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Renal > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

What are buffers?

A

acid-base pairs that can resist changes in pH either weak acids or weak bases

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2
Q

What do weak bases accept?

A

H+ ions

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3
Q

What do weak acids donate?

A

H+ ions

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4
Q

When there are too many H+ ions what happens?

A

buffers will absorb them, increasing pH

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5
Q

When there are low H+ ions what happens?

A

buffers will donate some to reduce the pH

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6
Q

What is the main ECF buffer?

A

carbonic acid (H2CO3)

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7
Q

What is the main ICF buffer?

A

sodium carbonate and proteins

(2NAHCO2), hemoglobin, albumin

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8
Q

What are the two buffers in the kidney?

A

hydrogen phosphate and ammonia

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9
Q

What is the main independent urinary buffer?

A

hydrogen phosphate

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10
Q

Useful for estimating the pH of a buffer solution and finding the equilibrium pH in acid-base reactions?

A

Henderson Hasselbalch equation

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11
Q

What does pH depend on?

A

the ratio of weak base to the weak acid

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12
Q

If there’s more weak acid, pH is ???

A

low (<7.35)

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13
Q

If there’s more weak base, pH is ???

A

high (>7.45)

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14
Q

What alters the pH?

A

ratio of base to the acid

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15
Q

Base is ??? related to pH?

A

directly

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16
Q

Acid is ??? related to pH?

A

inversely

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17
Q

If a acid increases, pH goes ???

A

down (acidiotic)

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18
Q

If a acid decreases, pH goes ???

A

up (alkalotic)

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19
Q

What is the pk?

A

6.1 (dissociation constant)

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20
Q

Acidemia?

A

blood < 7.35

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21
Q

Alkalemia?

A

blood > 7.45

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22
Q

What can only have one state?

A

blood (emia)

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23
Q

What can occur at the same time?

A

acidosis and alkalosis

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24
Q

In venous BMP what serves as the bicarb?

A

CO2

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25
Q

What is a bicarb?

A

a weak base

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26
Q

where is bicarb mainly produced?

A

kidney

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27
Q

How long does it take the kidneys to modify HCO3?

A

hrs to days

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28
Q

If alkalemia occurs the kidneys will ???? HCO3 to decrease pH?

A

dump

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29
Q

You cannot have ?? and ?? at the same time

A

respiratory acidosis and respiratory alkalosis

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30
Q

Anion gap is only checked in what?

A

metabolic acidosis

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31
Q

ROME?

A

Respiratory- Opposite

Metabolic- Equal

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32
Q

In metabolic acidosis how does the body compensate?

A

by breathing faster (pCO2 decreases)

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33
Q

What is anion gap?

A

the difference between the measured cations and measured anions

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34
Q

What is the normal range for anion gap?

A

6-12

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35
Q

equation for albumin anion gap?

A

AG= Albumin x 3

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36
Q

In metabolic alkalosis how does the body compensate?

A

by breathing slower (pCO2 should be high)

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37
Q

How does the lungs adjust pH levels?

A

by altering the PaCO2

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38
Q

The lungs produce a ?? response

A

immediate response

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39
Q

How does the kidneys adjust pH levels?

A

by altering the HCO3 or other buffers

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40
Q

The kidneys produce a ?? response

A

delayed response

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41
Q

What is the formula used for metabolic acidosis compensation?

A

winter’s formula

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42
Q

If actual pCO2 is less than calculated pCO2 = ?

A

respiratory alkalosis

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43
Q

If actual pCO2 is greater than calculated pCO2 = ?

A

respiratory acidosis

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44
Q

What is winter’s formula?

A

pCO2= (1.5 x HCO3-) + 8 (-/+2)

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45
Q

What causes respiratory acidosis?

A

primary decrease in respiration

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46
Q

What 3 things can cause respiratory acidosis?

A

lung injury, neurological or muscular disease

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47
Q

What is the txt for respiratory acidosis?

A

mechanic ventilation

Doxapram HCL- stimulate ventalation

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48
Q

What is the patho of respiratory acidosis?

A

Acute rise in CO2 causes fall in oxygen levels, dyspnea, AMS and eventually coma

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49
Q

Chronic respiratory acidosis can cause what?

A

bone loss and papilledema

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50
Q

What things can cause respiratory alkalosis?

A 
fever
brain disease
MI
mechanical ventilation
anxiety
pregnancy
sepsis
liver disease
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51
Q

What is the patho of respiratory alkalosis?

A

breathing too fast, blowing off CO2
Serum CO2 is low
Serum pH is high
Decreased cerebral blood flow

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52
Q

What is the most common presentation of respiratory alkalosis?

A

neuromuscular irritability, paresthesia, and CHEST PAIN

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53
Q

Wha is the txt for respiratory alkalosis?

A

txt underlying cause

exhalation of excess CO2

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54
Q

What is the txt for panic attacks?

A

relaxation, rebreathing

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55
Q

What condition is panic attacks seen in ?

A

respiratory alkalosis

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56
Q

What condition is hyperchloremic metabolic acidosis seen in?

A

metabolic acidosis

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57
Q

What is seen in non-anion gap or normal anion gap?

A

decrease in bicarb w/ increase in chloride

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58
Q

What happens to bicarb in metabolic acidosis?

A

it DUMPED! loss by gut or renal loss

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59
Q

What diseases is hyperchloremic seen in?

A 
ARF
CKD
High salt intake
Respiratory alkalosis
txt of DKA
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60
Q

What are s/s of metabolic acidosis?

A 
fatigue
muscle weakness
excessive thirst
dry mucous membranes
high bp
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61
Q

What symptoms is seen in metabolic acidosis with DKA?

A

Kussmaul’s respiration

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62
Q

“A CAT’S MUDPILE”

A

Anion gap acidosis

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63
Q

“FUSED CARD TIP”

A

Normal gap acidosis

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64
Q

What is seen in chronic metabolic acidosis?

A

osteoporosis and fractures

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65
Q

Txt for metabolic acidosis?

A

correct primary problem
IV bicarbonate (caution)
txt hyperkalemia
consult nephrology (dialysis)

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66
Q

A pH < ?? is an emergency in metabolic acidosis?

A

7.1

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67
Q

Txt for DKA?

A

fluids, insulin, judicious replacement of bicarb

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68
Q

Txt for salicylate overdose?

A

judicious bicarb txt

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69
Q

Txt for alcoholic MA?

A

thiamine w/ glucose to prevent Wernicke encep.

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70
Q

Txt for methanol intoxication?

A

fomepizole w/wo dialysis

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71
Q

Txt for RTA non gap MA?

A

large amounts of alkali replacements w/ salts, thiazides, potassium

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72
Q

What is metabolic alkalosis?

A

too much HCO3 (Tums) due to decrease in H+ concentration or increase in bicarb

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73
Q

What are the two classifications of metabolic alkalosis?

A

chloride responsive

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74
Q

What is chloride responsive?

A

acid loss w/ chloride depletion

75
Q

What is chloride resistant?

A

excessive aldosterone- no chloride depletion

76
Q

Black licorice- glycyrrhizinic acid?

A

metabolic alkalosis

77
Q

What does black licorice do?

A

upgrades renal mineralocorticoid receptors

Hypokalemic metabolic alkalosis and HTN

78
Q

What are the s/s of metabolic alkalosis?

A

muscle cramps, weakness, dysrhythmias, diminished breath sounds but adequate oxygenation

79
Q

What is the txt for metabolic alkalosis- chloride responsive?

A

chloride and volume replacement
txt renal problems
hypokalemia

80
Q

What is the txt for non-chloride responsive?

A

spironolactone or amiloride

oxygen ventilation w/ inspired CO2 and O2

81
Q

A pH of ?? is severe alkalosis?

A

7.60

82
Q

What is the txt of primary aldosteronism?

A

CAN ONLY BE TXT w/ potassium replacement

83
Q

What is the txt of primary hyperaldosteronism?

A

surgical removal of mineralocorticoid producing tumor

ACEI or spironolactone

84
Q

High anion gap?

A

metabolic acidosis

85
Q

Hyperglycemia?

A

DKA w/ ketones w/ metabolic acidosis

86
Q

Hypokalmeia/ hypochloremia?

A

metabolic alkalosis

87
Q

Hyperchloremia alone?

A

normal anion gap acidosis

88
Q

What are two things you can do in metabolic acidosis?

A

winter’s formula and anion gap

89
Q

Normal Cl- indicates?

A

Hyperchloremic metabolic acidosis

90
Q

Extreme metabolic acidosis is ?

A

a EMERGENCY! (lethargy, stupor, coma, seizures)

91
Q

What is hyperkalemia associated with?

A

metabolic acidosis

92
Q

Most abundant compartment?

A

Intracellular (ICF)

93
Q

What compartment shouldn’t have fluid?

A

3rd spacing

94
Q

Third spacing compartments?

A 
Lymph
Pleural
Peritoneal
Pericardium
CSF
GU
GI
95
Q

Net movement of molecules (STUFF) from a high concentration to a low concentration

A

Diffusion

96
Q

Movement of a substance down a concentration gradient

A

Diffusion

97
Q

Spontaneous movement of fluid through a selective semi-permeable membrane from a low concentration to a high concentration to equalize both sides

A

Osmosis

98
Q

Membrane not permeable to solutes

A

Osmosis

99
Q

Minimum amount of pressure, needed to stop osmosis across a membrane

A

Osmotic pressure

100
Q

Keep fluid from leaking out of blood vessels

A

hydrostatic pressure

101
Q

Pulls water into the blood vessels

A

oncotic pressure (proteins)

102
Q

Most important protein for exerting oncotic pressure in blood vessels

A

Albumin

103
Q

What opposes hydrostatic pressure?

A

oncotic pressure

104
Q

What is osmolarity based on?

A

temperature and pressure

105
Q

What is serum osmolality?

A

measure of the number of dissolved particles per unit of water in serum

106
Q

A low serum osmolality means ?

A

increase of water <285

107
Q

A high serum osmolality means?

A

decrease of water > 295

108
Q

Measure of dissolved particles per unit of water in the urine

A

urine osmolality

109
Q

Response of cells immersed in an external solution

A

tonicity

110
Q

What is the difference between osmolality versus tonicity?

A

BUN

111
Q

What is the calculation for Osmolality?

A

2NA + Glucose/18 + BUN/2.8 = 285

112
Q

What is tonicity calculation?

A

2NA + glucose/18 without BUN/2.8

113
Q

Excess fluid in the interstitial tissue is in what space?

A

2nd space

114
Q

normal distribution of fluid in both ECF and ICF compartments is in what space?

A

1st space

115
Q

Normal range for sodium

A

135-145

116
Q

The most abundant ECF electrolyte?

A

Sodium

117
Q

Normal range for potassium?

A

3.5-5.0

118
Q

The most abudant ICF electrolyte?

A

Potassium

119
Q

Chloride is a ICF or ECF electrolyte?

A

ECF

120
Q

Normal range for chloride?

A

95-105

121
Q

Normal range for Ca2+?

A

8.5-10.5

122
Q

Causes extracellular excitation?

A

Sodium

123
Q

Causes intracellular excitation?

A

Potassium

124
Q

What is the first thing that is tested in hyponatremia?

A

serum osmolarity

125
Q

What are the 3 types of hyponatremia?

A

Isotonic, Hypotonic, Hypertonic

126
Q

Most common electrolyte abnormality is hospitalized pts?

A

Hyponatremia

127
Q

Osmolality for isotonic?

A

285-295

128
Q

Osmolality for hypertonic?

A

> 295

129
Q

Osmolality for hypotonic?

A

<285

130
Q

What is the most common hyponatremia?

A

Hypotonic (90%)

131
Q

Pseudohyponatremia?

A

Isotonic Hyponatremia

132
Q

What is the txt for isotonic hyponatremia?

A

no txt

txt high protein and cholesterol

133
Q

Seen with DKA and mannitol txt?

A

hypertonic hyponatremia

134
Q

Txt for hypertonic hyponatremia?

A

get rid of extra components

135
Q

For txt of hypotonic hyponatremia what is needed?

A

patient’s volume status

136
Q

What is released in hypovolemic hypotonic?

A

ADH/ vasopressin

137
Q

Severe vomiting, diarrhea, dehydration

A

hypovolemic hypotonic hyponatremia

138
Q

SIADH

A

Euvolemic hypotonic hyponatremia

139
Q

What are the 3 most severe consequences of hyponatremia?

A

seizures, coma and death

140
Q

What is the txt for euvolemic hyponatremia?

A

free water restriction alone

141
Q

What is the txt for hypervolemic hyponatremia?

A

loop diuretics, dialysis if severe

142
Q

What is the txt for hypovolemic hyponatremia?

A

normal saline 0.9% or lactated ringers (judiciously)

143
Q

Neuro problem found in hypovolemic txt?

A

Central pontine myelinolysis (CMP)

144
Q

Txt for cerebral wasting syndrome?

A

hypertonic saline (3%)

145
Q

Txt for severe hyponatremia?

A

vaptans

146
Q

What are 3 types of hypernatremia?

A

Hypovolemic, Euvolemic, Hypervolemic

147
Q

In hypernatremia why isn’t serum osmolaity needed?

A

bc sodium determines tonicity so all are hyperosmolality > 285

148
Q

What is the least likely thing to cause hypernatremia?

A

excessive oral intake of sodium

149
Q

What cause hypernatremia to happen?

A

lose water and salt, then start losing more water than salt

150
Q

What is the txt for hypernatremia?

A

correct fluid loss

replace free water and electrolytes

151
Q

Cerebral edema

A

hypernatremia

152
Q

Txt for euvolemia hypernatremia?

A

oral replacement or D5W

153
Q

Txt for hypovolemic hypernatremia?

A

normal saline

154
Q

Hypervolemic hypernatremia txt?

A

D5W and loop diuretic

155
Q

What is the most common cause of K+ loss in developing countries?

A

GI loss from infectious diarrhea

156
Q

Which electrolyte if low can cause potassium not to be reuptaked?

A

magnesium

157
Q

What does a EKG for hypokalemia look?

A

BROADEN T waves, depressed ST segments, Prominent U waves, PVCs

158
Q

What is the txt for hypokalemia?

A 
Oral potassium (20-40m/d)
IV potassium for severe loss <3.0
159
Q

Txt for refractory hypokalemia?

A

magnesium

160
Q

What is the most common cause of hyperkalemia?

A

impaired renal execretion of K+

161
Q

What is hyperkalemia?

A

> 5.5

162
Q

Fist clenching and Trousseau sign?

A

Hyperkalemia

163
Q

Peaked T WAVES, prolonged PR interval?

A

hyperkalemia

164
Q

Txt for chronic K+?

A

Partiromer (FDA approved)

165
Q

What does sodium polystyrene txt cause?

A

colonic necrosis

166
Q

What is the emergent txt for hyperkalemia?

A

IV calcium, insulin, bicarb, beta agonists

167
Q

What percentage of america is dehydrated?

A

75%

168
Q

What is the minimum water intake?

A

1600 ml/day

169
Q

How much water is lost in urine?

A

500ml

170
Q

Where is more water lost?

A

urine and skin

171
Q

Where is most water intaked?

A

Food

172
Q

What is sensible loss?

A

fluid loss that can be measured

173
Q

What is insensible loss?

A

fluid loss that cannot be measured

174
Q

Who is at the highest risk for dehydration?

A

infants and elderly

175
Q

How is dehydration diagnosed?

A

concentrated urine

176
Q

What is the txt for dehydration?

A

prevention- stay hydrated
oral fluid replacement w/ pure water
IV hydration w/ crystalloids- severe

177
Q

What is hypovolemia?

A

state of decreased plasma (blood volume)

178
Q

What is the most common fluid imbalance seen?

A

hypovolemia

179
Q

What is given first in the txt of hypovolemia?

A

oxygen

180
Q

What is hypervolemia?

A

fluid overload

181
Q

What is the most common result of fluid overload?

A

CHF

182
Q

What is the txt for hypervolemia?

A

furosemide

183
Q

What are the most commonly used crystalloids?

A

NS and LR

184
Q

A mixture of insoluble particles suspended throughout another substance?

A

Colloids

Renal (9 decks)

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