Nephrology- Acid/ Base and Electrolytes

Question 1

Metabolic disorder in renal tubular acidosis

Answer 1

nonanion gap metabolic acidosis

Low Bicarb
Hypokalemia
Elevated Cl-

Question 2

Renal tubular acidosis

Answer 2

Inherited or acquired defect in the ability of the renal tubules to reabsorb HCO3- (type 2) or excrete H+ (type 1)

Question 3

S&S type 1 RTA

Answer 3

Alkalotic urine (pH5.5)
Failure to thrive
Chronic acidosis
Low Bicarb

Question 4

S&S type 2 RTA (Fanconi syndrome)

Answer 4

Urine pH <5.5
failure to thrive
glucosuria
depleted serum bicarb

Question 5

Contraction alkalosis

Answer 5

Activation of RAAS and elevated aldosterone functions to retain water at the expense of excreting both potassium and acid in the urine

Question 6

Electrolyte abnormalities in chronic alcoholism

Answer 6

Hypomagnesemia (most common)

Hypo Mg occurs together with Hypo K

Question 7

Mechanism of hypoMg in chronic alcoholism

Answer 7

Poor nutritional intake
Alcohol induced renal losses
Diarrhea

Question 8

Mechanism of refractory hypokalemia in chronic alcoholism

Answer 8

Mg inhibits K secretion by renal outer medullary potassium (ROMK) channels. Low Mg= increases K secretion.

Question 9

Management of electrolyte abnormalities in chronic alcoholism

Answer 9

Normalize Mg first

Decreases renal K losses allows for correction

Question 10

Base line acid/base abnormality in COPD

Answer 10

Chronic respiratory acidosis (CO2 retention) with compensatory (renal) metabolic alkalosis (high HCO3)