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PSL301: Water 4 Flashcards

Sodium balance (89 cards)

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0
Q

Early humans evolved in a ___ sodium environment

A

Low

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1
Q

sodium is required for…

A

normal blood volume, BP, organ perfusion

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2
Q

Inadequate sodium results in…

A
  • shock
  • low ECF volume
  • low BP
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3
Q

Human kidneys are designed to ____ sodium

A

retain

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4
Q

what happens when the kidneys retain sodium?

A

keep blood volume high / constant

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5
Q

Why is high blood pressure such a common problem nowadays?

A

Kidneys are designed to retain sodium, so now that we are getting a lot of Na in the diet, it leads to problems like hypertension

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6
Q

Possible ways to lose Na

A
  • diarrhea
  • sweating
  • diuretics
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7
Q

We retain Na in conditions like…

A

heart failure

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8
Q

What happens if we have too much Na?

A
  • edema / pulmonary edema
  • weight gain
  • breathing problems
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9
Q

Data for some populations suggest that low Na+ increases risk for…

A

deaths from cardio events

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10
Q

Which ethnicity is famous for high Na diet?

A

Japanese

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11
Q

Relationship between Na intake and risk of fatal stroke

A

Higher intake = higher risk for stroke

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12
Q

Where does dietary salt come from?

A
  • 75% from processed foods
  • bread, cheese, soup, sauces, restaurants
  • very little from home cooking
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13
Q

Normally, urine sodium =

A

dietary intake of sodium

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14
Q

Urine sodium decreases if…

A

there is Na lost from gut (diarrhea) or skin (sweating)

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15
Q

Urine sodium decreases to 0 when…

A

there is severe loss from the gut or skin

e.g. cholera

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16
Q

What can be used to estimate Na intake?

A

24h urine collection

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17
Q

How long does it take for the kidneys to adjust to increase Na in the diet?

A

several days is needed to form a new steady state

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18
Q

what happens if there is a sudden increase in Na from the diet?

A

ECF volume is large for a few days until kidneys adjust

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19
Q

what happens if there is a sudden decrease in Na from the diet?

A

ECF volume is small for a few days until kidneys adjust

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20
Q

Dietary sodium is a high risk factor for…

A
  • high BP
  • stroke
  • heart disease
  • kidney disease
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21
Q

reducing Na intake is used as a form of treatment for…

A
  • CHF
  • cirrhosis with ascites
  • kidney diseases
  • diseases that result in edema (all of above)
  • hypertension
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22
Q

What sends the kidney signals to increase / decrease Na exretion?

A

Signals from the vascular system

  • intravascular volume
  • effective circulating volume
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23
Q

What does not signal the kidneys to adjust Na levels?

A

serum [Na] concentration

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24
What does serum [Na] affect?
- water balance - ADH ??
25
What is effective circulating volume?
How well cardiac output fills the arterial system
26
When is effective circulating volume low?
- low intravascular volume - poor heart function - excessive arterial vasodilation
27
What is low effective circulating volume sensed by?
cardiovascular receptors - arterial baroreceptors - juxtaglomerular apparatus - atrial stretch receptors
28
What are possible causes of low intravascular volume?
- diarrhea - sweating - hemorrhage
29
What are possible causes of poor heart function?
congestive heart failure
30
What are possible causes of excessive arterial vasodilation?
liver cirrhosis (advanced liver disease)
31
The glomerulus is enclosed by...
Bowman's capsule
32
Cells that make up the Bowman's capsule
granular cells
33
What goes out of the Bowman's capsule?
proximal tubule
34
What goes in and out of the glomerulus?
in: afferent arteriole out: efferent arteriole
35
What lies beside the arterioles of the glomerulus?
ascending limb of Henle
36
What is the purpose of having the ascending limb beside the glomerulus?
allow glomerulus to sense things inside the ascending limb - feedback regulation - affect filtration rate, Na retention, etc. of glomerulus
37
What cells make up the ascending limb that lie next to the glomerulus arterioles?
macula densa cells
39
what are macula densa cells?
- reabsorptive cells that sense NaCl levels - sends signals to the glomerulus - regulates GFR
40
purpose of renin
angiotensinogen -> angiotensin I
41
what is the rate limiting step of the RAAS?
renin
42
angiotensin I
small, inactive AA
43
where can ACE be found?
on endothelial lining of pulmonary capillaries
44
ANG II has what effect?
- increase BP - increase blood volume - maintain osmolarity
45
ANG II: what does it do to cause increased BP?
- peripheral arterioles (efferent arteriole) vasoconstrict - cardiovascular control center in medulla tells cardiovascular system to increase BP - increased volume
46
where does ANG II affect?
- arterioles - cardiovascular center in medulla - hypothalamus - adrenal cortex
47
effect of ANG II on hypothalamus
- release vasopressin (ADH) - thirst Overall: more fluid in vessels
48
effect of ANG II on adrenal cortex
release aldosterone
49
effect of aldosterone
increase Na+ reabsorption (used to maintain osmolarity)
50
ANG II stimulates Na+ reabsorption in...
- proximal tubule - distal convoluted tubule - collecting duct
51
How does the body make sure only the efferent arteriole is constricted by ANG II?
AT1 receptors are only present on efferent arterioles
52
what increases renin secretion?
- low afferent arteriole BP - active SNS - low dietary NA - upright posture = more renin - reduced ECF volume: diuretic therapy, diarrhea, sweating, blood loss - reduced effective circulating volume (heart failure, liver cirrhosis)
53
what senses afferent arterole pressure?
- afferent arteriolar stretch | - macula densa
54
What senses pressure in the SNS?
baroreceptors
55
the RAAS has what effect on cardiac myocytes, arteries, mesangium?
release growth factor, which reduces compliance in arteries and kidneys
56
Mesangium
structure that can be found between the afferent & efferent arterioles. surrounded by capillaries but outside of capillary lumen.
57
where is aldosterone secreted?
zona glomerulosa of adrenal cortex
58
aldosterone is a ___ hormone
steroid
59
receptor for aldosterone
mineralocorticoid receptor
60
where can the receptor for aldosterone be found?
cortical collecting duct (intracellular receptor)
61
mechanism of aldosterone
Changes protein synthesis - increase Na channels (ENaC) - increase opening of already present channels
62
effect of aldosterone
- Na reabsorption - K excretion - H excretion
63
ANP is secreted by... in response to...
``` atrial myocytes atrial stretch (high BP) ```
64
function of ANP
- inhibits collecting duct Na reabsorption | - increase GFR
65
what does ANP inhibit?
- aldosterone - SNS - vasopressin overall: inhibits collecting duct Na reabsorption
66
Factors that affect Na excretion
1. reduced GFR (small effect) 2. ANG II 3. aldosterone 4. ANP and others not known yet
67
what causes decreased ECF volume?
1. sweating 2. diarrhea 3. vomiting 4. osmotic diuresis 5. diuretics 6. blood loss
68
how much Na is lost per L of sweat?
35 mmol/L
69
how much Na is lost per L of diarrhea?
100 - 120 mmol/L
70
bicarbonaturia
excretion of excessive amounts of bicarbonates in the urine
71
how much Na is in gastric fluid?
10 mM
72
Na loss in the urine is driven by...
bicarbonaturia | ??
73
what states can be seen when there is an excess of sodium?
1. congestive heart failure 2. cirrhosis with ascites 3. kidney disease
74
congestive heart failure
low CO
75
why might congestive heart failure cause Na retension
low CO (low BP) stimulates Na retention
76
why might cirrhosis with ascites cause Na retension
low arterial resistance lowers effective circulating volume -> stimulates Na retension
77
ascites
the accumulation of fluid in the peritoneal cavity, causing abdominal swelling
78
side effects of congestive heart failures
edema, pulmonary edema
79
What effect does high Na have on the heart?
aggravates heart failure - fibrosis - oxygen demand - reduces peripheral perfusion
80
What drugs can be used to treat heart failure caused by high Na?
- ACE inhibitors - angiotension receptor blockers - aldosterone blocker
81
ACE inhibitor drug
ramipril (-pril)
82
angiotension receptor blockers drug
losartan (-artan)
83
aldosterone blocker drug
spironolactone
84
ramipril, losartan, and spironolactone can be used to treat...
- congestive heart failure - hypertension - slow progression of chronic kidney disease - reduce protein loss in CKD
85
How to treat someone who has extremely low ECF due to high Na loss?
- IV sodium and water - isotonic saline - give something to drink: has salt, glucose, K, alkali
86
isotonic saline is...
150 mmol/L of Na in water
87
What does the WHO have to treat those who have severe diarrhea?
oral rehydration fluid: - NaCl - glucose - KCl - sodium citrate
88
why is glucose included in oral rehydration fluid?
Na is absorbed through SGLT 1 with glucose
89
antagonizing RAAS has major benefits in...
cardiovascular and kidney disease

PSL301 (29 decks)

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