By Burton Rose, Theodore Post
This beautifully written textual content offers scholars, citizens, and practitioners the sting in knowing the mechanisms and medical administration of acid-base issues. offers the middle details to appreciate renal and electrolyte body structure, and stories the remedy motive for all significant acid-base and electrolyte disturbances. the whole textual content is exhaustively revised, and now comprises questions and solutions in every one bankruptcy.
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Additional info for Clinical Physiology of Acid-Base and Electrolyte Disorders
Constriction reduces RPF but may augment Pgc and GFR. , the filtration fraction), since these parameters will tend to change in opposite directions. The opposing effects of efferent arteriolar tone on Pgc and RPF also mean that the direct relationship between this resistance and the GFR (Fig. 2-7) must be modified, since the RPF is an independent determinant of GFR. As an example, although efferent arteriolar constriction increases Pgc, the concomitant elevation in renal vascular resistance will reduce RPF, which will tend to lower the GFR.
The effect of these changes varies with the degree of neurohumoral activation. 163 In comparison, patients with advanced heart failure or severe volume depletion have more marked increments in norepinephrine and angiotensin II. 80,162 This is a very effective adaptation because it preferentially shunts perfusion to the critical coronary and cerebral circulations while maintaining GFR and therefore excretory capacity. Renal vasodilator prostaglandins play an important role in modifying these vasoconstrictive effects.
However, angiotensin II is a systemic vasoconstrictor, whereas the prostaglandins act locally, because they are rapidly metabolized when they enter the systemic circulation. 87 The contributions of the three major factors governing renin release can be appreciated from the response to hypovolemia (see Chap. 8). 94 Each of these changes then promotes renin secretion. 106 On the other hand, renin release is diminished by volume expansion (as with a high Na+ intake). 107 DETERMINANTS OF GLOMERULAR FILTRATION RATE The initial step in urine formation is the separation of an ultrafiltrate of plasma across the wall of the glomerular capillary.
Clinical Physiology of Acid-Base and Electrolyte Disorders by Burton Rose, Theodore Post