Renal Stuff Flashcards
what are causes of an osmolar gap?
recall and osmole is an amount of stuff that depresses the freezing point of a substance: ethylene methanol formaldyhyde lactic acidosis paraaldehyde Ketones Alcohol
what are natural osmoles present in all of us?
na and glucose, hence the calcuation of 2 salts and a sugar bun
how do you calculate an osmolar gap?
you need the measured osmoles ( bloodwork value)
then minus the calculated osmoles you would expect in a normal person ( 2 NA + glucose +bun)
what is the normal range for serum osmolality?
285-295
what are the causes of anion gap?
anything thats gives you extra charges floating around:
- hypercalcemia
- hyperMG
- decreased albumin ( chaaerone protein)
- lithium ( li+)
- paraproteins
- halides…?? lol
what are causes of an anion gap metabolic acidosis?
MUDPILES THAT SHIT also called AGMA Methanol Urea Drugs - paraldehyde Iron/ Isoniazad lactate Ethanol salicylates (ASA)
how do you get a NAGMA - non anion gap metabolic acidosis?
also called a NAGMA
you essentially have an acidosis and it is from ions just ones that we dont usually measure, so on paper it look slike a non-anion gap metabolic acidosis
- think about the patient losing bicarb ( aka GI fluids) and then the body retains Cl- to keep the charges balanced
what lab values do you order for an anion gap workup?
recall all of this is diagnosing dysfunction in your chem 7 - Na, Cl, K, Hc03,
Then also add in stuff that has charges like Ca, Mg, lactate, Salycilates
What are the commons causes of a NAGMA
diarrhea, ileal loop fluids, fistula ( their GI tract is just losing fluids to a different body site), type II RTA
How do Renal Tubular Acidoses give you NAGMAs?
rental tubular acidosis just means you are getting your blood acidic because the renal tubules are messed. They are not excreting acid like they should be, so its building up causing an acidosis
When should you give a bicarb infusion?
1) if you are losing bicarb, through a type of RTA or GI losses
2) Salycylate overdose ( corrects the acidemia/ inactivates the ASA)
3) severe acidemia under 7.15
what are the common causes of metabolic alkalosis
you are either gaining Hc03 ( relatively through dehydration or dieuretics)
- or you are losing your acids ( vomiting, NG suction, antacids)
- remmber they usually call it a contraction alkalosis
what is the pathophys of Renal Tubular Acidosis Type1? Yes i know this is a mean question
its a distal tubule problem where your kidneys cant ammonia-fy the excess H+ in your body, hence you get an acidosis that is metabolic ( kidney related).
This causes a NAGMA
hyPOkalemia
what is the pathophys of RTA type 2?
the proximal tubule doesnt reabsorb Hc03 ( bicarb) very well = lots of bicarb in the urine, and none in the body.
No bicarb in the body = acidic blood, –causing a NAGMA
HyPOkalemia
What is the pathophys of RTA type 4?
Distal tubule problem with HYPERKALEMIA which is different from the other two
Your body doesn’t respond to aldosterone, which is the main hormone that lets kidneys release K
