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DU PA Salt and Water

Duke PA Salt and Water

Water constitutes __% of total body weight in humans 60
Total body water is inversely proportional to the amount of __ body fat
__ are the major cations of the intracellular space potassium and magnesium
__ are the major anions of the intracellular space phosphate and protein
__ are the major anions of the extracellular space chloride and bicarbonate
__ is the major cation of the extracellular space sodium
__ determines the movement of fluid across the cell membrane osmotic gradient
Except for transient changes, the intracellular and extracellular fluid compartments are in __ osmotic equilibrium
The transfer of fluid between the vascular and interstitial compartments occurs across the capillary wall and is governed by the balance between ___ hydrostatic pressure gradients and plasma oncotic pressure gradients
Hemodynamic alterations to a perceived volume reduction tachycardia, vasoconstriction, venoconstriction
Renal conservation of salt and water lags behind hemodynamic alterations to a perceived volume reduction by __ hours 12-24
__ promotes salt and water retention in the kidneys ADH
__ is released from the atrial myocytes in response to atrial stretch associated with volume expansion atrial natriuretic peptide
__ increases GFR and inhibits sodium reabsorption in the collecting ducts atrial natriuretic peptide
__% of total body blood is in the atrial compartment 15
True volume depletion decrease in effective circulating volume and extracellular fluid volume
When volume depletion occurs from renal losses the urine is inappropriately __ dilute and sometimes rich in salt
Mild volume depletion may be associated with __ orthostatic dizziness and tachycardia
Patients with severe volume depletion may exhibit __ vasoconstriction, hypotension, mental obtundation, cool extremities, and negligible urine output
vasoconstrictor hormones released in response to hypovolemia catecholamine, angiotensin II
if doubt exists about the state of hydration, measurement of the pulmonary __ permits assessment of the intravascular volume status capillary wedge pressure
nearly all of the volume of solution containing __ are retained in the extrarenal space 0.9% sodium chloride and colloid
__ are the preferred parenteral solutions for the treatment of hypovolemia 0.9% sodium chloride and colloid
only 1/3 of infused __ remains in the extracellular compartment 5% glucose in water (D5W)
__ occurs when salt and water intake exceeds renal and extrarenal losses volume expansion
sever hypoalbuminemia associated with liver disease, nephrotic syndrome, or severe malnutrition may lead to __ edema
the mainstay in treating volume excess is ___ dietary sodium restriction in combination with diuretics
Diuretics enhance natriuresis by inhibiting the reabsorption of sodium and water
most patients with nephrotic syndrome have increased effective circulating volume resulting from primary renal sodium retention
___ inhibit sodium, chloride and potassium cotransporter of the thick ascending loop of henle loop diuretics (furosemide, bumetanide)
loop diuretics __ calcium excretion promote
thiazide diuretics __ calcium excretion decrease
__inhibit the sodium and chloride cotransporter of the distal tubule thiazide diurtetics
__ are useful in managing hypercalcemia thiazide diuretics
__ are useful in managing calcium stone formation loop diuretics
potassium sparing diuretics spironolactone (aldosterone agonist), amiloride (sodium channel blocker)
decreases sodium reabsorption in the cortical collecting duct spironolactone (aldosterone agonist), amiloride (sodium channel blocker)
because __ is the major cation in ght ECF, disorders of osmolality are generally reflected by and abnormal __ concentration sodium
__ causes renal water conservation by increasing water permeability and water reabsorption in the collecting ducts ADH
baroreceptors in the venous and arterial circulation stimulate __ release throu neuronal pathways when the EDF volume is reduced by about 10% ADH
Hyperglycemia and the use of mannitol may result in __ because of a water shift from the intracellular to extracellular space hyponatremia
most hyponatremic disorders are associated with hypo-osmolality
failure to suppress ADH secretion in response to hypotonicity SIADH
in most instances hypernatremia is caused by __ rather than by sodium gain excess water loss
__ is a powerful stimulus for thirst hypertonicity of the plasma
patients unable to sense thirst or with a lack of available water may develop hypernatremia
a disorder in which the collecting tubule is impermeable to water diabetes insipidus
hypernatremia that is associated with hypovolemia implies __ in addition to the water deficit a sodium deficit
hypernatremia that is associated with hypovolemia requires __ isotonic saline infusion
administration of fluids that are __ relative to the urine corrects hypernatremia hypotonic
the ascending limb of the loop of henle is __ to water impermeable
the ascending limb of the loop of henle is __ to NaCl permeable
the descending limb of the loop of henle is __ to water permeable
if the blood is hypoosmolar then ADH will be turned __ off
if the blood is hyperosmolar then ADH will be turned __ on
if the blood is hypoosmolar and ADH is turned on this is called __ SIADH
function of ADH increases water retention and results in a more concentrated urine, increases blood volume, decreases serum osmolalit
__ is a powerful vasoconstricor and increases cardiac output angiotensin II
__ initiates the active transport of Na from the distal tubules and collecing ducts into the bloodstream. this promotes the reabsorption of water aldosterone
major stimulus for angiotensin II low ECV, beta-adrenergics (via renin release)
major site of action of angiotensin II proximal convoluted tubule
major stimulation of aldosterone angiotensin II, hyperkalemia
major site of action of aldosterone cortical distal nephron
major stimulus for atrial naturetic factor vascular volume expansion
major site of action for atrial naturetic factor GFR, medullary CD
__% of body water is in the ICF 60
__% of body water is in the ECF 40
__% of ECF is intravascular 20
__% of ECF is interstitial 80
effective circulating volume is the same as intravascular volume
hyperosmolar is the same thing as less water
hypoosmolar is the same thing as more water
effective plasma osmolality is calculated by 2Na + glucose/18
nomral saline is given for intravascular fluid volume resuscitation
D5W is given for dehydration
__ is a true vascular volume expander packed red blood cells
if the serum is hyperosmotic the urine should be __ hyperosmotic
if the serum is hypoosmotic the urine should be __ hypoosmotic
if the kidneys are unable to to concentrate urine this is called diabetes insipidus
in SIADH if the serum osmolality is low the urine osmolality will be high
in DI or low ADH if the serum osmolality is high then the urine osmolality will be low
if the patient is hyponatremic, hypovolemic treat with normal saline
if the patient is hyponatremic and euvolemic treat with H2O restriction, hypertonic Na
if the patient is hyponatremic and hypervolemic treat with H2O and Na restriction
when a patient is in DKA you give them __ until the anion gap normalizes then you give them insulin fluids
in hyponatremia always correct sodium to __ 125
in hyponatremia correct the sodium at __ mEq/L/hr 0.5
if you correct hyponatremia too fast you can cause demylenation of neurons in the Pons
hypernatremia and hypovolmia treat with hypotonic saline
hypernatremia and euvolemia treat with water replacement
hypernatremia and hypervolemia treat with water and diuretics
don't use __ when treating diabetes insipidus loop diuretics
major complication of rapid correction of chronic hypernatremia is __ cerebral edema
safe initial correction of hypernatremia is at the rate of __mEq/L/hr 0.5
hypernatremia with severe hypovolemia treat with 0.9% saline
with a patient that is hypernatremic bring the Na to 140
Created by: bwyche