Sodium and Potassium Imbalances

  1. Is potassium higher inside or outside the cell?
  2. Is sodium higher inside or outside the cell?
  3. What factors can move potassium into the cell?
    • Insulin
    • Aldosterone
    • Beta adrenergic stimulation
    • alkalosis
  4. What factors move potassium out of the cell?
    • Insulin deficiency
    • Aldosterone deficiency (Addison’s disease)
    • Cell lysis
    • Acidosis
  5. True/false: most K+ Is excreted out through poop, not urine
    False; most K+ is excreted in urine, only some in poop
  6. What effect do insulin and aldosterone have on potassium movement?
    stimulates potassium uptake into cells
  7. Metabolic alkalosis leads to increased_______ potassium, stimulating _____.
    • Intracellular
    • Na/K ATPase
  8. Insulin deficiency can lead to ______kalemia after meals
  9. Metabolic acidosis leads to increased _____ potassium, probably by H+ inhibiting ____
    • Extracellular
    • Na/K ATPase
  10. Hypo-osmolarity drag water (and potassium) ____ cells, and hyperosmolarity drag water (and potassium) ____cells
    • out of
    • into
  11. Potassium out of cell is to metabolic _______; Potassium into cell is to metabolic ______.
    • Acidosis
    • Alkalosis
  12. True/false: decreased GFR can lead to hypokalemia
    False; leads to hyperkalemia
  13. Potassium secretion occurs through ______ cells, while potassium reabsorption occurs through _____ cells
    • Principal (Na+/K+)
    • Alpha-intercalated (K+/H+)
  14. True/false: excess aldosterone secretion (Conns Syndrome) usually leads to hypokalemia because aldosterone moves K+ into cells
  15. True/false: aldosterone act on the collecting duct for Na+ reabsorption and also stimulates K+ secretion
  16. How does increased Na+ intake not affect K+ excretion overall?
    Even though increased Na+ intake means less aldosterone is released, and you would think there would be less K+ secretion and result in increased K+ in plasma, HOWEVER, since there is no need for much Na+ reabsorption in the proximal tubule, creating more distal tubule flow and would thereby stimulate K+ secretion still, resulting in unchanged overall K+ excretion.
  17. True/false: acute acidosis would initially decrease K+ secretion, but as it progresses to prolonged acidosis, K+ secretion would increase
  18. Sodium imbalances usually affect _____. Potassium imbalance usually affects ____.
    • Brain
    • Heart
  19. What are changes in EKG in hypokalemia? Hyperkalemia?
    • Hypokalemia- FLATTENED T wave and prominent U wave
    • Hyperkalemia- Tented/peaked T wave, prolonged QRS
  20. Drugs that causes increase in Na/K ATPase activity would have what effect on potassium?
    Drive K+ into cell, leading to hypokalemia
  21. How does alkalemia affect potassium movement?
    Drives K+ into cells, resulting in hypokalemia
  22. GI loss of potassium would be _____ than 20 mmol/day. Urine loss of potassium would be_____ than 20 mmol/day
    • Less than
    • Greater
  23. GI loss of K+ includes:
    • Lower GI which consists of diarrhea and laxative use (metabolic acidosis)
    • Upper GI which consists of vomiting (metabolic alkalosis)
  24. Normal urinary volume hypokalemia, when EABV is contracted, what are the signs and symptoms?
    • Tiredness
    • Postural hypotension
    • Difficult palpating peripheral pulses
    • Cold extremities
    • Decreased skin turgor
  25. Normal urinary volume hypokalemia, what are the signs and symptoms when EABV is expanded ?
    • Increased BP
    • Bounding pulses
    • Warm exyremities
    • Normal skin turgor
  26. True/false: diuretics get rid of Potassium
  27. What could be causes of contracted EABV leading to hypokalemia?
    • Diuretics use
    • Bartter and Gitelman syndrome
    • Type 1 and 2 RTA
    • Low magnesium
    • Hyponatremia
  28. What could be causes of expanded EABV leading to hypokalemia?
    • Mineralcorticoid excess
    • Hypertension
    • Hypernatremia
  29. Low magnesium, think which other electrolyte abnormality?
  30. Mineralocorticoid excess, think which electrolyte abnormalities?
    • Hypokalemia
    • Hypernatremia
  31. What are drugs that can cause hyperkalemia?
    • ACE-I, ARB
    • Spironolactone (K+ sparing diuretics)
    • Amiloride (K+ Sparing diuretic)
    • NSAIDs
  32. What are EKG changes seen in hyperkalemia?
    • Tall tented T waves
    • Lost P waves
    • Widening QRS
  33. True/False: alkalosis is often with hyperkalemia
    False; acidosis often with hyperkalemia
  34. What is solvent drag?
    Is when water movement dragging potassium with it
  35. What would the TTKG be if cause of hyperkalemia is renal underexcretion?
    Less than 7 (means under secretion, a principal cell problem)
  36. What is the expected TTKG for a hyperkalemic patient?
    greater than 7 (in cases of reduced distal flow, as a result of reduced EABV secondary to heart failure)
  37. Adrenal insufficiency can lead to which abnormal electrolyte changes?
    • hyperkalemia
    • Hyponatremia
  38. Hyponatremia has too ____ water
  39. Hypovolemic hyponatremia is secondary to ________ losses
    GI or renal
  40. Euvolemic hyponatremia is secondary to _________
    • SIADH
    • Primary
    • Decreased dietary solute intake
  41. Hypervolemic hyponatremia is secondary to _______
    Heart failure or cirrhosis of the liver
  42. True/false: hyponatremia is a disorder of Na+ imbalance
    False; it is a disorder of WATER imbalance
  43. Increase ADH release in hyponatremic state is a(n) _____ response
  44. What is an example of artifactual hyponatremia?
    Hyperglycemia, drawing water in as a result, and diluting serum sodium level
  45. Hyponatremia CNS symptoms are due to _____
    Cerebral edema
  46. True/false: CNS symptoms are not as severe in chronic hyponatremia
  47. ADH release is more sensitive to ______ changes than _______ changes
    • Osmolality
    • Blood volume
  48. True/false: ADH is normally osmoregulatory but in conditions of stress is more volume regulatory
  49. What could result from rapid correction of hyponatremia?
    Osmotic demyelination syndrome
  50. True/false: majority of hypernatremia is loss of free water
  51. In Hypernatremia, what happens to the cells?
    Fluids shift out of the cell into plasma causing them to shrivel. Leading to cerebral contraction
  52. Rapid water repletion to treat hypernatremia might result in which condition?
    Cerebral edema
  53. What are signs of hypernatremia?
    • Orthostatic hypotention
    • Tachycardia
    • Dry mucous membranes, dry tongue, falt jugular vein
    • Decreased skin turgor
    • Decerased consciousness, coma
  54. What is HHS?
    Hyperosmolar hyperglycemic state- an osmotic diuresis, under renal loss for hypernatremia
  55. What is osmotic diuresis?
    When there is high oncotic pressure in the urine (ie glucose in renal tubule), drawing water into the tubule and result in polyuria. A renal loss subcategory of hypernatremia
Card Set
Sodium and Potassium Imbalances
Renal Final- Physiology and Clinical