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Renal > Acid Base > Flashcards

Acid Base Flashcards

0
Q

anion gap

A

Na- (HCO3 + Cl)

*adding acid consumes HCO3, therefore increasing anion gap

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1
Q

three types of buffers

A

bicarb
phosphate (buffering causes bone loss)
proteins (mostly albumin–H displaces Ca and Na)

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2
Q

factors that change the gap

A

increase- acid load

decrease- hypoalbuminemia

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3
Q

acute compensation for respiratory acidosis

A

1 meq/L per 10 mmHg increase in PCO2

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4
Q

chronic compensation in respiratory acidosis

A

3-4 meq/L per 10 mmg increase in PCO2

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5
Q

respiratory compensation for metabolic acidosis

A

1.2 mmHg per 1 mEq/fall

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6
Q

winter’s formula

A

calculates expected PCO2 (is compensation adequate?)

=(1.5*[HCO3-]+8) +/-2

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7
Q

delta delta rule

A

if change in anion gap doesnt equal change in hco3, an additional acid-base disorder may be present

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8
Q

hyperchloremic metabolic acidosis is either__ or __

A

retention of HCL or bicarb loss

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9
Q

reasons for high anion gap metabolic acidiosis

A 
MUD PILES
methanol
uremia
DKA
paraldehyde
INH
lactic acidosis
ethylene glycol
salicylate
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10
Q

osmolar gap

A

measured posm-calculated posm

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11
Q

calculated posm

A

2Na + glu/18 +BUN/2.8 + EtOH/4.6

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12
Q

if osmolar gap is high

A

intoxication with unmeasured osmoles

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13
Q

causes of increased osmole gap with acidosis

A

mud piles

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14
Q

causes of increased osmolal gap without acidosis

A 
DELLPIM
diethyl ether
ethanol
lipidemia
lithium toxicity
proteinemia
isopropanolol
mannitol
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15
Q

change in anion gap greater than change in bicarb

A

metabolic alkalosis present

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16
Q

change in anion gap less than change in bicarb

A

hypercholermic metabolic acidosis present

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17
Q

renal tubular acidosis presents as

A

hypercholermic acidosis

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18
Q

distal RTA

A

inability to excrete H+

19
Q

proximal RTA

A

inability to reabsorb HCO3

20
Q

urine anion gap

A

(Na+K)-Cl

21
Q

kidney excretes acid as

A

NH4Cl

22
Q

negative urine ion gap

A

expected in metabolic acidosis with healthy kidney

23
Q

positive urine anion gap

A

distal RTA

24
Q

TYPE 1 RTA

A

impaired H+ secretion in DISTAL tubulue

25
Q

type 1 urine pH

A

> 5.5

26
Q

causes of RTA 1

A

idiopathic
drugs- isofamide, amphoB, Lithium
hypercalciuria (damages distal nephron)
obstructive uropathy

27
Q

RTA 1 labs

A

low urine pH
positive UAG
hypokalemia

28
Q

type 2 RTA

A

cant reabsorb HCO3-

29
Q

acidosis in RTA 2

A

less severe

30
Q

labs in type 2 RTA

A

> 5.5 pH
UAG -
bicarb stays 12-18 because hits tmax
hypokalemia

31
Q

how to distinguish rta 2 from diarrhea

A

load with bicarb- shoudl immediately cause bicarburia

32
Q

tx or rta 2

A

lots of bicard

33
Q

type 4 RTA

A

hypercholremic acidosis with hyperkalemia

decreased aldosterone effect

34
Q

causes of type IV RTA

A 
decreased aldo production
aldo ressitance (ENAC blocked by K sparring diuretics, bactrim, pseudo hypoaldo because decreased distal Na low)
defects in Enac
35
Q

labs type 4 RTA

A

low bicarb
pH>5.5 in urine
hyperkalemia (should be suspected when hyperkalemic but no increased effort to excrete (urine K is normal))

36
Q

drug for hypoaldosteronism

A

fludocortisones

37
Q

acute metabolic comp for resp alkalosis

A

-2 mEq/L per -10 mmHg

38
Q

chronic respiratory alkalosis compensation

A

-4 per -10

39
Q

what makes you immediately thing salicylate toxicity

A

respiratory alkalosis with elevated AG acidosis

40
Q

mechanism of salicylate toxicity

A

hyperventilation because of salicylate acid–>rep alklaosis

also direct stim of resp center–>further hypervent–>lots of resp alklaosis

41
Q

compensation for metabolic alkalosis

A

+0.7 mmHg per 1 mEq/L

42
Q

contraction alkalosis

A

volume depeletion with Cl-containing fluid will stimulate an increase in Na reabs (via aldo)..since Cl- isnt pressent HCO3 will go with it

43
Q

milk-alkali syndrome

A

ingestion of HCO3 or CO3 alone is not enough to make alklaosis, but if you do it with calcium (tums, dairy, etc) you will inhibit distal HCO3 excretion

44
Q

tx metabolic acidosis

A

remove offending agent or block affected channels

Renal (17 decks)

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