5 Written Questions
5 Matching Questions
- What is the clinical marker for heart failure especially in CHF pts?
- What is the blood pressre and ECF fluid volume a refleciton of the level of what important cation?
- Does sodium retention help CHF?
- What is the excellent clinical marker for reduced effective circulating volume, in the absence of diuretics?
- Simplification of angII actions?
- a (1) reduced urinary sodium (Una<20)
- b (1) sodium
**Bp is the body's highest priority
- c (!) BNP
- d (1) raises BP
(2) sodium reab!!!
- e (1) at first it does
(2) contractility of the heart is improved at hgiher LVEDP (Frank-starling)
(3) but as the heart cont. to fail, the kidneys can never retain enough sodium to restore CO to normal
(4) baroreceptors are never satisifed
(5) therefore, renal sodiumr etention is never shut off (decompensated heart failure; filled up with fluid)
5 Multiple Choice Questions
- (1) sodium retention
- (1) unique in that most of the rteained sodium ends up as ECF in the peritoneal cavity--ascities
(2) "third-spaced" fluid
- (1) urinary sodium
- (1) helps to distinguish from ren vs non-renal losses
(2) if non-renal losses, renal sodium conservation should be maximal
(3) U Na <10 (or <20) mEq/l
5 True/False Questions
What is the "rate-limiting step" in AngII production? → (1) index of renal perfusion
(2) LOW with hypovolemia (assumign normal renal fxn)
(3) LOW with HYPERvolemia ...when eff circ vol is decreased
What are some disorders of hypervolemia? → (1) "sodium excess" state
(2) in normals, sodium rarely overwhelms excretory capacity--pedal edema with extremely high Na+ intake
(3) hypervolemia reflects renal retention of dietary sodium and water in disease state
How is an increase in renal water reab (least effective)? → (1) inc. GFR
(2) reducing tubular Na+ reab (? in IMCD?
What is a mineralocorticoid deficiency? → (1) lack of aldosterone
What is the effective circulating volume? → (1) concept that cannot be measured
(2) portion of the circulation that is ont the arterial side and is effectively perfusing tissue
(3) only 20% of the blood volume is intra-arterial (i.e. veins compliant ane more of the circulation pools there)
(4) normals, parallels the ECF volume--determined by body sodium stores bc sodium is confined to ECF (by Na/K atpase)