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Week 2 > Pathophys: Electrolyte Disturbance Na And K > Flashcards

Pathophys: Electrolyte Disturbance Na And K Flashcards

(51 cards)

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1
Q

60-40-20 Rule

A

Total body water = 60%
Of that… 40% Intracellular
20% extracellular

Of the extracellular
75% = Interstitial fluid
25% = plasma

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2
Q

Osmolality

A

The solute or particle concentration of a fluid

H2O diffuses across most cell membranes to achieve osmotic equilibrium

ECF osmolality = ICF-osmolality

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3
Q

Electrolyte solute compositions differ due to differences in….

A

Membrane permeability, activity of transporters, channels, and ATP driven pumps

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4
Q

Compartment restriction determines the ________

A

Toxicity or effective osmolality

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5
Q

Major ECF solutes include:

A

Na+
Cl-
HCO3-

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6
Q

Major ICF solutes include

A

K+ and ATP

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7
Q

Excreted solute

A

Organic waste and excess electrolytes

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8
Q

Main way the body controls water excretion in normal circumstances is to control__________

A

Urine osmolality

Electrolyte excretion is highly regulated

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9
Q

Regulation of water excretion (and urine osmolality) is _________ is solute excretion

A

Independent

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10
Q

ADH secretion is controlled by:

A

Osmoreceptors

Baroreceptors

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11
Q

Osmoreceptors

A

Neurons responsive to change in osmolality
Located in tissues surrounding the cerebral third ventricle
Shrink and swell in response to changes in local osmolality

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12
Q

Baroreceptors

A

Located in aortic arch and carotid arteries

Respond to changes in pressure

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13
Q

ADH is made in the ________ and stored in the __________

A

Made in the hypothalamus and stored in the posterior pituitary

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14
Q

ADH regulates these 2 things…

A

Plasma Osmolality

Blood pressure

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15
Q

How does ADH regulate plasma osmolality?

A 
Osmoreceptors detect changes in plasma osmolality
ADH release
V2 receptors in principle cells
Regulation of AQP2 H20 channels via Gs
H2O reabsorption/secretion
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16
Q

How does ADH regulate blood pressure?

A

Baroreceptors detect changes in volume
V1 receptors in VSM
Regulation of vascular tone
Changes in total peripheral resistance

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17
Q

What is the major cation in ECF?

A

Na+

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18
Q

Normal plasma Na+ values?

A

135-145 mEq/L

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19
Q

What is the normal plasma osmolarity?

A

285-295 mOsm/kg

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20
Q

Primary goal of regulating Na and H2O excretion?

A

Support the requirements of the cardiovascular system

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21
Q

Na disturbances are caused by changes in total body ________, not changes in Plamsa Na

22
Q

Disorders of plasma Na+ concentration are caused by _______

Study These Flashcards
A

H2O homeostasis

Changes in the relative ratio of Na+ to body water

23
Q

Na+ value of hyponatremia

Study These Flashcards
A

Na <135

Seizure threshold: 125
Life threatening: 120

24
Q

What happens to the cell in hyponatremia?

Study These Flashcards
A

Osmotic water shift into the cell
Increase ICF volume
Cellular swelling

25
Clinical features of Hyponatremia?
Nausea, eyes is, headache, malaise, lethargy, irritability, muscle twitching, weakness, hyperactive DTR ...Neuro symptoms: seizures, coma Chronic hyponatremia is better tolerated
26
What are the 2 types of hyponatremia based on Plasma osmolality?
Isotonic Hyponatremia (aka pseudohyponatremia) Hypertonic hyponatremia (aka redistributive hyopnatremia)
27
Isotonic hyponatremia
Normal plasma osmolality Caused by condition that leads to high serum lipid or protein levels Increase in plasma solids Decrease plasma osmolality due to proportion is plasma volume that is caused by excess lipids or proteins
28
Hypertonic Hyponatremia
Increased plasma osmolality Caused by HYPERGLYCEMIA or presence of osmotically active compound (mannitol, glycine, sorbitol) H2O movement from ICF to ECF Decrease Plasma sodium
29
What are the three types of hyponatremia based on volume status?
Hypovolemic Hyponatremia Euvolemic Hyponatremia Hypervolemic Hyponatremia
30
Hypovolemic Hyponatremia
Decrease ECF leads to Increase ADH This leads to Na+ reabsorption in PCT Increase ADH increases H2O reabsorption Nonrenal: Can be caused by vomiting, diarrhea, sweating, burns (urine Na<20) Renal: caused by inappropriate loss of Na and Cl in urine. Results in high ADH (urine Na>20)
31
Euvolemic Hyponatremia
Abnormally high levels of serum ADH Increased Na+ loss relative to H2O Decreased ALDO results in increased Na+ excretion in urine which NORMALIZES ECF
32
Hypervolemic Hyponatremia
Proportionally greater increase in total body water Decrease in Na+ plasma
33
Hypernatremia value
Na+ > 145
34
Hypernatremia
Can develop as a result gain of Na, loss of H20 or a combination of the two Cellular SHRINKAGE Effluent of H20 from ICF
35
Clinical features of Hypernatremia
Dehydration, "doughy" skin, irritability, lethargy, weakness, seizures Highest risk Elderly with decreased thirst or impaired thirst mechanism
36
Major cation in ICF
Potassium
37
Normal potassium values
2.5-5.0 Daily requirement: 1-2 Principle regulator: kidneys
38
Potassium is the major determinant of ___________
Resting membrane potential
39
Changes in plasma K have a direct effect on ________________
Cellular excitability and automaticity
40
Hypokalemia value
Plasma K <3.5
41
During hypokalemia, the resting membrane of excitable cells ________
Increases It becomes more negative and less sensitive to excitation Cellular hyperpolarization
42
EKG changes in Hypokalemia
``` Flattened or inverted T wave U wave: prolonged polarization or purkinje fibers Depressed ST Segment Widened PR interval Most marked when K <2.7 ```
43
Causes of hypokalemia
Alkalosis (H+ moves out of cell to buffer pH) Insulin B2-adrenergic agonist (albuterol) GI losses (vomiting diarrhea) Renal losses (diuretics, renal disease)
44
Hyperkalemia value
K > 5 Life threatening when K >7
45
During hyperkalemia, the resting membrane potential becomes less __________
Electronegative Partial depolarization
46
Clinical features of hyperkalemia
Impaired NM transmission Faster depolarization, delayed depolarization, decreased conduction velocity Cardiac conduction abnormalities Parenthesis -> weakness -> paralysis
47
EKG changes in hyperkalemia
Peaked T wave Disappearance of P wave QRS widening Sine wave pattern
48
Causes of Hyperkalemia
- Acidosis (H+moves into cell, K+ efflux) - Increases in total body K_ (renal failure, addison's) - Transcellular shift in ECF - Iatrogenic (K+ in IV fluids, NSAIDs, ACE inhibitors)
49
Pseudohyperkalemia
Lab findings of falsely elevated serum K+ Due to K+ efflux before or after blood draw Suspect in asymptomatic patient with no apparent cause for hyperkalemia
50
ADH responds to:
Decrease volume Increase Plasma osmolality Increase H2O reabsorption
51
Disturbances in K+ primarily effect the ________ system and Na+ effects the __________ system
K + = Cardiovascular system | Na+ = Neurological system

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