Mod 2 Flashcards
Renal tubular acidosis and types
Disorder of renal tubules that leads to anion gap acidosis which occurs if kidneys can’t acidity urine or can’t reabsorb bicarb. Type I II IV
Type 4 is hyperkalemia
Low aldo so less Na reabs so less K secreted so retained in blood
What drug stabilizes cardiac membrane during hyperkalemia
Calcium gluconate
What does Aldo do to k
Retains Na and wastes K via ROMK
Where is most k reabsorbed
PCT
ROMK and ENaC
Na enters cell and blood FROM lumen via ENaC
K plus leaves from cell into lumen via ROMK
What does lots of Na in CD do to K
Enters from lumen to cell via ENaC
Causing K to enter lu,en via ROMK
And Not enough k causes hyperkalemia
What can kidney disease do to k
Hypo
What can diarrhea and vomiting do to k
Hypo
Aldo released during vomiting causing secondary hyperaldonwhich reduces H and K (also k lost directly thru vomit anyway)
What does too much insulin do to K
Hypo
What does stress and catecholamine production do to K
Hypo
Hypokalemia without much K in urine is caused by
GI sources
Maybe laxatives etc
Hypokalemia with lots of k in urine
Due to diuretics like loop and thiazide
RTA types
Channelopathied
I classic distal- can’t secrete h so retained causing acidosis; basic urine
Hypokalemia
Ca P.O. rel from acidic env into filtrate for,Inc renal stones
II pRTA PT can’t reabs HCO3 causing acidosis and hypokalemia
IV distal caused by hypoaldo decr Na reabs this decr K secr causing HYPERKAL
What does Aldo do to sodiu, channels
Increases Na k pump and unregulated ENaC in distal
What does catecholdo to K
Hypokalemia bc muscled need to use the k for flight
What does DM do to k
Glucose in urine so water follows and then k follows via osmotic diuresis so hypokalemia
Most diuretics do what to k
Cause hypokalemia
Except k sparing
What does alcohol cisplatin and diuretics do to k and bp
Cause low/normal bp hypokal
Syndromes that cause hypokal
Barters
gitelmans
Liddles
Alphabetic, barters usu in kids
Which syndrome mimics loops and which syndrome mimics thiazides?
Barters LOOPS
Gitelmans THIAZIDES
Both decrease bp but in liddles bp is high
Barters
Like loop
Decrease bp k and Ca (bc triple cotransoorter issue so mg and ca wasted)
Bc we decr vol we lose Na and water thru RAAS and Aldo activation dumps H causing alkalosis (Ca is opposite in urine so is increased) “loops lose” ca
Gitelmans
Like thiazides
Which block Na cl cotrans so Na remains in filtrate
Low k; hi Aldo hi ca (cuz) in serum and low in urine
Hi bicarb
High bp hypokal varieties
Low renin and high renin high bp hypokal
Liddles bp renin and k
ENa is const on in liddles; low k but v high bp; treat by closing ENaC with amiloride or k sparing diuretic
Low renin
What does conns do to bp renin and k
Low renin
High bp
Low k bc extra aldo
What does licorice or CAH do to bp renin and k
Low renin
High bp
Low k
What does renal aa stenosis and renin secr tumors do to renin bp and k
Renin HIGH
Bp high
Low k
What do BBS do to k
Hyper
What does insulin deficiency do to k
Hyper
What does digoxin toxicity do to k
Hyper
What do rhabdomyo hemolysis and tumor lysis do to k
Release k causing hyper
What does Aldo deficiency do to k
Hyper
What does renal failure do to k and h
Hyper bc cant filter it out
H builds up also causing acidosis
What is triamterene
K sparing diuretic along with spiro and amiloride
What can some antibiotics do to k
Like trimethoprim pentamidine cyclosporine and tacrolimus
Hyper
Treatments for hyperkalemia
Calcium gluconate Maybe insulin if diabetic (Bicarb if acidotic Albuterol) Can also remove with diuresis or kayexalate Dialysis diet etc but slower
What will rhabdomyolysis in seizures do to k
Elevate it bc k leaking
Hyperkalemia
