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VOLUME CONTRACTION

Nephrology

VOLUME CONTRACTION

1. Vomiting causes metabolic alkalosis and low serum Cl - (losing stomach HCl in the emesis­), hypokalemia from renal K + wasting mediated by aldosterone.

2. Diarrhea causes metabolic acidosis (NAGMA) and an appropriately high serum Cl - (bicarbonate is lost in the stool, and chloride is reabsorbed to increase intravascular volume.)

3. Thiazide diuretics, like vomiting, cause a metabolic alkalosis with low serum cr, but, unlike vomiting, cause a high urinary Cl.

4. Diabetes insipidus (nephrogenic or neurogenic) may cause hypernatremia and volume con­traction.

5. Osmotic diure­sis (mannitol, hyperglycemia) causes a high urine output with a normal urine osmolality.


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REFERENCES

1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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