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MHD Block 5: Renal > acid/base > Flashcards

acid/base Flashcards

1
Q

Anion gap equation and normal anion gap

A

Gap = Na - Cl - HCO3

normal anion gap: 10-12 meQ/L

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2
Q

If HCO3- changes, how will the lungs compensate?

A

^ HCO3 = ^ CO2

The compensation will occur in the SAME direction as the primary change!!

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3
Q

How will a chronic vs acute change in acid/base status affect the compensatory response?

A
  • Larger compensatory response in chronic vs acute

- With chronic disorders, body has had more time to mount a response

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4
Q

What are the different types of acidosis?

A
  1. High anion gap
  2. Normal anion gap:
    - Type II renal tubular acidosis (RTA): proximal
    - Type I renal tubular acidosis (RTA): distal
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5
Q

What does an anion gap greater than 10-12 meq/L tell us?

A

It tells us that the acidosis is caused by an increase in acid production

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6
Q

Which disorders are associated with high anion gap acidosis?

A

*increased acid production OR decreased excretion of inorganic anions

  • ketoacidosis
  • lactate acidosis
  • toxin ingestion: methanol, ethylene glycol
  • renal failure: failure to excrete sulfate and phosphate
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7
Q

Which disorders are associated with normal anion gap: hyperchloremic acidosis?

A

*decreased bicarb in body and failure to excrete acid

  • GI: diarrhea
  • renal: CA inhibitors > decreased bicarb reabsorption
  • administration of acid: HCL or TPN = total parenteral nutrition
  • administration of large amounts of saline = dilute bicarb
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8
Q

Which disorders are associated with normal anion gap: RTA II?

A
  • normal anion gap
  • proximal tubule disease + decreased absorption of HC03-
  • leads to low bicarb and spillage of bicarb immediately into urine if treat with bicarb*
  • [normal person would reabsorb bicarb until normalized levels > then spill out into urine]
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9
Q

Which disorders are associated with normal anion gap: RTA I?

A

*normal anion gap
-distal tubule disease
-malfunctioning Na/H ATPase = inability to excrete H+
>H+ builds up into cells

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10
Q

How to treat RAS?

A
  • Give bicarb

- Treat underlying disease: determine if bicarb or excess acid is the issue

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11
Q

Alkalosis can be caused by: ?

A
  • increased bicarb
  • decreased acid
  • loss of chloride
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12
Q

What can loss of H+ be caused by?

A

-GI: vomit

–renal: excess MR = hyperaldosterone = less Na in tubule = negative lumen charge and more K and H into tubule to neutralize

—in response to hypokalemia: K from cells into blood, Na/H+ into cell from blood to balance

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13
Q

Define the relationship between chloride and bicarb?

A

> They go together; inversely proportional

> decrease bicarb, body will retain chloride (increase) and vice versa to main normal pH

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14
Q

What causes loss of chloride?

A

GI: stool and decreased absorption in gut

skin: sweat in CF
renal: diuretics; barters and gitelmans

**Lose Cl- = decreased volume = RAA + aldo > Ca/H+ loss

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15
Q

Name the two disease associated with chloride loss?

A

BARTER’S: BA = BABY like loop-to =loops

  • kids: inherited
  • inhibition of Na/K/2Cl- in the Loop of Henle
  • causes decrease absorption of all three ions = loss of Cl-
  • endogenous loop diuretic

GITELMAN’S:

  • adults: inherited
  • inhibits luminal Na/Cl- symporter in the DCT
  • causes decreased absorption of both ions
  • endogenous thiazide
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16
Q

The kidney should just be able to get rid of the excess base, but it doesn’t. What are the reasons for this?

A
  • ECF depletion: keeps HCO3 around to avoid volume depletion
  • Chloride depletion
  • K+ depletion: counterbalances mvmt of K from cells to blood during severe hypokalemia
  • Hypercapnea (increased PCO2): due to compensatory mechanisms > leads to keeping bicarb around to balance
17
Q

What is the treatment for alkalosis?

A

Give chloride > decrease HCO3

How? intercalated cells in the distal nephron act to increase
bicarb excretion

Type A: H+ ATPase stimulation > H+ and HCO3 into tubule

Type B: increase Cl- stimulates HCO3/Cl antiporter on the basolateral side; more Cl- INTO cell, more bicarb OUT and into blood

18
Q

What two categories can alkalosis be divided into for a differential?

A

chloride responsive: low chloride in urine; diuretics, vomit/diarrhea, CF

chloride resistant: high chloride in urine; MR excess states

19
Q

Other ways to treat alkalosis?

A
  • CA inhibitors: acetazolamide > decrease bicarb reabsorp
  • volume repletion: NaCl administration
  • K administration (for hypokalemic w/ Barter’s)
20
Q

Clinical findings of alkalosis?

A
  • HTN
  • hypoventilation (increase in CO2)
  • arrhythmia (pH >7.6)
21
Q

What is MUDPILES?

A

Causes of high anion gap

M: methanol ingestion
U: uric acid
D: iabetic ketoacidosis
P: ropylene glycol/antifreeze
I: nfection
L: actic acidosis
E: thylene glycol
S: alicylates

MHD Block 5: Renal (13 decks)

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