MD4003 > U&E's > Flashcards

U&E's Flashcards

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1
Q

Is water mainly intracellular or extracellular?

A

Intracellular

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2
Q

Is sodium mainly intracellular or extracellular?

A

Extracellular

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3
Q

Is potassium mainly intracellular or extracellular?

A

Intracellular

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4
Q

Give 2 examples of how you could loose an isotonic fluid?

A
  1. Haemorrhage

2. Fistula fluid

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5
Q

Describe the loss of isotonic fluids?

A
  • Loss from ECF
  • No change in sodium
  • No fluid redistribution
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6
Q

Give an example of how you could loose a hypotonic fluid?

A

Insensible loss (dehydration)

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7
Q

Describe the loss of hypotonic fluids?

A
  • Greater loss from ICF than ECF
  • Small increase in sodium
  • Fluid redistribution between ECF & ICF
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8
Q

Give an example of how you could gain isotonic fluids?

A

Saline drip

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9
Q

Describe the gain of isotonic fluids?

A
  • Gain is to ECF
  • No change in sodium
  • No fluid redistribution
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10
Q

Give 2 examples of how you could gain hypotonic fluids?

A
  1. Water

2. Dextrose

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11
Q

Describe the gain of hypotonic fluid?

A
  • Greater gain to ICF than ECF
  • Small decrease in sodium
  • Fluid redistribution between ECF & ICF
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12
Q

List 3 physiological compensatory mechanisms?

A
  1. Thirst
  2. ADH
  3. Renin / Angiotensin system
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13
Q

List 3 therapeutic compensatory mechanisms?

A
  1. IV therapy
  2. Diuretics
  3. Dialysis
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14
Q

What is the simple test to ascertain ADH status?

A
  • Measure plasma & urine osmolality. If Urine > Plasma = ADH active
  • Measure plasma & urine urea. If Urine»_space; Plasma = water retention
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15
Q

What is the Renin-angiotensin system activated by?

A

Reduced intra-vascular volume (IVV) ie. sodium depletion or haemorrhage

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16
Q

What is the simple test to ascertain renin-angiotensin system?

A
  • Measure plasma & urine sodium

- If Urine <10mmol/L = R/A/A active

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17
Q

What happens if you replace 2L of lost isotonic fluid with hypotonic fluid?

A
  • Fall in sodium

- Fluid redistribution

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18
Q

What happens if you replace 2L of lost isotonic fluid with isotonic fluid?

A
  • No change in sodium

- No fluid redistribution

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19
Q

What happens if you replace 3L of hypotonic fluid with hypotonic fluid?

A
  • Sodium is restored

- Fluid redistribution

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20
Q

What happens if you replace 3L of hypotonic fluid with isotonic fluid?

A
  • Sodium slightly increased

- No fluid redistribution

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21
Q

What is urea?

A

Normal breakdown product of protein metabolism

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22
Q

Describe how Urea is important to monitor?

A
  • In dehydration often first to show change

- Sodium and urea concentrations will often parallel each other during fluid correction

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23
Q

When is urea usually elevated?

A
  • CCF
  • Shock
  • MI
  • Severe burns
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24
Q

What is creatinine?

A

Breakdown product of protein and muscle

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25
What happens to urea and creatinine during loss of renal function?
- Decreased filtered volume | - Increased plasma urea & creatinine
26
What is GFR?
(Glomerular Filtration Rate) is the volume of fluid passing through the glomerulus, in a given period of time
27
What does a decrease in GFR usually precede?
Renal failure in all forms of progressive kidney disease
28
What is GFR influenced by?
- Renal perfusion pressure - Renal vascular resistance - Glomerular damage - Post- glomerular resistance
29
What is eGFR based on?
Creatinine
30
What are the 3 possible diagnosis's for hypovolaemia and >20 urine sodium levels?
1. Diuretics 2. Addison's 3. Sodium losing nephritis
31
What are the 3 possible diagnosis's for hyponatraemia, hypovolaemia and <20 urine sodium levels?
1. Vomiting 2. Diarrhoea 3. Skin loss
32
What are the 2 possible diagnosis's for hyponatraemia with oedema?
1. CCF cirrhosis | 2. Nephrosis
33
What are the 3 possible diagnosis's for hyponatraemia, euvolaemic with >20 urine sodium levels?
1. SIADH 2. Drugs 3. CRF
34
What are the 3 possible diagnosis's for hyponatraemia, euvolaemic with <20 urine sodium levels?
1. Stress 2. Post surgery 3. Hypothyroid
35
Does plasma potassium reflect the body potassium?
NO! Small proportion of total potassium is in the plasma
36
How is the total body potassium determined?
By total cell mass
37
Describe the relationship between potassium and hydrogen ions?
- Exchange across cell membrane | - Both bind to negatively charger proteins
38
What happens to potassium during acidosis?
Moves out of cells --> Hyperkalaemia
39
What happens to potassium during alkalosis?
Moves into cells --> Hypokalaemia
40
What are the 3 artifactual causes of hyperkalaemia?
1. Delay in sample analysis 2. Haemolysis 3. Drug therapy- excess intake
41
What are the 2 renal causes of hyperkalaemia?
1. Acute renal failure | 2. Chronic renal failure
42
What are the 2 mineralocorticoid dysfunctional causes of hyperkalaemia?
1. Adrenocortical failure | 2. Mineralocorticoid resistance ie. spironolactone
43
What is the cell death cause of hyperkalaemia?
Cytoxic therapy
44
What are the 5 treatments for hyperkalaemia?
1. Correct acidosis if this is the cause 2. Stop unnecessary supplements/intake 3. Give glucose & insulin (drives K into cells) 4. Ion exchange resins (GIT K binding) 5. Dialysis
45
What are the 3 increased urine loss causes of potassium depletion?
1. Diuretics/osmotic diuresis 2. Tubular dysfunction 3. Mineralocorticoid excess
46
What are the 3 GIT loss causes of potassium depletion?
1. Vomiting 2. Diarrhoea/laxatives 3. Fistulae
47
What are the 2 hypokalaemia without depletion causes?
1. Alkalosis | 2. Insulin/ glucose therapy
48
What does acute potassium depletion changes in ICF/ECF ratios cause?
- Lethargy - Muscle weakness - Heart arrhythmias
49
What does chronic potassium losses from the ICF cause?
- Lethargy - Muscle weakness - Heart arrhythmias - Polyuria - Alkalosis - Vascular & gut problems
50
What signs in the history could suggest potassium depletion?
- Diarrhoea, vomiting, drugs (diuretics, digoxin) - Symptoms of lethargy / weakness - Cardiac arrythmias
51
What signs in the electrolyte investigation could suggest potassium depletion?
- Hypokalaemia | - Alkalosis (raised HCO3)
52
What are the 2 possible treatments of potassium depletion?
1. Oral- 48mmol/day & diet | 2. IV- <20mmol/L
53
In what 4 cases would you monitor plasma potassium regularly?
1. Diuretic therapy 2. Digoxin use 3. Compromised renal function 4. In support of IV resuscitation (eg DM Ketacidosis)
54
What would the U&E's appear like in intra-renal failure?
- Increased creatinine - Increased urea - Increased K - Increased H - Decreased HCO3 - Metabolic acidosis
55
Describe the U&E's of hypovolaemia/dehydration?
- Increased urea - Increased creatinine - Increased haematocrit - Decreased urine volume
56
What is Addison's disease?
Primary adrenocortical insufficiency
57
Describe the electrolytes in Addison's disease?
- Decreased Na - Increased K - Increased Ca
58
What is Cushing's syndrome?
Excess plasma cortisol
59
Describe the electrolytes in Cushing's syndrome?
- Increased Na - Decreased K - Decreased Ca
60
Describe the electrolytes in Conn's syndrome?
- Increased/Normal Na | - Decreased K
61
What can cause increased urea, but normal creatinine?
- Dehydration - GI haemorrhage - High protein diet
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