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metabolic alkalosis Flashcards

1
Q

metabolic alkalosis

A

disorders which raise serum bicarbonate and pH

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2
Q

For every 1 mEq/L change in serum bicarbonate, a _______ mm Hg change in pCO2

A

0.6-0.75

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3
Q

mixed acid-base disorder including a metabolic alkalosis

A

HCO3 inappropriately elevated out of proportion to expected metabolic compensation (below) or neither HCO3 or pCO2 in direction consistent with compensation

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4
Q

generation of an alkali load (2)

A
  1. addition of an alkali load

2. loss of acid

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5
Q

loss of acid in metabolic alkalosis

A
  • vomiting leading to a loss in HCl from stomach

- primary mineralocorticoid excess leading to renal H+ secretion

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6
Q

alkali load in metabolic alkalosis

A
  • adm. of bicarb w/ fluids w/ kidney function impairement

- large vol. blood transfusion with products anticoagulated with citrate salts

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7
Q

Healthy kidneys initially excrete excess bicarbonate, HOWEVER…

1.

… may all conspire to enhance urinary acidification and maintain the alkalosis

A
  1. Increased mineralocorticoid activity (aldosterone)
  2. Chloride depletion
  3. Hypokalemia
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8
Q

which three cells of distal/collecting tubule maintain metabolic alkalosis

A
  • principal cell: Na+ reab
  • intercalated A: H+ secretion
  • intercalated B: HCO3- secretion
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9
Q

reduced delivery of _____ to JG triggers renin releasse

A

NaCl

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10
Q

aldosterone leads to the activation of the

A

ENaC

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11
Q

ENAC activation leads to

A
  1. Na reabs

2. tubular lumen more negative

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12
Q

intercalated A-cell is:

a. influenced by
b. secretes
c. leads to

A

a. influenced by aldosterone
b. secretes H+ion
c. leads to hypokalemia and increased conservation of potassium

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13
Q

intercalated B-cell:

a. channel
b. limited by

A

a. Pendrin (chloride-bicarb) bicarb efflux

b. limited by low chloride delivery leading to a reduced bicarb efflux

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14
Q

pendred syndrome:

a. inheritance
b. issue
c. under condition of increased distal Cl- delivery
d. severe
e. other organs affected

A

a. Autosomal recessive
b. reduced pendrin activity
c. under condition of increased distal Cl- delivery (like in thiazide diuretic), failure to reabsorb cl- and secrete HCO3
d. severe hypovolemia and metabolic alkalosis
e. other organs affected like hypothyroidism nad sensorineural hearing loss

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15
Q

Three important mineralocorticoid actions to enhance distal tubule H+ secretion

A
  1. Increase activity of Na+/K+ ATPase
  2. Increase number of open epithelial sodium channels (ENaC)
  3. Stimulate H-ATPase pump
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16
Q

Reduced chloride delivery to the distal tubule sensed at the juxtaglomerular apparatus (JGA)

A

chloride-dependent metabolic alkalosis

17
Q

aldosterone is secreted autonomously independent of chloride state

A

chloride independent metabolic alkalosis

18
Q

what does a low urine chloride indicate

A

chloride dependent

19
Q

what does a nl or elevated urine chloride

A

independent alkalosis

20
Q
  • Vomiting or nasogastric suction
  • Massive diuresis
  • Post hypercapnia
  • Congenital chloride diarrhea
  • Cystic fibrosis (sweat losses)
  • Bartters and Gitelmans syndromes*
  • Special circumstance – urine chloride high
A

examples of chloride dependent metabolic alkalosis

21
Q
  • Hyperaldosteronism
  • Calcium-alkali syndrome
  • Congenital and acquired hypermineralocorticoid states
A

examples of chloride independent metabolic alkalosis

22
Q

treatment of chloride dependent metabolic alkalosis

which is the indirect treatment?

A
  1. sodium chloride
  2. potassium chloride
  3. ammonium chloride
  4. arginine chlroride
  5. hydrochloric acid

indirect- CA inhibition

23
Q

chloride dependent alkalosis sees initial losses of __, ___ and ___ (volume), a raise in _____, a drop in plasma/urine ___ and stimulates ____ and ____

A

intial losses of H+, Cl- and Na+, raises plasma HCO3, drop in plasma/urine Cl-, and stimulate renin and aldosterone

24
Q

elevated plasma HCO3 in chloride dependent alkalosis is maintained by

A
  • tubular sodium/bicarbonate reabs in the PCT

- aldosterone accelerating H+ secretion in the CT

25
Q

true or false:

in chloride independent alkalosis, Na+ and Cl- deficiency is responsible for enhanced HCO3 reabs. anad H+ secretion

A

nope it is not responsible

26
Q

in chloride independent alkalosis, _______ is not related to volume depletion

A

mineralocorticoid excess

27
Q

chloride independent alkalosis, ___ and ____ supplementation do not enhance HC)3-

A

Na+ and Cl-

28
Q

do we see potassium depletion and hypokalemia play a major role in chloride independent alkalosis

29
Q

treatment of chloride independent metabolic alkalosis

  1. ______ repletion
  2. ______blockade
  3. other ________ diuretics
  4. discontinuation of _________ with _______effect
A
  1. potassium repletion
  2. mineralocorticoid blockade
  3. other potassium sparing diuretics
  4. discontinuation of exogenous agents with mineralocorticoid effect

renal (21 decks)

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