nephrology Flashcards
acidosis and acidemia
acidosis= low serum bicarb acidemia= serum pH<7.35
alkalosis and alkalemia
alkalosis= high serum bicarb
alkalemia=serum pH >7.45
effects of acidosis
decrease in force of cardiac contractions
decrease in vascular response to catecholamines
diminished response to the effects and actions of certain meds
effects of alkalosis
interferes w/ tissue oxygenation
interferes w/ normal neurological and muscular functioning
what causes oxy curve to shift to right
increased H ions (decrease in pH), increased CO2, increase in temp
mudpiles
methanol uremia DKA paraldehyde INH, IRON Lactic acidosis ethylene glycol salicylates
used CAR (non anion gap)
ureteral sigmoid diversions saline admin endocrinopathies (addisons, spironlacone, hyper PTH) diarrhea carbonic anhydrase inhibitors hyperalimentation RTA
when are urine Anion gaps seen
urine anion gap>20 is seen in metabolic acidosis
If urine anion gap is 0 or negative but serum Anion gap is positive the source is most liley GI (diarrhea or vomitting)
when to use winters and summers formula
in metabolic acid base disorders…used to calculate respiratory compensation
Winters= metabolic acidosis (when projected CO2 is higher than actual there is respiratory alkalosis….when projected co2 is lower than actual there is concommittent respiratory acidosis)
summers= metabolic alkalosis (when projected CO2 is higher than actual there is respiratory alkalosis…when projected CO2 is lower than actual there is concommittent respiratory acidosis)
triple ripple
calculate the delta anion gap
tells if 3rd derangement
metabolic alkalosis
GI hydrogen loss
contraction alkalosis
basically is DEHYDRATION
loss of large volume of fluid and leave HCO3 in body then its more concentrated and get alkalosis
caused by: loop diuretics, thiazides, prolonged vomiting (if giving diuretic need to monitor this), sweat loses in pts w/ cystic fibrosis (cause H and Cl are secreted together)
what do you need to do if have metabolic derangment
check for compensation by summers or winters
what do you need to do if have respiratory derangement
check for compensation by looking for change in bicarb
what do you want to do before you get an ABG
allens test
causes of metabolic alkalosis
vomiting or NG suction, increase aldosterone secretion, loop/thiazide diuretic, hypercalcemia, hypokalemia, contraction alkalosis (massive diuresis, sweat losses in Cystic fibrosis), posthypercapnic alkalosis ( usually by mechanical ventilation)
posthypercapnic alkalosis
overcorrect someone’s co2 (wrong ventilator setting)
2 basic categories of diseases when kidney’s retain HCO3
differentiated by response to NaCl
- chloride responsive (10) (these problems are telling kidney to retain HCO3 so NaCl won’t help)
a. excess mineralocorticoid (cushings syndrome, conn’s syndrome, exogenous steroid admin, bartter syndrome)
tx of chloride responsive
replace volume w/ NaCl if depleted
correct hypokalemia if present
tx of chloride resistant
treat underlying problem such as stop steroids, etc
can get metabolic alkalosis from blood (8 or more units)
true (due to citrate in blood)
waste products of metabolism
urea, creatine, uric acid
BUN increased w/ creatinine normal (>20/1)
prerenal azotemia catabolic state w/ increased muscle breakdown GI hemorrhage High protein intake drugs (tetracycline, steroid)
BUN increased and creatinine increased (>20/1)
postrenal azotemia (obstructive uropathy)
prerenal azotemia superimposed on renal disease
basicaly post renal stuff
decreased ratio w/ decreased BUN (<10/1)
acute tubular necrosis low protein diet/ starvation/ liver disease repeated dialysis SIADH pregnancy
decreased ratio w/ increased creatinine
rhabdomyolisis
muscular pts who get renal failure
purpose of urinalysis
detect systemic disturbances (endocrine abnormalities and metabolic disturbances)
detect intrinsic kidney/urinary system disorders (kidney disease/uti)
low specific gravity casues
diabetes insipidus
well hydrated
tubular damage and renal abnormalities
high specific gravity
diabestes adrenal insuffieciency hepatic disease CHF excessive water or other loss of water
severity of Na levels
> 130= usually not treated
120-130= depends on symptoms and situations
120< panic level
sxs of hyponatremia
fatigue and malaise are first sxs
hypotonic hyponatremia
due to GI loses or renal loses
can result in sxs of neuronal cell expansion and cerebral edema
Nausea, HA, seizure, coma, death
tx- normal saline slow bolus (1000cc over 1 hours)
hypervolemic hyponatremia
cirhosis, renal failure, CHF
tx- restrict fluids 1000-1200
restrict Na1000-1200
can use loop diuretic
hypervolemic hypernatremia
Iatrogenic
Hyperaldosteronism
hypovolemic hypernatremia
renal loses (diuretics, renal disease) extrarenal loses (sweating, diarrhea, fluid shifts (burns)
Euvolemic hypernatremia
diabetes inspidus
hypodipsia
hypervolemic hyponatremia
CHF
liver failure (cirrhosis)
nephrotic syndrome
hypovolemic hyponatremia
renal loss
extra renal loss
euvolemic hyponatremia
SIADH
hypothyroid
polydipsia
adrenal insuffieciency
pseudohyponatremia
increase glucose
increase lipids
increase proteins
increase urea
what causes hyperkalemia
renal failure volume depletion adrenal insuffieciency ACE inhibitors spironlactone increase in K intake (oral or IV) pseudohyperkalemia decrease insulin trauma beta blockers acidosis
what causes hypokalemia
renal loss (diuretics, hyperaldosteronism) GI loss (vommiting or diarrhea) decrese K intake increase insulin beta agonists (increase catecholamines) alkalosis
