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GU Block 1 Flashcards

1
Q

Where are kidneys and ureters located withing the body?

What are the 3 external layers covering the kidney?

A

Retroperitoneal, T11-L3

Fascia Adipose Capsules

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2
Q

What are the 3 internal layers of the kidneys

What is the functional organ, tissue and unit of the GU/kidney?

A

Cortex Medulla Pelvis

Kidney, Parenchyma, Nephron

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3
Q

Where do vessels and nerve structures enter/leave the kidney?

What is the path of blood to and from the kidney

A

Hilum

Abdominal aorta
Renal artery
Afferent arterioles
Glomerulus
Efferent arterioles
Peritubular capillaries
Vasa recta
Renal vein
IVC
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4
Q

What part of the NS regulates filtration and urine formation?

What other process is innervated here?

A

Sympathetic: superior mesenteric, innervates arterioles

RAAS- dec BP
Renin secretion- inc BP

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5
Q

What does a nephron consist of?

Where do ACEIs/ARBS exert their effects?

A 
Renal corpuscle (glomerulus, Bowmans)
Renal tubules (PCT, LoH, DCT)

Afferent arteriole

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6
Q

What are the 8 major functions of the kidneys?

A 
Regulate blood ions, pH, volume
BP regulation
Maintain blood osmolarity
Produce hormones
Regulate blood glucose
Excrete wastes
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7
Q

Kidneys regulate blood levels of what 5 E+

Where is renin secreted from and leads to ? result?

A

Na K Ca Cl PO4

Juxtaglomerular cells
Inc BP

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8
Q

Kidneys maintain blood osmolarity at ?

What are the two hormones produced in the kidneys?

A

300/L

Calcitriol- active form of Vit D, regulates PO4/Ca
EPO- stim production of RBCs in marrow

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9
Q

Production of urine is the end result of what 3 processes?

Define Glomerular Filtrate

A

Glomerular filtration
Tubular reabsorption
Tubular secretion

Fluid entering capsular space

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10
Q

What are the 3 components of glomerular filtration membrane?

A

Fenestrations- allows proteins/excludes cells/platelets

Basal lamina- allows small/med proteins through

Slit membrane- located between pedicels, only allows very small proteins through

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11
Q

Define Filtration Fraction

How much blood flows through kidneys?

How much GFR flows through kidneys each day?

A

Ratio of fluid from blood that becomes glomerular filtrate- 20% of total fluid reaching kidney becomes capsular space

1-1.2L/min

140-180L/day

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12
Q

What is a normal net filtration pressure w/in kidneys?

What are the 3 pressures and the changes occurring during glomerular filtration

A

10mmHg

Glomerular hydrostatic- 55mmHg
Capsular hydrostatic- 15mmHg
Blood colloid- 30mmHG

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13
Q

Water makes up 95% of urine, how much Na and K is found normally?

What is the fluid capacity of the bladder?

A

Na- 1g/L
K- 0.75g/L

700-800mL

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14
Q

What are the 3 layers of the bladder?

A

Mucosa- transitional epitherlium

Muscularis- detrusor

Serosa- superior surface covering or,

Adventitia- covers post/inf surface and continuous w/ ureters

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15
Q

2/3 of body water is ? and remaining 1/3 is ?

Of the 1/3 part, how much is intravascular?

A

2/3: intracellular
1/3: extracellular

1/4

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16
Q

Define Osmolality

Define Osmolarity

A

Solution concentration expressed as total solute particles/kg

Solution concentration expressed as total milimoles/L

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17
Q

Fat’s water content is ? than muscle

This is why obese people’s ratio is ?

A

Lower than muscle

Lower ratio of total body water to body weight

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18
Q

Define Tonicity

A solution’s tonicity is related to its ?

A

Ability of extracellular solution to make water move in/out of cell via osmosis

Osmolarity, total concentration of all solutes in a solution

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19
Q

Define Hypotonic

Define Isotonic

Define Hypertonic

A

ECF w/ lower osmolarity than the ICF, net flow is into cell

Same osmolarity between ICF/ECF w/ no water movement

ECF w/ higher osmolarity than inside the cell, water moves out of cell

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20
Q

What is the gold standard for evaluating renal E+ excretion?

What is a better method?

A

24hr urine collection

Fractional excretion of an E+ from spot urine samples

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21
Q

What does a Low FEx indicate?

What does a High FEx indicate?

A

Renal absorption, high avidity/E+ retention

Renal wasting, low avidity/E+ excretion

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22
Q

What does an FEx below 1% mean?

What does an FEx above 2% mean?

A

Pre-renal Dz (low output HF)

Acute tubular necrosis

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23
Q

What is the natural physiologic response to a decrease in renal perfusion?

Why is the natural response of sodium wasting seen w/ high FEx

A

Inc Na reabsorption

Tubular necrosis causes loss of Na/hypervolemia

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24
Q

Physiologic solute concentration is normally between ?

Define Tonicity

A

285-295mmol/kg

Osmolytes that are impermeable to cell membranes

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25
Q

Define Ineffective Osmoles

What is the major extracellular cation

A

Substances that easily permeate cell membranes and don’t contribute to tonicity and don’t cause shifts across compartments

Na

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26
Q

Define Osmolal gap

What does the presence of this gap suggest?

A

Discrepancy between measured and estimated osmolality more than 10mmol/kg

Presence of unmeasured osmoles- ethanol, methanol, ethylene glycol, mannitol, propylene glycol and isopropanol

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27
Q

Normally, how many mosmols need to be excreted each day?

What is the max urine osmolality?

What is the minimum urine output required for neural solute balance

A

60

1200mosmol/kg

500mL/day

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28
Q

Obligatory renal water loss is mandated by ?

How is serum sodium calculated

A

Minimum solute excretion required to maintain a steady state

Exchangeable Na + Exchangeable K/ Total body water

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29
Q

What is the primary stimulus for water ingestion?

What mediates this stimulus

A

Thirst

Inc effective osmolality
Dec ECF volume

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30
Q

Osmoreceptors are stimulated by ?

What is the average osmotic threshold for thirst?

A

Rise in tonicity

295 mosmol/kg

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31
Q

What is the major stimulus for ADH release

Osmolality is primarily determined by ?

A

Hypertonicity

Na concentrations

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32
Q

What are the 3 steps required for maintaining homeostasis and normal plasma Na

A

Filtration, delivery of water/E+ to diluting site of nephron

Active reabsoprtion of Na/Cl w/out water in ascending LoH

Maintenance of dilute urine due to CD impermeability if no ADH is present

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33
Q

Hypotonic fluids often contribute to hospitalized PTs acquiring ?

Hyponatremia start at ? level and reflects ?

A

Hyponatremia- MC E+ abnormality in hospitalized PTs from too much IV fluid

<135mEq
Excess water relative to Na levels

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34
Q

Define Isotonic Hyponatermia

What two conditions can this occur in?

A

Pseudohyponatremia- lab error underestimating Na concentrations

Hyperlipidemia
Hyperproteinemia

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35
Q

Pseudohyponatremia does not occur if serum Na is measured by ?

Hypertonic Hyponatremia is AKA and defined as ?

What type of result does this cause?

A

Ion specific electrode in direct assay of undiluted serum specimen

Translocational Hyponatremia- large amounts of substance can’t cross membrane, added to ECF compartment

Pulls intracellular water into ECF, dilutes sodium

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36
Q

What are two examples of Hypertonic hyponatremia etiologies

What type of d/o is this?

A

Hyperglycemia
Iatrogenic mannitol administration

Water redistributing in response to change of tonicity

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37
Q

Most causes of hyponatremia are ?

What are the 3 categories

A

Hypotonic

Hypovolemic Hypo Hypo
Euvolemic Hypo Hypo- STREP
Hypervolemic Hypo Hypo

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38
Q

Hypovolemic Hypotonic Hyponatremia

A

Occurs d/t extra/renal volume loss w/ hypotonic replacement

Total Na and water dec
ADH release= retained water

Osmolality sacrificed to preserve intravascular volume

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39
Q

What urine Na results indicate if volume loss is renal or extrarenal?

SIADH

A

Renal: >20 mEq
Extra: <10 mEq

Hypo Hypo Hypo
ADH released d/t hyperosmolality/dec arterial volume
Inappropriate water retained= concentrated urine (+300mEq) w/ high Na (>20mEq)

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40
Q

What are 3 common causes of Hypo Hypo Hypo-SIADH

Hypo Hypo Hypo- Hormonal abnormalities

A

CNS Pulm d/o and Malignancy

Severe hypothyroid and glucocorticoid insufficiency; can NOT be differentiated from SIADH w/ urine/serum results

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41
Q

Hypo Hypo Hypo Psychogenic Polydipsia and Low Solute diet

Hypo Hypo Hypo- Reset Osmostat

A

PT ingests normal solute diet but also 10-15L of water; kidney retain water, can’t excrete pure water

Appropriate ADH response to water deprivation/fluid challenges (pregnancy)

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42
Q

Hypo Hypo Hypo Exercise associated

Why are sports drinks not actually that good?

A

Combo of excessive hypotonic intake w/ inappropriate ADH secretion (basic trainee forced hydration)

Hypotonic compared to serum

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43
Q

Hypervolemic Hypotonic Hyponatremia

A

Cirrhosis, HF, Nephrotic syndrome, Adv KDz

Cirr/HF- dec volume from dilation/dec output causes ADH secretion

Dec osmolality in attempt to restore arterial volume

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44
Q

What are the Sxs of hyponatremia

What causes more severe Sxs

What labs would be considered?

A

Mainly neuro/brain edema
Mild 130-135: gait fall Fx
Sev <120: seizure herniation coma death

Sudden/rapid E+ shifts

Serum: E+ Cr Osmolality
Urine: Na K Osmolality
Thyroid/Adrenal function

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45
Q

What will be seen on lab results to Dx SIADH

What will be seen on lab results in Pseudohypnatremia and how is it Tx

A 
Normal thyroid/adrenal function
Urine Na >20mEq
Dec BUN <5-10mg
Hypouricemia <4mg
ADH levels not required

HyperTG, Hyperproteinemia
No Tx req’d

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46
Q

How is Translocational Hyponatremia Tx

How fast does chronic hypotonic hyponatremia need to be corrected?

What can happen if Tx is too fast?

A

Tx hyperglycemia, d/c Mannitol

4-6mEq/L/24hrs
No more than 6-8/24

Osmotic demyelination syndrome (central pontine myelitis)

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47
Q

If hyponatremia is Tx too quickly, what S/Sxs will be seen?

What is the adverse outcome of Tx Translocational HypoNa too quickly?

A

Flaccid paralysis Dysarthria
Dysphagia

Rapid reduction of osmolality= cerebral edema

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48
Q

How is Hypovolemic HypoNa Tx

How is Hypotonic Hpervol HypoNa Tx

A

Isotonic fluids to suppress hypovolume stimulus to release ADH

Loop diuretics
PTs w/ A/CKDz- dialysis

49
Q

How is Psychogenic Hypo Euvo Hypo Tx

How is Hypo Euvo Hypo 2* to SIADH Tx

A

Psych- Water restriction
Low solute diet- water restriction, inc solute diet

Fluid restriction
D/c offender
Furosemide/Demelocycline
Sxs/resistant- vasopressin 2 antagonist (Tolvaptain)

50
Q

Do these PTs stay in fluid restricted status when taking Tolvaptain?

How are PTs w/ Sxs or severe hyponatremia Tx

How are PTs w/ chronic hyponatremia Tx to avoid demyelination?

A

No fluid restrictions, can lead to excessive Na correction

Admit Consult D/c
Seizures= 100mL 3% saline across 10min for Sx relief
24hr correction 4-6mEq

100mL 3% at 0.5-5mL/kg/hr

51
Q

When Tx HypoNa, what finding may signal excess ADH secretion has stopped and PT is at risk for over correction

What class of med is added to Tx of HypoNa in PTs w/ CHF?

A

High hourly urine output

Vasopressin 2

52
Q

How are PTs w/ seizure/coma from HypoNa Tx

A 
100mL 3% over 10-15min
Measure levels, stop at 5mEq
Rpt, max of 300mL
KLO w/ 0.9% NS
Max increase of 8mEq in first 24hrs
53
Q

Causes of Isotonic HypoNa

Causes of Hyper Hypo

A

Hyperproteinemia
Hyperlipidemia

Hyperglycemia
Mannitol
Contrast

54
Q

Causes of Hypo Hypo w/ <10 mEq

Causes of Hypo Hypo w/ >20

A

GI Skin 3rd space

Diuretic Nephropathies
Mineralcorticoid deficiency
CSWSyndrome

55
Q

Causes of Hypo Euvolume

Causes of HypoNa HyperVol

A

<100: Pysch, low solute diet
>100: SIAD Hypothyroid Glucocorticoid deficiency
Variable- reset osmostat

HF Cirrhosis Nephrotic syndrome AKDz

56
Q

When do PTs w/ HypoNa need to be referred?

What are the two main defenses against hypernatremia?

What is used to differentiate renal/non-renal water loss?

A

Severe Sxs
Hypertonic V2 dialysi
Severe liver/heart dz

Inc thirst/water intake

Urine osmolality

57
Q

What is the defining criteria for HyperNa

All PTs w/ hypernatremia have ? which usually stimulates ? responses

A

> 145mEq

Hyperosmolality- usually triggers ADH and thirst

58
Q

What is a less common form of HyperNa that occurs in hospitalized PTs

What type of HyperNa is usually mild and ASx

A

Hypervolemic HyperNa

HyerpNa in Primary aldosteronism

59
Q

What is a renal cause of HyperNa?

What are two non-renal causes of HyperNa?

A

Diabetes insipidus

GI loss
Burns

60
Q

S/Sxs of HyperNa

A

Lethargy Irritable Weak= early signs

Hyperthermia Delirium Seizure/Coma in severe

61
Q

Since all PTs w/ HyperNa are hyperosmolality too, what S/Sxs are seen at different osmolality ranges?

HyperNa lab results showing urine osmolality is >400 can point to ? non/renal etiologies

A

320-330: somnolence, confusion
340-350: coma death

Non-renal: low intake, hypotonic fluid loss
Renal- glycosuria

62
Q

HyperNa lab results showing urine osmolality <250 can be due to ? issues

What are some common causes?

A

Diabetes insipidus-
Central: dec ADH release
Nephrogenic: ADH insensitivity

Lithium Demecyocycline
Obstruction relief
Interstitial nephritis
HyperCa/HypoK

63
Q

What happens if HyperNa is Tx too quickly

What is the fluid Tx of choice for hyperna w/ hypo volume

A

Cerebral edema
Neuro impairment

Isotonic to restore volume then hypotonic
PO water is excellent

64
Q

How is HyperNa w/ Euvolume Tx

What caution needs to be taken when treating PTs w/ dec GFR?

A

Water ingestion
IV 5% dextrose

Adding diuretic may increase Na excretion, but impair renal concentration

65
Q

How is HyperNa w/ Hypervolume Tx

How is acute hyperNa Tx

A

5% dextrose to red hyperosmolality
Loop diuretics to promote urination/lower Na
Possible dialysis

5% dextrose if lost free water
Continue therapy w/ 0.45%NS w/ dextrose

66
Q

How is chronic HyperNa Tx

In HyperNa, total body water is ? in men and ? in women

A

W/ goal to restore 140mEq
Max Na correction- 10mEq/day
PO water preferred if safe or,
5% dextrose IV

M: 50% x kg
F: 40% x kg

67
Q

When do Pts w/ HyperNa need to be referred or admitted

Equation for free water deficit

A

Refer: refractory/unexplained
Admit: symptomatic

TBW * Na-140/140
M- 50%
W- 40%

68
Q

What is used to distinguish renal from non-renal cause of K loss

What is the MC cause of K

A

Transtubular K concentration gradient

GI- infectious diarrhea

69
Q

HypoK and acidosis suggests ?

What two med classes need to be avoided to decrease risk of arrhythmias

A

Profound K depletion

B 2 agonists and diuretics

70
Q

HypoK increases chances of ? toxicity

What needs to be considered in PTs w/ hypoK that is refractory to Tx

A

Digitalis

HypoMg

71
Q

Low k+ can lead to what 2 adverse events

? drug can cause substantial renal loss of K

A

Arrythmias
Rhabdo

Loop diuretics

72
Q

S/Sxs of mild HypoK

The presence of HTN may indicate there is excess of ?

A

Mild: Weak Fatigue Cramps
Sev: flaccid paralysis hyporeflexia hypercapnia

Aldosterone
Mineralcorticiods

73
Q

What are renal manifestations of hypoK

If working up HypoK, what is seen on urine results?

A

Nephrogenic Di
Interstitial nephritis

Low: extra renal loss, V/D
High: mineral corticoid excess

74
Q

What does a Transtubular K Gradient TTKG >4 indicate?

What will be seen on EKG?

A

K+ loss w/ inc distal K secretion

Dec amplitude
Broad T w/ U waves
Premature V contractions
Depressed ST segments

75
Q

How is HypoK Tx

A

PO- safest/easiest for mild/mod

IV 40mEq if severe/non-PO w/ constant EKG monitoring

Avoid glucose fluids

Check Mg if refractory

76
Q

When is HypoK referred or admitted

How can PTs develop acquired HyperK

A

R: unexplained refractory alternative Dx
A: Sx and Severe- cardiac manifestations

ACEI/ARB
K+ sparing diuretics

77
Q

What is the ratio of K+ inc to pH inc

Persistent mild HyperK w/out presence of ACEI/ARB is usually due to ?

A

K inc 0.7/0.1pH inc

Type 4 tubular acidosis

78
Q

S/Sxs of HyperK

What is the first step in Dx

A

Flaccid paralysis
Weakness
Ileus

Repeat labs, especially if no meds are present

79
Q

What are the indications to Tx HyperK urgently

How is HyperK urgently Tx

A

Cardiac toxicity
Muscle paralysis
>6.5

Insulin BiCarb B-agonist
Dialysis if A/CKDz

80
Q

Name of medication used to Tx HyperK in PTs w/ CKD and already on drug that inhibits RAAS

MOA of CaGluconate

MOA of BiCarb, Insulin and Albuterol

A

Patiromer

Antagonize cardiac conduction

Distributes K into cells

81
Q

Of the 4 meds used to Tx HyperK, do any remove K from body

When are HyperK PTs referred/admitted

A

No, all shift K into cells
Ca only one that DOESNT shift K to cells

R: HyperK from renals Dz and reduced K excretion
A: >5.5, any EKG changes or Concomitant

82
Q

What can cause PTs to develop HypoCa

MC cause of low total serum Ca is ?

What is the most accurate method of measuring

A

Dec PTH VitD or Mg

Hypoalbuminemia

Ionized Ca concentration

83
Q

True HypoCa indicated insufficient action of ?

What is the MC cause of HypCa

A

PTH or Vit D

Adv CKDz- dec Vit D3 production and Hyperphosphatemia catalyze

84
Q

S/Sxs of HypoCa

What EKG changes will be seen?

A

Cramps Spasms Convulsions
Chvostek sign
Trousseau sign

QT prolongation predisposes ventricular arrhythmias

85
Q

How does serum phosphate present during HypoCa

What other E+ is commonly low in HypoCa

A

Inc in hyperparathyroidism/adv KDz
Dec early CKDz or Vit D deficiency

Mg

86
Q

How is Sx/Sev HypoCa Tx

How is ASx HypoCa Tx

A

10-15mg Ca/kg
Monitor serum q4-6hrs

PO Ca and Vit D/sterols
Monitor urinary Ca excretion

87
Q

When is HypoCa referred/admitted

What are the MC causes of HyperCa

A

R: Complicated from hyperparathyroid, familial hypoCa or CKDz
A: PTs w/ tetany, arrhythmia seizure or severe

ASx/Mild: Hyperparathyroid
Sev: Malignancy related HyperCa

88
Q

What PE/lab finding may be seen indicating pending hypercalcemia

HyperCa levels above ? usually indicate malignancy

A

Hypercalciuria

> 14mg

89
Q

What is the MC cause of hyperCa in ambulatory PTs

What type of HyperCa presentation suggest benign cases

A

Primary hyperparathyroidism

Chronic
Nephrolithiasis

90
Q

What is the MC paraneoplastic endocrine syndrome

What is this the MC cause of

A

Tumor producing PTH related proteins

HyperCa in InPts

91
Q

How/why do granulomatous Dzs cause HyperCa

Define Milk-Alkali Syndrome

A

Sacroidosis/TB cause HyperCa via overproduction of active Vit D3

Ca ingestion to prevent osteoporosis causes AKI from renal constriction

92
Q

Sxs usually appear when Ca levels pass ?

What Sxs may be seen in mild cases?

What is seen in severe cases

A

> 12mg

ASx, constipation N/V anorexia

Weak Drowsy Coma Death

93
Q

What are clinical findings seen w/ HyperCa

A

Ionized Ca >1.32

Hyperparathyroid- high serum Cl, low serum phosphate

Mild Alkali syndrome- low Cl, high BiCarb- Hypocalciuric Hypercalcemia

Malignancy- >14mg

94
Q

How to differentiate Hyperthyroid or malignancy induced HyperCa

How is HyperCa Tx

A

Hyperthyroid- inc PTH
Malignancy- dec PTH, inc PTHrP

Promote excretion- calciuresis
Dec volume but normal Heart/kidney- 0.9% NS

95
Q

What is the Tx of Choice for malignancy inducer HyperCa

Kidney is most important regulator of serum ?

A

Bisphosphonates, take 72hrs
Calcitonin as bridge

Phosphate levels

96
Q

If need to measure serum phosphate is needed, what does PT need to do

What PT population is severe hypophosphatemia commonly seen in?

A

Fasting, phosphate decreases w/ food intake

Alcoholics

97
Q

What will be seen on lab findings when investigating hypophosphatemia

How is hypophosphatemia Tx

A

Urine excretion <100mg/day

If PT has DKA- diet
POR replacement preferred
Chronic- PO repletion mixture of Na/K phosphate
Severe Sx- infusions

98
Q

S/Sxs of acute/severe hypophosphatemia

S/Sxs of chronic/sev hypophosphatemia

What are c/is to replacing phosphate to Tx hypophosphatemia

A

Rhabdo Encephalotphaty Parasthesis

Fx Anorexia Pain

Hypoparathyroid
Advanced CKD
Tissue damage/necrosis
Hypercalcemia

99
Q

What is the MC cause of hyperphosphatemia

How can hyperphophatemia be Tx

A

Advanced CKD w/ dec urinary excretion

Dec dietary intake
Phosphate binders- Ca carbonate/acetate
Dialysis if A/CKDz

100
Q

If dec Mg levels are suspected, what is the first lab ordered?

Low levels can manifest w/ ? Sxs

Low Mg will impair the release of ? endocrine hormone?

A

Urine

Neuro Sxs
Arrhythmias

PTH

101
Q

What are etiologies of HypoMg

Since HypoMg also suppresses PTH, what other issues will be seen?

A

Diuretics Diarrhea Alcoholism
Aminoglycosides Amphotericin

Organ resistance to PTH and dec Vit D3 levels= HypoCa that is refractory to Ca Tx methods

102
Q

S/Sxs of HypoMg

How is it Tx

A

HypoCa/HypoK
Babinksi response
Athetoid movement
HTN/Tachy

Chronic- Mg Oxide
Sx- Mg sulfate

103
Q

What are two potential exogenous sources of HyperMg

What are the characteristic manifestations of HyperMg

A

Antacids
Laxatives

Weak, Dec DTRs, Confusion

104
Q

What is seen on lab results for HyperMg

What is seen on EKG

A

Inc MG
If Pt has CKD- inc BUN, Cr, K, PO4 and Uric acid
Low Ca

Inc PR interval
Broad QRS
Peaked T waves d/t HyperK

105
Q

How is HyperMg Tx

In order to assess PTs acid-base status, what 3 things need to be measured?

A

IV Ca chloride
Dialysis if severe CKDz

Arterial pH, PCo2- blood gas analyzer
Plasma BiCarb

106
Q

Since arterial and venous blood gases won’t be equivalent during cardiopulmonary arrest, where/what are the most accurate measurements?

Acidotic is below ? w/ ? PCo2 and BiCarb measurements

A

Arterial pH and PCO2

<7.40
PCO2 <40
BiCarb >24

107
Q

There can be mixed acid-base d/os but there will never be ?

What are the 5 steps of determining acid-base d/os

A

Two primary respiratory d/os

Primary d/o, met/resp
Presence of mixed d/o
Calculate anion gap
Calculate corrected BiCarb concentration
Examine PT
108
Q

What is the Anion Gap formula

What are the two reasons for calculating anion gaps?

A

Gap= Na - (HCO3 + Cl)

ID abnormal gap w/ normal E+
Gap >20 suggest primary metabolic regardless of pH/bicarb, abnormal anion gap is never compensatory response to respiratory d/o

109
Q

A wide anion gap means there are ? located in the ?

What 3 issues form the largest anion gaps?

A

Unaccounted ions in serum

Lactic acidosis
Ketacidosis
Toxins

110
Q

Metabolic acidosis w/ normal anion gap is caused by what 2 issues

How can the cause be distinguished?

A

GI BiCarb loss or RTA

Urine anion gap

111
Q

What is the hallmark of metabolic acidosis

What underlying issues can cause the interpretation of the anion gap to be more difficult

A

Dec BiCarb

Hypalbumin
ABX
Reduction unmeasured anion/
Inc unmeasured cations

112
Q

What effect does hypoalbuminemia have on an anion gap?

What are the 4 principle causes of inc anion gap metabolic acidosis

A

2 mEq dec in gap occurs for every 1g decline of albumin

Lactic acidosis
Ketacidosis
Ingested toxins
Acute/chronic renal failure

113
Q

What effect does uremia have on an anion gap?

What type of gap does lactic acidosis create?

? types of PTs may present w/ Type B Lactic Acidosis

A

Inc gap

Elevated gap, dec pH w/out other acid-base disturbances

UnDx/poorly controlled DM
Alcholics
PTs in shock

114
Q

What type of gap does DKA create

What two pieces of info are used to monitor/track PT improvement during Tx

A

Hyperglycemia, acidosis and inc gap

Clinical status
pH

115
Q

What are the 3 types of metabolic acidosis seen in alcoholic PTs

What type of anion gap can develop from volume contraction/vomiting

A

Ketoacidosis
Lactic acidosis
Hyperchloremic acidosis from BiCarb loss in urine

Metabolic alkalosis

116
Q

What can cause respiratory alkalosis to develop/

What lab results are used to support a Dx of alcoholic ketoacidosis

A

Pain Alcohol withdrawal Liver dz Sepsis

No DM Hx
Normoglycemia after initial therapy

117
Q

What type of poisoning can present w/ a normal anion gap

How would Isopropanol poisoning show?

A

Toluene poisoning

Inc osmolar gap, unaffected anion gap

118
Q

Define Uremic Acidosis

What are two major causes of normal anion gap acidosis

A

GFR <30= kidney can’t synthesize NH3
Reduced H+ and organic acid excretion inc anion gap metabolic acidosis

GI BiCarb loss- N/V/D
Renal tubular acidosis
Use urine anion gap to differentiate

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