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House Clinical Pathology > WATER AND ELECTROLYTE METABOLISM > Flashcards

WATER AND ELECTROLYTE METABOLISM Flashcards

(105 cards)

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1
Q

WATER DISTRIBUTION

Total Body Water: ___L

_____% of body weight in men

_____% of body weight in women

A

42

60

55

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2
Q

WATER DISTRIBUTION

§____% is in ICF. ___L
§____% is in ECF. ___L
§ __% is in plasma: ____L: interstitial: ___L

A

66; 28

33; 14

8; 3.5; 11

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3
Q

Electrolyte Composition: between ECF and ICF

Which has more sodium
Which has more potassium
Which has more calcium
Which has more magnesium

A

Ecf
ICF
Ecf
ICF

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4
Q

Electrolyte Composition: between ECF and ICF

Which has more chloride
Which has more bicarbonate
Which has more proteins
Which has more phosphates
Which has more sulfates

A

Ecf
Ecf
ICF
ICF
Ecf

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5
Q

Anion gap in normal health=____-___mmol/l

A

6-20

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6
Q

Formula for Anion gap= _____________________

A

(Na+K)-(Cl+HC03)

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7
Q

Water distribution

Water is freely permeable through ECF and ICF depending on ________ of these compartments.

Except in the _____ , where the osmotic concentrations of these compartments are _____

A

osmotic contents

kidney

equal

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8
Q

Water distribution

ECF osmolality-_____-_____mOsmol/kg of water

A

282-295

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9
Q

Arginine vasopressin (ADH)

§ Specialised cells in the ________ sense the differences between their ———- and that of the _____ and adjust the secretion of AVP from the ————-

A

hypothalamus

osmolality; ECF

posterior pituitary gland.

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10
Q

Arginine vasopressin (ADH)

§ A rising ECF osmolality (promotes or switches off?) secretion of AVP a declining osmolality (promotes or switches off?) AVP.

A

Promotes

Switches off

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11
Q

Arginine vasopressin (ADH)

AVP causes _____ to be retained by the ____ with (increase or reduction?) of urine production.

A

water

kidneys

Reduction

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12
Q

Planning fluid therapy:asssessing the patient
Take History!

§ cardiac or renal disease, liver disease.
§ Vomiting or diarrhea
§ Nausea, headache, confusion
§ Fever, nasogastric suction, surgical drains, fistulae, artificial ventilation.

A

🍻

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13
Q

Clinical Assessment
Examination

§ Plasma volume-____,_____,____,______.

§ The interstitial volume- check for ______

§ Intracellular volume - (easy or difficult?) to assess clinically: so, look for evidence of ______ dysfunction like _____,______

A

BP, pulse, JVP, CVP

oedema

Difficult

cerebral

drowsiness, coma.

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14
Q

SODIUM DISTRIBUTION

70kg man-Total body sodium- _____mmol

___% of this is exchangeable

% not exchangeable- incorporated in _____ and has a (slow or fast?) turn over.

A

3700

75

25; bone

Slow

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15
Q

SODIUM DISTRIBUTION

Most of exchangeable volume is found in the ________ fluid

§ reference interval : ____-____mmol/L

A

extracellular

135-145

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16
Q

SODIUM DISTRIBUTON

____mmol/day-___mmol/day in Western diets. Intake=output

Most Na is excreted in the _____. But also _____ and ______.(____mmol/L).

A

100; 300

kidneys

Sweat and faeces; 5

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17
Q

SODIUM DISTRIBUTON
In disease , GIT loss is very important as children die of water and sodium loss in _____________.

A

infantile diarrhea

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18
Q

SODIUM DISTRIBUTON

Urinary sodium output is regulated by;
§____________
§____________

A

Aldosterone

Atrial Natriuretic peptide

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19
Q

Sodium excretion

Aldosterone ___eases urinary sodium excretion by _____________ at the expense of _____________________ ions.

A

decr

increasing sodium reabsorbtion in the renal tubules

potassium and hydrogen

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20
Q

Sodium excretion

Aldosterone secretion is stimulated by ____eased ECF volume.

A

decr

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21
Q

Sodium excretion

Cells of the ____ apparatus sense decrease in BP and secrete ____

A

JG

renin

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22
Q

angiotensin is gotten from ________

aldosterone is gotten from _______

A

Liver

Zona glomerulosa of adrenal cortex

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23
Q

Sodium excretion: Atrial Natriuretic peptide

Polypeptide hormone secreted by ______ of the _______ of the ——-

A

cardiocytes

right atrium; heart

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24
Q

Sodium excretion: Atrial Natriuretic peptide

It ____eases urinary sodium excretion

A

incr

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25
Regulation of Volume of sodium Amount of Na in _____ determines what its volume will be.
ECF
26
Regulation of Volume of sodium __________ and _______ interact to maintain normal volume and concentration of ECF
Aldosterone and AVP
27
HYPONATRAEMIA (Rise or Fall?) in plasma Na below the reference range of ____-_____mmol/L.
Fall 135-145
28
HYPONATRAEMIA Can either be ______ or _______
Oedematous Non oedematous
29
HYPONATRAEMIA caused by Congestive cardiac failure Oedematous or Non oedematous ?
Oedematous
30
Oedematous HYPONATRAEMIA leads to a reduced _________
effective blood volume
31
HYPONATRAEMIA caused by Nephrotic syndrome Oedematous or Non oedematous ?
Oedematous
32
HYPONATRAEMIA caused by SIAD Oedematous or Non oedematous ?
Non oedematous
33
HYPONATRAEMIA caused by renal failure Oedematous or Non oedematous ?
Non oedematous
34
HYPONATRAEMIA caused by compulsive water drinking Oedematous or Non oedematous ?
Non oedematous
35
HYPONATRAEMIA caused by both water and sodium overload Eg: by ______________ Treatment is by : _______ and ———-
inappropriate iv saline diuretcs and fluid restriction.
36
Hyponatraemia due to sodium loss from GIT or Urine. GIT LOSS § Vomiting-______ §______ § _______ Fistula
pyloric stenosis Diarrhoea Enterocutaneous
37
Hyponatraemia due to sodium loss from GIT or Urine. § URINARY LOSS §_______ deficiency- _____ disease §_______ antagonists- _______ or _____
Aldosterone; Addisons Aldosterone Spironolactone or triamterine
38
Hyponatraemia due to Na loss If Na and water are lost There would be a Reduction in blood volume which gives rise to ________ ——- secretion overriding the osmotic control mechanism which leads to ________ and hyponatraemia.
non osmotic AVP Water retention
39
Hyponatraemia due to Na loss Diagnosis of hyponatraemia- ____tension and _____cardia Treatment is correction of Na loss
hypo tachy
40
SIAD - ___________________ (Oedematous or Non oedematous?) hyponatraemia
Syndrome of inappropriate antidiuresis Non oedematous
41
Hyponatraemia: SIAD (Elevated or depressed?) prices total body sodium level Hyponatraemic, _____tensive, _____ glomerular filtration rate and a ____ serum urea and creatinine.
Normal normo normal normal
42
Hyponatraemia: SIAD This syndrome is encountered in many situations:- infections, malignancy, trauma,carcinoma of the ____,___ injury. Drug induced eg __________
Lungs; head thiazide diuretics.
43
In SIAD, there is _______________ stimulation and if they are exposed to excess water load eg oral or iv fluids they become ____natraemic.
non osmotic AVP Hypo
44
SIAD Triggered by Non –osmotic stimuli which include; ___________ Nausea and vomiting ______
Reduction in circulating blood volume Pain
45
SIADH secretion In SIADH, there is a continued _____ despite the (low or high?) plasma sodium concentration because _____ is maintained by ______ and there is therefore no ______ stimulus to stimulate ________ secretion.
natriuresis Low ; plasma volume water retention ; hypovolaemic aldosterone
46
Hyponatraemia with natriuresis can also occur in ______ failure and in ______ disorders and they must be excluded before a diagnosis of SIADH can be made.
adrenal renal
47
Water intoxication should always be considered as a possible cause of a confusional state T/F
T
48
natriuresis = ______eased sodium excretion and _____eased sodium reabsorption
Incr Decr
49
Water Overload Hyponatremia in patients (with or without?) oedema, who have (low, high or normal ?) serum urea and creatinine, and blood pressure have water overload. This is treated by _________
Without normal fluid restriction.
50
HYPERNATRAEMIA CAUSES- ______ depletion __________ depletion,eg_______, Excess _______, ______ in children excess sodium ______ or ____: eg taking ______ to correct _____
water water and sodium; diabetes mellitus sweating; diarrheoa intake or retention Sodium bicarbonate; acidosis
51
HYPERNATRAEMIA Clinical Presentation- ______in water loss and indications of ________ in Na retention- Increased ______ and _____
dehydration fluid overload JVP and pulmonary oedema.
52
HYPERNATRAEMIA MANAGEMENT. Due to water loss, give ________ (slowly or rapidly ?) or __% dextrose (slowly or rapidly?)
oral fluids Slowly 5 Slowly
53
diabetes insipidus causes _____ natremia
Hyper
54
diabetes mellitus causes _____natremia .
Hyper
55
Conn’s syndrome causes ______natremia
Hyper
56
Cushing’s syndrome causes ______natremia
Hyper
57
POTASSIUM HOMOESTASIS § Total body potassium: _____ mmol §____% intracellular, ___% extracellular
3600 98 5
58
POTASSIUM HOMOESTASIS § Output: variable. Mainly by the ______ § Excretion dependent on _________
kidneys glomerular filtration
59
POTASSIUM HOMOESTASIS Important factor of potassium excretion regulation in urine is the ____________ ____% lost in faeces
plasma potassium concentration. 5
60
Serum potassium ____% of total body potassium is in the ECF Conc.___-___ mmol/L.
2 3.5 – 4.5
61
Serum potassium Varies greatly with shift in ________
intracellular potassium.
62
Serum potassium Reciprocal relationship between potassium and ______ ions In metabolic _____ the opposite occurs.
Hydrogen Acidosis
63
Potassium ECF levels vary much in response to water loss or retention. T/F
F It doesn’t
64
Cellular uptake of potassium stimulated by ______.
insulin
65
Serum potassium Despite its low conc in the ECF potassium determines the ___________ of cells.
resting membrane potential
66
Serum potassium Changes in potassium concentration makes excitable cells like nerve and muscle cells to respond differently to stimuli. T/F
T
67
Serum potassium In particular because ____ is mainly muscle and nerve, very low potassium and very high potassium may have life threatening effects.
heart
68
POTASSIUM DEPLETION AND HYPOKALAEMIA Hypokalaemia means serum potassium levels (more or less?) than ___ mmol/L
Less 3
69
POTASSIUM DEPLETION AND HYPOKALAEMIA Clinical effects of hypokalaemia include severe ______, ____reflexia, cardiac ______ , and cardiac arrest at less than 3mmol/L
weakness hypo arrhythmias
70
POTASSIUM DEPLETION AND HYPOKALAEMIA ECG changes include __________ and _________ and increased sensitivity to ______.
flattened T waves prominent U wave digoxin
71
Causes of hypokalaemia GIT losses – _______ ,________,_______
vomiting, diarrhoea, fistula
72
Causes of hypokalaemia Renal losses – from renal disease, _____ therapy or increased _____ production (_____ Syndrome)
diuretic aldosterone Conns
73
Causes of hypokalaemia Drug induced –_________ and ______.
thiazide diuretics corticosteroids
74
Causes of hypokalaemia Alkalosis causes a shift of potassium from the ______ to the _____
ECF to the ICF
75
Cabenoxolone has ______corticoid activity
mineralo
76
Treatment of hypokalaemia §_____ potassium supplements § ________ potassium
Oral Intravenous
77
Intravenous potassium should not be given faster than ____mmol/h and must be given under monitoring with ECG
20
78
Hyperkalaemia means potassium levels (lesser or greater?) than ____ mmol/L
Greater 5
79
_________ is the commonest and most serious electrolyte emergency encountered in clinical practice
HYPERKALAEMIA
80
Clinical Features of hyperkalemia Muscle ______ ECG changes include _______ and ______
weakness widened QRS complex, peaked T waves
81
Above __ mmol/L of serum potassium there is a serious risk of cardiac arrest
7
82
Causes of hyperkalaemia Renal failure – the kidneys cannot _________ due to a ___________ Mineralocorticoid deficiency –_____ Disease, patients on antagonists of _______ like _______ and ______
excrete a large load of potassium very low glomerular filtration Addison’s; aldosterone spironolactone or triamterene
83
Causes of hyperkalaemia (Alkalosis or Acidosis?) Potassium released from ______ cells ______ increase in hemolysed serum
Acidosis damaged Artefactual
84
Treatment of hyperkalaemia Infusion of ______ and _____ to move potassium ion into the cells Infusion of ________ given to counter the effects of hyperkalaemia
insulin and glucose calcium gluconate
85
Treatment of hyperkalaemia Dialysis Cation exchange resin like _______
resonium A
86
SOURCES OF HYDROGEN IONS IN THE BODY § ________nmol/L is reference range
35-45
87
SOURCES OF HYDROGEN IONS IN THE BODY <____and >____nmol/L is not compatible with life. § Known as pH in the past. (pH ___-____)
20 120 7.35-7.45
88
SOURCES OF HYDROGEN IONS IN THE BODY § ________: Especially ——— of the _____ containing _______ of proteins ingested as food. As dissolved ______ in blood.
Metabolism oxidation; sulphur amino acids Carbon dioxide
89
BUFFERING OF HYDROGEN IONS A buffer is a solution of the ____ of a _______ which is able to bind ________
salt weak acid hydrogen ions.
90
BUFFERING OF HYDROGEN IONS A buffer (temporarily or permanently?) mops up any excess hydrogen ions which are produced.
temporarily
91
Buffers Blood buffers include:- _______,_______,_______ Urinary buffers include:_______ and ______ buffers.
bicarbonate, haemoglobin, proteins phosphate and ammonium
92
The permanent way in which the body gets rid of hydrogen ions is through _______ bound to ______
renal excretion urinary buffers.
93
Arterial blood gas values § H+-35 -46nmol/ L § Bicarbonate-22-30mmol/L § PCO2-4-6kP (36-46mmHg) § PO2-11-15kP (85-105 mmHg)
Are we really learning this?!!
94
DISORDERS OF HYDROGEN ION HOMOEOSTASIS § Metabolic disorders are those which directly cause a change in __________ § Respiratory disorders affect directly _____
bicarbonate concentration. PCO2
95
METABOLIC ACIDOSIS •H is _______ • bicarbonate is ______
high or normal always low.
96
METABOLIC ACIDOSIS §_____ disease §______ ketoacidosis §_______ acidosis
Renal Diabetic Lactic
97
RESPIRATORY ACIDOSIS •H is usually _________________ •PCO2 is __________
high or within the reference range always raised.
98
RESPIRATORY ACIDOSIS . § In chronic cases, (H+) settles to a new steady state in which the compensation is (minimal or maximal?) .
Maximall
99
RESPIRATORY ACIDOSIS Can be caused by: Airways _____, respiratory centre ______, ____ disease, neuromuscular disease like ————. Extrapulmonary thoracic disease like _______
obstruction depression lung; poliomyelitis flail chest
100
RESPIRATORY ALKALOSIS Common or Not common ? usually acute conditions which occur when _____ is over stimulated or is no longer ___________
Not common respiration; subject to feedback control.
101
Other causes of respiratory alkalosis •________ overventilation •Hysterical ________ § Raised _________
Mechanical overbreathing intracranial pressure.
102
hypoxia causes (respiratory or metabolic?) (alkalosis or acidosis?)
respiratory alkalosis
103
METABOLIC ALKALOSIS H is ______ bicarbonate is _________
depressed always raised.
104
METABOLIC ALKALOSIS Respiratory compensation results in _____________
elevated PCO2
105
METABOLIC ALKALOSIS Commonest cause is _________ But can also be caused by ______ suction, _____ syndrome
prolonged vomiting. Nasogastric Conns

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