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95 Cards in this Set
- Front
- Back
Substances with ____MW have more particles?
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low
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What are the 3 ions in the extracellular compartment?
intracellular? |
EC= Na, Cl, HCO3
IC = K, Mg, HPO4 |
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The ICF composes what percent?
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2/3
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Hypernatremia always = what?
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hyperosmolality
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What is lab evidence of hypernatremia dehydration?
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Increased Hct, TP, BUN/Creatinine, Na, Cl, AG, hypersthenuria
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What are causes of hypernatremia + dehydration?
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1 - adpsia due to lack of water (concentrated urine, thirsty)
2 - adipsia due to abnormal thirst mechanism (concentrated urine, not thirsty) 3 - diabetes insipidus with lack of water (dilute - hyposthenuria with thirst) |
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Is central or nephrogenic diabetes insipidus responsive to ADH?
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central
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What is the value for isothenuria?
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1.008-1.012
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What is an appropriate renal response in dehydration?
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hyperththenuria
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What are causes of hypernatreimia + normal hydration (normovolemia)?
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-salt poisoning
-consumption of sea water -primary hypernatremia (don't want to drink) -increase in Na and CL only |
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What are causes of hypernatremia + normal hydration (hypovolemia - increased ICF)?
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Osmotic agents
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What is the formula for estimating osmolality?
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2 (Na + K) + (Glucose/18) + (BUN/2.8)
-significant if greater than 10-15 of measured value |
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If an osmolar gap is identified, what could be possible active substances?
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-lactate, ketones, ethylene glycol , drugs
-will not be anything that is in the formula |
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What is a cause of normonatremic dehydration?
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feces>intake
(Na and water are lost in equal proportions) |
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What are some important causes of Hyponatremic dehydration?
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Na loss> water loss
-due to disease -renal loss -GI (foals) -lactating dairy cow -horses sweating -uroperotoneum -hypoaldosteronism -hyperglycemia -muscle damage |
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What is a major cause of relative hypokalemia? (shifting from ECF to ICF)
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-alkalosis - vomiting
-insulin Rx |
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What are caused of absolute hypokalemia?
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-decreased intake
-increased loss - renal (diuresis, ketonuria, metabolic alkalosis) -hyperaldosteronism -GI - vomiting, diarrhea, sequestration, saliva loss, sweat |
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What can happen with hyperkalemia?
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cardiac arrest
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What are causes of relative/spurious increases in K? (5)
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-thrombocytosis
-hemolysis -oriental breeds acidemia -massive tissue necrosis |
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What are causes of absolute increase in K?
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-decreased renal excretion (ruptured urinary bladder, acute renal failure, post renal obstructive disease)
-hypoaldosteronism |
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What are other signs of hypoaldosteronism?
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-hyperkalemia
-hyponatremia and hypochloridemia -Na/K ratio<23 -hypercalcemia -inappropriately concentrated urine with azotemia -looks like renal failure |
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When is hypochloridemia seen without hyponatremia?
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vomiting of pure stomach contents - because gastric fluids are rich in HCl
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What values are see with a urinary bladder rupture?
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decreased Na and Cl
increased K, BUN and Creatinine -plasma values look like urine values |
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What does plasma look like?
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increased Na and Cl
decreased K, BUN and Creatinine |
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What are the arterial pH limits?
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7.36 - 7.44
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What 3 ways does the body control pH?
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-buffer system (weak acid and salt of its conjugated base)
-lungs (works fast) -kidneys (slowest, but do most of the work) |
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What types of buffer systems are there is the body?
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bicarb buffer system
-phosphate (can't be manipulated by the lungs) -protein (can't be manipulated by the lungs) |
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What is the hydration equation?
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CO2 +H2O <--> H2CO3 <--> H(+) + CO3(-)
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How does the kidney restore balance in an acidosis condition?
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-gets rid of H+ (acidic urine)
-keeps HCO3- |
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What makes a carnivore's pee acid?
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methionine and cystein
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What makes an herbivores pee alkaline?
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malate in plant materials
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How do the lung keep balance in an acidosis condition?
-in an alkalotic condition? |
shift to left and blows of CO2 (H+ decreases)
-shift to the right and conserve CO2 (hold breath) (H+ increases) |
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What does hypoventilation, or pneumonia cause?
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respiratroy acidosis
-drives equation to the right |
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What does hyperventilation or panic attack cause?
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respiratory alkalosis
-drives equation to the left |
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What two types of metabolic acidosis are there?
-what do you see with each? |
titration acidosis (associated with a increased AG - KLUE)
secretion acidosis = diarrhea, salivation in ruminants |
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What are causes of metabolic alkalosis?
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-loss of H+ (gastric vomiting, abomasal reflux)
-gain base (ammonia/urea toxicant; bicarb fluids) |
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What are the steps to determining acid base problems?
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-pH
-PCO2 -BE -whatever agrees with pH is the primary problem with compensation in the other direction |
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What does total CO2 tell you?
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BE or HCO3-
-does not always indicate a primary change therefore must use with clinical data to differentiate |
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What types of acid base disturbances are there?
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-simple
-compensated -mixed |
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What are 4 predisposing factors to paradoxical aciduria?
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1 - metabolic alkalosis (increased HCO3-)
2 - hypovolemia (often due to dehydration so therefore have hyponatremia) 3 - severe hypochloremia (vomiting) 4 - hypokalemia |
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What is the formula for anion gap?
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UA - UC
(Na + K) - (Cl + HCO3-) |
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What are the unmeasured anions and cations in an anion gap?
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anions - phosphate, sulfates, albumin, lactate
cations - Ca, Mg, gammaglobulins |
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What are caused of increased anion gap and decreased AG?
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increased - KLUE
decreased - hypoalbuminemia, hypercalcemia, hypermagnesemia |
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What two things are needed to diagnose a mixed acid base disturbance?
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-increased AG
-increased or normal HCO3 (metabolic acidosis (titration acidosis like dehydration, renal failure, diabetic ketoacidosis) with metabolic alkalosis - vomiting) |
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Does Cl increase or decrease with secretion acidosis?
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increase
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What are the four main markers of cellular leakage?
-what are 2 others |
AST
K CK Mgb other - LDH and ALT |
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Which is the most specific indicator for muscle damage?
is there a long or short half life? |
CK
-short half life therefore may return to reference level before measured |
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What does CK do in the body?
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it makes ATP available for use in the body and in the process makes creatinine
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How is creatinine eliminated and what does this estimate?
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via the urine and therefore estimates glomerular filtration
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What are conditions that can cause an increase in CK?
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-myositis (infectious or immune mediated)
-trauma -equine rhabdomyolysis -strenuous exercise -maybe secondary to arthritis |
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What artifacts could cause an increase in CK?
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-hemolysis
-traumatic venipuncture |
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How much higher is CK in neonates?
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5 x higher
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AST is an injury enzyme of what?
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skeletal muscle and liver
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What are causes of hyperkalemia?
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-acidosis
-muscle necrosis -secondary to rhabdomyolysis -diabetes mellitus -oleander toxicity -obstruction of urine outflow -addisons disease |
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What are causes of hypokalemia?
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-renal disease
-gereatric cats -marginal dietary intake |
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What are the three types of hypokalemic myopathies?
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1 - rhabdomyolysis secondary to K depletion (weakness -> increased CK -> necrosis --> myoglobinuria
2 - diabetic animals 3 - bovine post-partum ketosis (downers) |
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What are three rule outs with a positive occult blood?
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1 - hematuria (sediment at bottom)
2 - hemoglobinuria (red plasma) 3 - myoglobinuria (clear plasma) |
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With myoglobinuria, what does the plasma look like and what does the urine look like?
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plasma - clear
urine - brown |
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Bacteria have urease. This can make the urine....
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alkaline
-produces CO2 (drives equation to the left) and ammonia (combines with free H+ ions) |
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What are artifacts of alkaline urine?
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-causes cells to lyse
-casts to dissolve -changes crystal formation -false positive on urine dipstick for protein |
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If you want to confirm presence of protein on a urine dipstick with alkaline urine, what test do you need?
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Bumin test
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What happens if a dilute urine sits too long?
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cells lyse and it is difficult to determine if there is hemoglobin or RBC
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What does light do to bilirubin and urobilinogen?
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are degraded by light
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How do you describe ketones?
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volatile - therefore escape form urine
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What could brown urine mean?
green-brown |
hemoglobinuria, myoglobinuria
bilirubinuria |
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What does a refractometer measure and what does it infer?
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RI --> SG --> osmolality
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What two things overestimate osmolality?
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glucose and protein
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What is the measured bilirubin on a dipstick?
what does it mean? |
conjugated
cholestasis |
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What is the order of sensitivity of tests for cholestasis in dogs?
-cats |
ALP>GGT>urinine bili>serum bili
GGT>ALP>serum bili>urine bili |
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Bilirubin is degraded to what in the large intestine by bacteria?
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urobilinogen and sterobilinogen
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What does decreased urobilinogen mean?
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biliary obstruction
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Once protein is detected on a dipstick, what should you evaluate it for?
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hematuria or cystitis (look at RBC and WBC)
-if not that, may be glomerular or tubular disease |
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What does the urine P:C ratio mean?
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>3 often means glomerular injury
<3 often means tubular injury |
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What does glucosuria mean and what is the renal threshold?
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-hyperglycemia
-180 for most -100 more ruminants |
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When would you see ketones in the urine?
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with increased lipolysis (starvation, bovine ketosis, diabetic ketoacidemia, ovine preg. toxicosis)
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What is normal for RBC or WBC on sediment on 40x?
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5 cells
-greater than this means hematuria or pyuria |
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What are conditions that increase BUN only?
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1 - endogenous protein break down
2 - high protein meal 3- GI bleeding |
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What are the 2 causes of prerenal azotemia?
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-decreased GFR (dehydration and decreased CO)
-increased nitrogen load (where BUN increases without Creatinine) |
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What are the characteristics of prerenal azotemia?
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-decreased GFR
-hypersthenuria (at least 1/3 of nephrons are still functioning) -azotemia |
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What is the order of abilities lost with renal failure?
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1 - ability to concentrate or dilute urine
2- Ability to eliminate nitrogenous wastes 3- Ability to produce EPO |
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If the kidneys can't concentrate or dilute urine how many nephrons are lost and what does this reflect function of?
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- >2/3 of nephrons are lost (with fixed SG)
- measure of tubular function |
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Other than isothenuria, what are some other indicators of tubular damage?
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-increased fractional excretion of Na
-increased GGT -increased NAG -increased retinal binding protein -P:C ratio is greater than 1-3 -greater than 3 casts/LPF |
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Once the kidneys have lost the ability to eliminate N wastes, how many functioning nephrons are lost?
What is this a function of |
>3/4 are lost
-measure of glomerular function |
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What is the exception to azotemia appearing before loss of concentrating ability?
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cats and primary glomerular disease
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With primary glomerular disease, what is seen?
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-proteinuria
-retain limited ability to concentrate -microalbuminemia -urine P:C ratio is >1-3 |
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What are findings of post-renal azotemia?
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-anuria
-lg or ruptured urinary bladder (decreased Na and CL) (increased K, P, BUN, and Creatinine) -pronounced azotemia -titration acidosis |
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What are the species difference of renal failure with horses?
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-increased Ca
increased P |
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What are the species differences of renal failure with ruminants?
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-decreased Ca
-decreased Na and Cl -increased fibrionogen |
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What is lost with a protein loosing nephropathy?
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albumin with hypocalcemia
ATIII -hypercholesterolemia -edema -metabolic acidosis |
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What conditions cause PU/PD?
-list 8 |
-renal failure
-diabetes mellitus (osmotic diuresis) -Cushings -Addisons -liver failure -psychogenic -hypercalcemia -Diabetes insipidus |
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jeder (jedes, jede ...)
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each, every
(uses case endings) |
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After a dehydration, what causes concentrated urine?
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thirst center
psycogenic (medullary washout) |
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hyposthenuria is typically what type of problem?
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ADH
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After a dehydration test, what causes hyposthenuria?
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diabetes insipidus
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In an animal with Diabetes Insipidus, after administration of ADH, central causes...
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concentrated urine
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