NAGMA

Question 1

What is the equation for compensation of metabolic acidosis?

Answer 1

PCO2 = 1.5 * (HCO3) +8 (+-2)

Question 2

What is the real definition of non anion gap metabolic acidosis?

Answer 2

Hyper chloremic acidosis

Question 3

What is really going on with a normal anion gap metabolic acidosis?

Answer 3

Increase in chloride equals the loss or decrease of bicarb

Question 4

How do you calculate urine anion gap?

Answer 4

Sodium + potassium - (chloride)

Question 5

What does it mean if the urine anion gap is negative?

Answer 5

Chloride is greater than sodium and potassium collectively and indicates ammonium is being secreted just fine and the acidosis is non renal cause.

Question 6

What does it mean if the urine anion gap is positive?

Answer 6

Ammonium is low in the urine and the kidney is not secreting it indicating a renal cause of acidosis.

Question 7

What does pyelonephritis present like in a patient causing metabolic acidosis?

Answer 7

Flank pain, fever, history of previous UTI, pretty sick.

Question 8

What does kidney stones present as?

Answer 8

Flank pain radiating to groin, pain waxing and waning, blood in urine.

Question 9

When does DKA become normal anion gap acidosis?

Answer 9

When they get to the point that they are compensating well with the respiratory system. When they aren’t compensating they are high anion gap.

Question 10

What is the first type of Rental Tubular Acidosis and what is the defect?

Answer 10

Classic distal RTA. Defect is in the chloride/bicarb exchanger and the hydrogen atpase pump

Question 11

What drug and systemic disease causes RTA type 1?

Answer 11

Lithium and lupus

Question 12

What 3 urine findings do we get for RTA type 1?

Answer 12

Less NH4, urine pH greater than 5.5, positive UAG

Question 13

What is the important serum finding for RTA type 1?

Answer 13

Hypokalemia.

Question 14

What type of stones would we expect from RTA type 1, and what bone problems in kids and adults would we expect?

Answer 14

Calcium oxalate, rickets and osteoporosis

Question 15

What is another name for RTA type 4 and what is the result because of the type?

Answer 15

Hypo aldosteronism so hyperkalemia.

Question 16

What is the pH of RTA type 4 and why>

Answer 16

It is normal because less hydrogen is reabsorbed by the counter transport which means less hydrogen is secreted. However the hydrogen pump still works so the urine ph stays the same.

Question 17

What two drug families do we want to avoid with a RTA 4 and why?

Answer 17

Ace inhibitors and potassium sparing diuretics because the potassium is already high and this will jack it up even more.

Question 18

What two conditions lead to hypoaldosteronism?

Answer 18

Chronic kidney disease and diabetes.

Question 19

Whats going on with RTA type 2?

Answer 19

Unable to reclaim filtered bicarb, so they have a chronic low bicarb level. If for some reason their bicarb levels increase, they will pee it all out.

Question 20

What is the pH for RTA type 2?

Answer 20

Less than 5.5 normally, but it will go up above 6.5 when they pee all the increased bicarb out.

Question 21

What will the Urine Fractional Excretion of bicarb be with the bicarb challenge?

Answer 21

Greater than 15%

Question 22

What is the big time syndrome for RTA type 2 and what are the 4 characteristics?

Answer 22

Fanconi syndrome. Phosphaturia, aminoacduria, glycosuria, bicarbonaturia

Question 23

What deficiency, syndrome, genetic disease, 2 hormonal diseases, cancer, and metal is a cause of RTA Type 2?

Answer 23

Arborio anhydrase deficiency, fanconi, Wilson, hyperparathyroidism, vitamin d deficiency, multiple myeloma, and lead.

Question 24

What is the impairment for generalized tubular defect?

Answer 24

Impaired potassium and hydrogen secretion.

Question 25

What urine pH do we have with generalized tubular defect?

Answer 25

Higher than 5.5

Question 26

What is generalized tubular defect associated with?

Answer 26

Interstitial kidney disease like SLE sickle cell anemia and obstructive uropathy

Question 27

What two things are low with diarrhea?

Answer 27

Potassium and bicarb

Question 28

How will you tell diarrhea from an RTA?

Answer 28

No high anion gap in diarrhea

Question 29

What is the GFR for chronic progressive KD and what is the result?

Answer 29

Less than 40 with a hyperchloremic acidosis