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26 Cards in this Set
- Front
- Back
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Regulator of ADH?
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secreted from the posterior pituitary in response to increased serum osmotic pressure and volume depletion
**central diabetes insipidus (DI): failure to appropriately concentrate urine in response to dehydration and a rise in urine osmolality in response to administered ADH **nephrogenic diabetes insipidus (DI): urine cannot be concentrated in either case |
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Aldosterone?
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reabsorption of sodium in the cortical collecting duct
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urinary clearance of a substance?
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C=UV/P
C: concentration, ml/min U: concentration of the substance in urine, mg/dL V: volume of urine** in a typical 24hour urine collection, divide the total mililiters of urine by 1440 (minutes in 24 hours) to get V in mL/min P: plasma concentration of substance in mg/dL |
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Fractional excretion of any compound (x)= FE(x)
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FE(x)=clearance (x) / clearance (creatinine)
FE(x)= VuU(x)/P(x) / VuU(creatinine)/P(creatinine) |
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Jaffe reaction
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old standard for measuring creatinine
alkaline picrate (which may detonate) forms a colored orange complex that absorbs light at 485nm creatinine slightly overestimates GFR **CERTAIN CHROMOGENS ARE THE SAME COLOR AND GIVE POSITIVE INTERFERENCE--GLUCOSE, FRUCTOSE, ASCORBIC ACID, PYRUVATE, URIC ACID negative interfering agents:lipids, bilirubin, hemoglobin ***cimetidine blocks tubular secretion of creatinine |
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Henderson-Hasselbach
pH=pK + log (base/acid) pH=7.4 pK=6.1 base=[bicarb]=24 acid=dissolved pCO2=0.03 x pCO2=0.03X40=1.2 7.4=6.1 + log (24/1.2)= 6.1 +1.3=7.4 |
The body makes every attempt to maintain the validity of this equation. The pH must be maintained at 7.4 and the pK is constant---only the [bicarb] and PaCO2 can be altered
in order to maintain the validity of the formula the ratio must remain 20:1, so whenever one goes up so must the other |
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Disorder: respiratory acidosis
primary change? compensation? |
increase pCO2
increase HCO3 decrease Cl *respiratory acidosis: pH and [HCO3] go opposite direction |
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Disorder: respiratory alkalosis
primary change? compensation? |
decrease pCO2
decrease HCO3 increase Cl *respiratory alkalosis: pH and [HCO3] go opposite direction |
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Disorder: AG metabolic acidosis
primary change? compensation? |
decrease HCO3
decrease pCO2 |
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Disorder: non AG metabolic acidosis
primary change? compensation? |
decrease HCO3
decrease pCO2 increase Cl |
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Disorder: metabolic alkalosis
primary change? compensation? |
increase HCO3
increase pCO2 decrease Cl |
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anion gap
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[Na] - ([Cl] + [HCO3]); normal <12
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reason for increased anion gap?
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bicarbonate is low, it has been replaced by the anion of an organic acid such lactic acid, ketoacid, acetosalicylic acid
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osmolal gap
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measured osm — (2[Na] + [Glu]/18 + BUN/2 .8); normal < 10
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metabolic acidosis and osmolal gap?
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methanol
propylene glycol ethylene glycol paraldehyde ethanol (sometimes) |
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no metabolic acidoisis and osmolal gap?
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isopropyl alcohol
glycerol sorbitol mannitol (use to treat cerebral edema) acetone ethanol (sometimes) |
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Estimated GFR
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(140-age)/(weight-kg) / plasma Cr x 72
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two drugs that stimulate the respiratory center directly and cause respiratory alkalosis?
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salicylates
progesterone |
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Syndrome of inappropriate ADH (SIADH)
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hyponatremic individual who is relatively normovolemic and has high urinary sodium
caused by: small cell carcinoma o f the lung pancreatic adenocarcinoma various interstitial pulmonary disorders cerebral trauma drug chlorpropamide |
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patient presents with altered mental status, weakness, hypotension, and the typical bio-chemical abnormalities including hypoglycemia , hyponatremia and hyperkalcemia with a metabolic acidosis
?disorder |
Addison's
patients with primary adrenal causes of Addison's, co-hypersecretion of melanocyte stimulat-ing hormone (MSH) results in diffuse hyperpigmenta-tion of the skin Addison's syndrome may be due to Addison's dis-ease (primary adrenal insufficiency) or pituitary hypofunction (secondary adrenal insufficiency) . Most cases today are related to exogenous cortisol administration that can lead to irreversible (or very slowly reversible) suppression of endogenou s ACTH production by the pituitary. |
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Enzymatic measurements of urea or BUN actually measure released
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Ammonia
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Two drugs that stimulate the respiratory center leading to respiratory alkalosis
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Salicylate and progesterone
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For ever 100mg/dL of glucosa above normal, the sodium will fall by
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1.5mmol/L
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FE(Na) is less than 1% in prerenal azotemiz due to the action of which hormone?
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Aldosterone
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electrolyte concentrations in sweat?
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Na 50mEq/L
K 5 mEq/L sweat is hypotonic |
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the most common cause of hypokalemia?
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renal wasting of potassium, most often due to increased activity of aldosterone either as a primary disorder or secondary to increased renin secretion
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