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Renal Week 2 > Acid Base Balance > Flashcards

Acid Base Balance Flashcards

1
Q

what is cutoff for acidotic urine?

A

less than 5.3 pH

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2
Q

what is cutoff for alkalotic urine?

A

more than 6.0 pH

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3
Q

what are the two buffers of acid in the urine?

A

ammonia

dibasic phosphate

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4
Q

when eating fruit/veggies you are getting a lot of citrate…does citrate act as a base or acid?

A

it acts as a base because it is easily converted to bicarbonate

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5
Q

so if you have acidemia…would you secrete more citrate into the urine or hold onto more citrate?

A

hold onto more citrate in acidemia and secrete more in alkalemia

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6
Q

what does citrate bind in the urine? what can this be useful for?

A

bind calcium…can be useful for avoiding calcified kidney stones

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7
Q

where in the nephron does glutamine lead to ammonia?

A

PCT

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8
Q

what glutamine lead to in the PCT?

A

ammonia and more H+

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9
Q

the two bases in urine are ammonia and dibasic phosphate…which of these is in a fixed amount? and which can be generated?

A

dibasic phosphate is fixed

ammonia can be generated

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10
Q

in an acidotic state, which base is higher occupied in the urine?

A

ammonia because you are able to make more of it

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11
Q

what is the winters formula? which acidosis or alkalosis is it used for?

A

expected pCO2 = HCO3 times 1.5 plus 8+-2

metabolic acidosis

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12
Q

what is the compensation equation for metabolic alkalosis

A

for every 1 HCO3 increase you should get 0.7 CO2 increase

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13
Q

what is the anion gap formula?

A

sodium minus chloride plus bicarb

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14
Q

what is a normal anion gap?

A

8-12

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15
Q

what is the mnemonic for anion gap metabolic acidosis

A

GOLDMARK

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16
Q

in GOLDMARK what does the G stand for

A

glycols

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17
Q

what glycols are included in metabolic acidosis with anion gap?

A

ethylene glycol, diethylene glycol, propylene glycol

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18
Q

what does ethylene glycol cause in the kidneys?

A

binds with calcium and can lead to stones

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19
Q

which glycol can cause stones in the kidneys?

A

ethylene glycol

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20
Q

which glycol leads to lactate production?

A

propylene glycol

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21
Q

in GOLDMARK what does the O stand for?

A

oxoproline

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22
Q

in GOLDMARK what does the L stand for?

A

L-Lactate

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23
Q

in GOLDMARK what does the D stand for?

A

D-lactate

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24
Q

where does D-lactate come from?

A

bacteria in gut

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25
Q

where does L lactate come from?

A

anaerobic respiration from hypoxia or hypoperfusion

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26
Q

in GOLDMARK what does the M stand for?

A

methanol

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27
Q

what does methanol cause?

A

vision changes

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28
Q

in GOLDMARK what does the A stand for?

A

aspirin toxicity

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29
Q

in GOLDMARK what does the R stand for?

A

renal failure

30
Q

in GOLDMARK what does the K stand for?

A

ketoacidosis

31
Q

name the two alcohols that lead to an osmolal gap and a metabolic acidosis with anion gap

A

methanol and ethylene glycol

32
Q

what alcohol causes an osmolal gap but does not cause a metabolic acidosis?

A

isopropyl alcohol

33
Q

what is the mnemonic for non anion gap metabolic acidosis?

A

ACCRUED

34
Q

in ACCRUED for non anion gap metabolic acidosis, what does the A stand for?

A

acute kidney disease

35
Q

in ACCRUED for non anion gap metabolic acidosis, what does the two Cs stand for?

A

chronic kidney disease

carbonic anhydrase inhibitors

36
Q

in ACCRUED for non anion gap metabolic acidosis, what does the R stand for?

A

renal tubular acidosis

37
Q

in ACCRUED for non anion gap metabolic acidosis, what does the U stand for?

A

ureteroenterostomy

38
Q

in ACCRUED for non anion gap metabolic acidosis, what does the E stand for?

A

expansion..volume

39
Q

in ACCRUED for non anion gap metabolic acidosis, what does the D stand for?

A

diarrhea

40
Q

if you have a metabolic acidosis and patient has not compensated as expected and has higher CO2 than youd expect, what else do they likely have?

A

primary respiratory acidosis

41
Q

if you have metabolic acidosis and compensation is too much so CO2 is way too low…then what else might you have?

A

primary respiratory alkalosis

42
Q

what three disorders cause respiratory alkalosis and metabolic acidosis combined?

A

sepsis
liver failure
aspirin toxicity

43
Q

what are two common sites of acid loss that lead to excess of bicarb?

A

GI tract

renal

44
Q

what is the mnemonic for metabolic alkalosis?

A

BARFED

45
Q

In BARFED for metabolic alkalosis, what does the B stand for?

A

Barters or gitelmans syndrome

46
Q

In BARFED for metabolic alkalosis, what does the AR stand for?

A

Aldosteronism

47
Q

In BARFED for metabolic alkalosis, what does the F stand for?

A

FOmiting Vomiting

48
Q

In BARFED for metabolic alkalosis, what does the E stand for?

A

excess alkali

49
Q

In BARFED for metabolic alkalosis, what does the D stand for?

A

diuretics

50
Q

what are the two phases of metabolic alkalosis in vomiting?

A

generation and maintenance

51
Q

in generation phase ofvomiting, what happens to Cl in the kidneys?

A

it is reabsorbed

52
Q

in generation phase of vomiting what happens to Na, K and HCO3 in kidneys?

A

all are secreted more than reabsorbed

53
Q

in generation phase of vomiting is the urine pH low or high?

A

high cause of the HCO3

54
Q

in generation phase of vomiting are urine levels of chloride and sodium high or low?

A

low chloride in urine

high sodium in urine

55
Q

in maintenance phase of vomiting, what happens to HCO3, Na and Cl in the kidneys?

A

reabsorbed because of the activation of RAAS due to severe hypovolemic state

56
Q

in maintenance phase of vomiting, is pH of urine high or low?why?

A

low because HCO3 being reabsorbed and aldo is active so H+ getting pumped out

57
Q

in maintenance phase of vomiting is the urine levels of Cl and Na high or low?

A

both are low

58
Q

is serum HCO3 higher in generation or maintenance phase of vomiting?

A

maintenance

59
Q

explain how loop an thiazide diuretics lead to metabolic alkalosis? what other solute is low with these?

A

they block early channels and lower volume…so RAAS activates Aldo and there is a greater gradient for flow…this leads to Na reabsorption in DCT and the K+ and H+ go out in exchange…so you get hypokalmic metabolic acidosis

60
Q

what diuretic is barter syndrome like?

A

loop

61
Q

what diuretic is gitelman syndrome like?

A

thiazide

62
Q

what are urine sodium and chloride levels in active diuretic use?

A

sodium and chloride are both high

63
Q

what are urine sodium and chloride levels in remote diuretic use?

A

sodium and chloride are both low

64
Q

what is primary hyperaldosteronism? why does it lead to metabolic alkalosis?

A

when too much aldo is secreted from the adrenal gland and it leads to more K+ and H+ secretion into urine so you get alklosis

65
Q

what is secondary hyperaldosteronism? what causes it?

A

when low blood supply leads to RAAS activation and aldosterone is placed

66
Q

how to differ between primary and secondary hyperaldo?

A

renin and aldo levels

67
Q

which of primary or secondary hyperaldo has high renin levels?

A

secondary

68
Q

are urine levels of sodium and chloride high or low in primary and secondary hyperaldo?

A

high for both

69
Q

why are urine sodium and chloride levels high in primary and secondary hyperaldo?

A

volume increases and leads to ANP and pressure natriuresis

70
Q

with metabolic alkalosis, if you have a high BP what are you thinking?

A

primery hyperaldo or secondary hyperaldo

71
Q

with metabolic alkalosis if you have normal or low BP what are you thinking of?

A

vomiting…

volume loss from kidneys so diuretics or gitelman/barter

Renal Week 2 (4 decks)

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