First Aid Renal Electrolytes & Acid-Base Flashcards by Caitriona McGovern

what 6 things can cause hyperkalemia?

DO Insulin LA(beta)s

Digitalis
HyperOsmolarity
Insulin deficiency
Lysis of cells
Acidosis
Beta-adrenergic antagonist

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What four things can cause hypokalemia?

Hypo-osmolarity
Insulin (increased Na+/K+ ATPase)
Alkalosis
Beta-adrenergic agonist (inc Na+/K+ ATPase)

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Low serum sodium

Nausea + malaise, stupor, coma

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High serum sodium

Irritability, stupor, coma

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Low potassium concentration

U waves on ECG, flattened T waves, arrhythmias, muscle weakness

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High potassium concentration

Wide QRS and peaked T waves on ECG, arrhythmias, muscle weakness

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Low calcium concentration

Tetany, seizures

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High calcium concentration

Stones (renal),
Bones (pain),
Groans (abdominal pain)
Psychiatric overtones (anxiety, altered mental status)

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Low magnesium concentration

Tetany, arrhythmias

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Tetany from an electrolyte imbalance could be

low calcium

low magnesium

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Bone loss and osteomalacia from an electrolyte imbalance

low phosphate

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Low phosphate

Bone loss + osteomalacia

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High phosphate

Renal stones,
metastatic calcifications,
hypocalcemia

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High magnesium

decreased DTRs, 
lethargy, 
bradycardia, 
hypotension, 
cardiac arrest, 
hypocalcemia

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decreased DTRs, 
lethargy, 
bradycardia, 
hypotension, 
cardiac arrest, 
hypocalcemia

High magnesium

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Pco2 =1.5 (HC03-) + 8 +/- 2

Winter’s formula - tells you about mixed acid-base

Henderson-Hasselbalch from PCO2

pH = 6.1 + log [HCO3-]/(0.03 x PCO2)

| pH< 7.4 with PaCO2>40

| Respiratory acidosis

| pH< 7.4 with PaCO2<40

| Metabolic acidosis with compensation (hyperventilation)

Respiratory acidosis (hypoventilation)

Airway obstruction
Acute lung disease
Chronic lung disease
Opioids, sedatives
Weakening of respiratory muscles

What is a normal anion gap?

8-12

Increased anion gap metabolic acidosis with respiratory compensation (MUDPILES)

Methanol (formic acid)
Uremia
Diabetic ketoacidosis
Propylene glycol
Iron tables or INH
Lactic acidosis
Ethylene glycol (oxalic acid)
Salicylates (LATE! - it's a respiratory alkalosis first)

Normal anion gap metabolic acidosis with respiratory compensation (HARD-ASS)

Hyperalimentation
Addison’s disease
Renal tubular acidosis
Diarrhea
Acetazolamide (carbonic anhydrase inhibitor)
Spironolactone (aldosterone receptor blocker)
Saline infusion

pH> 7.4, PCO2<40

respiratory alkalosis

causes of respiratory alkalosis

- hyperventilation (early high-altitude exposure) | - salicylate intoxication (early - aspirin makes you hyperventilate!)

pH> 7.4, PCO2 >40

Metabolic alkalosis with respiratory compensation (hypoventilation)

4 causes of metabolic alkalosis

1. Loop diuretics 2. Vomiting 3. Antacid use 4. Hyperaldosteronism

Defect in COLLECTING TUBULE's ability to excrete H+. Untreated patients have urine pH>5.5. Associated with HYPOkalemia. Increased risk for calcium phosphate kidney stones as a result of increased urine pH (alkaluria) and bone resorption

Renal Tubular Acidosis Type I ("proximal")

Defect in proximal tubule HCO3- reabsorption. May be seen with Fanconi's syndrome. Untreated patients typically have urine pH

RTA Type II ("distal")

Hypoaldosteronism or lack of collecting tubule response to aldosterone. The resulting HYPERkalemia impairs ammonia genesis in the proximal tubule leading to decreased buffering capacity and decreased urine pH.

RTA type IV ("hyperkalemic")