
- Dx: Waterhouse-Friderichsen syndrome, which is hemorrhagic necrosis of the adrenal glands secondary to septicemia.
*Give hydrocortisone (cortisol analogue)
*Cortisol upregulates alpha 1 receptors, Epi and NE agonize these receptors to cause vasoconstriction.
Both no change
- Dexamethasone is a cortisol analogue
- Low serum ACTH + high cortisol = Cushing syndrome
- Ddx: exogenous glucocorticoids, ACTH-secreting tumor of Ant Pit (Cushing disease), corstol secreting tumor of adrenal cortex, small cell bronchogenic carcinoma secreting ACTH)
- high dose dex = Cushing Disease
Where does Mannitol act on?
PCT and Thin descending limb of LOH
