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Renal 2 Final > Clinical Medicine part 2 > Flashcards

Clinical Medicine part 2 Flashcards

1
Q

Causes of Hypoxia

A
  • hypoventilation
  • V/Q mismatch as seen in pulmonary embolus
  • shunting e.g. cardiac anomalies
  • low inspired fraction of O2
  • high altitude
  • diffusion abnormalities e.g. alveolar hemorrhage, connective tissue disorder
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2
Q

Metabolic Acidosis Expected Compensation

A

-1.5HCO + 8 (+/-2)

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3
Q

If pH and PCO2 change in same direction, the process is

A

metabolic

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4
Q

If PH and PCO2 change in opposite directions, the process is

A

respiratory

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5
Q

Anion Gap

A

Na-(Cl + HCO3)

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6
Q

Metabolica acidosis

A
  • decrease in extracellular pH caused by a decrease in HCO3
  • loss of HCO from GI tract, renal
  • increase H+ load–DKA or lactic acidosis
  • Decrease H+ excretion by kidney–uremic acidosis or RTA
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7
Q

High Anion Gap Acidosis

A
  • MUDPILES

- CCAT

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8
Q

High Anion Gap Acidosis

M

A

methanol–formic Acid

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9
Q

High Anion Gap Acidosis

U

A

uremia (renal failure)

  • increased BUN, creatinine
  • increased sulfates, phosphate as unmeasured anions
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10
Q

High Anion Gap Acidosis

D

A

diabetic ketosis

  • increased glucose; starvation, alcohol abuse
  • acetoacetic acid, B-hydroxybutyric acid
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11
Q

High Anion Gap Acidosis

P

A

paraldehyde

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12
Q

High Anion Gap Acidosis

I

A
  • INH, iron

- isoniazid taken after PPd result comes back positive for TB!

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13
Q

High Anion Gap Acidosis

L

A

-lactic acid–shock, sepsis, low perfusion, marathon runners

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14
Q

High Anion Gap Acidosis

E

A

ethylene glycol

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15
Q

High Anion Gap Acidosis

S

A

salicylates

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16
Q

High Anion Gap Acidosis

CCAT

A

-CO, cyanide, alcohol, toluene

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17
Q

Lactic Acidosis Type A

A
  • tissue hypoxia

- shock, severe anemia, herat failure, CO poisoning

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18
Q

Lactic Acidosis Type B1

A
  • associated with systemic disorders

- DM, liver failure, sepsis, seizures

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19
Q

Lactic Acidosis Type B2

A
  • associated with drugs/toxins

- ethanol, methanol, ethylene glycol, ASA

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20
Q

Lactic Acid Type B3

A
  • associated with inborn errors of metabolism

- G6PD deficiency

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21
Q

Normal anion gap metabolic acidosis

A

-HCO3 falls and Cl rises
-hyperchloremic metabolic acidosis
HARDUPS

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22
Q

Normal anion gap metabolic acidosis

H

A

hyperalimentation (nutrition support)

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23
Q

Normal anion gap metabolic acidosis

A

A

acid infusion, acetazolamide

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24
Q

Normal anion gap metabolic acidosis

R

A

Renal Tubular Acidosis-renal loss of HCO3/or decreased H+ secretion

25
Normal anion gap metabolic acidosis | D
diarrhea--losing HCO3, decreased K
26
Normal anion gap metabolic acidosis | U
-uretheral sigmoid or ileal diversion--losing HCO3/increased Cl and H+ resorption
27
Normal anion gap metabolic acidosis | P
pancreatic fistula--losing HCO3, decreased K+
28
Normal anion gap metabolic acidosis | S
Spironolactone
29
Distal Renal Tubular Acidosis
- decreased secretion of H+, so not getting rid of acid, i.e. "failure to acidify urine" (type I) - SLE, Sjogrens, toluenes
30
Proximal Renal Tubular Acidosis
- decreased absorption of HCO, so not absorbing buffer - Type II - multiple myeloma, heavy metal poisoning, wilson's disease, amyloidosis
31
Hyperkalemic renal tubular acidosis
- Hyporenin and hypoaldosterone - decreased NH4 excretion and decreased HCO3 production - Type 4 - analgesic nephropathy, sickly cell disease, and SLE
32
Treatment of Metabolic Acidosis
Treat underlying cause | treat CV compromise; pH
33
Metabolic Alkalosis
- increased pH, increased HCO3, increased CO2 - compensate paCO2 increase 0.7 for every 1 increase in HCO3 - Cl loss or HCO3 excess - volume contraction
34
Cl loss
-vomiting, N/G suction, villous adenoma, diuretics
35
HCO3 excess
-enhanced HCO3 resorption (hyperaldosteronism, licorice excess)
36
Metabolic Alkalosis Causes
CLEVER PD
37
Metabolic Alkalosis | C
Contraction of volume
38
Metabolic Alkalosis | L
licorice
39
Metabolic Alkalosis | E
endocrine (Conns, Cushings, Bartters)
40
Metabolic Alkalosis | V
vomiting
41
Metabolic Alkalosis | E
excess alkali
42
Metabolic Alkalosis | R
refeeding alkalosis
43
Metabolic Alkalosis | P
post hypercapnia
44
Metabolic Alkalosis | D
diuretics
45
Chloride Responsive metabolic alkalosis
- urine Cl- less than 10-20 - improves with NaCl and volume - decreased serum Cl- and volume contraction - vomiting, NG suction, diuretics
46
Chloride Unresponsive metabolic alkalosis
- urine Cl- less than 10-20 - unresponsive to saline - endocrine causes: bartters, severe K depletion, hyperaldosteronism, Cushings
47
Treatment of Metabolic Alkalosis
- treat underlying cause - NaCl, KCl, magnesium - spironolactone for mineralocorticoid excess
48
Hypokalemia ECG findings
- flattened T wave | - ST depression
49
Hyperkalemia ECG findings
- peaked T wave - widened QRS - loss of P wave
50
Conn's Syndrome
- primary hyperaldosteronism - mineralocorticoid excess - saline resistant (urine Cl- >20) - increased HCO3 excretion in urine
51
Respiratory Acidosis
- decreased pH, increased CO2, increased HCO3 - anything that causes hypoventilation - CNS depression--drugs, CVA, neuromuscular airway obstruction, pneumonia, pulmonary edema, pneumothorax, pleural disease, COPD, restrictive disease (disorders of the chest wall, respiratory muscles)
52
Respiratory Alkalosis
- increased pH, decreased CO2, decreased HCO3 - anything that causes hyperventilation - CHAMPS
53
Respiratory Alkalosis | C
CNS disease
54
Respiratory Alkalosis | H
hypoxia
55
Respiratory Alkalosis | A
anxiety
56
Respiratory Alkalosis | M
mechanical ventilation
57
Respiratory Alkalosis | P
progesterone
58
Respiratory Alkalosis | S
salicylates, sepsis, stress

Renal 2 Final (5 decks)

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