Fluid, Electrolytes, Acid-Base Disorders

The renal system maintain homeostasis in the body avoiding significant modifications in the balance of fluid electrolyte or acid–base parity until the Glomerular filtration rates reduced to below 25 ml/min because of  a series of versatile changes, both Renal and extra renal. With dynamic decrease in renal capacity these components are overpowered bringing about unsettling influences in water digestion system adding to hypernatremia and hypernatremia. The modified control of sodium transport causes irritated volume status including volume over-burden and exhaustion. The rate of Hyperkalemia and metabolic acidosis is more incessant in Chronic Kidney Disease (CKD) with GFR beneath 10 ml/min. In this survey article we will endeavor to audit the renal and additional renal adjustment components looking after liquid, electrolyte and corrosive base equalization in endless kidney illness alongside variables which cause disappointment of these instruments. The article will likewise highlight the normal liquid electrolyte and corrosive base issue in interminable kidney ailment and their treatment.

Fluids and Electrolytes

  1. List the normal range of Na+, K+, HCO3-, Cl- in serum and indicate how these ranges change in perspiration, gastric juice, bile and ileostomy contents.
  2. List at least four endogenous factors that affect renal control of sodium and water excretion.
  3. List least six symptoms or physical findings of dehydration.
  4. List and describe the objective ways of measuring fluid balance.
  5. List the electrolyte composition of the following solutions:
    1. normal (0.9%) saline
    2. 1/2 normal saline
    3. 1/3 normal saline
    4. 5% dextrose in water
    5. Ringer’s lactate
  6. In the following situations, indicate whether serum Na, K, HCO3, Cl and blood pH will remain stable, rise considerably, rise moderately, fall moderately, or fall considerably:
    1. excessive gastric losses
    2. high volume pancreatic fistula
    3. small intestine fistula
    4. biliary fistula
    5. diarrhea
  7. In the following situations, indicate whether serum and urine Na, K, HCO3, Cl and osmolality will remain stable, rise considerably, rise moderately, fall moderately, or fall considerably:
    1. acute tubular necrosis
    2. dehydration
    3. inappropriate ADH secretion (SIADH)
    4. diabetes insipidus
    5. congestive heart failure
  8. Describe the possible causes, appropriate laboratory studies needed, and treatment of the following conditions:
    1. hypernatremia
    2. hyponatremia
    3. hyperkalemia
    4. hypokalemia
    5. hyperchloremia
    6. hypochloremia
  9. Describe the concept of a "third space" and list those conditions that can cause fluid sequestration of this type.

Acid Base Balance

  1. List the physiological limits of normal blood gases.
  2. List the factors that effect oxygen delivery and consumption.
  3. Indicate the mechanisms, methods of compensation, differential diagnosis, and treatment of the following acid base disorders:
    1. acute metabolic acidosis
    2. acute respiratory acidosis
    3. acute metabolic alkalosis
    4. acute respiratory alkalosis
  • Disorders of Plasma Osmolality
  • Metabolic Alkalosis
  • Respiratory Acidosis
  • Metabolic Acidosis
  • Physiology of Acid-Base System
  • Disturbances of Plasma Calcium Concentration
  • Disturbances of Plasma Potassium Concentration
  • Disturbances of Plasma Sodium Concentration
  • Hydration in Kidney Disease Prevention
  • Electrolyte Disorders in Diabetes Mellitus
  • Cardiovascular Calcification

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