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Clin Med > Renal: Acid Base > Flashcards

Renal: Acid Base Flashcards

1
Q

what three processes must occur everyday in order to maintain acid base balance

A
  1. buffering by ICF and ECF buffers
  2. Alveolar ventilation to control PACO2
  3. control of serum HCO3 via renal H+ excretion
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2
Q

acid ph=

basic ph=

A

<7.3 acid

>7.45 alkalosis

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3
Q

PCO2 is high or low with metabolic acidosis and alkalosis

A 
acidosis = LOW PCO2 
alkalosis= HIGH PCO2
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4
Q

what is the compensation for acidosis

A

a reduced CO2 partial pressure (PCO2) that should be predictable

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5
Q

acidosis levels:

  • bicarb
  • pco2
A

low biacrb

low PCo2

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6
Q

alklaosis
-PCO2
-Biacarb
levels

A

bicarb and PCO2 will be high

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7
Q

where is most of the bicarb reabsorbed

A

proximal tubules MAINLY

little in the distal

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8
Q

why is CO2 increased in metabolic alkalosis

A

because it is the comepnsatory mechanism done by the lungs

high bicarb=alkalosis state—so to compensate the lungs RETAIN CO2 to bring the pH back down

HIGH BICARB + HIGH CO2= met alkalosis with compensation

same for met acidosis
—>low bicarb—>kidneys want to excrete more CO2 to bring the pH Up

LOW BICARB + LOW CO2= MET ACIDOSIS with compensation

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9
Q

describe amonias role in the kidney buffer system

A

ammonia NH3 picks up intracellular H+–> now becomes ammonium NH4+ (‘yum’ eats the H+)–>gets secreted into PCT–>excreted into CD

**for each H+ secreted there is a HCO3- gained in systemic circulation

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10
Q

what is the osmolar gap

A

compares measured and calculated osmolality

Plasma osm (measured) - Plasma osm (calculated)

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11
Q

METABOLIC ACIDOSIS

  • values for bicarb and co2 and ph
  • three main causes
  • types
A

PH <7.35

  • LOW CO2 (bc respiratory compensation=hyperventilation to get rid of CO2 to raise ph)
  • LOW BICARB <22

CAUSES

  1. increased acid production
  2. decrease acid excretion
  3. Loss of HCO3 (diarrhea)

**can be HIGH ANION GAP ACIDOSIS or NORMAL ANION GAP ACIDOSIS

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12
Q

Normal anion gap

  • define anion gap
  • equation
A

reflects unmeasured anions present in serum
AG= measured cations-measured anions (ECF)
AG= NA- (Cl+HCO3-)

10-12

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13
Q

ways to lose bicarb aka what type of met acidosis?

A

NON ANION GAP ACIDOSIS

H-->hyperalimentation 
A-->acetazolamide 
R-->renal tubular acidosis 
D-->diarrhea 
U->ureero-pelvic shunt
P-->post-hypocapnia 
S-->spironolactone
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14
Q

ways to gain acid

-aka causes of type of met acidosis?

A

HIGH ANION GAP ACIDOSIS

M--> methanol 
U-->uremia 
D-->DKA
P--> propyelen glycol 
I-->Isoniazid, infection 
L-->lactic acidosis 
E-->ethyelen gycol 
S--> salicylates
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15
Q

high anion gap acidosis

A
  • *means there is an increase in some other acid (other than Cl-) in the serum
  • the H+ is buffered by the HCO3 but the other newly added acid is not buffered
  • *increasing the gap

*use winters formula is used to measure the respiratory compensation for met acidosis

{(1.5 X HCO3-) + 8}

MUDPILES= causes

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16
Q

normal anion gap met acidosis

  • lab finding
  • causes
A

low ph
low bicarb
low co2
normal AG

*lost bicarb is replaced by CL- so there is no change in AG but there is an accumulation of CL-
OR
*in cases of dirrhea or RTA–> loss of sodium bicarb and kidney tries to preserve volume by retaining NACL

HARDUPS=causes

17
Q

CM for metabolic acidosis

A

Cardiovascular

  • imparied contractility
  • decrease CO
  • vasodilation
  • Vasocontriction
  • arrhythmias

Respiratory

  • hyperventilation
  • resp muscle fatigue

Metabolic

  • hypercalcemia
  • hyperK
18
Q

causes for high osmolar gap >20 mOsm/L

A

TOXIC ALCOHOL INGESTIONS

  • methanol
  • ethanol
  • isopropanol
  • ethylene gylcol
  • propylene glycol
  • diethyelen glycol
19
Q

causes for elevated osmolar gap but not >20

A

alcoholik ketoacidosis
lactic acidosis
renal failure

20
Q

equation for CALCULATED osmolality

A

2 (NA+) + (Glucose/18) + (BUN/2.8)

21
Q

explain why normal AG acidosis can occur

A

if the acid that accumulates is HCL–>no change in the AG!

also called Hyperchloremic MA

22
Q

two main causes for normal AG met. acidosis

A
  1. Loss of HCO3-
    * diarrhea
    * proximal RTA (2)
    * ketoacidosis
  2. Decreased acid secretion
    * kidneys will filter and reabsorb HCO3- at prox tubules
    * decr GFR
    * distal (type 1) and Type IV RTA
23
Q

urinary anion gap

-what is it

A

distinguishes extra renal from renal causes of normal AG MA

24
Q

what does a large -UAG mean

-cause

A

metabolic acidosis of extra renal cause

  • diarrhea
  • assoc with incr excetion of NH4
25
Q

what does a large + UAG mean

-cause?

A

metabolic acidosis of renal origin

  • NH4 excretion is minimal/impaired
  • distal renal tubular acidosis
26
Q

levels for met alkalosis

-what is this often accompanied by?

A

HIGH: bicarb, ph and PaCO2
**hypocholoremia and hypoK

**bicarb can sometimes be normal or low

27
Q

list two causes of elevated HCO3 and LOW CL-

A

metabolic alkalosis
resp acidosis

**need AGBs and electrolyte pannel to disntinguish the diff

28
Q

causes of met. alklaosis

A
  1. administration of alkali—antacids, citrate in blood transfusions
  2. Chronic alkali administration—MILK ALKALI SYNDROME–> too much tums
    - ->nephrocalcinosis
    - ->renal insuff
    - ->CA Carbonate
29
Q

hypoK does what to ammonium excretion

A

increases it

30
Q

what is the compensation for met. alk

A

resp

  • hypoxemia
  • ***retain CO2
  • hyPOventilation
  • increase in bicarb
  • paCO2 increases 6mmHg for each 10mEq/L increase in HCO3
31
Q

how to calculate PaCo2

A

Bicarb + 15

32
Q

two basic causes of met. alk

A
  1. H+ decrease

2. HCO3- increase

33
Q

causes of H+ decrease aka met alk

A
  1. renal loss of H+
    - aldosterone causes acid secretion (secretes K and H)
    - hyperaldosteronism= incr secretion of acids–leaving behind basic environment
  2. Shift of H+ into cells
    * H and K exchanged across cell membrane
    * in the state of hypoK–> K+ shifts out of the cells to balance K–>but H+ goes into cell as K+ leaves
  3. vomiting
    * loss of H+
34
Q

Causes of HCO3- increase aka met alk

A
  1. increased intake
  2. loss of acid
    * hyperaldosteronism
  3. Volume depletion
    *contraction alkalosis
    *fluid with low bicarb [ ] is lost, leads to increase in bicarb [ ]
    EX: over diuresis
35
Q

metabolic alkalosis phases

A
  1. GENERATION
    * acid loss (ie vomiting or prolonged NG tube suction)
    * gain HCO3 (Primary hyperaldosteronism)
  2. MAINTENANCE
    * kidney is unable to excrete HCO3 and instead absorbs it
36
Q

CM of met alkalosis

A

HYPOK–>arrhythmias
HYPOCA–>tremors, muscle cramps, tingling of fingers/toes
hypochloremia

incr anxiety 
seizures
confision 
HYPOventilation 
incr irritability

Clin Med (52 decks)

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