First Aid Renal Electrolytes & Acid-Base Flashcards
Di
what 6 things can cause hyperkalemia?
DO Insulin LA(beta)s
- Digitalis
- HyperOsmolarity
- Insulin deficiency
- Lysis of cells
- Acidosis
- Beta-adrenergic antagonist
What four things can cause hypokalemia?
- Hypo-osmolarity
- Insulin (increased Na+/K+ ATPase)
- Alkalosis
- Beta-adrenergic agonist (inc Na+/K+ ATPase)
Low serum sodium
Nausea + malaise, stupor, coma
High serum sodium
Irritability, stupor, coma
Low potassium concentration
U waves on ECG, flattened T waves, arrhythmias, muscle weakness
High potassium concentration
Wide QRS and peaked T waves on ECG, arrhythmias, muscle weakness
Low calcium concentration
Tetany, seizures
High calcium concentration
Stones (renal),
Bones (pain),
Groans (abdominal pain)
Psychiatric overtones (anxiety, altered mental status)
Low magnesium concentration
Tetany, arrhythmias
Tetany from an electrolyte imbalance could be
low calcium
low magnesium
Bone loss and osteomalacia from an electrolyte imbalance
low phosphate
Low phosphate
Bone loss + osteomalacia
High phosphate
Renal stones,
metastatic calcifications,
hypocalcemia
High magnesium
decreased DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia
decreased DTRs, lethargy, bradycardia, hypotension, cardiac arrest, hypocalcemia
High magnesium
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)
<p>
| pH< 7.4 with PaCO2>40</p>
<p>
| Respiratory acidosis</p>
<p>
| pH< 7.4 with PaCO2<40</p>
<p>
| Metabolic acidosis with compensation (hyperventilation)</p>
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
- Loop diuretics
- Vomiting
- Antacid use
- 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”)
