Batlle & Friends

Front 1

(164);

Back 1

(164);

Front 2

3 principal regulators of serum K+;

Back 2

Epi Insulin Aldosterone;

Front 3

K+ in mineral vs organic acidosis

Back 3

Mineral: Increase K+ because anions are held extracellularly (pulling K+ out) Organic: No change. Organic anions are taken into cell

Front 4

Hyperkalemia and EKG

Back 4

1. High T wave 2. Prolonged PR, depressed ST 3. IV block 4. Vfib

Front 5

Principal cell

Back 5

Cell in CCT Na/K control (reg by ald)

Front 6

Na channel blockers

Back 6

Amiloride Triamterene Trimethoprim Pentamidine

(DCT Na blocking diuretics)

Front 7

Pseudohypoaldosteronisms

Back 7

True Aldosterone Resistance Type IA Dominant - defect in Mineralocorticoid receptor
(Milder) Type IB Recessive - defect in ENaCl (Severe)
Type II Dominant - unknown (defective chlorine shunt)

Front 8

Bartter's vs Gitelmans

Back 8

BOTH: Hypokalemia, metabolic alkalosis, normal/low BP, Inc renin, res to Ang II
Bartter's (like loop)(Defect in TAL)- Normal or in Ca2+, Normal to low Mg2+
Gitelman's (Like thiazide)(na/cl coT in DCT) - Low ser Mg, low urine Ca+B26

Front 9

Types of Bartter's

Back 9

Type I - NKCC2 - Na/2Cl/K CoT
Type II - ROMK - K passive
Type III - CIC_Kb - Cl passive

Front 10

How do NSAIDs cause hyperkalemia?

Back 10

Block Renin.

Front 11

How does Heparin cause hyperkalemia?

Back 11

Blocks production of aldosterone.

Front 12

How does Beta2 stim affect [K+]?

Back 12

Redistribution --> hypokalemia.

Front 13

Hypokalemia /w low bP

Back 13

BIG DAM - Bartters, Induced (drug), Gitelman's, Diuretics, Acidosis (tubular), hypoMagnesemia

Front 14

Hypokalemia w/ hypertension

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ALL - Aldosterone, Liddle's, Licorice

Front 15

165

Back 15

165

Front 16

What is the capacity of the kidneys to excrete water

Back 16

About 15% of the GFR

Front 17

How does ADH work to increase water reabsorption?

Back 17

Binds to V2 recopter of CD cells--> Increased insertion of AQP-2 into apical membrane (luminal side)

Front 18

How does ADH work to increase BP

Back 18

Binds V1 receptor --> smooth muscle contraction.

Front 19

Which diuretics causes hyponatremia

Back 19

Thiazides, Loops, Osmotics, (ADH)

Front 20

Explain translocational hyponatremia

Back 20

Another osmole (I.e. glucose) pulls water out of cells --> hyponatremia.

Front 21

What osmoles can cause trans. Hyponatremia

Back 21

Glucose, Glycine, Maltose, Mannitol

Front 22

What cause psuedohyponatremia

Back 22

Hyperlipid or Hyperparaprotein

Front 23

SIADH

Back 23

Too much ADH --> hyperosmotic urine (esp from lung cancer/pulm infection, drug induced)

Front 24

Osmotic Demyelination

Back 24

Demyelination when hyponatremia is corrected too fast.

Front 25

166

Back 25

166

Front 26

Where are high pressure vol receptors?

Back 26

Carotid Sinus, Aortic Arch, L. Ventricle, JGA

Front 27

Where are low pressure vol receptors?

Back 27

Cardiac Atria, R ventricle, Pulm Vessicles

Front 28

Proximal Tubule Cell: Impt actions

Back 28

Na/H antiport, Na nutrient symport.

Front 29

Thick Ascending Limb: Imp Actions

Back 29

NaK2Cl symport, paracell. cation trans.

Front 30

Distal Convoluted Tubule: Impt Actions

Back 30

Ca/Na antiport, NaCl symport.

Front 31

Aldosterone renal actions

Back 31

Inrease Na abs, K & H exc

Front 32

ANP

Back 32

Atrial Natriuretic Petptide - Relased from cardiac atria. --> Vasodilator, Na excretor

Front 33

Pressure Natriuresis

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Backup mechanism - Hypertension --> na excretion. Hypotension --> na retention.

Front 34

(170)

Back 34

(170)

Front 35

Henderson-Hasselbach

Back 35

pH = 6.1 + log[HCO3-]/(.03Pco2)

Front 36

Normal anion gap

Back 36

12-14 w/ potassium 6-10 w/o potassium

Front 37

Causes of high anion gap Acidosis

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MUDTILES Methanol Uremia Diabetic ketoacidosis Toluene Infection Lactic Acidosis Ethylene glycol Salicylates

Front 38

Causes of hyperchloremic metabolic acidosis(extrarenal)"

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HCl generating compounds - NH4Cl, HCl, Larginine, Llysine, Cl gas, Hyperalimentation GI HCO3 losses - Diarrhea, Ileus, Pancreatic/Biliary fistula, laxatives

Front 39

Relevance of L Arginine, L Lysine, Hyperalimentation

Back 39

Cause hyperchloremic acidosis.

Front 40

Net Acid Excretion

Back 40

NAE = (NH4+ + TA) - HCO3 TA = titrable acid

Front 41

RTA's

Back 41

Type I - Distal - Decreased H+ (NH4) excretion --> acidosis (Alkaline urine)
Type II - Proximal - HCO3 wasting esp above threshold
Type III - Distal w/ HCO3 waste Type IV - Hyperkalemic ass. W/ Aldost deficiency.

Front 42

171

Back 42

171

Front 43

Drugs that suppress ADH

Back 43

"Make All Dicks Leak" - Methoxyflurane, Amphotericin B, Democlocycline, Lithium

Front 44

How can Lithium polydipsia be prevented?

Back 44

Give amiloride (diuretic) - blocks the ENaCl transporter that also uptakes Li.

Front 45

172

Back 45

172

Front 46

Normal Compensation for increased HCO3

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Approximately .6-.7 increase in pCO2

Front 47

ECF Expansion causes (pH)

Back 47

Decreased HCO3- -> dec pH

Front 48

Aldosterone and PH

Back 48

Stimuleates H+ secretion (by increasing Na reabsorption)

Front 49

PTH & PH

Back 49

PTH blocks HCO3 reabs

Front 50

Ang II and pH

Back 50

Ang II stimultes HCO3 reabsorption

Front 51

Hypokalemia and pH

Back 51

Hypokalemia stimulates HCO3 reabs

Front 52

Responsive alkaloses

Back 52

Low urine chloride - Gastric fluid loss, Stool loss, diuretic therapy

Front 53

Resistant Alkaloses

Back 53

High urine chlored - Primary hyperaldosteronism, steroids, Bartter's, Gittelmans

Front 54

Hypokalemic Metabolic Acidoses ??? Typo

Back 54

Diuretic, Vomiting, Bartter's

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173

Back 55

173

Front 56

What do loop diuretics block?

Back 56

Na2ClK channel in Thick ascending loop of henle

Front 57

Function of early distal tubule

Back 57

Reabsorb Na, Cl. Impermeable to water.

Front 58

Which are the K sparing diuretics?

Back 58

Amiloride, Triamterene, Spironolactone (A&T close Na channels in principle cell, spironolactone blocks ADH)

Front 59

Which diuretics are carbonic anhydrase inhibitors?

Back 59

Acetazoliamide and Benzolamide - Block CA --> blocks Na-H antiporter in Proximal Tubule

Front 60

What are the loop diuretics?

Back 60

Bumetadine, Furesomide, ethacrynic acid

Front 61

How do loop diuretics work?

Back 61

Block the NaK2Cl transporter. Also increase Ca, k wasting.

Front 62

How do thiazide diuretics work?

Back 62

Block the NaCl transporter in the distal tubule. Also block Ca reabs.

Front 63

CA diuretics do what to pH

Back 63

decrease

Front 64

Second function of CA diuretics.

Back 64

Glaucoma

Front 65

Which ions do loop diuretics waste?

Back 65

Ca, H, K

Front 66

Thiazides and calcium?

Back 66

Thiazides increase calcium reabs.