Notes in 01 Fluid and Electrolyte Disorders

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Published	11/14/2023	The most important physiologic stimulus for increasing antidiuretic hormone (ADH) secretion is {{c1::increased plasma osmolarity}}
Published	11/14/2023	What receptors sense an increase in plasma osmolarity, providing stimuli to increase ADH secretion?{{c1::Osmoreceptors in the anterior hypothalamus::W…
Published	11/14/2023	What is the effect on ADH secretion if a patient has low volume AND low osmolarity? {{c1::Volume trumps osmolarity and ADH is secreted}}
Published	11/14/2023	What is the effect on ADH secretion if a patient has high volume AND high osmolarity?{{c1::Volume trumps osmolarity and ADH is not secreted (or less i…
Published	11/14/2023	Which ADH disorder is characterized by high levels of circulating ADH and thus inappropriately concentrated urine?{{c1::Syndrome of inappropriate…
Published	11/14/2023	Syndrome of inappropriate ADH (SIADH) may be treated with {{c1::water::first line treatment}} restriction, with {{c3::conivaptan/tolvaptan}}, or …
Published	11/14/2023	What endocrine pathology is treated with demeclocycline?{{c1::SIADH}}
Published	11/14/2023	What percent of total Ca2+ in the blood is ultrafilterable?{{c1::60%}}
Published	11/14/2023	What percent of total Ca2+ in the blood exists in an ionized form (i.e. as Ca2+)?{{c1::45-50%}}
Published	11/14/2023	Hyperreflexia, spontaneous twitching, muscle cramping, tingling, and numbness are signs of which calcium imbalance? {{c1::Hypocalcemia}}
Published	11/14/2023	The {{c3::Chvostek}} sign is {{c2::twitching of the facial muscles}} elicited by tapping on the facial nerve; it is an indicator of {{c1::hypocalcemia…
Published	11/14/2023	The {{c3::Trousseau}} sign is {{c1::carpopedal spasm}} upon inflation of a blood pressure cuff; it is an indicator of {{c2::hypocalcemia}}
Published	11/14/2023	Why does hypocalcemia cause symptoms such as tingling/numbness and twitching/cramping?{{c1::Decreased extracellular Ca2+ decreases the threshold poten…
Published	11/14/2023	Constipation, polyuria, polydipsia, lethargy, and hyporeflexia are signs of which calcium imbalance? {{c1::Hypercalcemia}}
Published	11/14/2023	Parathyroid hormone (PTH) secretion is regulated by plasma {{c1::Ca2+}} concentration
Published	11/14/2023	Secretion of PTH is controlled by extracellular (serum) Ca2+ binding to {{c1::Ca2+-sensing}} receptors in the parathyroid cell membrane
Published	11/14/2023	{{c2::Severe decreases}} in serum Mg2+ concentration cause {{c1::decreased}} PTH secretion
Published	11/14/2023	The actions of PTH are coordinated to produce an increase in serum {{c1::Ca2+}} and a decrease in serum {{c1::phosphate (PO43-)}}
Published	11/14/2023	In bone, the long-term effect of PTH is bone {{c1::resorption}} via indirect action on {{c1::osteoclasts}}
Published	11/14/2023	The overall effect of PTH on bone is to promote bone {{c1::resorption}}, which delivers both {{c2::Ca2+}} and {{c2::phosphate}} to extracellular fluid
Published	11/14/2023	PTH acts on the kidney to inhibit renal {{c1::phosphate}} reabsorption in the {{c2::proximal convoluted tubule}}, which therefore increases phosphate …
Published	11/14/2023	PTH acts on the kidney to increase renal {{c1::calcium}} reabsorption in the {{c2::distal convoluted tubule}}
Published	11/14/2023	PTH stimulates the renal enzyme {{c1::1α-hydroxylase}}, which converts 25-hydroxycholecalciferol to the active form, 1,25-dihydroxycholecalciferol (vi…
Published	11/14/2023	How does PTH increase intestinal Ca2+ absorption?{{c1::Indirectly, by stimulating production of 1,25-(OH)2D3 in the kidney}}
Published	11/14/2023	PTH Actions Summary Picture: no answer {{c1:::)}}
Published	11/14/2023	{{c1::Primary hyperparathyroidism}} is characterized by hypercalcemia, hypophosphatemia, and increased circulating levels of PTH
Published	11/14/2023	Hypoparathyroidism is characterized by decreased serum {{c1::calcium (hypocalcemia)}} and increased serum {{c1::phosphate (hyperphosphatemia)}}
Published	11/14/2023	Cholecalciferol is converted to {{c1::25-hydroxycholecalciferol (25-OH-cholecalciferol)}} in the {{c2::liver}}; this compound is chemically {{c3::inac…
Published	11/14/2023	In the {{c4::kidney}}, 25-hydroxycholecalciferol may be hydroxylated by the enzyme {{c1::1α-hydroxylase}} to produce {{c2::1,25-dihydroxycholecalcifer…
Published	11/14/2023	In the kidney, 25-hydroxycholecalciferol may be hydroxylated to produce {{c1::24,25-dihydroxycholecalciferol}}; this compound is chemically {{c2::inac…
Published	11/14/2023	The activity of the renal enzyme 1α-hydroxylase is increased with {{c1::decreased}} serum phosphate concentration
Published	11/14/2023	Similar to its action on the intestines, 1,25-dihydroxycholecalciferol increases the {{c1::renal}} reabsorption of Ca2+ and phosphate
Published	11/14/2023	Etiologies of {{c1::central}} diabetes insipidus include pituitary tumor, autoimmune, trauma, surgery, and ischemic encephalopathy
Published	11/14/2023	Both central and nephrogenic diabetes insipidus are characterized by blood hyperosmotic volume {{c1::contraction}}
Published	11/14/2023	Treatment for central diabetes insipidus includes hydration and {{c1::desmopressin}}, which is an ADH analog
Published	11/14/2023	Diagnosis of diabetes insipidus is aided by the {{c1::water deprivation}} test
Published	11/14/2023	In diabetes insipidus, the water deprivation test fails to {{c1::increase}} urine osmolality
Published	11/14/2023	SIADH may be caused by drugs, such as (Can't Concentrate Serum Sodium)- C{{c1::arbamazepine}}- C{{c2::yclophosphamide}}- S{{c3::SRI}}
Published	11/14/2023	The very low serum Na+ concentration in SIADH can lead to {{c2::cerebral}} {{c1::edema}} and seizures
Published	11/14/2023	In SIADH, serum Na+ levels must be corrected slowly to prevent {{c1::osmotic demyelination}} syndrome
Published	11/14/2023	{{c1::Nephrocalcinosis}} is the deposition of calcium in the tubules of the kidney due to primary hyperparathyroidism
Published	11/14/2023	{{c1::Calcitonin}} is a peptide hormone that directly inhibits osteoclasts, causing decreased bone resorption
Published	11/14/2023	Calcitonin promotes Ca2+ {{c1::excretion}} by the kidney
Published	11/14/2023	One class of drugs that may treat nephrogenic diabetes insipidus is {{c1::thiazide diuretics}}, which enhances the uptake of NaCl and H2O in the {{c2:…
Published	11/14/2023	{{c1::Amiloride}} is a K+ sparing diuretic that may be used to treat {{c1::Lithium}} induced {{c2::nephrogenic}} diabetes insipidus
Published	11/14/2023	Which antacid is associated with hypercalcemia (milk-alkali syndrome) and rebound acid increase?{{c1::Calcium carbonate}}
Published	11/14/2023	Atrial baroreceptors respond to {{c2::decreased}} blood volume by increasing release of {{c1::vasopressin (ADH)}} from the posterior pituitary
Published	11/14/2023	Vasopressin (ADH) causes water reabsorption by the renal distal tubule and collecting ducts by activating {{c2::V2}} receptors
Published	11/14/2023	Plasma osmolarity may be estimated by Posm = {{c1::(2 * Na+) + (Glucose/18) + (BUN/2.8)}}
Published	11/14/2023	How does osmolarity change with SIADH? {{c1::Decreased (hyposmolarity)}}
Published	11/14/2023	SIADH is a cause of {{c1::hypo}}-osmotic volume expansion
Published	11/14/2023	How does plasma protein concentration change with hyposmotic volume expansion (e.g. SIADH)? {{c1::Decreased}}
Published	11/14/2023	85% of the filtered phosphate is reabsorbed in the {{c1::proximal tubule}}
Published	11/14/2023	What percent of plasma Ca2+ is filtered across glomerular capillaries?{{c1::60% (40% bound to plasma proteins)}}
Published	11/14/2023	The bulk of Ca2+ reabsorption occurs in the {{c1::proximal convoluted tubule}} (67%)
Published	11/14/2023	The {{c1::thick ascending limb (loop of Henle)}} is responsible for approximately 25% of Ca2+ reabsorption
Published	11/14/2023	Ca2+ is reabsorbed in the thick ascending limb (on Henle) via a(n) {{c1::paracellular}} route
Published	11/14/2023	What drives Ca2+ reabsorption in the thick ascending limb (of Henle)?{{c1::Lumen-positive potential difference}}
Published	11/14/2023	What effect do loop diuretics have on serum Ca2+ levels? {{c1::Decreased}}
Published	11/14/2023	The {{c1::distal tubule}} is responsible for approximately 8% of Ca2+ reabsorption
Published	11/14/2023	What is the site of regulation for Ca2+ reabsorption? {{c1::Distal tubule}}
Published	11/14/2023	{{c1::Parathyroid}} hormone stimulates {{c2::Ca2+-Na+}} exchange in the basolateral membrane of distal tubule cells
Published	11/14/2023	PTH action causes {{c1::hypo}}-calciuria
Published	11/14/2023	What effect do loop diuretics have on serum Mg2+ levels? {{c1::Decreased (hypomagnesemia)}}
Published	11/14/2023	{{c1::Hyper}}-osmotic urine is produced when the circulating levels of ADH are {{c2::high}}
Published	11/14/2023	{{c1::Osmolar gap}} is the difference between measured plasma osmolarity and estimated plasma osmolarity
Published	11/14/2023	Hypocalcemia in chronic renal disease is caused, in part, by decreased {{c1::1-α-hydroxylation}} of vitamin D
Published	11/14/2023	{{c2::Mannitol}} is a(n) {{c1::osmotic}} diuretic that acts at the {{c3::proximal tubule}} and {{c3::descending limb (of Henle)::location}}
Published	11/14/2023	What effect does mannitol have on urine flow?{{c1::Increased urine flow (diuretic)}}
Published	11/14/2023	Which osmotic diuretic may cause dehydration as a possible adverse effect?{{c1::Mannitol}}
Published	11/14/2023	{{c1::ADH::aldosterone or ADH}} primarily regulates osmolarity; may also respond to low volume states
Published	11/14/2023	Which electrolyte disturbance causes nausea, malaise, stupor, coma, and seizures? {{c1::Low Na+ (hyponatremia)}}
Published	11/14/2023	Which electrolyte disturbance causes irritability, stupor, coma? {{c1::High Na+ (hypernatremia)}}
Published	11/14/2023	Which electrolyte disturbance causes tetany, seizures, QT prolongation, twitching, and spasm? {{c1::Low Ca2+ (hypocalcemia)}}
Published	11/14/2023	Which electrolyte disturbance causes stones, bones, groans, and psychiatric overtones?{{c1::High Ca2+ (hypercalcemia)}}
Published	11/14/2023	Which electrolyte disturbance causes tetany, torsades de pointes, and hypokalemia? {{c1::Low Mg2+ (hypomagnesemia)}}
Published	11/14/2023	Which electrolyte disturbance causes decreased DTRs, cardiac arrest, bradycardia, hypotension, and hypocalcemia? {{c1::High Mg2+ (hypermagnesemia)}}
Published	11/14/2023	There is an increased risk for {{c2::hypophosphatemic}} rickets with {{c1::proximal}} renal tubular acidosis due to Fanconi Syndrome
Published	11/14/2023	{{c2::Thiazide}} diuretics may be useful in the treatment of {{c1::nephrogenic}} diabetes insipidus
Published	11/14/2023	{{c2::Thiazide}} diuretics may cause {{c1::hypo}}-natremia as an adverse effect
Published	11/14/2023	What is the storage form of vitamin D?{{c1::25-OH D3}}
Published	11/14/2023	What is the active form of vitamin D?{{c1::1,25-(OH)2 D3}}
Published	11/14/2023	Vitamin D {{c3::increases}} intestinal absorption of {{c1::calcium}} and {{c2::phosphate}}
Published	11/14/2023	Vitamin {{c2::D}} deficiency is associated with hypocalcemic {{c1::tetany}}
Published	11/14/2023	Vitamin {{c3::D}} excess presents with {{c1::hyper}}-calcemia and {{c2::hyper}}-calciuria
Published	11/14/2023	{{c2::Osmotic Demyelination Syndrome}} is also referred to as {{c1::Central pontine myelinolysis}}
Published	11/14/2023	Osmotic demyelination syndrome is characterized by massive axonal demyelination of the {{c1::pons::brain stem area}}
Published	11/14/2023	Rapid correction of {{c1::hypo}}-natremia results in {{c2::Osmotic Demyelination Syndrome}}
Published	11/14/2023	Osmotic Demyelination Syndrome typically occurs in severely {{c1::malnourished}} patients
Published	11/14/2023	Osmotic Demyelination Syndrome classically presents as "{{c1::locked in}}" syndrome
Published	11/14/2023	What endocrine pathology is rarely caused by SSRIs?{{c1::SIADH}}
Published	11/14/2023	The massive insulin surge in refeeding syndrome results in {{c1::hypo}}phosphatemia, {{c1::hypo}}kalemia, and {{c1::hypo}}magnesemia
Published	11/14/2023	Calcitriol stimulates increased {{c1::reabsorption}} of Ca2+ and {{c2::reabsorption}} of phosphate by the kidney
Published	11/14/2023	Calcitriol increases {{c2::absorption}} of Ca2+ and {{c1::absorption}} of phosphate in the intestine
Published	11/14/2023	Calcitriol {{c1::increases}} Ca2+ and phosphate release into the bloodstream by {{c2::stimulating}} osteoblasts to {{c2::activate}} osteoclasts
Published	11/14/2023	Calcitriol {{c1::inhibits}} PTH production by the parathyroid gland
Published	11/14/2023	Calcitriol is useful in the long term management of {{c1::hypocalcemia}} due to chronic disorders
Published	11/14/2023	Hypocalcemia can lead to {{c1::tetany}} and in severe cases lead to {{c2::seizures}}
Published	11/14/2023	{{c2::Cinacalcet}} is an allosteric activator of the {{c1::Ca2+ sensing (CaSR)}} receptor on the Parathyroid Gland
Published	11/14/2023	Tumor Lysis Syndrome results from the fulminant release of tumor cell contents into the plasma, resulting in the following problems- {{c1::Hyper}}kale…
Published	11/14/2023	In treating SIADH, {{c1::hyper}}tonic saline is given when treating a patient with severe symptoms, and {{c1::iso}}tonic saline is given for mild symp…
Published	11/14/2023	What drug class may be used to treat hypercalcemia due to immobilization?{{c1::Bisphosphonates}}
Published	11/14/2023	Electrolyte abnormalities, such as {{c1::hypokalemia}} and {{c1::hypomagnesemia}}, can result from amphotericin B use
Published	11/14/2023	Which antifungal agent can result in hypomagnesemia and hypokalemia?{{c1::Amphotericin B}}
Published	11/14/2023	Rhabdomyolysis typically presents with muscle pains, weakness, vomiting, and {{c1::hypo}}calcemia
Published	11/14/2023	What psychological disorder is characterized by increased intake of free water, leading to hyponatremia and production of a volume of dilute urine?{{c…
Published	11/14/2023	Osteoporosis and reduce risk of vertebral fractures = {{c1::nasal calcitonin::drug}}
Published	11/14/2023	↓ Albumin = {{c1::↓}} serum total calcium
Published	11/14/2023	{{c1::ESRD::condition}} associated with calciphylaxis (calcification) leading to ischemic skin necrosis
Published	11/14/2023	What is the immediate treatment for severe hypercalcemia (> 14mg/dL or symptomatic)?{{c1::NS and calcitonin}}
Published	11/14/2023	If hypercalcemia is found on labs, you need to {{c1::checking ionized calcium / correct for albumin::next step (not treatment)}}
Published	11/14/2023	Osmolal gap > {{c1::10}} indicates presence of unaccounted osmoles (e.g. methanol, ethanol, ethylene glycol)
Published	11/14/2023	Milk alkali syndrome is characterized by a triad of {{c1::hypercalcemia}}, {{c2::metabolic alkalosis}}, and {{c3::AKI}}
Published	11/14/2023	Phosphate is {{c1::reabsorbed}} in the {{c2::proximal tubule}} and {{c1::reabsorbed}} in the {{c2::distal tubule}}
Published	11/14/2023	Phosphate is reabsorbed in the proximal tubule via {{c1::Na-Phos cotransporter}}, whose activity can be {{c2::decreased}} by {{c3::PTH}…
Published	11/14/2023	In the thick ascending limb, calcium reabsorption is regulated by {{c1::CaSR}}, which responds to elevated serum Ca by inhibiting …
Published	11/14/2023	Medical therapy for hyperparathyroidism can include cinacalcet and {{c1::calcitriol}}
Published	11/14/2023	{{c2::FGF23}} is produced in response to elevated {{c1::phosphate}} levels. Its function is to promote excretion of {{c1::phosphate}} in order to…
Published	11/14/2023	2nd most common cause of hypercalcemia is {{c1::malignancy::condition}}
Published	11/14/2023	The most important treatment for {{c2::hyper}}-calcemia is {{c1::normal saline}}
Published	11/14/2023	{{c1::Calcium carbonate::OTC drug}} can be used to complex with phosphorus in the GI tract and prevent {{c2::absorption::absorption or excretion}…
Published	11/14/2023	What is the treatment for mild hypophosphatemia?{{c1::Food (milk, cheese, eggs)}}
Published	11/14/2023	Destroyed muscle cells in Rhabdomyolysis release large amounts of {{c1::potassium::electrolyte}} and {{c1::phosphate::electrolyte}}
Published	11/14/2023	In ESRD, calciphylaxis is associated with increased {{c1::calcium}}-{{c1::phosphate}} product
Published	11/14/2023	Initial treatment of hypermagnesemia is {{c1::IV calcium (to stabilize cardiac membrane)}}, followed by {{c2::loop diuretics}}
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Published	11/14/2023	Na(2) + BUN/2.8 + glucose/18 is used to calculate the {{c1::serum osmolar gap}}.
Published	11/14/2023	Top 3 Causes of Hypervolemic Hyponatremia:{{c1::Heart failure}}{{c2::Cirrhosis}}{{c3::Nephrotic Syndrome}}
Published	11/14/2023	Pseudohyponatremia is caused by {{c1::lab error}} due to either {{c2::hypertriglyceridemia}} or {{c2::elevated serum proteins}}.
Published	11/14/2023	{{c1::Hyperosmolar hyponatremia}} is most commonly caused by increased osmolality in the blood due to {{c2::mannitol}}, {{c2::IV contrast}}, or {{c2::…
Published	11/14/2023	Most of the K+ in our body is located {{c1::intracellularly}} with most of it getting excreted in the {{c1::urine}}
Published	11/14/2023	Pseudo-{{c1::hypo}}kalemia is when K+ is normal but is measured to be abnormal, and this can be caused by {{c2::acute myeloid leukemia}}
Published	11/14/2023	Pseudo-{{c1::hyper}}kalemia is when there is high K+ because of lysis of cells, and can be caused by leukocytosis, thrombocytosis, test tube hemolysis…
Published	11/14/2023	K+ is mostly absorbed in the {{c1::PCT}} but there is some reabsorbed in the ascending limb of LoH
Published	11/14/2023	Aldosterone stimulates {{c1::K+}} secretion to make up for the Na+ reabsorption in the DCT and collecting duct
Published	11/14/2023	ENaC stimulation leads to Na+ reabsorption and consequent {{c1::K+}} secretion (to make up the charge difference in the urine)
Published	11/14/2023	Only {{c1::20}}% of people with hypokalemia show symptoms
Published	11/14/2023	Symptoms of hypokalemia include {{c1::muscle weakness}} and sudden death
Published	11/14/2023	EKG of hypokalemia shows {{c1::Shallow T waves}}, {{c1::ST depression}}, {{c1::prominent U wave}}
Published	11/14/2023	Hypokalemia with low urine K+ (< 20 mEq/L) are caused by {{c1::lower GI issues}} (diarrhea, fistula) or {{c1::upper GI issues}} (loss of HCl, bicar…
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Published	11/14/2023	Aldosterone stimulates {{c1::ENaC}} channels and {{c1::Na+-K+ ATPase}} pumps
Published	11/14/2023	In apparent mineralocorticoid excess (AME), you have increased production of {{c1::aldosterone}}
Published	11/14/2023	In glucocorticoid remediable aldosteronism, 11beta-hydroxylase gene is mutated and makes {{c1::aldosterone}} instead of cortisol
Published	11/14/2023	Loop and thiazide diuretics impair Na+ reabsorption, causing you to have a {{c1::secondary hydraldosteronism state}} as there is more distal Na+ deliv…
Published	11/14/2023	Gitelman's syndrome presents similarly to taking {{c1::thiazide diuretics}}
Published	11/14/2023	Be sure to unsuspend diabetes insipidus cards from week 2!
Published	11/14/2023	Barrter's syndrome presents similarly to taking {{c1::loop diuretics}}
Published	11/14/2023	{{c1::Hypokalemic periodic paralysis}} is intermittent acute attacks of muscle weakness with hypokalemia triggered by large carbohydrate meals and res…
Published	11/14/2023	You treat Liddle syndrome with {{c1::amiloride}}
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Published	11/14/2023	When replacing K+ for treating hypokalemia, you can use {{c1::oral}} or {{c1::IV}} administration
Published	11/14/2023	{{c1::Hypomagnesemia}} can also be seen with hypokalemia because Mg 2+ blocks K+ channels, causing increased renal K+ wasting
Published	11/14/2023	Symptoms of hyperkalemia include {{c1::muscle weakness}} (cardiac and skeletal)
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Published	11/14/2023	Inhibition of RAAS causes {{c1::hyper}}kalemia
Published	11/14/2023	EKG of hyperkalemia shows {{c1::peaked T waves}}, {{c1::long PR interval}}, {{c1::widened QRS complex}}, and {{c1::sine waves::severe}}
Published	11/14/2023	In hyperkalemia management, IV calcium is given since it reduces serum K+ levels{{c1::False::T/F}}
Published	11/14/2023	IV insulin + dextrose works to treat hyperkalemia because the insulin shifts K+ {{c1::into}} the cell and the dextrose prevents {{c1::hypoglycemia}}
Published	11/14/2023	NaHCO3 is used to treat hyperkalemia if there is {{c1::severe acidemia}} present
Published	11/14/2023	Beta2 adrenergic agonists aren't used regularly for {{c1::hyper}}kalemia because they are inconsistent in lowering K+ levels and tachyarrhythmias
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Published	11/14/2023	{{c1::Patiromer::Hyperkalemia treatment}} works in the colon to exchange K+ for Ca 2+, but it interacts with other drugs
Published	11/14/2023	{{c1::Sodium zirconium cyclosilicate (SZC)::Hyperkalemia treatment}} works in the intestine to exchange K+ for Na+/H+, and it does NOT interact with o…
Published	11/14/2023	Answer = {{c1::A}}
Published	11/14/2023	Answer = {{c1::C}}
Published	11/14/2023	CaSRs are located in the {{c1::kidney}}, {{c1::PTH}} gland and {{c1::intestine}}.
Published	11/14/2023	{{c1::Malignancy}} is the most common cause of non-PTH mediated hypercalcemia.
Published	11/14/2023	{{c1::Aggressive volume replacement}} is the most important treatment for hypercalcemia.
Published	11/14/2023	{{c1::CKD}} is the most common cause of hyperphosphatemia.
Published	11/14/2023	The 3 D's of treating hyperphosphatemia:{{c1::DietDietary BindersDialysis}}
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