Acid-Base

Question 1

Fanconi Syndrome

Answer 1

PCT reabsorptive defect
Metabolic acidosis (proximal tubular acidosis)

Question 2

Bartter Syndrome

Answer 2

Defect in NKCC (Autosomal Recessive)
HypoKalemia
Metabolic alkalosis
HyperCalciuria

Question 3

Gitelman Syndrome

Answer 3

NC defect (Autosomal Recessive)
Hypokalemia, HypoMagenesemia
Metabolic alkalosis
HypoCalciuria

Question 4

Liddle Syndrome

Answer 4

Gain of function of ENaC in CT (Autosomal Dominant)
Hypertension
HypoKalemia
Metabolic alkalosis
Low aldosterone

Question 5

Syndrome of Apparent Mineralocorticoid Excess

Answer 5

Cortisol can bind mineralocorticoid-R
Hypertension
HypoKalemia
Metabolic alkalosis
Low aldosterone
Acquired from licorice

Question 6

Shifts K+ into cell (hypoKalemia)

Answer 6

Hypoosmolarity
Alkalosis
Beta-agonists (Na/K ATPase increase)
Insulin (Na/K ATPase increase)

Question 7

Shifts K+ out of cell (hyperKalemia)

Answer 7

Digitalis (blocks Na/K ATPase)
Hyperosmolarity
Lysis (tumor lysis, crush, rhabdomyolisis)
Acidosis
Beta-blockers
High blood sugar
Succinylcholine (burns and trauma)

Question 8

Respiratory Acidosis Causes

Answer 8

Airway obstruction
Acute lung injury
Chronic lung injury
Opioids, sedative
Weakening of respiratory muscles

Question 9

Elevated anion gap metabolic acidosis causes

Answer 9

Methanol
Uremia
DKA
Propylene glycol
Isoniazid, iron
Lactic acids
Ethylene glycol
Salicylates (late)

Question 10

Normal anion gap metabolic acidosis causes

Answer 10

Hyperalimentation
Addison's
RTAs
Diarrhea
Acetazolamide
Spironolactone
Saline

Question 11

Respiratory alkalosis causes

Answer 11

Hysteria
Hypoxemia
Salicylates (early)
Tumor
Pulmonary embolism

Question 12

Metabolic alkalosis causes

Answer 12

Loop diuretics
Vomiting
Antacid use
Hyperaldosteromism

Question 13

Type 1 RTA (Distal Tubule)

Answer 13

Normal AG, hyperchloremic metabolic acidosis
Urine pH >5.5
alpha cells can’t secrete H+ (no urine acidification), so no new HCO3- is generated leading to metabolic acidosis
Hypokalemia
Risk of calcium phosphate stones (pH)
Causes: amphotericin B, analgesics, congenitial UT obstruction

Question 14

Type 2 RTA (PCT)

Answer 14

Normal AG, hyperchloremic metabolic acidosis
Urine pH <5.5
Defect in HCO3- reabsorption and increased excretion
Alpha-cells can acidify urine so that’s fine
HypoKalemia
Causes: Fanconi syndrome, CA inhibitors

Question 15

Type 4 RTA (DCT/CD)

Answer 15

Normal AG, hyperchloremic metabolic acidosis
Urine pH <5.5
Caused by hypoaldosteronism which leads to decreased ammonia genesis in the PCT and less NH4+ excretion from an inability to buffer acid in the distal nephron
Alpha-cells also won’t be able to secrete H+
Causes: hypoaldosteronism from inhibition, Addison’s, diabetic hypreninism, ACEIs, ARBs, NSAIDs, heparine, cyclosporine) Also aldo. resistance (Spironolactone, obstruction, Bactrim)