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52 Cards in this Set
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conns, will the person be HTN
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yep
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in COnns what does K look like, about about pH
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hypokalemic (Na reabs at the cost of K)
**metabolic alkalosis, kidneys secrete LOTS of HCO3, compensated usually by hyperventalation |
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what does K secretion look like in Conns
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INCREASED
**ALDO is being secreted and does Na reabs and K secretion |
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why do we want Cr with urinalysis
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it can be used to measure GFR
**Cr is the excretion rate. ER= Urine Conc x Urine Vol. |
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in conns is renin high or low
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low
**aldo is high |
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what does it mean when renin is decreased nad ALDO is high
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aldo is coming from another place, ALDO tumor. CONNs disease
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in Conns is it 1 hyperaldosteronism
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yep
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how do we know in conns only ALDO is being secreted
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cortisol is normal (the precurson to all of the hormoneS)
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how do we know that the HTN in conns is due to ECF volume overload and not something like constriction
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catacholamines are normal
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how does excess ALDO affect Na, H and K
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Na: reabs (reabs H20)
K: secreted H: secreted |
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how does aldo affect pH
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in a intercalated cell in DCT the Na/H ATPase. Puts na for reabs and H enters the lumen for excretion. this makes more bicarb
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why is there mm weakness in conns
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lack of K,
**resting membrance potential is hyperpolarized |
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why is renin not increased in Conns
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renin is decreased bc we are volume overload, increased BP so renin is low. ALDO coms from another source
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other than surgery how is conns treated
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1. ALDO antagonist in DCT (also a diuretic)
**spironolactone *blocks AlDO so less Na reabs and less K excretion |
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what hormone should be elevated in COnns
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ANP, the increased BV and BP will cause this to be rleased
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what is Na in the plasma in conns
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normal, we increase reabs of Na but also increase H2O reabs,
**thirst centers also activated to decrease Na conc |
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in what disease do we drink eat and pee lots
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DKA
**diabetes mellitus, diabetic ketoacidosis |
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ehat are physical findings of DKA other than pee and dring
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1. fruity breath'
2. hyperventalate 3. low BP 4. High pulse **orthostatic changes in BP and pulse **volume depleted so cant have high BP |
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what is K like in DKA
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hyperkalemic
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what is bicarb like in DKA
metabolic or respiratory? compensated? |
SUPER LOW, acidosis metabolic with partial compensation by lungs (hyuperventalation)
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what happens to glucose in DKA
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excreted (not normal)
plasma is WAY HIGH, increase plasma OMS |
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what part of the urinalysis is useful to determine GFR
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Cr clearance
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given GFR, plasma [Gluc], Appearance of GLuc in urine calc transport glucose, estimate tubular max.
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?????????????
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why is it important to measure Tm in DKA
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we have glucose in the urine. if Tm is normal we know the kidney is healthy and that the gluc in the urine is due to increased plasma of glucose
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what is fraction excretion (FE)
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secretio rate/FL
**when its more than 0.1-0.2 it means its being secreted. Loosing **IN DKA we loose na |
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what goes on with Na and k in DKA
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loose Na
Keep K |
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what happens if Ch20 (free water clearance) is negatine
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not clearing water, RETAIN water
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is there an anion gap in DKA
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yep!!! HUGE
**large decrease in HCO3 Na - (HCO3 + Cl) |
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in type 1 diabetes why can we get adicid
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cent use sugar so we use protein, protein degradation makes acetoacetic acid and b hydroxy butyric acid. these acids eat up the HCO3 and make us metabolically acidic
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what does the increased glucose do to the kidney
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acts as diuretic, Pee lots
Cosm: increased FE Na: increased Na and water are excreted. as well as a high osmotically active clearance |
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why do we pee lots in DKA
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glocose in the nephron acts as a diruretic and pulls water in for excretion
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why is BP low in DKA
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fluid loss, you pee lots bc glucose acts as a diuretic
**but you do have free water retention, go figure...its slight |
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why does HCO3 decrease in DKA? how does it affect pH, anion gap
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lots of acid being produced
Metabolic acidosis with partial compensation **increases anion gap (Na- (HCO3+ Cl) |
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what type of diuretic does glucose act like
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thiazide
*loose Osmolites and water |
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what hormones are elevated in DKA, think about whats happening in plasma? what hormoes are low
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plasma volume decreases
1. renin increased 2. ALDO 3. ANG II 4. ADH LOW ANP |
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why is K low in DKA
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low insulin, insulin stim cells to take in K
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what can cause contraction alkalosis
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vomit, loose volume and loose acid
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what is hte main hormone for hyperosm
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ADH, regulates BV when hyperosmotic
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what happens to K, Cl, Na, pH bicarb in vomit
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K high
Cl high Na normal pH: alkaline Bicarb: high |
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so what 3 things are lost in vomiting
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1. fluid
2. acid 3. K |
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in vmit what is the initial reason for alkalosis, what maintains it
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loose HCL in vomit
**then maintained by low K, and low volume |
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low K and Low volume lead to what
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alkalosis
1. Volume depletion increases renin, ANG, ALD, this increases H secretion - ANG II stim Na/H antiport in PCT --> increased HCO3 -ALDO stim H secretion by H ATPase in DCT in a intercalated cells (and K loss from principal cells) |
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what does ALDO do to K and H? what part of nephron, what transporters, what cells
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increase secretion
**DCT *H ATPase, a intercalated *Na/K principal cells |
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what controlls the Na/K in the principal cells of DCT
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ALDO
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what does ANG II do to ion transport
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stim Na/H antiport in PCT
**in contraction alkalosis ANG II is stim to promote BP but it causes H to be secreted and HCO3 to be formed, this worsens the alkalosis |
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Volume contraction stimulates what hormone,
wht is the pH state in volumic contraction due to emesis which does this hormone do to pH state |
ALDO
alkalosis ALDO FURTHERS alkalosis and secreted more K (H uniport in DCT, Na/K in DT) |
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hypokalemia does what to H secretion
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increased secretion
**H/K ATPase in DCT **so we are volume contracted which decreases K, the decreased K makes us secreted acid but we are already alkolotic so this just makes us more basic |
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what happens to Cl with contraction alkalosis
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lowers
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wht does the low Cl in volumic contraction alkalosis
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increases h secretion!
**cl doesnt leave the lumen with na so the lumen gets (-) this makes the lumen (-) and draws + ions like H and K into the lumen |
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when you can correct contraction alkalosis with saline what type was it
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saline responsive
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is conns fixed with saline
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NOPE
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what does giving saline to alkalotic volume contraction do? (3)
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1. replaces fluid: renin ALDO ANG ADH decrease
2. Cl can be transported out of the lume along with Na, the lumen is no longer (-) and drawing in H and K 3. HCO3 is secreted |
