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RENAL Pathology > Acid-Base > Flashcards

Flashcards in Acid-Base Deck (36):
1

The kidney is able to stabilize acid base by ?

altering either acid elimination (H+ excretion) or base elimination (HC03 excretion).

2

The lung eliminates massive amounts of acid as (1), but if there is pulmonary disease, then the kidney excretes (2)

1. C02
2. H+ thereby raising the blood pH.

3

In times of base excess, there is more (1) filtered, so the kidney eliminates more (1), thereby (2)

1. bicarbonate (HC03)
2. lowering the blood pH.

4

Cells use the ability of carbonic anhydrase to catalyze the formation of C02 from (1) to achieve charge neutrality and add either (2) to the blood or the urine as needed.

1. hydrogen and bicarbonate
2. H+ or HC03

5

Buffers such as (3) allow neutralization of pH without massive excretion of charged ions

3. phosphate and ammonia

6

The simplest way to solve acid base problems is by first determining if there is an acidosis or alkalosis by evaluating the pH. If the pH is below the normal range (1), then there is (2), whereas if it is above the normal range, there is (3)

1. 7.35-7.45
2. acidosis
3. alkalosis.

7

Next, evaluate whether the respiratory or metabolic component can explain the observed pH change. If an acidosis, then (1)

1. elevated pC02 or a reduced HC03

8

Next, evaluate whether the respiratory or metabolic component can explain the observed pH change. If an alkalosis then (1)

1. reduced pC02 or an elevated HC03

9

For example: If the pH is 7.2 and the pC02 is above the normal range (35-45 mm Hg), then the patient has (1). We may also expect to find (2) in such a patient, but that is the (3)

1. respiratory acidosis
2. an elevated HC03
3. compensatory metabolic alkalosis.

10

In some patients with a metabolic acidosis, there are (1) present (2) which can be calculated by determining the (3)

1. excess anions
2. lactic from lactic acidosis or ketone bodies from diabetic ketoacidosis
3. anion gap

11

Anion gap is calculated by (1). The normal range for the anion gap is usually between (2)

1. taking the sodium and then subtracting the Cl and HC03
2. 8-16.

12

An anion gap should really only be present if there is a component of a (1) and not just as a compensation

1. metabolic acidosis

13

Because the lung eliminates C02 as acid, (1) causes a respiratory alkalosis and (2) causes a respiratory acidosis.

1. hyperventilation
2. hypoventilation

14

Hypoventilation can be caused by?

airway obstruction, neurological diseases (stroke, sleep apnea,Guillain-Barre), chest wall deformities, or pulmonary diseases such as asthma or COPD.
It can cause a respiratory acidosis

15

Winter’s formula:
Checks if there is compensation for METABOLIC ACIDOSIS

PaCO2 = 1.5 {HCO3-} + 8

16

anion gap formula

AG = [Na+] – ([HCO3-] + [Cl-])

17

anion gap Determines cause of 1)

metabolic acidosis

18

Normal Anion Gap
HARD-ASS

Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion

19

normal anion gap value

8-12 mEq/L

20

Increased Anion Gap

Indicates accumulation of unmeasured anion.

21

Diarrhea

Normal Anion Gap Metabolic acidosis

22

Acetazolamide

Normal Anion Gap Metabolic acidosis

23

Increased Anion Gap metabolic acidosis causes:
MUDPILES

Methanol
Uremia
Diabetic Ketoacidosis
Propylene glycol
Iron tablets or Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

24

contraction alkalosis occurs secondary to ECF volume contraction; pH? and K?

pH is INCREASED
K is decreased;

25

Diabetic Ketoacidosis

Increased Anion Gap metabolic acidosis

26

Salicylates

Increased Anion Gap metabolic acidosis

27

Lactic acidosis

Increased Anion Gap metabolic acidosis

28

Vomiting

Metabolic alkalosis

29

Bicarb is CONTRAINDICATED

Diabetic Ketoacidosis

30

asthma, COPD, chronic fibrosis, and interstitial disease

Respiratory Acidosis

31

Water Deficit =

DBW – CBW

32

Desirable body water (DBW) =

(DBW) = (Current sodium/140) * CBW

33

Current body water (CBW) =
Use 0.5 for females

0.6 * Body weight

34

Insulin shifts K+ into cells --> leads to 1)

hypokalemia.

35

Filtration fraction =

GFR/RPF where GFR is measured by creatinine clearance and RPF by PAH clearance

36

RPF measured by 1)

PAH clearance