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Nephrology Board Review > Acid-Base Disorders: Normal Physiology and Compensation > Flashcards

Acid-Base Disorders: Normal Physiology and Compensation Flashcards

1
Q

what is the modified Henderson-Hasselbach equation?

A

H+ = (K+ x pCO2)/HCO3-

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2
Q

where is most of your acid eliminated?

A

lungs

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3
Q

how much HCO3- is reabsorbed in a day w/ a GFR of 120 ml/min?

A

120 ml/min x 1440 min/day x l/1000 ml x 24 mmol/l = 4080 mmol HCO3- filtered/day

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4
Q

causes of NAG metabolic acidosis

A
  • renal causes

- extrarenal causes

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5
Q

renal causes of NAG metabolic acidosis

A
  • distal (type 1) RTA
  • proximal (type 2) RTA
  • hyporenin hypoaldosteronism (type 4) RTA
  • medications (acetazolamide, topiramate, ifosfamide)
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6
Q

extrarenal causes of NAG metabolic acidosis

A
  • diarrhea
  • enterovesical fistula
  • “dilutional”
  • hyperalimentation
  • Addison’s (hypoaldosteronism)
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7
Q

in proximal (type 2) RTA

A

dumping HCO3- in urine

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8
Q

in distal (type 1) RTA

A

impaired ammoniagenesis (low NH4+ excretion)

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9
Q

urine AG

A

urine (Na+ + K+) - (Cl-)

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10
Q

causes of proximal (type 2) RTA

A
  • congenital (cystinosis)
  • medications (acetazolamide, topiramate)
  • acquired; usually Fanconi’s syndrome (glycosuria, aminoaciduria, phosphaturia) from ifosfamide, tenofovir, or MM
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11
Q

symptoms of proximal (type 2) RTA

A
  • asymptomatic
  • hyperventilation as compensation from metabolic acidosis
  • growth restriction in children
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12
Q

tx for proximal (type 2) RTA

A
  • 10-15 meq/kg/day NaHCO3- and/or K+citrate

- +/- PO4 and vitamin d for normal growth in children

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13
Q

causes of distal (type 1) RTA

A
  • hereditary causes

- acquired causes

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14
Q

hereditary causes of distal (type 1) RTA

A
  • AD
  • AR w/ deafness
  • AR w/o deafness
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15
Q

acquired causes of distal (type 1) RTA

A
  • AI causes; Sjögren syndrome, or SLE
  • hypergammaglobulinemia
  • chronic liver disease; primary biliary cholangitis, chronic hepatitis
  • ifosfamide
  • amphotericin B
  • topiramate (can cause both proximal and distal RTA)
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16
Q

signs/symptoms of distal (type 1) RTA

A
  • severe hypokalemia
  • muscle weakness
  • nephrolithiasis (MC calcium PHOS stones)
  • nephrocalcinosis (bone is buffer)
  • alkaline urine
  • hypoCITRATURIA
  • CKD
  • osteopenia
  • growth restriction in children
17
Q

how much K+citrate do you need to neutralize daily net acid load in adult?

A

1-3 meq/kg/day

18
Q

how much K+citrate do you need to neutralize daily net acid load in children?

A

2-5 meq/kg/day

19
Q

serum bicarb in proximal (type 2) RTA

A

14-20 mmol/l

20
Q

serum bicarb in distal (type 1) RTA

A

< 10 mmol/l

21
Q

serum bicarb in hyperkalemic (type 4) RTA

A

16-22 mmol/l

22
Q

UpH in proximal (type 2) RTA

A

5 at steady state

23
Q

K+ in proximal (type 2) RTA

A

LOW

24
Q

tx in proximal (type 2) RTA

A

K+citrate 10-15 mmol/kg/day

25
Q

UpH and UAG in distal (type 1) RTA

A

> 5.5 and positive UAG

26
Q

K+ in distal (type 1) RTA

A

LOW

27
Q

tx in distal (type 1) RTA

A

K+citrate 1-3 mmol/kg/d

28
Q

UpH in hyperkalemic (type 4) RTA

A

5.5-6.5

29
Q

K+ in hyperkalemic (type 4) RTA

A

HIGH

30
Q

tx in hyperkalemic (type 4) RTA

A
  • loop diuretic
  • fludrocortisone
  • NaHCO3
31
Q

AD genetic abnormality in distal (type 1) RTA

A

NaCl exchanger

32
Q

AR genetic abnormality in distal (type 1) RTA

A

B1 and a4 subunits of H+ATPase

33
Q

AR genetic abnormality in proximal (type 2) RTA

A

NaHCO3 cotransporter

34
Q

AR genetic abnormality in distal and proximal (type 3) RTA

A

carbonic anhydrase 2

35
Q

genetic abnormalities in hyperkalemic (type 4) RTA

A
  • pseudohypoaldosteronism type 1; mineralocorticoid receptor, Na+ channel
  • pseudohypoaldosteronism type 2 (Gordon’s) WNK 1 and 4 kinases

Nephrology Board Review (4 decks)

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