Electrolytes and renal function

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corbin19
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11470
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Electrolytes and renal function
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2010-03-29 11:10:29
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MLT 10005
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Electrolytes and renal funtion for Navy MLT
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  1. What is the small cone-shaped structure that regulates homeostasis, thirst, hunger, body temperature, water balance and blood pressure?
    Hypothalamus
  2. An adrenocortical insufficiency that results in low levels of adrenal corticosteroid hormones, including aldosterone and cortisol.
    Addison's Disease
  3. In what disease do patients display hyperkalemia and hyponatremia due to aldosterone deficency?
    Addison's Disease
  4. This syndrome is caused by an increased production of adrenocorticotropic hormone (ACTH) and characterized by obesity and week muscles.
    Cushing's Syndrome
  5. A property of a solution that is influenced by size and shape of the molecules, but not the individual composition.
    Colligative Properties
  6. What are some colligative properties?
    • -Boiling point
    • -Freezing point
    • -osmotic pressure
    • -vapor pressure
  7. Average water content is ______ of total body weigt.
    40-75%
  8. Water content declines in:
    • -Elderly people
    • -obese people
    • -women
  9. Why do women have a lower average water content than men?
    higher fat content
  10. all of the following are functions of what?
    -transport nutrients to cells
    -determine cell volume
    -remove waste products by way of urine
    -act as body coolant by way of sweating
    water
  11. Intracellular fluid (ICF) account for how much of total body water?
    2/3
  12. extracellular fluid (ECF) accounts for how much of total body water?
    1/3
  13. how is the interior of each cell separated from the ECF?
    by the semi permeable membrane
  14. how is extracellular fluid subdivided?
    • -intravascular cellular fluid (plasma)
    • -interstitial cell fluid
  15. what ECF contains 93% water and 7% lipids and proteins?
    intravascular cellular fluid
  16. what ECF surrounds the cells in the tissues?
    Interstitial cell fluid
  17. This type of movement requires ATP, solute mover from an area of lower concentration to an area of higher concentration.
    Active Transport
  18. Passive transport of solutes from an area of higher concentration to an area of lower concentration that eventually results in an equal distribution of solutes within the two areas.
    Diffusion
  19. Passive movement of fluid across a membrane from an area of lower solute concentration and comparatively more fluid into an area of higher solute concentration and comparatively less fluid. when does it stop?
    • Osmosis
    • Stops when enough fluids move through the membrane to equalize the solute concentrations in both sides of the membrane.
  20. what is the average glomerular filtration rate?
    it leads to the production of how much urine?
    • -125ml of blood every minute or about 180L/day.
    • -1-2 L/day of urine
  21. if the body loses even _____ of its fluid the kidneys reabsorb more water than solute.
    1-2%
  22. What does ATP stand for?
    adenosine triphosphate
  23. Where is ADH produced?
    hypothalamus
  24. where is ADH stored and released?
    The pituitary gland
  25. ADH regulates the body's reabsorption of what?
    Water
  26. what is the process that the renin-angiotensin-aldestorone system uses to regulate the reabsorption of Na and water?
    • - Juxtaglomerular cells secrete renin that leads to production of Angiotensin II a powerful vasoconstrictor
    • -angiotensin II stimulates aldosterone which raises blood pressure
    • -Aldosterone regulates reabsorption of Na and H20 within the nephron
  27. This is produced as a result of renin-angiotensin mechanism and regulates the absorption of H20 and Na.
    Aldosterone
  28. What is the cardiac hormone released when atrial pressure increases?
    Atrial natriuretic peptide
  29. what are the four ways atrial natriuretic peptide decreases ADH?
    • -Decreases blood pressure and reduces intravascular blood volume
    • -supresses renin levels
    • -decreases ADH release
    • -Causes vasodilation
  30. Physical property of a solution, which is based on the concentration of solutes, expressed as millimoles per kilograms of solvent.
    Osmolality
  31. What are the two ways to measure osmolality in the laboratory?
    • Freezing point depression
    • vapor pressure decrease
  32. what are the two ways the body corrects increased osmolality?
    • ADH secretion
    • sensation of thirst
  33. What is another name for ADH?
    vasopressin
  34. Disorder characterized by a deficiency of ADH that results in hypernatremia and dehydration.
    Diabetes insipidus
  35. Normal plasma osmolality
    275-295 mOsm/kg of water
  36. Sodium and it's associated anions account for approx ______ of osmotic activity in plasma.
    90%
  37. How are osmolality regulation and volume regulation related?
    • osmolality is regulated by a change in water balance
    • volume is regulated by changes in sodium balance
  38. how does excess water intake affect osmolaity and ADH?
    • lower plasma osmolality
    • supressed ADH and suppressed sensation of thirst
  39. what is the clinical significance of excess water intake?
    • hypo-osmolality
    • hyponatremia
  40. what are the effects of water deficit on osmolality and ADH?
    • increased plasma osmolality
    • ADH secretion and thirst sensation activation
  41. what is the clinical significance of water deficit
    • hyper osmolality
    • hypernatremia
  42. why is plasma not recommended for measuring osmolality?
    anticoagulant contamination
  43. what is urine osmolality used to measure?
    • to measure the ability of the kidneys to concentrate ions
    • (kidney function)
  44. Serum osmolality is used as a comparison for what?
    urine osmolality
  45. What is used to standardize osmometers (QC)?
    sodium chloride reference solution
  46. true or false
    freezing point is a colligative property
    true
  47. what is the formula for calculated osmo?
    1.86(Na)+glucose/18+BUN/2.8
  48. The difference between the measured and calculated osmolality is called what?
    Osmolal Gap
  49. Ions capable of electrical charge are what?
    Electrolytes
  50. positively charged ions
    cations
  51. negatively charged ions
    Anions
  52. Elecrolytes differ in concentration but totals balance to achieve a neutral electrical charge.
    electroneutrality
  53. what are some extracellular ions?
    • Sodium
    • chloride
    • calcium
    • bicarbonate
  54. what are some intracellular ions?
    • potassium
    • phosphate
    • magnesium
    • calcium
  55. this is the principle extracellular cation that accounts for 90% of all extracellualr cations.
    Sodium (Na)
  56. what is the primary function of Na
    Body hydration
  57. what percent of filtered sodium is reabsorbed in the PCT?
    60-75%
  58. what is the recommended daily consumption of salt?
    6-7.5g salt/Day or 2,400-4,500mg Na/day
  59. What is the renal threshold of Na?
    110-130 mmol/L
  60. what is the hormone which regulates renal reabsorption of sodium?
    Aldosterone
  61. This disorder is characterized by a hypersecretion of aldosterone.
    Primary Aldosteroneism
  62. what are the three important processes of regulating Na?
    • intake of water in response to thirst
    • excretion of water
    • blood volume status
  63. Na reference ranges for
    Serum, Plasma:
    Urine (24hr):
    CSF:
    Serum/Plasma: 136-145 mmol/L
    Urine (24hr): 40-220 mmol/day
    CSF: 136-150 mmol/L
  64. Hyponatremia becomes clinically significant below what level of sodium?
    130 mmol/L
  65. A deficiency of sodium in the blood below 135 mmol/L
    hyponatremia
  66. what are the four causes of Hyponatremia?
    • increased sodium loss
    • increased water retention
    • water imbalance
    • addison's disease
  67. how is addisons disease involved in hyponatremia?
    involves inadequate secretion of aldosterone resulting in decreased reabsorption of Na by the renal tubules
  68. an abnormally decreased volume of circulating fluid in the body with a sodium loss in excess of water loss.
    hypovolemic hyponatremia
  69. how treatment of hyponatremia is directed?
    • appropriate management of fluid administration
    • correction of the underlying condition
  70. in hypovolemic hyponatremia with a urine Na >20mmol/day what is occurring? why
    renal loss of sodium and water due to ketonuria and aldosterone deficiency
  71. An increased volume of circulating fluids in the body with a sodium loss in excess of water loss is what?
    hypervolemic hyponatremia
  72. Hypervolemic hyponatremia is nearly always a problem of what?
    water overload
  73. hypervolemic hyponatremia with a urine sodium >20mmol/day indicates what?
    acute or chronic renal failure
  74. hypervolemic hyponatremia with a urine sodium <20 mmol/day indicates what?
    • nephrotic syndrome
    • cirrhosis
    • CHF
  75. increased serum sodium concentration >150mmol/L is called what?
    hypernatremia
  76. Inability to reabsorb water in patients of ______ my result in hypernatremia.
    diabetes insipidus
  77. what are some laboratory findings associated with Hypernatremia?
    • high urine osmolality
    • increased hematocrit and protein
    • BUN increased
    • creatinine normal
    • Spec. Grav. very high
    • serum sodium is >160 mmol/L
  78. treatment for hypernatremia is directed at what?
    correction of the underlying condition that caused the water depletion or sodium retention.
  79. Principal/major intracellular cation
    20x greater inside the RBC than in ECF
    only 2% circulates in plasma
    exhibits no renal threshold
    potassium
  80. this electrolyte is invloved in:
    regulation of neuromuscular excitability
    contraction of the heart
    ICF volume
    hydrogen ion concentration
    Potassium
  81. forearm exercise during venipuncture can cause what to become erroneously high?
    Potassium
  82. what is the relationship between Na and K under the influence of aldosterone?
    K is secreted into the urine in exchange for sodium
  83. reference range for potassium for:
    Plasma/serum:
    Urine (24hr):
    • Plasma/serum: 3.4-5.0 mmol/L
    • Urine (24hr): 25-125
  84. Plasma K concentration below the lower limit of the reference range is called what?
    Hypokalemia
  85. Causes of hypokalemia
    • GI loss
    • Renal loss
    • Increased cellular uptake
    • decreased intake
  86. why are K levels below 3 mmol/L a concern for patients with cardiovascular disorders?
    because of an increased risk of arrythmia
  87. Potassium concentration above the upper limit of the reference range is called what?
    Hyperkalemia
  88. cellular shift due to acidosis, muscle/cellular injury, chemotherapy, lukemia and hemolysis may be causes of what?
    hyperkalemia
  89. what could cause an artificial increase in plasma K (hyperkalemia)?
    • sample hemolysis
    • thrombocytosis
    • prolonged tourniquet use or excessive fist clenching
  90. what symptom of hyperkalemia does not devlop until plasma K reaches 8 mmol/L?
    Muscle weakness
  91. what treatment for hyperkalemia can provide an immediate but short-lived protection?
    administration of calcium
  92. what is the extracellular anion that shifts secondarily to the movement of sodium or bicarbonate ions?
    Chloride
  93. what are the functions of chloride?
    • maintains osmolality
    • blood volume
    • electric neutrality
  94. the regulation of what anion is passively related to Na levels?
    chloride
  95. Reference Ranges for chloride
    Plasma/serum:
    Urine (24hr):
    • plasma/serum: 98-107 mmol/L
    • Urine (24hrs): 110-250 mmol/day
  96. disorders of this anion are often a result of the same causes that disturb Na levels because it passively follows Na.
    Chloride
  97. An abnormally diminished level of chloride in the blood.
    hypochloremia
  98. this electrolyte may be seen in conditions associated with high serum bicarbonate concentrations such as compensated respiratory acidosis or metabolic alkalosis.
    Chloride
  99. an abnormally high level or chloride in the blood.
    hyperchloremia
  100. This may occur when there is an excess loss of bicarbonate ion due to GI losses, renal tubular acidosis, and metabolic acidosis.
    Hyperchloremia
  101. This is an autosomal, recessively inherited diseases of infants and children that causes obstruction of the exocrine glands, mucous glands, and pancreas.
    Cystic Fibrosis
  102. In Cystic Fibrosis more than 98% of affected infants have elevated sweat ____ and _____ and low serum levels.
    • Na
    • Cl
  103. this is the most common diagnostic tool for the ID of cystic fibrosis based on the pilocarpine nitrate iontophoresis method.
    Sweat Chloride Test
  104. 80% of this predominant intracellular anion is contained in the bone.
    Phosphate
  105. This electrolyte facilitates oxygen delivery to the tissues, promotes energy transfer to cells through the formation of ATP, and is important for WBC phagocytosis?
    Phosphate
  106. loss of regulation by ____________ has the most profound effect on phosphate.
    The kidneys
  107. what vitamin increases phosphate in the blood by increasing phosphate absorption in the intestines?
    Vitamin D
  108. what is the most important factor in the regulation of Phosphate? why?
    • parathyroid hormone
    • lowers blood concentration by increasing renal excretion
  109. What is the anticoagulant of choice for chloride collection?
    Lithium heparin
  110. reference ranges for Phosphate:
    Serum
    -Neonate:
    -Child:
    -Adult:
    Urine 24 hr:
    • Neonates: 1.45-2.91 mmol/L
    • Child:1.45-1.78 mmol/L
    • Adult: 0.87-1.45 mmol/L

    urine 24hrs: 13-42 mmol/L
  111. abnormal decrease of phosphate in the blood
    hypophosphatemia
  112. why would long term treatment with total prenateral nutrition cause hypophosphatemia?
    they are high in calcium
  113. this disease can result from dietary phosphate deficiency, vit D deficiency or inherited disorder of Vit D or phosphorous metabolism.
    Rickets
  114. what is an abnormal increase of phosphate in the blood called?
    hyperphosphatemia
  115. Neonates with underdeveloped PTH and Vit D metabolism are especially susceptible to what?
    hyperphosphatemia
  116. what is the average Mg content of the human body?
    24g
  117. what electrolyte is an essential cofactor in >300 enzymes?
    Magnesium
  118. processed foods can cause inadequate intake of what electrolyte?
    Magnessium
  119. in what electrolyte will PTH increase renal reabsorption but aldosterone will have the opposite effect?
    Magnesium
  120. reference range for magnesium
    serum/plasma:
    Serum/plasma: 0.63-1.0 mmol/L
  121. What is an abnormally low Mg content of the blood called?
    hypomagnesia
  122. what is the least likely cause of severe magnesium deficency?
    reduced intake
  123. hypomagnesia patients are asymptomatic until serum levels fall below what level?
    0.5 mmol/L
  124. the most frequent symptoms of ________ involve cardiovascular, neuromuscular, psychiatric, and metabolic abnormalities.
    hypomagnesia
  125. What is the treatment for hypomagnesia?
    • oral intake using:
    • Mg-lactate
    • Mg-oxide
    • Mg-chloride
    • antacid contgaining Mg
  126. what is abnormally high levels of Mg in the blood called?
    hypermagnesemia
  127. what is the most common cause of hypermagnesemia?
    Renal Failure
  128. most severe elevations of magnesium are usually a result of the combined effects of decreased _________ and increased intake of _______, ________, or ________.
    Renal functions

    • antacids
    • enemas
    • cathartics
  129. Hypermagnesemia can associated with endocrine disorder can be caused by a decrease in excretion due to what?
    • hypothyroidism
    • hypoaldosteronism
  130. bone carcinoma, dehydration, bone metastases, and addison's disease can cause what magnesium disorder?
    hypermagnesemia
  131. symptoms of hypermagnesemia do not occur until the serum level exceeds what level?
    1.5 mmol/L
  132. normal hemostasis is ________-dependent.
    calcium
  133. elevated Mg levels may inhibit _____ release and target tissue response. This may lead to ________ and __________.
    PTH

    • hypocalcemia
    • hypercalcuria
  134. how is Mg percipitation avoided when collectiong a 24 hour urine specimen?
    Urine is acidified with HCl
  135. what are the three common colormimetric methods for Mg testing?
    • calmagite method
    • forazen dye method
    • methylthymol blue method
  136. what percent of Ca is found in the bones?
    99%
  137. what are the three forms of calcium and what percent of total calcium is each form?
    • protein bound- 40%
    • ionized- 45%
    • complexed-15%
  138. what is the only form of calcium that is physiologically active?
    Ionized Calcium
  139. Ionized calcium is elevated in __________ due to reabsorption of Ca.
    hyperparathyroidism
  140. hyperalbuminemia will increase total calcium but does not affect what?
    ionized calcium
  141. This electrolyte plays a role in the formation and structure of bones and teeth; as well as the blood clotting process, and the release of hormones.
    Calcium
  142. what are the three main factors that affect calcium regulation.
    • PTH
    • Calcitonin
    • Vitamin D
  143. what is the effect that parathyroid hormone has on ionized calcium leves and phosphorous levels?
    PTH raises calcium levels and lowers phosphorous levels
  144. how does increase serum Ca?
    it draws calcium from the bones and promotes transfer of Ca and P into the plasma
  145. What promotes calcium reabsorption from the bones and kidneys?
    Vitamin D
  146. What are the sources of Vitamin D?
    • Dairy products
    • Sunlight
  147. what is the hormone produced in the thyroid gland that acts as an antagonist to PTH in order to regulate Ca levels?
    Calcitonin
  148. The reduction of blood calcium below normal level of 1.88 mmol/L
    hypocalcemia
  149. Hypoparathyroidism, hypomagnesemia, and hypoalbuminemia are are all causes of what?
    hypocalcemia
  150. Primary hyperthyroidism, malignancies, and primay hyperparathyroidism are ally main causes of what disorder?
    hypercalcemia
  151. This is the major component of the buffering system in the blood.
    Bicarbonate
  152. a relative increase in total body acid and decreased bicarbonate that is compensated by hyperventilation indicates what disorder?
    metabolic acidosis
  153. elevated CO2 concetration and increased pH that is compensated by hypoventilation indicates what disorder?
    metabolic alkalosis
  154. What is the normal pH of arterial blood?
    7.35-7.45
  155. this expresses acid-base relationship in a mathematical formula.
    henderson-hasselbalch equation
  156. when kidneys and lungs are functioning properly what is the ratio of HCO3 to H2CO3?
    20:1
  157. An increase in the concentration of dissolved CO2 in the ECF which leads to increased carbonic acid and hydrogen ions.
    respiratory acidosis
  158. excessive pulmonary ventilation that decreases the hydrogen ion concentration in the ECF.
    Respiratory alkalosis
  159. what does NPN stand for?
    Non protein nitrogen.
  160. what is the realtionship between CO2 and pH?
    • increased CO2 = decreased pH
    • decreased Co2 = increased pH
  161. what is the relationship between bicarbonate and pH?
    • increased HCO3 = increased pH
    • decreased HCO3 = decreased pH
  162. the volume of plasma from which the kidneys can remove all of a given substance in a certain period of time, usually one minute.
    renal clearance
  163. this is the primary non protein nitrogenous compound which builds up in the blood.
    urea
  164. what is the sole site of urea formation?
    the liver
  165. concentrations of this fairly stable compound vary with age and gender due to muscle mass.
    creatinine
  166. This is the final breakdown product of purine metabolism.
    uric acid
  167. this arises from the deamination of amino acids.
    ammonia
  168. the indirect kinetic method utilizing urease reaction coupled with L-glutamate dehydrogenase and measures the rate of disappearance of NADH at 340nm is the methodolgy for the test for:
    urea
  169. What is the reaction where creatinine reacts with picric acid in alkaline pH to form a red-orange chromogen?
    jaffe reaction
  170. what is the methodology for the uric acid test?
    Caraway method
  171. in this method uric acid is oxidized to allantoin, which functions as a reducing agent in many colorimetric reactions.
    caraway
  172. the test for ammonia provides an indication of of what disease?
    severe liver disease
  173. what is the methodology for ammonia that uses glutamate dehydrogenase?
    coupled enzymatic analysis
  174. why does ammonia have to be placed on ice and analyzed as soon as possible?
    ammonia levels rise significantly after collection due to deamination of proteins within the tube.
  175. the purpose of this test is the determine the amount of creatinine cleared from the blood by the kidneys.
    creatinine clearance test
  176. this is produced at a constant rate by an individual therefore providing a basis for determining renal performance
    creatinine
  177. what is the formula for calculating creatinine clearance
    UV/P

    • U= urine concentration in mg/dl
    • V= volume of urine in ml/min
    • P= plasma concentration in mg/dL
  178. how many minutes are in 24 hours.
    1440

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