First Aid Renal Electrolytes & Acid-Base

Question 1

what 6 things can cause hyperkalemia?

Answer 1

DO Insulin LA(beta)s

1. Digitalis
2. HyperOsmolarity
3. Insulin deficiency
4. Lysis of cells
5. Acidosis
6. Beta-adrenergic antagonist

Question 2

What four things can cause hypokalemia?

Answer 2

1. Hypo-osmolarity
2. Insulin (increased Na+/K+ ATPase)
3. Alkalosis
4. Beta-adrenergic agonist (inc Na+/K+ ATPase)

Question 3

Low serum sodium

Answer 3

Nausea + malaise, stupor, coma

Question 4

High serum sodium

Answer 4

Irritability, stupor, coma

Question 5

Low potassium concentration

Answer 5

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

Question 6

High potassium concentration

Answer 6

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

Question 7

Low calcium concentration

Answer 7

Tetany, seizures

Question 8

High calcium concentration

Answer 8

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

Question 9

Low magnesium concentration

Answer 9

Tetany, arrhythmias

Question 10

Tetany from an electrolyte imbalance could be

Answer 10

low calcium

low magnesium

Question 11

Bone loss and osteomalacia from an electrolyte imbalance

Answer 11

low phosphate

Question 12

Low phosphate

Answer 12

Bone loss + osteomalacia

Question 13

High phosphate

Answer 13

Renal stones,
metastatic calcifications,
hypocalcemia

Question 14

High magnesium

Answer 14

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

Question 15

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

Answer 15

High magnesium

Question 16

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

Answer 16

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

Question 17

Henderson-Hasselbalch from PCO2

Answer 17

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

Question 18

<p>

| pH< 7.4 with PaCO2>40</p>

Answer 18

<p>

| Respiratory acidosis</p>

Question 19

<p>

| pH< 7.4 with PaCO2<40</p>

Answer 19

<p>

| Metabolic acidosis with compensation (hyperventilation)</p>

Question 20

Respiratory acidosis (hypoventilation)

Answer 20

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

Question 21

What is a normal anion gap?

Answer 21

8-12

Question 22

Increased anion gap metabolic acidosis with respiratory compensation (MUDPILES)

Answer 22

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)

Question 23

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

Answer 23

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

Question 24

pH> 7.4, PCO2<40

Answer 24

respiratory alkalosis

Question 25

causes of respiratory alkalosis

Answer 25

• hyperventilation (early high-altitude exposure)

- salicylate intoxication (early - aspirin makes you hyperventilate!)

Question 26

pH> 7.4, PCO2 >40

Answer 26

Metabolic alkalosis with respiratory compensation (hypoventilation)

Question 27

4 causes of metabolic alkalosis

Answer 27

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

Question 28

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

Answer 28

Renal Tubular Acidosis Type I (“proximal”)

Question 29

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

Answer 29

RTA Type II (“distal”)

Question 30

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.

Answer 30

RTA type IV (“hyperkalemic”)