NAGMA Flashcards
(29 cards)
What is the equation for compensation of metabolic acidosis?
PCO2 = 1.5 * (HCO3) +8 (+-2)
What is the real definition of non anion gap metabolic acidosis?
Hyper chloremic acidosis
What is really going on with a normal anion gap metabolic acidosis?
Increase in chloride equals the loss or decrease of bicarb
How do you calculate urine anion gap?
Sodium + potassium - (chloride)
What does it mean if the urine anion gap is negative?
Chloride is greater than sodium and potassium collectively and indicates ammonium is being secreted just fine and the acidosis is non renal cause.
What does it mean if the urine anion gap is positive?
Ammonium is low in the urine and the kidney is not secreting it indicating a renal cause of acidosis.
What does pyelonephritis present like in a patient causing metabolic acidosis?
Flank pain, fever, history of previous UTI, pretty sick.
What does kidney stones present as?
Flank pain radiating to groin, pain waxing and waning, blood in urine.
When does DKA become normal anion gap acidosis?
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.
What is the first type of Rental Tubular Acidosis and what is the defect?
Classic distal RTA. Defect is in the chloride/bicarb exchanger and the hydrogen atpase pump
What drug and systemic disease causes RTA type 1?
Lithium and lupus
What 3 urine findings do we get for RTA type 1?
Less NH4, urine pH greater than 5.5, positive UAG
What is the important serum finding for RTA type 1?
Hypokalemia.
What type of stones would we expect from RTA type 1, and what bone problems in kids and adults would we expect?
Calcium oxalate, rickets and osteoporosis
What is another name for RTA type 4 and what is the result because of the type?
Hypo aldosteronism so hyperkalemia.
What is the pH of RTA type 4 and why>
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.
What two drug families do we want to avoid with a RTA 4 and why?
Ace inhibitors and potassium sparing diuretics because the potassium is already high and this will jack it up even more.
What two conditions lead to hypoaldosteronism?
Chronic kidney disease and diabetes.
Whats going on with RTA type 2?
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.
What is the pH for RTA type 2?
Less than 5.5 normally, but it will go up above 6.5 when they pee all the increased bicarb out.
What will the Urine Fractional Excretion of bicarb be with the bicarb challenge?
Greater than 15%
What is the big time syndrome for RTA type 2 and what are the 4 characteristics?
Fanconi syndrome. Phosphaturia, aminoacduria, glycosuria, bicarbonaturia
What deficiency, syndrome, genetic disease, 2 hormonal diseases, cancer, and metal is a cause of RTA Type 2?
Arborio anhydrase deficiency, fanconi, Wilson, hyperparathyroidism, vitamin d deficiency, multiple myeloma, and lead.
What is the impairment for generalized tubular defect?
Impaired potassium and hydrogen secretion.
