Potassium, Acid-Base Flashcards

1
Q

What is the definition of resolution of DKA?

A

AG normalization, normal serum ketones (specifically, beta-hydroxybutyrate)

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2
Q

why is urine alkalinization used to address salicylate toxicity?

A

an alkaline pH makes an acid ionized, the ionized drug cannot be reabsorbed by the renal tubule & the ionized drug cannot get into cells. the drug gets excreted into the drug

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3
Q

match the ingestion with the acid
1. methanol
2. ethylene glycol
3. toluene
a. hippuric acid
b. formic acid
c. oxalic acid

A

methanol = formic acid
ethylene glycol = oxalic acid
toluene = hippuric acid

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4
Q

what acid base disorder is caused by topiramate?

A

NAGMA.
by inhibiting CAI, it can cause pRTA

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5
Q

which should be replaced first when both K & Mg are low?

A

replace Magnesium first. low Magnesium can cause K wasting

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6
Q

what is the treatment of ethylene glycol or antifreeze poisoning?

A

Fomepizole.
It inhibits alcohol dehydrogenase & prevents the metabolism to oxalic acid, acidosis, & crystal-induced AKI.
Continued until alcohol level is < 20mg/dl or <10 mg/dL if with end-organ damage

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7
Q

what is the equation for calculated osmolality?

A

2Na + glu/18 + BUN/2.8

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8
Q

what can cause a patient to have low K, nL or low BP, high urine Cl, high urine Ca?

A

Bartter’s or loop diuretics

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9
Q

Is urine ketone measurement important in following DKA management?

A

No.
urinary ketones may still be high despite resolution of DKA.

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10
Q

match Gitelman and Bartter syndromes with these findings:
hypercalciuria, hypocalciuria, hypomagnesemia

A

Bartter (loop like): hypercalciuria,
Gitelman (thiazide like): hypocalciuria, hypomagnesemia

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11
Q

in dRTA, is the urine anion gap positive or negative? is the uOsm gap > 150 or < 150 mOsm/kg H2O?

A

dRTA: urine anion gap is (+), uOsm gap is < 150

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12
Q

Renal potassium retention is suggested by what ratio of urine K:crea?

A

Urine K:crea < 15 meq/g

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13
Q

A urine Cl < 10 with hypokalemia should raise concerns for

A

Surreptitious vomiting

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14
Q

name 2 drugs that can cause both pRTA and dRTA

A

topiramate and zonisamide

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15
Q

Name 5 drugs a/w dRTA?

A

topiramate, zonisamide, lithium, amphotericin B, toluene

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16
Q

what test is useful to diagnose incomplete dRTA?

A

rapid urine acidification test with lasix 40mg and fludrocortisone 1 mg

nL: urine pH < 5.3
incomplete dRTA: urine pH > 5.3

17
Q

what is the formula for bicarbonate deficit?

A

TBW x [desired HCO3 - current HCO3]

18
Q

a uOsm gap that is < 150 is suggestive of?

A

failure of urinary acidification (eg dRTA)

19
Q

what are complications of bicarbonate therapy?

A

increased pCO2
increased lactate
decreased iCa
volume overload
hypernatremia
overshoot alkalosis
decreased tissue O2 delivery (d/t unopposed effect of RBC 2,3 DPG), - the O2 dissociation curve shifts left

20
Q

DDx for HAGMA + high osmolal gap

A

toxic alcohols; DKA, Lactic acidosis, alcohol ketoacidosis, AKI, salicylate intoxication

21
Q

what is the cause of HAGMA associated with an acquired form of glutathione deficiency?

A

pyroglutamic acidosis

22
Q

What are triggers of acquired forms of glutathione deficiency leading to HAGMA?

A

acetaminophen, vigabatrin, & dietary glycine deficiency (malnutrition, pregnancy, DM2, antibiotics)

23
Q

what is suggested by hyperchloremic metabolic acidosis, NAGMA, urine pH of > 5.5?

A

distal RTA

24
Q
A