Keef: Acid Base Select Topics Flashcards
Does diarrhea cause acidosis or alkalosis? Hypo or hyperkalemia?
Acidosis; hypokalemia
Does renal failure cause acidosis or alkalosis? Hypo or hyperkalemia?
Acidosis; hyperkalemia
Does renal tubular acidosis cause hypo or hyperkalemia?
Hypokalemia
Does diabetic ketoacidosis cause hypo or hyperkalemia?
Hyperkalemia
Does lactic acidosis cause hypo or hyperkalemia?
Neither; normal K+ levels
In RTA type 1, NH4Cl can be administered. It will dissociate into HCl and H+ will be available to enter the distal nephron. If RTA type 1, urine pH will not decrease below (blank)
5.5
Impaired apical H+ATPase or H+/K+ ATPase or basolateral HCO3/Cl- exchanger; increased apical membrane leakiness to H+
Type 1 Renal tubular acidosis
In type 1 RTA, you cannot adequately secrete H+. So what happens to urine HCO3-, pH, K+, and Cl- with Type 1 RTA.
Increased HCO3-
Increased urine pH
Urine K+ will increase
Urine Cl- will decrease
What is the cause of hyperkalemia in diabetic ketoacidosis?
No insulin around to stimulate Na+/K+ pump, so extracellular K+ builds up.
What is the cause of hyperkalemia in metabolic acidosis?
Add an acid to the body, such as HCl. Cl will dissociate and H+ will flow into the cell, where it will build up and not allow the exchange of Na+ for K+. So, high extracellular K+.
Secretion of H+ is the way to get (blank) back into the body.
HCO3-
Secretion of H+ is fundamental to getting (blank) back into the body.
HCO3-
Type 1 and 2 renal tubular acidosis cause hyper or hypokalemia?
Hypokalemia
Does the anion gap change in renal tubular acidosis?
No
Things that may occur with renal tubular acidosis?
Bone demineralisation
Urinary stone formation
Nephrocalcinosis
Failure to thrive
How to distinguish type 2 from type 1 RTA?
Give NH4Cl; in this case, urine pH will go down below 5.5
How to treat renal tubular acidosis?
Give base! NaCO3 or sodium citrate
After a single episode of vomiting, what three things increase?
K+
HCO3-
pH
Vomiting leads to loss of (blank) and an increase in (blank).
H+; HCO3-
Loss of H+ causes less H+ to be secreted, so less (blank) can be reabsorbed.
HCO3-. This can return pH to a normal level.
With persistent vomiting, what happens to plasma [Na+], [K+], [Cl-], [HCO3-] and pH.
Dehydration, so want to save Na+! So plasma Na+ will stay the same.
High levels of aldosterone will excrete lots of K+, so plasma K+ will go down!
When you vomit, you lose Cl-, so it will go down.
Bicarb will be higher!
pH will go up!
What happens to BUN and plasma creatinine with prolonged vomiting?
Dehydration causes a huge concentration of urea in urine. Creatinine will also increase, because low GFR due to low urine flow.
What happens to pCO2 with prolonged vomiting?
High pCO2, trying to compensate for alkalotic condition.
What will happen to urine [Cl-], [Na+], and [K+] with prolonged vomiting?
All will be low.
Body is reabsorbing Na+.
K+ body stores are depleted.
Cl- is following Na+ back into body, so it will be low.
Why is urine pH within the normal range after days of prolonged vomiting?
If you vomit once, expect alkalotic urine. BUT, with prolonged vom, acidic urine. Aldosterone will increase K+ excretion, causing hypokalemia. Low K+ stimulates H+ATPase, so greater H+ secretion, leading to acidic urine!
3 things that occur with hyperaldosteronemia?
- Increased Na+ reabsorption
- Increased K+ secretion
- Increased H+ secretion
In respiratory acidosis, what is the primary disturbance? What is the compensation mechanism?
- increase in pCO2
2. increase HCO3-
In respiratory alkalosis, what is the primary disturbance? What is the compensation mechanism?
- decreased pCO2
2. decrease HCO3-
In metabolic acidosis, what is the primary disturbance? What is the compensation mechanism?
- decreased HCO3-
2. decreased CO2
What is the primary disturbance in metabolic alkalosis? What is the compensation mechanism?
- increased HCO3-
2. increased CO2
