Electrolyte abnormalities A/B disorders Flashcards
B. Undiagnosed thyroid disease
C. Thiazide diuretic use
E. Albuterol use
E. Greater than 100 mEq
Below 3.5 mEq/L [K] replace with 10 mEq per 0.1 decrease in concentration. More agressive replacement is required once under a [K] of 3.0 mEq/L
C. 500 mL/hr
Administering KCl through a peripheral line, you generally should not give more than 10-20 mEq/hr. If you need faster administration, central venous access is an appropriate route (up to 40 mEq/hr.)
D. Start bolus of magnesium sulfate
B. Lisinopril
D. Decreased renal tubular flow
E. Digoxin
G. Spironolactone
A. Start normal saline
D. Stop digoxin
E. Administer IV insulin w/ D50
G. Administer calcium gluconate
Giving fluids to dilute potassium and increase distal tubular flow
A. Administer IV calcium chloride
CaCl2 irritates and can damage blood vessels
Stabilizes cardiac myocytes - EKG shows sinusoidal waveform
D. 7.6 mg/dL
A. Sevelamer
Sevelamer is an intestinal binder
(B and C are intestinal potassium binders)
A. Magnesium
D. PTH
E. Vit D
High Mg blocks PTH
Mnemonic used to remember renal tubular acidosis
2,1,4 - low, low, more
Ms. Espinosa is a 38 year old patient who has been admitted to the hospital for acute metabolic acidosis. Her anion gap is 8. She has had no GI symptoms. Her potassium is elevated at 6.3 mEq/L. What is her most likely diagnosis?
Type 4 renal tubular acidosis
Mr. Cox is a 57 year old patient with a previous history of type 2 renal tubular acidosis. He is on oral sodium bicarbonate. Mr. Cox’s primary pathology is with what process?
Bicarbonate reabsorption in the proximal tubule
Ms. Reid is a 42 year old patient who is being admitted to the hospital for metabolic acidosis. Her initial labs are significant for a sodium of 137 mEq/L, a bicarbonate of 16 mEq/L, and a chloride of 99 mEq/L. What is her anion gap?
22
Mr. Dorian is a 28 year old patient who is seeing you for vomiting due to acute gastroenteritis. His labs demonstrate an elevated bicarbonate. You suspect metabolic alkalosis, which is being caused by the loss of what ion in his emesis?
Chloride
A person develops respiratory alkalosis as a result of hyperventilation. If this condition persists, what response would we expect by the kidneys?
An increase in urinary bicarbonate excretion
In states of chronic metabolic acidosis, the metabolism of which of the following amino acids in the proximal tubule is most important in maximizing acid excretion by the kidneys?
Glutamine
What is primary molecule of fixed acid excretion by the kidney?
Ammonium
What is the primary role of filtered phosphate in the context of renal acid-base balance?
The addition of new bicarbonate
Which of the following correctly describes the fate of filtered bicarbonate during its reabsorption in the proximal tubule?
A. It leads to a net gain of bicarbonate in the body
B. It leads to a net loss of H+ from the body
C. It is converted to CO2 and water before being reabsorbed
D. It is the main mechanism of acid excretion by the kidney
C. It is converted to CO2 and water before being reabsorbed
E
It ammonium excretion increased during metabolic alkalosis?
No
Ammonium excretion tends to be reduced as the kidneys prioritize bicarbonate excretion to correct the alkalosis
What is the major site of ammonia synthesis in the nephron?
Proximal convoluted tubule
Ammonia production is increased during metabolic acidosis
What ion can substitute for K+ in ROMK channels, NKCC channels, and Na/K ATPase?
NH4+
B. Metabolic alkalosis
D. Urine chloride
In saline responsive (<20 mEq urine Cl) typically = hypovolemic
Saline unresponsive = euvolemic/hypervolemic
C. Hyperaldosteronism
What type of acid-base imbalance presents with diuretics?
Saline responsive metabolic alkalosis
What type of acid-base imbalance presents with severe vomiting?
Saline responsive metabolic alkalosis
A. Metabolic acidosis
What does the urinary anion gap represent?
Urinary anion gap represents a measure of ammonium (therefore H+) excretion
C. Urine pH 6.5, serum [K] 3.0 mEq/L, uring anion-gap positive
Type 1 RTA - can’t secrete protons in PCT therefore can’t form ammonium in urine
What does a negative urinary anion gap represent?
Elevated ammonium excretion
A. Potassium supplementation
B. Normal saline
D. Insulin
During DKA - there is an extracellular shift of potassium (K-H exchangers) - kidneys start excreting potassium depleting total body potassium over time
As long as potassium is normal - start potassium repletion (otherwise insulin will tank potassium)
B. NS
E. Abx
H. NE
Type A lactic acidosis
due to tissue hypoxia - shock, mesenteric ischemia, respiratory failure, carbon monoxide poisoning
Type B lactic acidosis
Due to impaired mitochondrial oxygen utilization – can include metabolic causes such as diabetes, liver disease, or renal disease, or toxins, such as ethanol and methanol.
What Rx can cause euglycemic DKA?
SGLT-2 inhibitors
