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UTHSC M2016 CBD - Renal > Regulation of K+ balance (Showkat) > Flashcards

Regulation of K+ balance (Showkat) Flashcards

1
Q

Storage of K in humans

A

98% intracellular

2% extracellular (90-95 mEq/d renal excretion, 5-10 mEq/d GI excretion)

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2
Q

Stores & intake of K

A

120-140 mEq/dl ICF
4-5 mEq/dl ECF
100 mEq/d intake

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3
Q

Places K+ is excreted

how? channel/transporter, energy, and signal

A

CCT & OMCD

ROMK channel on lumen side (counters Na+)
3Na+/2K+ ATPase on basolateral side
Aldosterone binding R-Aldo

also influenced by concentration/chemical gradients & permiability

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4
Q

Places K+ is resorbed

how? channel/transporter, energy, and signal

A 
TALH:
Na+/K+/2Cl- cotransporter (lumen)
K+ channel (lumen)
Na+/K+ ATPase (basolateral)
(counterbalanced by Cl- basolateral channel)
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5
Q

Potassium excretion potentiated by

A

aldosterone

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6
Q

K+ absorption determined by

A

flow rate

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7
Q

4 causes of decreased renal K+ secretion

A

renal failure
distal tubular dysfunction
decreased distal tubular flow
hypoaldosterism

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8
Q

3 effectors of internal potassium balance

A

Plasma conc of K+
Insulin
Epinephrine

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9
Q

Relation to pH shift (increase/decrease in H+)

A

reciprocal shift of K+ balancing charge

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10
Q

Metabolic acid-base disturbance or respiratory disturbance causes greater effect on K+?

A

Metabolic

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11
Q

Bigger effect: organic acids or inorganic acids?

A

inorganic acids

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12
Q

Cell proliferation effect on K+

A

consumes extracellular K+

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13
Q

Cell lysis effect on ECF K+

A

increases/releases

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14
Q

3 causes of Hyperkalemia

A

excessive intake
decreased renal excretion
internal redistribution

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15
Q

Decreased renal excretion of K+ 4 reasons

A

acute/chronic renal failure
decreased distal tubular flow
distal tubular dysfunction
hypoaldosteronism

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16
Q

Internal redistribution mechanisms for hyperkalemia (5)

A 
insulin deficiency
beta2-adrenergic blockade
hypertonicity
acidemia
cell lysis
17
Q

EKG manifestations of K+:

  1. 0 mEq/L
  2. 0 mEq/L
  3. 0 mEq/L
  4. 0 mEq/L
  5. 0 mEq/L
A
  1. 0 mEq/L normal
  2. 0 mEq/L peaked T-wave
  3. 0 mEq/L Wide QRS complex, shortened QT interval, Prolonged PR Interval
  4. 0 mEq/L Further widening of QRS complex, absent P-wave
  5. 0 mEq/L Sinde-wave morphology, ventricular tachycardia
18
Q

signs of hyperkalemia

A

EKG changes/cardiac problems

ascending weakness, ileus

19
Q

hyperkalemia treatment

A

stabilization of cardiac muscles (IV Ca+)
Lowering serum K+
move K into cells (insulin, beta agonists, bicarb)
removing K+ (diuretics, resins, dialysis)

20
Q

Ca effect on K+ (mechanism)

A

antagonize membrane depolarization

21
Q

Insulin (& glucose) effect on K+ (mechanism)

A

Increase K+ uptake

22
Q

Bicarbonate effect on K+ (mechanism)

A

Increase K+ uptake

23
Q

Albuterol effect on K+ (mechanism)

A

increase K+ uptake

24
Q

Furosemide effect on K+ (mechanism)

A

removal of K+ in kidney

25
Q

K-exchange resin effect on K+ (mechanism)

A

Removal of K+ in GI tract

26
Q

Hypokalemia causes (3)

A

decreased intake
increased excretion
internal redistribution

27
Q

3 types of external losses of K+ (excretion)

A

GI, cutaneous, renal

28
Q

2 types of renal loss hypokalemia

A

normotensive

hypertensive

29
Q

2 types of normotensive hypokalemia disorders

A

with metabolic alkalosis

with metabolic acidosis

30
Q

4 types of normotensive hypokalemias with metabolic acidosis

A

diuretics (loop & thiazide)
Prolonged vomiting, nasogastric suction
Bartter’s syndrome
Gitelman’s syndrome

31
Q

Gitelman’s syndrome

A

normotensive hypokalemia with metabolic alkalosis

transport problem in DCT (like thiazides)

32
Q

Bartter’s syndrome

A

normotensive hypokalemia with metabolic alkalosis

transport problem in TALH (like furosemide)

33
Q

4 types of hypokalemia in hypertensive disorders

A

hyperreninemia (renal artery stenosis or renin secreting tumor)

primary hyperaldosteronism (Conn’s syndrome) (adrenal hyperplasia or tumors)

Cushing’s syndrome (glucocorticoid excess)

Congenital adrenal hyperplasia (enzymatic defect in cortisol biosynthesis)

34
Q

Clinical manifestations of hypokalemia (muscle, cardiac, smooth muscle, renal)

A

weakness, rhabdomyolysis
EKG changes/arrhythmias-tachyarrythmias
hypertension, Ileus
rephrogenic dibetes incipidus

35
Q

4 levels of decreasing serum K+ EKG (including normal)

A

normal
flat T wave
prominent U wave (after T wave)
depressed ST segment

36
Q

Hypokalemia Rx

A

K replacement (oral, IV)

K+-sparing diuretics

37
Q

K+-sparing diuretics (2 types x 2)

A

ENaC sodium chanel inhibitors (amiloride, triamterene)

MC antagonists (spironolactone, eplerenone)

UTHSC M2016 CBD - Renal (7 decks)

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