True/false: most K+ Is excreted out through poop, not urine
False; most K+ is excreted in urine, only some in poop
What effect do insulin and aldosterone have on potassium movement?
stimulates potassium uptake into cells
Metabolic alkalosis leads to increased_______ potassium, stimulating _____.
Intracellular
Na/K ATPase
Insulin deficiency can lead to ______kalemia after meals
Hyper
Metabolic acidosis leads to increased _____ potassium, probably by H+ inhibiting ____
Extracellular
Na/K ATPase
Hypo-osmolarity drag water (and potassium) ____ cells, and hyperosmolarity drag water (and potassium) ____cells
out of
into
Potassium out of cell is to metabolic _______; Potassium into cell is to metabolic ______.
Acidosis
Alkalosis
True/false: decreased GFR can lead to hypokalemia
False; leads to hyperkalemia
Potassium secretion occurs through ______ cells, while potassium reabsorption occurs through _____ cells
Principal (Na+/K+)
Alpha-intercalated (K+/H+)
True/false: excess aldosterone secretion (Conns Syndrome) usually leads to hypokalemia because aldosterone moves K+ into cells
True
True/false: aldosterone act on the collecting duct for Na+ reabsorption and also stimulates K+ secretion
True
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.
True/false: acute acidosis would initially decrease K+ secretion, but as it progresses to prolonged acidosis, K+ secretion would increase
True
Sodium imbalances usually affect _____. Potassium imbalance usually affects ____.
Brain
Heart
What are changes in EKG in hypokalemia? Hyperkalemia?
Hypokalemia- FLATTENED T wave and prominent U wave
Hyperkalemia- Tented/peaked T wave, prolonged QRS
Drugs that causes increase in Na/K ATPase activity would have what effect on potassium?
Drive K+ into cell, leading to hypokalemia
How does alkalemia affect potassium movement?
Drives K+ into cells, resulting in hypokalemia
GI loss of potassium would be _____ than 20 mmol/day. Urine loss of potassium would be_____ than 20 mmol/day
Less than
Greater
GI loss of K+ includes:
Lower GI which consists of diarrhea and laxative use (metabolic acidosis)
Upper GI which consists of vomiting (metabolic alkalosis)
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
Normal urinary volume hypokalemia, what are the signs and symptoms when EABV is expanded ?
Increased BP
Bounding pulses
Warm exyremities
Normal skin turgor
True/false: diuretics get rid of Potassium
True
What could be causes of contracted EABV leading to hypokalemia?
Diuretics use
Bartter and Gitelman syndrome
Type 1 and 2 RTA
Low magnesium
Hyponatremia
What could be causes of expanded EABV leading to hypokalemia?
Mineralcorticoid excess
Hypertension
Hypernatremia
Low magnesium, think which other electrolyte abnormality?
hypokalemia
Mineralocorticoid excess, think which electrolyte abnormalities?
Hypokalemia
Hypernatremia
What are drugs that can cause hyperkalemia?
ACE-I, ARB
Spironolactone (K+ sparing diuretics)
Amiloride (K+ Sparing diuretic)
NSAIDs
What are EKG changes seen in hyperkalemia?
Tall tented T waves
Lost P waves
Widening QRS
True/False: alkalosis is often with hyperkalemia
False; acidosis often with hyperkalemia
What is solvent drag?
Is when water movement dragging potassium with it
What would the TTKG be if cause of hyperkalemia is renal underexcretion?
Less than 7 (means under secretion, a principal cell problem)
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)
Adrenal insufficiency can lead to which abnormal electrolyte changes?
hyperkalemia
Hyponatremia
Hyponatremia has too ____ water
Much
Hypovolemic hyponatremia is secondary to ________ losses
GI or renal
Euvolemic hyponatremia is secondary to _________
SIADH
Primary
Decreased dietary solute intake
Hypervolemic hyponatremia is secondary to _______
Heart failure or cirrhosis of the liver
True/false: hyponatremia is a disorder of Na+ imbalance
False; it is a disorder of WATER imbalance
Increase ADH release in hyponatremic state is a(n) _____ response
Inappropriate
What is an example of artifactual hyponatremia?
Hyperglycemia, drawing water in as a result, and diluting serum sodium level
Hyponatremia CNS symptoms are due to _____
Cerebral edema
True/false: CNS symptoms are not as severe in chronic hyponatremia
True
ADH release is more sensitive to ______ changes than _______ changes
Osmolality
Blood volume
True/false: ADH is normally osmoregulatory but in conditions of stress is more volume regulatory
True
What could result from rapid correction of hyponatremia?
Osmotic demyelination syndrome
True/false: majority of hypernatremia is loss of free water
True
In Hypernatremia, what happens to the cells?
Fluids shift out of the cell into plasma causing them to shrivel. Leading to cerebral contraction
Rapid water repletion to treat hypernatremia might result in which condition?
Hyperosmolar hyperglycemic state- an osmotic diuresis, under renal loss for hypernatremia
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
