MTB 5 Flashcards
Normal gap Metabolic Acidosis with positive UAG
RTA
Normal gap Metabolic Acidosis with negative UAG
Diarrhea
- kidney’s ability to excrete acid intact
Causes of Metabolic Acidosis - Normal AG
RTA
Diarrhea
Causes of Metabolic Acidosis - Increased AG
MUDPILES Methanol toxicity Uremia DKA Phenytoin, Paraldehyde INH Ethylene glycol Salicylates
ABG in Metabolic Acidosis
All low
Low pH, pCO2, HCO3
Causes of Metabolic Alkalosis
GI loss - vomiting, NG tube Increased aldosterone Diuretics Milk-alkali syndrome - hi volume liquid antacids Hypokalema
ABG in Metabolic Alkalosis
All high
High pH > 7.40
High HCO3
High pCO2
What are the 2 phases of Vomiting?
- Generation phase - loss of gastric fluids (HCl, etc) causes retention of H2O and HCO3. Loss of gastric acid - no stimulus for pancreas to secrete HCO3, so HCO3 is retained in blood = Metabolic Alkalosis
- Maintainance phase - volume loss causes ECV to go down, decreased renal perfusion so kidneys activate RAAS. Aldosterone retains H2O, loss of H+ and K+ to get Hypokalemia and contraction alkalosis
TX for Vomiting
IVF
NS
This will tx contraction alkalosis
Equation for minute ventilation
Minute ventilation = RR x TV
Respiratory Alkalosis
pCO2?
Minute ventilation?
Low pCO2
Minute Vent =Increased
Causes of Respiratory Alkalosis
Anemia Anxiety Pain Fever Interstitial Lung Dz Pulmonary Emboli
Respiratory Acidosis
pCO2?
Minute ventilation?
High pCO2
Minute vent = Decreased
Causes of Respiratory Acidosis
COPD/Emphysema Drowning Opiate OD Alpha 1 antitrypsin deficiency Kyphoscoliosis Sleep apnea/morbid obesity
MCC nephrolithiasis
Calcium Oxalate in alkaline urine
MS risk factor for nephrolithiasis
Overexcretion of calcium in urine
Most accurate test for nephrolithiasis
CT scan
- does not need contrast
IVP needs contrast, takes hours
Pt w excruciating pain in left flank radiating to groin presents to ED. Next step?
Ketorolac - NSAID provides pain relief like opiates
Which GI disorder do we see kidney stones?
Crohn dz b/c of increased oxalate absorption
Also, fat malabsorption increases stone formation
When is IVP the right answer in nephrolithiasis
Never
Best initial TX for renal colic
- Analgesics
- Hydration
- Imaging to confirm stone location
- CT/Sonography to detect obstruction, ie hydronephrosis
How to assess etiology of kidney stone?
Stone analysis
Serum calcium, uric acid, PTH, Mg, PO4
24 hr urine for volume, calcium, oxalate, citrate, cystine, pH, uric acid, PO4, Mg
How do we visualize uric acid stones
CT
Not on X-ray
TX for cysteine stones
Surgical removal
Alkalinize the urine
What does in-dwelling catheter increase the risk of
Urease producing bacteria - Proteus - Pseudomonas - Klebsiella - Morganella - Staph - Ureaplasma Alkalinize urine, increase pH
When is lithotripsy TX for stones
Between 0.5 - 3 cm
Which size stones spontaenously pass
Less than 5 mm
Which size stones do we surgically TX
Larger than 2 cm
Long term management of calcium stones
HCTZ removes calcium from urine - increased distal tubular reabsorption of calcium
What binds to calcium in the bowel
Oxalate
Metabolic Acidosis and kidney stone relationship
Met Acidosis removes calcium from bones and increase stone formation
- Also decreases citrate levels (which binds calcium)
Stress Incontinence Presentation
Older woman w painless urinary leakage w coughing, laughing, lifting objects
Test for Stress Incontinence
Have pt stand and cough - observe for leakage
TX for Stress Incontinence
- Kegals
- Local estrogen cream
- Surgical tightening of urethra
Urge Incontinence Presentation
Sudden pain in bladder, followed by overwhelming urge to urinate
Test for Urge Incontinence
Pressure measurements in half-full bladder
Manometry
TX for Urge Incontinence
- Bladder training exercises
- Local anticholinergics
- Oxybutynin
- Tolterodine
- Solifenacin
- Dariferancin - Surgical tightening of urethra
Causes of HTN
RA stenosis Glomerulonephritis Coarctation of Aorta Acromegaly Pheo Hyperaldosteronism Cushing syndrome/Hypercortisolism/GC use CAH
Renal Artery Stenosis Presentation
Bruit is auscultated in flank - abdominal bruit
Continuous throughout systole and diastole
Failure to control BP despite multiple meds
Coarctation of Aorta Presentation
UE»_space; LE BP
HTN pts tested for
EKG
UA
Glucose for diabetes
Cholesterol
Best initial TX for HTN
Weight loss
Sodium restriction
DASH diet
Exercise
How long do we try lifestyle modifications before medications started
3-6 months
Does tobacco smoking stop HTN
NO.
Prevents CVD
Best initial drug for HTN
Thiazides
When do we start 2 medications for HTN
BP > 160/100
If BP not controlled with thiazide, next step
Add: ACE ARB Beta blocker CCB
Antihypertensive for Osteoporosis
Thiazides
What is hypertensive crisis
HTN + end-organ damage
- High BP
- Confusion
- Blurry vision
- Dyspnea
- Chest pain
AE’s of thiazides
Hyperglycemia Increase LDL Increase TG Hyponatremia Hypokalemia Hypercalcemia
Best initial TX for hypertensive crisis
Labetolol
Nitroprusside
Presentation of Renal Cell Carcinoma
Triad: Flank pain + Hematuria + Palpable Abd mass
Varicocele - fails to empty when pt is recumbant = tumor obstruction of gonadal vein
Polycythemia - Ectopic EPO
Management for Renal Cell Carcinoma
CT Abdomen
