acid base + electrolytes Flashcards
what can cause high oxoproline
- chronic acetaminophen use ( esp if renal failure present)
- pregnancy, malnutrition, vegan –> deplete glycine (which is required for glutathione synthesis)
Anion gap metabolic acidosis etiology w/ incrase osmolar gap
Organic alcohol poisoning:
* Methanol
* Ethylene glycol
* Paraldehyde
* Ketoacidosis (Etoh + Diabetic)
* Lactic acidosis
* Severe CKD
increased osmolar gap without metabolc acidosis
Ethanol
Isopropyl alcohol
Mannitol
Sorbitol
*pseudohyponatremia
*Early toxic alcohol!
Hyperlipidemia
Hyperproteinemia
in organic alcohol intox, what do you see first
osmolar gap or anion gap
- osmolar gap w/o AG
- AG w/o osmolar gap
causes of RTA 1
CTD ( Sjogren»_space; Ra, SLE )
Hypercalciuria
Drugs (ifosfamide)
causes of RTA 2
Fanconi
Myeloma
tenofovir
Acetazolamide
other findings of RTA 1
Calcium phosphate stones
other findings of RTA2
low phospate, low vit d, glycosuria
hco3 levels in type 4 RTA
> 17
rta 4 etiology
- Drugs: aldost antag, RAAS blockers, heparin, CI,
- Adrenal insufficiency
- DB
what to tx with rta 4
florinef if low bp
if htn = thiazide
diabetes can cause which RTA
type 4
if metab alkalosis, with urine CL > 20, what’s the next step
your blood pressure
– HighBP:
* Hyperaldosterone (htn, hypoK, alkalosis, high aldo)
* Liddle’s (htn, hypoK, alkalosis, low aldo) * Cushings
– LowBP:
* Barter’s (mimics Loops – low K, low Mg)
* Gittleman’s (mimics thiazides – low K, low Na, high Ca)
similarities and difference between hyperaldosteronism state and liddle
both : htn, alkalosis, high urine CL, hypoK
difference : liddle has little aldosterone vs hyperaldost has high aldo
another causing urine CL > 20 not related to bp
excess bicarb ingestion
when do you start worrying of urine output (amount) in context of overcorrected hyponatremia ?so what to do?
when UO > 150 ml/hr
DDAVP, D5W
isotonic hyponatremia (280-295) etiology
pseudohypo
- hypertg
- paraprot ( MM)
- obst jaundince
hypertonic osm hyponatremia etiology ( sosm>295)
Mannitol
hyperglycemia
IVIG
if hyponatremia in dialysis patient.. cause?
drinking ++ h20 in between dialysis sessions
causes of nephrogenic DI
- HyperCA
- Lithium
- post resolution of obstruct nephropathy
- Hereditary
how do you test for DID
step 1
- high serum na and low urine osm
- fail water deprivation test
step 2
- provide them with DDAVP and see response to differentiate the subtype
how can you differentiate DI from polydipsia ?
water deprivation test , urine osm rises
also they have hyponatremia, not hypernatremia
hyperosmolarity ( i.e. glucose or mannitol), would cause hyperkalemia or hypokalemia ?
hyperkalemia
harmonize trial says what about K binders
can continue using lokelma/sodium zirconium in CKD to allow RAAS blockade meds
dialyze study says what about K binders
lokelma /sodium zirconium can be used in IHD patients with chronic pre IHD hyperkalemia
risk associated with kayexelate in terms of e+
hypoCa
hypoMg
why impt to check mg with hypokameia
important bcs need mg for function of romk channels to reabsp K in the kidneys
thyrotoxic periodic paralysis can cause what ?
hypokalemia
u waves makes you think of which electrolyte abN ?
hypokalemia
if i tell you chronic K loss in renal and you have met alkalosis, what will you check next ?
BP
aminoglycoside canb lead to which genetic channelopathy ?
bartner
what does renin and aldost look like in barter and gittleman
both high
can use nsaid as tx for barter and gitleman ?
yes
defect in liddle ?
enac mutation –> reabsp too much na –>high bp
*low renin, low aldost
tx for liddle ?
amiloride
K levels in liddle ?
low
nocturnal dips in bp associated with what ?
high risk of cv events
