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Renal 02 Elec. Dis.

Hamra: Electrolyte Disorders

QuestionAnswer
Hyponatremia Too much water relative to Na : Na <135 mmole/L
Hypernatremia Too little water relative to Na : Na >144 mmole/L
Osmolality Concentration of ALL solutes
Tonicity Concentration of solutes that will cause a water shift : E.g. Na & Cl, not Urea
True (absolute) Hypovolemia Hemorrhage, GI fluid loss, Diuretics, Burns
Relative Hypovolemia Increased capacitance of the compartment : either from vasodilation (drugs, sepsis, NO) or decreased effective arterial blood flow (edema and third spacing)
Primary Renal Hypervolemia Na/water rentention from renal disease
Secondary Renal Hypervolemia Na/water retention from systemic diseases such as cardiac failure and cirrhosis
Name the 5 hormonal regulators of Na (1) Aldosterone (2) ADH (3) ANP (4) Sympathetic Nervous System (5) Angiotensin II
Effects of Angiotensin II and NE in the proximal tubule Tweek (1) the Na/H exchanger on the lumenal side and (2) the Na/K pump on the interstitial side
Effects of Aldosterone in the Cortical Collecting Duct Principal Cells Increases activity of (1) ENaC and (2) Aquaporin channels on the lumenal side and (3) Na/K pump on the interstitial side.
Where does ADH work to increase Na reabsorption? The thick ascending limb and CCD
How does ADH effect Urea It increases Urea transport in the intermedullary collecting duct
How does ADH increase water reabsorption? With the insertion of acquaporin channels in the collecting duct
What is the equation associated with Na excretion Filtered load of Na (GFR X plasma [Na]) - tubular reabsorption of Na
What does ANP do (generally) Increases the excretion of Na and water
Name the three controllers of water balance. Osmolality, Volume, Angiotensin
In the presence of competing volume and osmolality signals, which one wins? Volume always wins
Increase/decrease of which factors will increase ADH? Increase in osmolality, decrease in volume, increase in angiotensis
Increase/decrease of which factors will increase thirst? Increase in osmolality, decrease in volume, increase in angiotensis
What do you expect to see with Hypervolemic Hyponatremia in regards to plasma Na, water/Na, osmolality, Una and Uosm? Plasma Na <136 mm/L : big increase in water, small increase in Na : decrease in plasma osmolality : Una <20 mm/L : Uosm high to isosmotic
Name some examples of Hypervolemic Hyponatremia. CHF, decompensated cirrhosis with ascites, advanced renal failure, nephrotic syndrome (least common)
What changes to the Starling forces would cause edema? increase cap. hydraulic pressure : decrease cap. oncotic pressure : increase cap. permeability : Lymph obstruction
Increase in capillary hydraulic pressure can be caused by what? Increased blood volume or venous obstruction
What is the common denominator seen in Hyper. hypo situations? Decreased EABV
What two physiologic responses will increase water retention? Increased thirst and ADH
what two physiologic responses will increase Na retention? Increased SNS and RAAS
Hypovolemic Hyponatremia indicates what? There is a past or on going Na loss event
What do you expect to see with Hypovolemic Hyponatremia in regards to plasma Na, water/Na, osmolality, Una and Uosm? Plasma Na <136 mm/L : decreased water with big decrease in Na : decreased plasma osmolality : Una depends : Uosm ranging from low to high
Name some examples of Hypovolemic Hyponatremia. GI loss, bleeding, urine, skin (major sweating or burns)
How do you distinguish between Extrarenal and renal hypo hypo? Extrarenal the Una <20 mm/L Renal the Una >20 mm/L
Examples of Extrarenal causes of hypo hypo. GI Loss, Excessive sweating, burns, third spacing of fluids
Examples of Renal causes of hypo hypo. Diuretics, salt-wasting neuropathy, mineralocorticoid deficiency, ketonuria, bicarburia
What type of urine would you expect to see in a pt with a Renal cause of hypo hypo? Isosmotic or concentrated urine (high Uosm)
What is the "key" with Euvolemic Hyponatremia? There is neither a volume or osmolar signal to increase ADH.
What do you expect to see with Euvolemic Hyponatremia in regards to plasma Na, water/Na, osmolality, Una and Uosm? Decreased plasma osmolality : decreased Pna : very high Una (>40 mm/L) : Uosm is high
What maybe the cause of the really high Una? SIADH: either lots of ADH or increase renal responce to ADH
What kind of conditions can cause SIADH? Tumor, CNS disorder, thorasic dz, chest wall dz
What conditions mimic SIADH Hypothyroidism and adrenal glucocorticoid deficiency
Name 3 examples of euvol. hypo with low Uosm. Primary polydipsia, beer potomania, and tea and toast diet
What can cause Hypernatremia? Primary Na gain or a primary water deficit
What would you expect to see in hypernatremia in respect to Pna and Posm? Pna > 144 mm/L : Posm would be high
What is the normal response to hypernatremia? Increase water intake and excrete a maximally concentrated, minimum volume urine
What can cause Hypervolemic Hypernatremia? Over zealous administration of hospital IV fluids
What would you expect to see in regards to water, Na, plasma osmolality and Uosm? Increase in water : big increase in Na : high plasma osmolality : Uosm will depend on the competing signals for ADH
What patient populations do you tend to see Euvolemic Hypernatremia in? Elderly, those in nursing homes, people with no access to water, those with dibetes insipidus, and febrile patients
What would you see in regards to water, Na, plasma osmolality, and Uosm? Decrease in water : no change in Na : high plasma osmolality : Uosm would be very low
What is the hallmark seen in euvolemic hypernatremia? A pure net loss of water with no change in Na
What would you expect to see in hypovolemic hypernatremia in respect to water, Na, plasma osmolality and Uosm? Big decrese in water : decrease in Na : increase in plasma osmolality : Uosm would be high
Name some Extrarenal causes of hypo hyper. GI loss, excessive sweating and burns
Nam some Renal causes of hypo hyper. Loop diuretics and osmotic diuretics (not drugs: urea, glucose, mannitol, glycol)
Created by: bcriss