Index

A Aluminum hydroxide, 255 Acid–base disorder, 301, 306, 307, 309, 311 Ambulatory patients in SIADH Acid-base physiology, 289, 290, 292, 293, asymptomatic chronic , 295, 297–299 treatment of, 115, 116 buffers, 290–292 Angiotensin-converting enzyme-inhibitors collecting duct, 295 (ACE-Is), 63 distal tubule, 294 Angiotensin receptor blockers (ARBs), 63 filtered HCO3, reabsorption of, 293 Anion gap (AG), 301, 304 HCO3 reabsorption, regulation of, 295 Antidiuretic hormone (ADH), 45, 101 kidneys, 292 actions, 94 lungs, 292 mechanism, 94 proximal tubule, 293 release control, 92 Acidosis structure and synthesis, 92 due to chronic kidney disease, 363 Apparent mineralocorticoid excess syndrome Acute Decompensated Heart Failure (ADHF) (AME), 164 edema management, 62, 63 Aquaporin-1 (AQP-1), 28 Acute Aquaporins distribution treatment of, 142 in kidney, 93 Acute , 257 Asymptomatic hyponatremia in hospitalized Acute , 208 patients Acute kidney injury (AKI), 13, 219, 253, 320 treatment of, 114, 115 differential diagnosis, 18 Atomic weight, 1 FENa, 14 Autosomal dominant hypophosphatemic Acute respiratory acidosis, 410, 413 rickets (ADHR), 241 physiology, 407, 409 Autosomal dominant proximal RTA, 351 Acute respiratory alkalosis, 422 Autosomal recessive hypophosphatemic causes of, 422 rickets (ARHR), 241 Acute severe symptomatic , Autosomal recessive proximal RTA, 351 246, 247 Acute symptomatic hyponatremia B treatment of, 113, 114 Balanced electrolyte solutions, 36 Acute tubular necrosis (ATN), 14 Bartter syndrome, 166 Addison’s disease, 179 Beer potomania, 109 Adenosine triphosphate (ATP), 233 Biliary and pancreatic fistulas, 377 Adrenal hyperplasia, 180 Body fluid compartments, 6 Adult respiratory distress syndrome (ARDS), 41 Buffers, 292 Albumin, 36

A. S. Reddi, Fluid, Electrolyte and Acid-Base Disorders, 443 DOI 10.1007/978-1-4614-9083-8, © Springer Science+Business Media New York 2014 444 Index

C Crystalloid IV fluids, 33 Ca2+-Sensing Receptor (CaSR), 194 Cytokines, 221 calcitonin, 196 calcitriol, 195 D PTH, 195 Dehydration, 87, 88 Ca acetate, 255 Diabetic ketoacidosis (DKA), 327 Calcitriol, 221 diagnosis of, 335 (Ca2 +) Diarrhea clinical manifestation, 222 acid-base disorders, 376 Calcium (Ca2+), 193 treatment of, 376, 377 channel (TRPV5), factors, 198 types of, 375 collecting duct, 198 water and electroltyte loss, 374 distal and connecting tubule, 197 Dilutional acidosis, 362 homeostasis, 193, 194, 196 Disorders of extracellular fluid, 85, 87 plasma, 196 Disorders of water balance, 101, 105, proximal tubule, 196 108–110, 112–116 renal handling of, 196, 197, 198 Distal Convoluted Tubule (DCT), 25, 268 thick ascending limb, 197 renal handling of Mg2+, factors, 268 transport, factors, 198 Distal nephron Carbonic anhydrase (CA) deficiency, 352 water reabsorption, 28 Cardiogenic shock, 41 Distal tubule, 25, 26, 295 Cardiorenal syndrome (CRS), 63 collecting duct, 26, 27 Cellular metabolism, 265 Diuresis Central diabetes insipidus solute, 45 (CDI), 136, 143 water, 45 Cerebral edema, 110 Diuretics, 45 Cerebral salt wasting (CSW), 106 classification, 45 Cholestyramine, 379 clinical uses, 48 Chronic hypernatremia complications, 49 treatment of, 143 physiological effects, 45 Chronic hyperphosphatemia, 258 D-Lactic acidosis, 326, 327, 338 Chronic hypocalcemia, 209 Chronic hypophosphatemia, 247 E Chronic kidney disease (CKD5), 179 Ecstacy, 108 Chronic kidney injury (CKD), 253 Edema, 79, 81 Chronic respiratory acidosis, 413, 415 plasma volume leaks, 79 Chronic respiratory alkalosis, 424 Edema formation, 53, 56, 57, 80 causes of, 422 Edema management, 61 Chronic symptomatic hyponatremia ADHF patient, 62, 63 treatment of, 114 ambulatory patient, 61, 62 Clinical manifestations Edema treatment, 71 of , 285 ascites formation, 71, 72 of metabolic acidosis, 319, 320 ascites treatment, 72 Colloid IV fluids, 33 diuretics, 72, 73 Colloids salt restriction, 72 albumin, 36 Effective arterial blood volume (EABV) Complete blood count (CBC), 60, 81 concept of, 55, 56 Congestive heart failure (CHF), 59 Electrolyte composition, 2 African-American patients, 63 Electrolyte-free water clearance (TeH2O), 16 clinical evaluation, 59 calculation, 98 effective medical therapy, 61 Electrolyte therapy, 39 Na+reabsorption, 59 Endogenous acids, 290 Connecting tubule (CNT), 25 Endogenous bases, 290 Cortical collecting duct (CCD), 26 Index 445

Epithelial Na+ channel (ENaC), 79 Hepatorenal syndrome (HRS), 74 Exercise-induced hyponatremia (EIH), 108 diagnosis of exclusion, 74 Extracellular fluid (ECF), 5, 6, 21, 33 other treatment modalities, 75 osmolarity, 7 pathogenesis of, 74 water movement, 7 renal impairment, 74 Extracellular fluid volume treatment, 74, 75 depletion of, 53 vasoconstrictor therapy, 75 maintenance of, 21 Hereditary hypophosphatemic rickets with Extracellular fluid volume disorders, 69, 71 hypercalciuria (HHRH) due to type IIa mutation, 242 F due to type IIc mutation, 242 Familial hypocalciuric hypercalcemia (FHH), Hypercalcemia, 194, 196, 198, 215, 220, 221 218 causes of, 217, 219, 220, 222 Familial tumor calcinosis (FTC), 256 Causes of, 215 Fanconi syndrome, 352 diagnosis, 222, 223 causes, 352 treatment, 223, 224 defined, 352 Hyperchloremic metabolic acidosis, 347, 363 laboratory and clinical manifestations, 352 non-renal cause, 374 FGF-23, 236 Hyperchloremic metabolic acidosis (HCMA), Fluid administration 371, 376 selection and route of, 142 , 177 Fluid management in the elderly, 39 clinical manifestations, 182 Fluid therapy treatment, 183, 184 goals of, 37 Hyperkalemic distal RTA, 358, 359 septic shock, 40 causes, 359 special conditions, 39 diagnosis of, 361 volume contraction, 39, 40 treatment of, 361, 362 Fractional Excretion of Na( (FENa) Hyperkalemic periodic paralysis (HyperPP), diuretics patients, 14 177 Fractional Excretion of Na(FENa), 13 Hyperlipidemia, 79 AKI patients, 14 Hypermagnesemia, 285, 287 Fractional excretion of Urea Nitrogen clinical manifestations of, 285 (FEUrea), 13, 14 treatment of, 286, 287 Hypernatremia, 133 G brain adaptation, 135 Gastrointestinal bleeding diagnosis of, 135 hemorrhagic shock, 40 mechanisms of, 133, 134 Gastrointestinal (GI) tract patients at risk for, 133, 134 intestinal electrolyte transport, 371, 373, patient with, 134, 135 374 signs and symptoms of, 136 water handling, 371 specific causes of, 136, 137, 139 Gestational diabetes insipidus (GDI), 136, 138 treatment of, 140 Gitelman syndrome, 166 Hyperosmolality, 133, 139 Glomerular filtration rate (GFR), 45, 88 Hyperphosphatemia, 256 Granulomatous diseases, 221 causes of, 253, 256, 257 clinical manifestations of, 257 diagnosis of, 257 H treatment, 257 HATPase, 293 Hypervolemic hypernatremia, 143 Hemorrhagic shock Hypoalbuminemia, 79 gastrointestinal bleeding, 40 Hypocalcemia, 196, 201 trauma, 40, 41 causes of, 201, 203, 204 Henderson equation, 301–303, 308, 311 clinical manifestations, 207–209 Henle’s loop, 166, 294 diagnosis, 204, 206 446 Index

Hypokalemia, 161, 166 K causes of, 163, 165 Kidneys, 292 Causes Of, 161 KLOTHO, 237 clinical manifestations of, 168 treatment of, 168, 169 L Hypokalemic distal, 354 Lanthanum carbonate, 255 backleak of H + , 355 Large volume paracentesis (LVP), 73 causes, 356 Laxative abuse, 378 characteristics, 354 Liddle syndrome, 164 defective H + secretion, 354 Lipiduria, 79 , 355 Liver cirrhosis, 69 nephrocalcinosis and nephrolithiasis, 355, complications, 71 356 stages of, 71 pathophysiology, 354 L-Lactic acidosis, 321, 326 toluene ingestion, 356 Loop of Henle Hypokalemic distal RTA water reabsorption, 28 diagnosis of, 357 Lungs, 292 treatment of, 358 Hypokalemic-hypertensive disorders, 163 M Hypokalemic periodic paralysis (HypoPP), Magnesium (Mg2+), 265 161, 163 homeostasis, 265 Hyponatremia, 13, 14, 101 proximal tubule, 267 causes of, 106, 108, 109 renal handling of, 266, 267 consequences of, 110–112 Magnesium (Mg) carbonate, 256 development of, 101 Maintenance fluid therapy, 38 diagnosis of, 13, 110 Malignancy, 220 pathophysiology of, 105 Malignant hypertension, 163 patient with, 101 Medullary center, 409 signs and symptoms of, 110 Metabolic acidbase disorder, 292 hyponatremia, treatment of, 112, 114, 115 Metabolic acidosis, 306, 307, 309–311, 430, Hypoparathyroidism, 201, 203 432, 433, 436 Hypophosphatemia Metabolic alkalosis, 307, 310, 311, 430, 432, causes of, 239, 242, 243 434, 436, 437 clinical manifestations of, 243 diagnosis, 393 diagnosis, 243, 245 Milk (calcium)-alkali syndrome, 219 in critical care units, 243 Mineralocorticoid receptor (MR), 164 treatment, 245, 247 activating mutations of, 165 Hyporeninemic Hypoaldosteronism (SHH) Mixed acid-base disorders syndrome of, 180 analysis of, 434, 436 Hypovolemic hyponatremia, 143 treatment of, 436, 437 Mixed Acid-Base Disorders I Analysis Of, 430 Inner medullary collecting duct (IMCD), 26 Multiple endocrine neoplasia (MEN) type 1 Intracellular fluid (ICF), 6, 33 and type 2a, 217 osmolarity, 7 water movement, 7 N Intravenous fluids (IVF), 33 NaCl handling in the kidneys, 22–24 Isolated proximal RTA Na+ reabsorption, 21, 22 causes of, 351 Natriuresis, 45 Neonatal severe hyperparathyroidism, 218 J Nephrogenic diabetes insipidus (NDI), 136, Jansen’s disease, 218 137, 138, 144 Index 447

Nephrogenic syndrome of inappropriate Primary hypodipsia, 139 antidiuresis (NSIAD), 106 Production of endogenous acids, 289 Nephrotic syndrome, 79 and bases, 289, 290 clinical evaluation, 80 Propressophysin, 92 edema formation, 79, 80 Proximal RTA, 349 Na+ renal retention, 79 causes, 350 pertinent electolyte abnormalities, 81 characteristics, 349 Net acid excretion (NAE), 347 clinical manifestations, 351 Nonsteroidal anti-inflammatory drugs diagnosis of, 353 (NSAIDs), 59, 80 hypokalemia, 350 Nonvolatile (fixed) acids, 290 pathophysiology, 349 Normal pH treatment of, 353, 354 maintenance of, 290–292, 294, 295, 297, Proximal tubule, 21, 293 298 water reabsorption, 28 Normovolemic (euvolemic) hypernatremia, Pseudohyperkalemia, 177 143 Pseudohyperparathyroidism, 218 Pseudohypoaldosteronism type II (PHA II), O 180 Oral sodium phosphate (OSP), 256 Pseudohypoaldosteronism type I (PHA I), 180 Osmolal gap, 329 Pseudohypoparathyroidism (PsHPT), 203, 204 Osmolarity vs Osmolality, 4 PTH, 236 Osmosis, 4, 5 PTHrP, 220 Osmotic demyelination syndrome (OSD), 111 clinical manifestations, 111 R diagnostic test, 112 Refeeding syndrome (RFS), 242, 243 falls, 112 Refractory ascites, 73 fractures and osteoporosis, 112 Renal artery stenosis, 163 management and prognosis, 112 Renal blood flow (RBF), 45 precipitating factors, 112 Renal disease, 79 Osmotic force, 4, 5 progression prevention, 81 Outer medullary collecting duct (OMCD), 26 Renal failure, 218 Renal salt wasting syndrome\t see Cerebral P salt wasting (CSW), 106 Phosphate, 233 Renal tubular acidoses (RTAs), 347 homeostasis, 235 Renal tubular acidosis (RTA), 165, 362 Homeostasis, 234 Reset osmostat, 107 proximal tubule, 235 Respiratory acidbase disorder, 292 renal handling of, 235, 236 Respiratory acidosis, 307, 310, 409, 433, 434, renal handling, regulation of, 236, 237 436, 437 Phosphate binders, 255 hypercapnia, secondary physiologic Phosphate binders in, 255 response to, 409 Phosphorus, 233 respiratory alkalosis Physiologic saline, 36 secondary physiologic response, 421 Plasma osmolality, 91, 92, 99 Respiratory alkalosis, 309–311, 432–434, 436, polyuria 437 diagnosis of, 139, 140 clinical manifestations, 422, 424 Poor oral intake, 109 diagnosis of, 424, 425 Post-operative hyponatremia, 109 treatment of, 426 Primary aldosteronism, 164 Primary hypercapnia\t See Respiratory S acidosis, 409 Secondary hyperparathyroidism, 218 Primary hyperparathyroidism (PHPT), 215, 217 Secondary physiologic response Primary hypocapnia, 421 (compensation), 301 448 Index

Selective serotonin reuptake inhibitors Urinary dilution, 95, 96 (SSRIs), 108 measurements, 96–98 Sevelamer HCl (Renagel), 255 Urinary-intestinal diversions, 378 Sodium phosphate Urine use, 256 pH, 347 Solute diuresis, 136, 138 Urine anion gap (UAG), 15, 348 Sporadic form, 351 Urine osmolal gap (UOG), 348 Starvation ketoacidosis, 328 Urine osmolality, 101, 110 Syndrome of inappropriate antidiuretic Urine specific gravity, 17 hormone secretion (SIADH), 106 measurement of, 18 Syndrome of inappropriate antidiuretic hormone (SIADH), 14 V Système International (SI), 2 Villous adenoma, 378 Vitamin D deficiency, 204 T Vitamin D intoxication, 221, 222 Tertiary hyperparathyroidism, 219 Volatile acid, 290 Thiazide diuretics, 107 Volume contraction, 39, 40, 85 Thick ascending limb of Henle’s loop ECF diagnosis, 87 (TALH), 267 hypertonic, 87 renal handling of Mg2+, factors, 268 hypotonic, 87 Thick ascending limb of the Henle’s loop isotonic, 87 (TALH), 24 Volume depletion, 88 Thin ascending limb (TAL), 24 Volume expansion Thin descending limb (TDL), 24 conditions of, 55 Thirst control, 91, 92 Volume recognition Titratable acid excretion mechanisms, 53, 54, 55

generation of new HCO3, 296 Titratable acidity, 297 W Total body water, 6, 7 Water balance disorders, 99, 101, 105, Total body water (TBW), 101 108– 110, 112–116, 133–135, 138–140, Transtubular K( gradient (TTKG), 15 143, 144 assumptions, 15 Water deficit Transtubular K(gradient (TTKG), 15 calculation of, 141, 142 Trauma Water loss hemorrhagic shock, 40, 41 dehydration, 85 Triple acid-base disorders, 436 high serum hypertonicity, 85 Tumor-induced osteomalacia (TIO), 242 hypertonic contraction, 87 Type III RTA, 358 hypertonic volume contraction, 87 TYPE I RTA, 354, 356 X U X-linked hypophosphatemia, 239 Urinary acidification, 298, 299 Urinary concentration, 95, 96 measurements, 96–98