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P&T Block 5 Renal > L50 + 51 > Flashcards

L50 + 51 Flashcards

1
Q

What is compensation?

A

Development of a 2ary AB disorder to help correct the 1ary

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2
Q

Does compensation return the pH to normal?

A

NO

If back to normal, you should suspect mixed

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3
Q

How do you get rid of H+ in the urine?

A

Prox tubule
Carbonic anhydrase for bicarb reabsorption
To gain bicarb, you lose H

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4
Q

What does low PaCO2 mean practically?

A

Hypervent (1ary or 2ary)

CO2 = acid

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5
Q

Name the 4 steps of compensating for high H+ in the blood and the timeframe in which each occurs.

A
  1. Buffer with bicarb in blood - immediate
  2. Resp comp - mins
  3. Intracell buffering - hrs
  4. Renal H+ secretion - days
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6
Q

How is H+ secreted in urine?

A

Ammonium

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7
Q

If you have a metabolic acidosis and your urine is acidic, does that imply a renal or non-renal source of increased H+ produciton?

A

Non-renal

You’re excreting protons as you should to increase your bicarb

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8
Q

If you have a metabolic acidosis and your urine is basic, does that imply a renal or non-renal source of increased H+?

A

Renal

  1. Renal tubular acidosis = H+ secretion impaired so losing bicarb
  2. Chronic kidney disease = ↓nephron #
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9
Q

What are the effects of metabolic acidosis on the body?

A 
Hb/O2 curve shifts R = dissociation, more O2 delivered to tissues
↓CNS
Arrhythmia
↓Cardiac contractility 
Hyper K
↓Pulm BF
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10
Q

What GI problem would cause a metabolic acidosis?

A

Diarrhea - losing bicarb

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11
Q

Formula for anion gap

A

Na - (HCO3 + Cl)

Acid minus the bases

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12
Q

Mudplies for anion gap metabolic acidosis

A 
Methanol (formaldehyde)
Uremia (creatinine)
DKA (ketones)
Propylene glycol 
Lactate
Iron tabs/isoniazid
Ethylene glycol (anti-freeze look for oxalate)
Salicylates
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13
Q

Heart CCU for non-gap metabolic acidosis

A 
Hyperalimentation (feeding tube)
Expansion
Acetazolamide
Renal tubular acidosis
Diarrhea
Cholestyramine 
Carbonic anhydrase inhibitors
Utererosigmoidostomy
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14
Q

If you’re normally reabsorbing bicarb in the kidney by excreting H into urine, where are you naturally compensating by doing the opposite?

A

Colon - bicarb into poop, reabsorb H

Why diarrhea loses bicarb -> acidosis

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15
Q

Describe the metabolic acidosis caused by renal tubular acidosis

  • Gap?
  • Urine pH
A

↑Cl metabolic acidosis
Non-gap
Urine pH not max acid (aka should be more acidic to compensate for acidosis)

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16
Q

Effects of metabolic alkalosis on the body

A 
Left shift Hb/O2 curve: ↓O2 tissues
↓Cerebral blood flow
Arrhythmia
Tetany
Seizure
17
Q

Extra-renal causes of metabolic alkalosis

A 
HypoK
GI:
1. Bicarb ingestion (antacids)
2. Vomiting
3. NG suctioning
18
Q

Renal cause of metabolic alkalosis

A

Diuretics!

19
Q

What is the main difference between transient and maintained metabolic alkalosis?

A
  1. Maintained: H+ secretion increased
    Some stimulus to make prox tubule reclaim all the bicarb
  2. Volume, Cl- or K+ depletion occurs during HCO3 loading
20
Q

Why does volume depletion lend to akalosis?

A

Vol depleted - want to reabsorb Na
via Na/H exchanger
Must secrete H

21
Q

Why does ↓Cl- lend to alkalosis?

A

Cl depleted - there is no Cl- in the urine to reabsorb

Conversion to mostly alpha intercalated cells = H secreting cells

22
Q

Why does ↓K lend to alkalosis?

A

@ renal tubular cell

To reabsorb K, you have to secrete H to maintain electrical neutrality

23
Q

When does Cl- loss and HCO3 load occur at the same time?

A

Vomiting
Lose Cl- from stomach acid
Therefore bicarb from the stomach rises
Look at image in slides

24
Q

3 causes of transient metabolic alkalosis

A 
1. Bicarb loading
Exogenous = tumor lysis syndrome
Endo = bone dissolution from immobility 
2. Recovery from met acidosis
3. Post-hypercap resp acidosis
25
Q

↓Cl- or vol depleted causes of persistent metabolic alkalosis

A

Vomiting
NG suction
Diuretics
Post-hypercap alkalosis

26
Q

↓K causes of persistent metabolic acidosis

A 
"Saline resistant"
HypoK
Aldosterone excess
Diuretics
Renal failure due to ↓GFR
27
Q

↓Cl- AND K causing metabolic alkalosis

A

Liddle’s syndrome

Bartter’s & Gitelman’s

28
Q

What does urine Cl tell you about a persistent metabolic alkalosis?

A 
U Cl
UCl  20 (norm) - check U K
29
Q

What does urine K tell you about persistent metabolic alkalosis?

A

U K 20 = (high) renal/hyperaldo cause K

30
Q

Is maintained metabolic acidosis associated with basic or acidic urine?

A

Maintained metabolic alkalosis associated with paradoxical aciduria

31
Q

4 causes resp acidosis

A

CNS depressants
Resp muscle dysfxn
Airway obstruction
Poor gas exchange

32
Q

5 causes resp alkalosis

A
  1. Hypoxia
  2. Lung disease
  3. Sepsis
  4. Salicylates
  5. CNS stim

P&T Block 5 Renal (30 decks)

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