p.4
Fluid and Electrolyte Homeostasis
What happens to aldosterone levels in conditions of volume overload?
Aldosterone is created to increase sodium conservation, while ADH is suppressed, leading to increased urine volume and dilution.
p.14
Signs and Symptoms of Dehydration and Volume Depletion
What ECG abnormalities are consistent with hyperkalemia?
AV block, prolonged PR interval, peaked T waves, widened QRS, fusion of P and T wave into QRS.
p.4
Renal Regulation of Sodium and Water
What role does the juxtaglomerular apparatus play in kidney function?
It senses glomerular blood flow and filtration, leading to renin production when GFR is low.
p.17
Pathophysiology of Fluid Loss
How does hypomagnesemia affect potassium levels?
It may lead to hypokalemia.
p.1
Fluid and Electrolyte Homeostasis
What factors influence the distribution of water in the body?
Solute concentrations, osmolarity, and semi-permeable cellular membranes.
p.14
Management of Electrolyte Disorders
What is a common cause of hyperkalemia related to renal dysfunction?
Inhibition of renin-angiotensin-aldosterone due to parenchymal disease or drug-induced factors.
p.4
Volume Status and Resuscitation
How does the body prioritize blood flow during volume depletion?
The sympathetic nervous system shunts blood away from peripheral organs to preserve flow to the central nervous system and cardiac perfusion.
p.17
Diagnostic Studies for Electrolyte Imbalances
What diagnostic tests are recommended for evaluating hypomagnesemia?
Serum Mg, Total Protein, Serum K, Ca, and Phos levels.
p.19
Diagnostic Studies for Electrolyte Imbalances
How is the serum anion gap calculated?
Serum anion gap = Measured cations - Measured anions (Na - (Cl + HCO3)).
p.5
Diagnostic Studies for Electrolyte Imbalances
What laboratory values are included in a basic metabolic panel?
Serum Sodium, Potassium, Chloride, Bicarbonate, Glucose, Blood Urea Nitrogen, and Creatinine.
p.7
Pathophysiology of Fluid Loss
What can lead to fluid gain in patients?
Excessive IV fluids, excessive sodium intake, reduced inotropy, renal parenchymal disease, cirrhosis.
p.19
Pathophysiology of Fluid Loss
What causes Hyperchloremic Metabolic Acidosis?
Loss of HCO3 (e.g., diarrhea, RTA, ileal loop) and reduced acid loss from the kidney.
p.18
Management of Electrolyte Disorders
What are some causes of hyperchloremia?
Dehydration, diarrhea (loss of HCO3), renal insufficiency, diuretics.
p.9
Volume Status and Resuscitation
What is required for maintenance fluid therapy when output exceeds input?
Supplemental resuscitation.
p.6
Signs and Symptoms of Dehydration and Volume Depletion
What does oliguria suggest?
Significant volume depletion and/or dehydration.
p.21
Massive Transfusion Protocols
What does FAST indicate in this case?
Positive for internal bleeding.
p.14
Pathophysiology of Fluid Loss
What condition can lead to redistributive hyperkalemia?
Uncontrolled hyperglycemia, such as in diabetic ketoacidosis or hyperosmolar hyperglycemic state.
p.7
Management of Electrolyte Disorders
What is essential for correcting pH abnormalities during resuscitation?
Adequate tissue perfusion.
p.7
Diagnostic Studies for Electrolyte Imbalances
What tools are available to monitor intravascular resuscitation?
Monitoring vital signs and laboratory values.
p.14
Management of Electrolyte Disorders
What is the treatment for hyperkalemia involving calcium?
Calcium chloride (500-1000mg) infused over 2-3 minutes.
p.4
Diagnostic Studies for Electrolyte Imbalances
How does urinary sodium concentration indicate sodium replacement adequacy?
A concentration below 20 mM suggests inadequate sodium replacement, especially below 10 mM.
p.1
Volume Status and Resuscitation
What does the term 'volume status' refer to?
The extracellular space, including intravascular and interstitial volume.
p.16
Diagnostic Studies for Electrolyte Imbalances
What ECG findings are associated with hypokalemia?
Tachyarrhythmias, T wave inversion, ST depression, U waves, and prolonged QT interval.
p.18
Pathophysiology of Fluid Loss
How does diarrhea contribute to hyperchloremia?
By causing loss of bicarbonate (HCO3).
p.10
Fluid and Electrolyte Homeostasis
What is the effect of feeding on H ion concentration?
Increases from about 50 mM to up to 100 mM.
p.2
Fluid and Electrolyte Homeostasis
What is the key to accessing and managing the intracellular space?
Treating the extracellular space.
p.11
Management of Electrolyte Disorders
What happens to serum sodium levels in Acute Tubular Necrosis (ATN)?
Sodium levels fall moderately.
p.11
Signs and Symptoms of Dehydration and Volume Depletion
What is the effect of dehydration on serum sodium levels?
Sodium levels may rise or fall depending on the etiology.
p.11
Management of Electrolyte Disorders
What is the effect of Inappropriate ADH secretion (SIADH) on serum sodium levels?
Sodium levels fall considerably.
p.2
Fluid and Electrolyte Homeostasis
What is the difference between volume resuscitation and maintenance fluids?
Volume resuscitation restores cardiac output, while maintenance fluids address daily needs for homeostasis.
p.20
Diagnostic Studies for Electrolyte Imbalances
What lab tests are recommended for assessing electrolyte imbalances?
Basic metabolic panel, including glucose and creatinine.
p.5
Signs and Symptoms of Dehydration and Volume Depletion
What vital signs changes may indicate volume depletion?
Progressive tachycardia, clinical orthostasis, postural hypotension, and narrowed pulse pressure.
p.18
Management of Electrolyte Disorders
What can an abrupt elevation in magnesium concentration lead to?
Reduced magnesium retention and paradoxical urinary excretion.
p.18
Signs and Symptoms of Dehydration and Volume Depletion
What ECG abnormalities are consistent with hypomagnesemia?
Ectopy, prolonged QT interval, tachyarrhythmias (e.g., torsades de pointes).
p.17
Management of Electrolyte Disorders
What should be monitored after administering magnesium sulfate?
Serum magnesium and potassium levels.
p.1
Signs and Symptoms of Dehydration and Volume Depletion
What are common causes of intracellular electrolyte and volume loss?
They are directly related to extracellular causes.
p.9
Volume Status and Resuscitation
What should patients be monitored for postoperatively?
Evolving tachycardia and pulse pressure shifts from volume output exceeding input.
p.10
Signs and Symptoms of Dehydration and Volume Depletion
What type of metabolic disturbance can result from gastric losses?
Chloride-responsive metabolic alkalosis.
p.13
Signs and Symptoms of Dehydration and Volume Depletion
What are the symptoms of mild to moderate hyponatremia?
Fatigue, nausea, confusion, ataxia (serum Na 121-129).
p.13
Signs and Symptoms of Dehydration and Volume Depletion
What are the severe symptoms of hyponatremia?
Obtundation, seizure, coma (serum Na < 120).
p.13
Diagnostic Studies for Electrolyte Imbalances
What should be monitored when administering hypertonic saline?
Serum sodium levels must be checked regularly to avoid overcorrection.
p.8
Management of Electrolyte Disorders
What characterizes hypertonic solutions?
An osmolarity greater than 340 mOsm/kg.
p.8
Management of Electrolyte Disorders
What is the composition of 5% Dextrose in Water (D5W)?
pH 4.0, 50 g/L glucose, 0 Na+, 0 Cl-, 0 K+, 0 Ca++, 0 Lactate.
p.15
Management of Electrolyte Disorders
What are cation exchange resins indicated for?
Potentially life-threatening hyperkalemia when dialysis is not readily available.
p.3
Volume Status and Resuscitation
What is the purpose of maintenance fluid needs in patients?
To maintain stabilization until the patient can adequately intake fluids orally.
p.5
Signs and Symptoms of Dehydration and Volume Depletion
What are common symptoms of volume depletion and dehydration?
Thirst, nausea, emesis, lethargy, confusion, and obtundation.
p.1
Volume Status and Resuscitation
What surgical conditions can lead to acute volume loss?
Trauma, acute peritonitis, or abscess.
p.19
Diagnostic Studies for Electrolyte Imbalances
What is included in a basic metabolic panel?
Glucose, creatinine, and consider LFTs (albumin).
p.7
Pathophysiology of Fluid Loss
What are some sources of fluid loss?
Hemorrhage, emesis, stool/ostomy output, drains, diuresis.
p.5
Diagnostic Studies for Electrolyte Imbalances
What does a BUN/Creatinine ratio > 20:1 suggest?
Volume depletion pre-renal hypoperfusion.
p.4
Management of Electrolyte Disorders
What hormone counters the effects of the renin-angiotensin-aldosterone system during hypervolemia?
Atrial natriuretic factor (ANF) promotes natriuresis and reduces sodium reabsorption.
p.7
Volume Status and Resuscitation
What is the role of trend analysis in patient management?
To identify input adjustment needs relative to calculated output.
p.16
Management of Electrolyte Disorders
What should be considered when correcting potassium levels?
Potassium values are difficult to correct when magnesium levels are also low; both may need correction.
p.16
Management of Electrolyte Disorders
What is the preferred method for potassium replacement?
Oral replacement when possible, especially for larger doses needed quickly.
p.19
Signs and Symptoms of Dehydration and Volume Depletion
What are common causes of hypochloremia?
Vomiting, diarrhea, gastrointestinal suction, diuretics, SIADH, and water intoxication.
p.8
Volume Status and Resuscitation
What are the goals of treatment for volume depletion?
Improvement of vital signs and establishment of urine output.
p.13
Management of Electrolyte Disorders
What is the effect of isotonic saline (0.9% NaCl) on serum sodium?
Raises serum Na by 1 meq/L for each liter infused.
p.13
Volume Status and Resuscitation
What conditions may require volume restriction in hyponatremic states?
Edematous states such as congestive heart failure (CHF).
p.15
Management of Electrolyte Disorders
What is the dosage of albuterol for nebulization in this context?
10-20 mg in 5 ml saline nebulization.
p.11
Pathophysiology of Fluid Loss
What are the causes of hypernatremia?
Electrolytes are ingested and retained without corresponding amounts of water or when water is lost at a greater rate than electrolytes.
p.20
Signs and Symptoms of Dehydration and Volume Depletion
What can hypochloremia indicate?
Significant volume depletion and dehydration, leading to concurrent hypokalemia, hyponatremia, and metabolic alkalosis.
p.20
Management of Electrolyte Disorders
What should be monitored after restoring chloride levels?
Serum bicarbonate values and serum potassium concentration.
p.20
Pediatric Fluid Resuscitation
How should maintenance fluid needs be calculated for a child?
Using the 4-2-1 rule over 24 hours.
p.21
Massive Transfusion Protocols
What should be considered regarding blood products during a massive transfusion?
Types of products, infusion rate, and product ratios (e.g., 2:1 or 1:1).
p.1
Fluid and Electrolyte Homeostasis
What is the daily volume requirement estimation for a healthy individual?
30-40 ml/kg/day, 1.5 L/meter²/day, or 100 ml/100 kcal.
p.1
Fluid and Electrolyte Homeostasis
Why might volume requirement estimations be inaccurate in certain patients?
Due to conditions like obesity, frailty, or cancer.
p.14
Diagnostic Studies for Electrolyte Imbalances
What lab tests are essential for diagnosing hyperkalemia?
Basic metabolic panel, including glucose and creatinine.
p.17
Pathophysiology of Fluid Loss
What are some causes of hypomagnesemia?
Starvation, alcohol dependence, pancreatitis, vomiting, diarrhea, diuretics.
p.1
Fluid and Electrolyte Homeostasis
What is the relationship between a patient’s homeostasis and total body water?
Homeostasis is related to total body water and its distribution between intra and extracellular spaces.
p.14
Pathophysiology of Fluid Loss
What is a potential scenario that could lead to hyperkalemia?
A patient with end-stage renal disease (ESRD) who missed dialysis.
p.4
Pathophysiology of Fluid Loss
What is the effect of hypovolemia on the renin-angiotensin cascade?
Reduced GFR stimulates renin production, activating the renin-angiotensin cascade to conserve volume.
p.19
Diagnostic Studies for Electrolyte Imbalances
What is the normal range for the serum anion gap?
3 to 10 meq/L, averaging 6 meq/L.
p.17
Management of Electrolyte Disorders
What is the immediate treatment for hypomagnesemia in cases of ventricular arrhythmia?
IV MgSO4 1-2 g slow IV over 5-60 minutes.
p.16
Management of Electrolyte Disorders
What are common causes of hypokalemia?
Enteritis, diarrhea, vomiting, diabetic ketoacidosis, diuretic use, and primary hyperaldosteronism.
p.21
Massive Transfusion Protocols
What are some indications for initiating a massive transfusion protocol?
Assessment of Blood Consumption/ABC score, persistent hemodynamic instability, active bleeding requiring operative or IR embolization, ongoing blood transfusion.
p.18
Management of Electrolyte Disorders
What regulates renal magnesium reabsorption?
Serum magnesium concentration.
p.5
Signs and Symptoms of Dehydration and Volume Depletion
What physical examination findings suggest volume loss?
Dry mucous membranes, reduced skin/tongue turgor, and prolonged capillary refill.
p.18
Signs and Symptoms of Dehydration and Volume Depletion
What conditions can lead to hypomagnesemia?
Enteritis, diarrhea, chronic pancreatitis, proton pump inhibitor use, renal losses from diuretics, chronic alcohol abuse.
p.4
Signs and Symptoms of Dehydration and Volume Depletion
What is the distinction between dehydration and volume depletion?
Dehydration is a loss of total body water, while volume depletion is a loss of extracellular fluid volume.
p.16
Management of Electrolyte Disorders
How is potassium deficit calculated for hypokalemia?
For every 1 mEq/L decrease in serum potassium, the potassium deficit is approximately 200-400 mEq.
p.19
Pathophysiology of Fluid Loss
What characterizes RTA Type 1 (Distal)?
Reduced H excretion and normal anion gap due to filtered sulfates and phosphates.
p.9
Resuscitation Strategies in Trauma
What type of solutions are used for resuscitation?
Bolus isotonic solutions (e.g., 10-20cc/kg).
p.13
Management of Electrolyte Disorders
What is the treatment goal for increasing serum sodium?
Increase by 4 to 6 meq/L over 4-24 hours, not exceeding 8 meq/L in 24 hours.
p.10
Management of Electrolyte Disorders
What is the recommended treatment for fluid loss from stomas or fistulae?
Isotonic solutions containing Na, replaced cc for cc.
p.6
Signs and Symptoms of Dehydration and Volume Depletion
What is the significance of urine sodium being low (< 20meg/L)?
It may indicate volume depletion (aldosteroma).
p.6
Diagnostic Studies for Electrolyte Imbalances
What is the calculated osmolarity formula?
200-300 mOsm/L = 2 [Na(mEq/L) + 2 [K(mEq/L)] + [Glucose (mEq/dL)]/18 + [BUN (mEq/dL)]/2.8.
p.6
Volume Status and Resuscitation
What is the mainstay of treatment for volume depletion?
Goal-directed resuscitation to restore intravascular volume.
p.6
Volume Status and Resuscitation
What should be monitored during resuscitation?
Maintenance of volume and metabolic/electrolyte correction.
p.20
Management of Electrolyte Disorders
What are some causes of electrolyte imbalances mentioned?
Excessive sweating, adrenal insufficiency, hyperaldosteronism, and certain drugs (e.g., laxatives, corticosteroids, bicarbonate).
p.2
Resuscitation Strategies in Trauma
What is necessary after restoring adequate vascular volume?
Treatment of anemia/coagulopathy.
p.11
Signs and Symptoms of Dehydration and Volume Depletion
What are the signs and symptoms of hypernatremia?
Thirst, confusion, muscle twitching, and seizures.
p.3
Renal Regulation of Sodium and Water
What is the effect of aldosterone on renal function?
Stimulates sodium absorption while excreting potassium and hydrogen.
p.14
Management of Electrolyte Disorders
What medications can contribute to hyperkalemia?
ARB/ACE inhibitors and diuretics such as spironolactone or amiloride.
p.14
Fluid and Electrolyte Homeostasis
What happens to potassium levels during volume repletion and insulin administration in hyperkalemia?
It may restore condition, but patients may still have a whole body potassium deficit.
p.13
Management of Electrolyte Disorders
What is the initial fluid replacement for hyponatremia?
D5W at 1 ml/kg/hr until serum Na is 140 meq.
p.4
Resuscitation Strategies in Trauma
What is the priority in resuscitation after restoring intravascular volume?
The focus must shift to address intracellular needs.
p.6
Signs and Symptoms of Dehydration and Volume Depletion
In which conditions is serum osmolarity elevated?
Dehydration, hyperglycemia (DKA, HONK), Diabetes Insipidus.
p.19
Management of Electrolyte Disorders
What is the treatment for RTA Type 2 (Proximal)?
Bicarbonate supplementation (10 to 15 meq/kg/day) and monitoring of serum K.
p.8
Resuscitation Strategies in Trauma
What is the fluid of choice for large volume resuscitation in trauma patients?
Lactated Ringer’s solution.
p.9
Signs and Symptoms of Dehydration and Volume Depletion
What is the electrolyte change in excessive gastric losses?
Na falls considerably, K falls moderately, HCO3 rises, Cl falls considerably.
p.9
Signs and Symptoms of Dehydration and Volume Depletion
What is the electrolyte change in high volume pancreatic fistula?
Na falls considerably, K falls moderately, HCO3 falls considerably, Cl remains stable.
p.8
Management of Electrolyte Disorders
What is the significance of electrolyte correction in resuscitation?
Isotonic and hypotonic solutions may be chosen for maintenance and electrolyte correction.
p.11
Fluid and Electrolyte Homeostasis
What is the typical response of the body to excess salt intake?
Increased thirst response and ADH release.
p.15
Diagnostic Studies for Electrolyte Imbalances
What tests are included in the basic metabolic panel for hypokalemia?
Glucose, creatinine, magnesium, urine potassium, and ECG (U wave).
p.3
Fluid and Electrolyte Homeostasis
What are the sources of fluid requirements in an average adult?
Insensible losses (exhalation, sweat), feces, urine, oral fluids, food, and IV infusion.
p.3
Fluid and Electrolyte Homeostasis
What triggers the secretion of antidiuretic hormone (ADH)?
Hyperosmolality and volume depletion sensed by baroreceptors.
p.5
Management of Electrolyte Disorders
What electrolyte imbalance can occur with gastric fluid loss?
Hypochloremic hypokalemic metabolic alkalosis with paradoxical aciduria.
p.10
Pathophysiology of Fluid Loss
What is a potential consequence of pancreatic or proximal intestinal fluid loss?
Acute fluid loss and electrolyte imbalance.
p.13
Management of Electrolyte Disorders
How much water should be replaced in the first day for chronic hyponatremia?
3 mL/kg body weight x 10, totaling 1800 mL/24 hr.
p.8
Signs and Symptoms of Dehydration and Volume Depletion
What are physical findings suggestive of volume depletion or dehydration?
Dry skin, low turgor, dry mucous membranes, and weight loss.
p.8
Volume Status and Resuscitation
What is the initial management for volume depletion?
Restoration of intravascular circulating volume with 20cc/kg boluses of isotonic crystalloid.
p.9
Fluid and Electrolyte Homeostasis
How should losses from drains be replaced?
Ml for ml with solutions whose electrolyte composition mirrors the fluid lost.
p.12
Pathophysiology of Fluid Loss
What are some causes of hypotonic fluid losses?
Vomitus, infectious or cathartic induced diarrhea, glycosuria, osmotic or loop diuretic use, Diabetes Insipidus.
p.12
Signs and Symptoms of Dehydration and Volume Depletion
What happens to urine osmolality in Diabetes Insipidus?
Urine osmolality is less than plasma osmolality (< 300 mosmol/kg).
p.12
Management of Electrolyte Disorders
What indicates a response to ADH in urine osmolality?
Urine osmolality > 600 mosmol/kg.
p.12
Volume Status and Resuscitation
What is the formula for calculating Free Water Deficit to treat Hypernatremia?
Water deficit = current TBW X (Serum Na - 1) / 140.
p.12
Resuscitation Strategies in Trauma
How is the hourly infusion rate calculated for replacing acute hypernatremia?
Hourly infusion rate (mL/hour) > Water deficit in mL ÷ 24 hours.
p.12
Diagnostic Studies for Electrolyte Imbalances
What urine sodium level suggests excessive salt ingestion relative to free water?
Urine sodium > 100meq/L with normal renal function.
p.11
Diagnostic Studies for Electrolyte Imbalances
What laboratory studies are needed for diagnosing hypernatremia?
Serum sodium levels and osmolality.
p.3
Volume Status and Resuscitation
What factors can assist in determining the adequacy of initial maintenance fluid calculations?
Monitoring trends of the patient’s vital signs and urine output.
p.20
Pediatric Fluid Resuscitation
What should be considered when calculating fluid needs for a burn patient?
The child's maintenance needs and additional losses from an NG tube if placed.
p.7
Diagnostic Studies for Electrolyte Imbalances
What laboratory values are important for tailoring specific needs in fluid management?
Serum and urine electrolytes, osmolarity, BUN, creatinine, and GFR.
p.19
Management of Electrolyte Disorders
What is the treatment for Hyperchloremic Metabolic Acidosis?
Hydration solutions containing bicarbonate, acetate, citrate, or phosphate salts.
p.5
Diagnostic Studies for Electrolyte Imbalances
What may elevated BUN and creatinine levels indicate?
Possible volume depletion or acute kidney injury.
p.16
Management of Electrolyte Disorders
When should potassium supplements be considered?
When serum potassium levels are < 3.8 mEq/L.
p.13
Pathophysiology of Fluid Loss
What is the risk of too rapid correction of hyponatremia?
Central pontine myelinolysis.
p.13
Management of Electrolyte Disorders
What is the role of hypertonic saline in treating severe hyponatremia?
1 mL/kg body weight of 3% saline increases serum Na by approximately 1 meq/L.
p.2
Volume Status and Resuscitation
What is the ultimate goal of resuscitation?
Restoration of cellular perfusion and correction of electrolyte and metabolic disarray.
p.2
Pathophysiology of Fluid Loss
Why do fluid requirements become less reliable in the presence of disease?
Because fluid/electrolyte administration must relate closely to clinical context.
p.2
Management of Electrolyte Disorders
What must clinicians understand to apply proper fluid and electrolyte therapy?
The patient’s underlying medical conditions and their contribution to the pathophysiological state.
p.2
Volume Status and Resuscitation
What does volume resuscitation aim to restore?
Cardiac output through intravenous solutions.
p.15
Management of Electrolyte Disorders
What are the contraindications for using cation exchange resins?
Postoperative patients, patients with an ileus, bowel obstruction, or receiving opiates.
p.20
Volume Status and Resuscitation
What is the initial treatment for restoring intravascular volume?
Resuscitation with chloride-rich isotonic fluid, such as 0.9% normal saline.
p.15
Management of Electrolyte Disorders
What is the dosage of calcium gluconate for peripheral access?
1000 mg (10 ml of a 10% solution) infused over 2-3 minutes.
p.15
Management of Electrolyte Disorders
How is insulin administered for electrolyte management?
10 units regular bolus injection with either D50 (50 ml) or in 500 ml D10W over 60 minutes.
p.15
Management of Electrolyte Disorders
When should glucose be held during insulin administration?
If serum glucose level is ≥ 250.
p.11
Volume Status and Resuscitation
What happens to serum sodium levels in Congestive Heart Failure (CHF)?
Sodium levels remain stable or fall.
p.2
Signs and Symptoms of Dehydration and Volume Depletion
What signs might indicate acute volume depletion from hemorrhage?
Tachycardia, hypotension, tachypnea, cool extremities, and diminished pulses.
p.15
Signs and Symptoms of Dehydration and Volume Depletion
What are common causes of hypokalemia?
GI losses (diarrhea, vomiting) and renal causes (diuretics, renal artery stenosis).
p.3
Pathophysiology of Fluid Loss
What happens if urine volume is less than the required amount?
Solutes will accumulate, leading to renal failure.
p.12
Volume Status and Resuscitation
What is the treatment for a volume depleted patient with high plasma osmolality?
Resuscitation of intravascular volume followed by isotonic or hypotonic solutions.
p.20
Pediatric Fluid Resuscitation
What is the appropriate fluid treatment for a pediatric patient with signs of dehydration?
Aggressive fluid resuscitation using isotonic solution at 10-20 mg/kg bolus.
p.3
Renal Regulation of Sodium and Water
How is volume regulation predominantly exerted?
Through renal function, maintaining water and electrolyte compositions.
p.3
Renal Regulation of Sodium and Water
What is the role of urine output in fluid balance?
To remove metabolic byproducts and excess solute; it depends on solute excretory load and kidney's ability to concentrate urine.
p.3
Fluid and Electrolyte Homeostasis
How does dehydration with hyperosmolarity affect ADH and aldosterone balance?
ADH stimulation and water reabsorption are greater than aldosterone's effects, returning osmolarity to normal.
