Renal Physiology: Acid Base Disorders Flashcards
Normal anion gap is…
8-16
anion gap is calculated by…
Sodium - (Cl- + bicarb)
What causes of metabolic acidosis would maintain a normal anion gap?
simple bicarb loss due to diarrhea or RTAs
What increases to meet the drop in bicarb in metabolic acidosis with a normal anion gap?
chloride increases
When does the anion gap increase?
acidosis of fixed acid accumulation
What are some examples of substances that would increase the anion gap, pushing downward the concentration of bicarb without allowing adjustment to chloride?
Lactic acid, oxalic acid
Which RTA is this?
H+-ATPase activity reduced
generalized failure of alpha-intercalated cells
Type I, distal
Which RTA is this?
Sodium-Hydrogen Antiporter activity reduced
Type II, proximal
Which RTA is this?
reduced NH4+ formation
due to hyperkalemia secondary to aldosterone deficiency
glutamin enzymes inhibited
Type IV
Which RTA is this?
Metabolic acidosis
Hypokalemia
Normal anion gap
Type I, distal
The below mechanism represents which RTA?
Impaired H-ATPase
Decreased H+ secretion
Decreased bicarb recovery
Chronic metabolic acidosis
Type I, Distal
Which RTA is this?
Caused by Toxins, genetics
Loss of bicarbonate recovery
Impaired H+ secretion
Less severe than type I
Normal anion gap
Type II, proximal
Type II RTA is caused by a defective _______ in what region of the nephron?
Sodium-Hydrogen Antiport
Proximal Convoluted Tubule
The below mechanism represents which RTA?
Decreased H+ secretion and bicarb recovery
Mild results in decreased plasma bicarb and mild acidemia
——
Severe results in urinary sodium loss, RAAS activation,
Increased potassium secretion and hypokalemia
type II, proximal
Which RTA is this?
impaired bicarb generation
metabolic acidosis
hyperkalemia
inhibition of renal glutaminase
aldosterone deficiency
normal anion gap
Type IV
What is characteristic of type IV RTA?
hyperkalemia
Aldosterone deficiency
In type IV RTA, inhibition of renal glutaminase impairs formation of ____
NH4+
Type IV RTA is correlated with Aldosterone deficiency. How does aldosterone deficiency lead to acidosis?
Decreased CD H+-ATPase activity leads to decreased H+ secretion
Decreased sodium reabsorption leads to decreased potassium secretion
Hyperkalemia inhibits glutaminase, leading to decreased NH4+ leading to acidosis
The following would have what effect on anion gap?
lactic acidosis ketoacidosis renal failure salicylate poisoning ehtylene glycol poisoning methanol poisoning
Increased anion gap
renal failure can be secondary to accumulation of which acids?
phosphoric and sulphuric acids
Patient presents with:
Otherwise healthy
severe HA
Muscle Weakness
HTN Urgency
this presentation is concerning for…
Conn syndrome
A patient has the following labs concerning for:
Decreased potassium
Increased potassium excretion
Increased bicarb
increased pH
Increased PCO2
Increased serum aldosterone
decreased plasma renin
Conn Syndrome
What should you expect to see on UA with Conn syndrome?
Elevated potassium
What should you expect to see on blood work with Conn Syndrome?
Decreased potassium
Increased bicarb
increased pH
Increased PCO2
Increased serum aldosterone
decreased plasma renin
