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SP2 Endocrine > Lecture 1 1/23/25 > Flashcards

Lecture 1 1/23/25 Flashcards

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1
Q

Which factors impact daily water intake?

A

-environment
-diet
-age
-preferences

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2
Q

What is the normal daily water intake?

A

40-60 mL/kg/day

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3
Q

What controls body water homeostasis?

A

-plasma osmolality
-kidneys
-vascular volume
-hypothalamus thirst center
-pituitary

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4
Q

What is osmolality?

A

-concentration of osmotically active particles in solution
-# of particles in 1 kg of solution

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5
Q

What does osmolality depend on?

A

size and number of molecules

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6
Q

What is osmolarity?

A

of particles per 1 L of solvent

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7
Q

Which factors impact plasma osmolality?

A

-sodium
-blood glucose
-BUN

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8
Q

What increases alongside an increase in plasma osmolality?

A

-thirst
-ADH secretion

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9
Q

Which types of receptors are found within the hypothalamus thirst center?

A

-osmoreceptors
-baroreceptors

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10
Q

What are the triggers for thirst?

A

-hyperosmolality
-decreased vascular volume

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11
Q

Where is ADH produced?

A

hypothalamus

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12
Q

What is the role of the posterior pituitary in terms of ADH?

A

stores ADH and releases it as necessary

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13
Q

What are the potential triggers for ADH release?

A

-hyperosmolality
-hypovolemia
-angiotensin II
-emotional states

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14
Q

What are the effects of ADH?

A

-increase water reabsorption
-concentrate the urine

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15
Q

How does ADH function?

A

causes an increase in aquaporins within the kidneys to allow for greater water reabsorption/urine concentration

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16
Q

Why is it important that sodium is the key determinator of plasma osmolality?

A

helps to keep plasma osmolality within a tight range

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17
Q

Where are the receptors for ADH?

A

distal renal tubule

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18
Q

What is the main mediator of the thirst center?

A

hypothalamic osmoreceptors

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19
Q

What happens when there is decreased renal perfusion?

A

RAAS is activated

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20
Q

What is the polydipsia rate?

A

greater than or equal to 100 mL/kg/day

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21
Q

What is the polyuria rate?

A

greater than or equal to 50 mL/kg/day

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22
Q

What should be gathered during a history to determine if a patient has PUPD?

A

-frequency
-volume
-consciousness of micturition

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23
Q

What counts as PUPD?

A

frequent, large amounts of urine with consciousness of micturition

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24
Q

Which disorders are commonly mistaken for PUPD?

A

-pollakiuria/dysuria/small, frequent amounts
-incontinence/unaware of urination
-behavior disorders

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25
When should PUPD be considered?
-increased water intake -increased urine output -USG persistently less than fully concentrated
26
What is the USG range for hyposthenuria?
1.00 to 1.007
27
What is the USG range for isosthenuria?
1.008 to 1.012
28
What is the USG range for minimally concentrated urine?
-1.013 to 1.030 in dogs -1.013 to 1.040 in cats
29
What is the USG range for concentrated urine?
-greater than 1.035 in dogs -greater than 1.045 in cats
30
What is needed to produce concentrated urine?
-functioning nephrons -hypertonic medullary gradient -ADH -response to ADH
31
What fraction of nephrons must be working in order to concentrate urine?
1/3
32
Which molecules contribute to the hypertonic medullary gradient?
sodium and urea
33
What percent of fluid filtered at the glomerulus is reabsorbed in the proximal tubule?
80-90%
34
Which solutes are reabsorbed with fluid in the proximal tubule?
sodium and glucose
35
Where does selective reabsorption of sodium occur?
thick ascending loop
36
What is the function of ADH on the distal nephron?
allows for reabsorption of up to 90% of the remaining fluid not absorbed in the proximal tubule
37
What can cause primary polyuria?
-osmotic diuresis -reduced/absent ADH production -reduced/absent ADH-receptor function -medullary washout
38
What is osmotic diuresis?
impaired fluid reabsorption in the proximal tubule
39
Which solutes are poorly reabsorbed and instead draw water into the urine?
-mannitol -urea -glucose
40
What are the mechanisms of osmotic diuresis?
-presence of poorly reabsorbed solutes -excessive salt intake -increased fluid volume reaching distal tubule -overwhelmed capacity to reabsorb water
41
What condition occurs when there is reduced/absent ADH production or ADH-receptor function?
diabetes insipidus
42
What is central diabetes insipidus?
reduced/absent ADH production stemming from the brain
43
What is nephrogenic diabetes insipidus?
reduced/absent ADH-receptor function in the kidneys
44
What are the causes of central diabetes insipidus?
-congenital/primary -acquired/secondary -idiopathic
45
What can cause acquired diabetes insipidus?
-neoplasia -trauma -radiation
46
How can central diabetes insipidus be treated?
administration of exogenous ADH
47
What are the characteristics of congenital nephrogenic diabetes insipidus?
-very rare -more common in male dogs -defect in cellular mechanism that opens water channels -cannot respond to exogenous ADH -obligate water drinker; will die rapidly without access
48
What are the characteristics of acquired nephrogenic diabetes insipidus?
-something interferes with ADH receptor -most common cause of DI in dogs and cats -potentially reversible
49
What can interfere with the ADH receptor?
-cortisol -endotoxins -electrolytes/hypercalcemia
50
What can lead to impaired medullary gradient?
-impaired reabsorption of sodium and urea due to increased urine and/or blood flow -decreased urea due to liver insufficiency/low protein diet -decreased sodium due to hypoadrenocorticism, loop diuretics, or diarrhea
51
What are the potential causes of primary polydipsia?
-psychogenic: pain, stress, insufficient exercise -neurologic -GI disease -hepatic encephalopathy
52
What are the characteristics of primary polydipsia diagnosis?
-diagnosis of exclusion -can conc. urine with water restriction -serum sodium may be low/diluted
53
What is the first step to addressing PUPD?
-confirm PUPD with good history, including diet and medications -perform a physical examination
54
What are the possible conclusions if an animal appears to have PUPD and has concentrated urine?
-not consistent with obligatory PUPD -normal animal -primary polydipsic - conc. with water restriction
55
What are the possible conclusions if an animal appears to have PUPD and has dilute (USG < 1.008) urine?
-diabetes insipidus -primary polydipsia
56
What are the possible conclusions if an animal appears to have PUPD and has isosthenuric urine?
-CKD -nephrogenic diabetes insipidus secondary to an underlying cause -partial central diabetes insipidus
57
What should be evaluated on a urinalysis?
-evidence for tubular dysfunction; glucose, protein, pH -active sediment -systemic disease
58
What are the characteristics of urine culture in PUPD diagnosis?
-recommended for all PUPD animals -impaired conc. can predispose to UTI
59
What is the minimum database that should be run in PUPD patients?
-CBC -Chem panel -T4 in cats
60
Which endocrine screening tests can be done in patients with PUPD?
-Cushing's/ACTH stim. test -Addison's/low dose dexamethasone suppression test
61
Which imaging techniques should be done in PUPD patients?
-thoracic rads -abdominal rads -ultrasound
62
What are tests that can be run to identify less common causes of PUPD?
-bile acids -SDMA -lepto. testing
63
What is the thought process when an animal has decreased serum sodium?
-decreased serum sodium indicates psychogenic PUPD -animal should undergo modified water deprivation test
64
What is the thought process when an animal has normal to increased serum sodium?
-normal to increased serum sodium indicates central DI -animal should undergo desmopressin trial
65
How does an animal's response to synthetic ADH indicate the disease process?
-concentrating with synthetic ADH indicates CDI -partial concentration with synthetic ADH indicates secondary NDI or partial CDI -not concentrating with synthetic ADH indicates primary NDI or psychogenic cause
66
What are the steps of the desmopressin trial?
-measure water intake for 2-3 days prior to trial -check USG before trial -administer desmopressin for 5 to 7 days -recheck; want to see decreased drinking and increase of USG
67
When should a water deprivation test NOT be performed?
-animal can concentrate greater than 1.030 -animal has pre-existing dehydration, azotemia, and/or hyponatremia -unable to fully monitor animal
68
What are the steps of a modified water deprivation test?
-check blood and USG prior to trial -weigh patient -check USG and weight every 30-60 minutes once beginning trial -if patient concentrates over 1.030, animal is normal and has psychogenic cause -if patient concentrates less than 1.030 and/or loses 3% or greater body weight, administer desmopressin and check USG 2 and 4 hours later -if USG increases, animal has CDI

SP2 Endocrine (22 decks)

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