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Eating disorder, TBL 4.2 MECHANISTIC DIAGRAM, 23: Gerry Guo, Kara Harris,…

- - - - Increases sodium delivery to cortical collecting duct
        
        Excess dumping of potassium
        
        Hypokalemia
        
        Flattened T-wave
        
        ECG
        
        U-wave present
        
        Muscle weakness
        
        4/5 weakness proximally in upper and lower limbs
        
        Shifts K+ from intracellular to extracellular space
        
        H+ moves into cells to maintain electroneutrality, detaching from bicarbonate
        
        Increases HCO3- plasma concentration
        
        1 more item...
        
        Serum biochemistry - potassium 2.1mmol/L
        
        KCL infusion (slow)
      - Decreased potassium recycling
        
        More negative potential difference
        
        Loss of Mg2+ and Ca2+ in urine as shunt pathway inhibited
        
        Hypocalcaemia
        
        Serum biochemistry
        -Calcium 2.05 mmol/L
        -Magnesium 0.55 mmol/L
        
        Hypomagnesaemia
    - - Low plasma Cl-
        
        Serum biochemistry - chloride 90 mmol/L
  - - - Serum biochemistry - urate 0.48 mmol/L
- - - - Hyponatraemia
        
        Increased renin production by juxtaglomerular cells
        
        Converts angiotensinogen to angiotensin I
        
        Angiotensin I converted to angiotensin II by ACE
        
        Vasoconstriction of efferent arteriole
        
        INHIBITS ----|
        
        Aldosterone release from adrenal gland
        
        Increased reabsorption of sodium and hence water
        
        1 more item...
        
        Increased potassium excretion
        
        1 more item...
        
        Serum biochemistry - sodium 129 mmol/L
    - - Postural hypotension
        
        Reduced cardiac output
        
        Tachycardia
        
        Palpitations
        
        BP 105/70 lying, 95/70 sitting upright, 85/65 standing
        
        Light-headedness/pre-syncope
      - Decreased GFR
        
        eGFR 56 mL/min/1.73m^2
        
        Reduced urea excretion
        
        Urea buildup
        
        Serum biochemistry - urea 10.5 mmol/L
        
        Serum biochemistry - urea 10.5 mmol/L
        
        Creatinine 120 uM
      - Increased ADH secretion
      - Replenish and hydrate
      - Saline
      - Hypoperfusion of kidney and decreased filtration pressure in kidney
        
        PRE-RENAL AKI