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302/308 > Acid base and electrolyte disturbance > Flashcards

Acid base and electrolyte disturbance Flashcards

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1
Q

What is urea produced and excreted by

A
  • Produced by liver, excretion of ammonia and breakdown products of amino acids
  • Excreted in urine
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2
Q

When do urea levels decrease

A

Liver disease

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3
Q

When are urea levels raised

A
  • Intravascular depletion
  • Blood meal
  • Renal failure
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4
Q

Effects of high urea levels

A

Urea>20 - Nausea, decreased appetite, itchiness, tiredness, smelly breath, metallic taste in mouth

Urea > 60 - Extreme ureamic frost, uraemic pericarditis, encephalopathy

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5
Q

What is creatinine a product of

A
  • Breakdown product of creatinine phosphate in muscle

- Usually produced at a fairly constant rate by the body

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6
Q

Link between number of nephrons and creatinine levels

A

The less the number of nephrons the more the build up of creatinine - therefore creatinine levels are indicative of kidney function

  • Creatinine is not toxic itself
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7
Q

How affected are creatinine levels by fluid shifts

A
  • Less affected by fluid shifts
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8
Q

What can creatinine levels be used to calculate

A
  • eGFR
  • MDRD
  • Cockcroft and Gault
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9
Q

Normal creatinine clearance rate

A

> 90 mls/min

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10
Q

CKD 1 eGFR

A

> 90 mls/min

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11
Q

CKD 2 eGFR

A

> 60 mls/min

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12
Q

CKD 3a eGFR

A

> 45 mls/min

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13
Q

CKD 3b eGFR

A

> 30 mls/min

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14
Q

CKD 4 eGFR

A

> 15 mls/min

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15
Q

CKD 5 eGFR

A

< 15 mls/min

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16
Q

Location of bulk of water and electrolytes

A
  • Bulk of water and electrolytes are not in the serum but in the cells
  • Integrated homeostatic mechanisms maintain body fluid compositions
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17
Q

What is glomerular filtration diminished by

A
  • Age
  • Renal disease
  • Congestive heart failure
  • Cirrhosis
  • Nephrotic syndromes
  • Volume depletion
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18
Q

Causes of hyponatremia - hypovolemia - renal losses >20mmol/L

A
  • Diuretic excess
  • Mineralocorticoid deficiency
  • Self-losing nephropathy
  • Bicarbonaturia with renal tubular acidosis and metabolic alkalosis
  • Ketonuria
  • Osmotic diuresis
  • Cerebral salt wasting
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19
Q

Causes of hyponatremia - hypovolemia - extrarenal losses <20 mmol/L

A
  • Vomiting
  • Diarrhoea
  • Third spacing of fluids in burns, pancreatitis and trauma
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20
Q

Causes of hyponatremia - euvolemia(no edema) - increase in total body water, no change in total body Na+ (>20 mmol/L)

A
  • Glucocorticoid deficiency
  • Hypothyroidism
  • Stress
  • Drugs
  • SIADH
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21
Q

Causes of hyponatremia - Hypervolemia - >20mmol/L

Study These Flashcards
A
  • Acute or chronic renal failure
22
Q

Causes of hyponatremia - hypervolemia - <20mmol/L

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A
  • Nephrotic syndrome
  • Cirrhosis
  • Cardiac failure
23
Q

What is pseudohyponatremia

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A
  • A physiologically normal plasma water sodium concentration, but a reduced measured plasma sodium concentration.
24
Q

What can cause pseudohyponatremia

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A
  • Hypertriglyceridemia associated with conditions such as diabetes, obstructive liver disease, nephritic syndrome and acute pancreatitis
  • Can also be caused by administering IV immunoglobulins
25
What is translocational hyponatraemia
Translocational hyponatremia refers to the translocation of water from the ICF compartment to the ECF compartment usually in the setting of hypertonicity, which dilutes the PNa
26
Potassium distribution
- Wide distribution - extracellular and intracellular - The major intracellular cation - Primarily distributed intracellularly (100-120mmol/L) - Serum K = 3.2-5.1 mmol/L
27
Hypokalaemia causes - redistribution
- Insulin, theophylline, adrenergic use
28
Hypokalaemia causes - non renal loss
- Sweating, vomiting or diarrohea
29
Another cause of hypokalaemia
Poor diet
30
Causes of hypokalaemia - renal loss > 20mmol/l
- Drugs, diuretics, aminoglycosides, amphotericin - RTA or metabolic acidosis - Low BP bartter's or gittlemans - High BP - High aldosterone normal cortisol - hyperaldosteronism - Low aldosterone normal cortisol liddle's - Low aldosterone high cortisol cushing's syndrome
31
Chronic hypokalaemia - cardiovascular complications
- Hypertension | - Ventricular tachyarrhythmias
32
Chronic hypokalaemia - endocrine complication
- Impairs insulin activity and sensitivity
33
Chronic hypokalaemia - muscular complication
- Impairs muscle contraction --> weakness
34
Chronic hypokalaemia - renal complications
- Mild tubulointerstitial fibrosis - Renal cyst formation - Metabolic alkalosis (increased net renal acid excretion) - Polyuria
35
Chronic hypokalaemia - liver complications
- Increases renal ammonia production which may worsen hepatic encephalopathy
36
What does hyperkalaemia indicate
- Kidneys have a large capacity to excrete K+ | - Hyperkalaemia indicates impaired renal excretion
37
What causes hyperkalaemia
Impaired renal excretion - CKD4/5 - Drugs impairing secretion - spironolactone, amiloride, ACE-I, ARB - Increased K load - rhabdomyolysis, haemolysis, GI bleed - Increased dietary intake
38
Pseudohyperkalaemia
- Haemolysis During blood collection/storage Rheumatoid/infectious mononucleosis
39
Hyperkalaemia - treatment
Back into cells - Salbutamol, insulin and dextrose, sodium bicarbonate(if acidotic) Stabilisation - Calcium gluconate Removal - If passing urine, pee it out, iv fluids and diuretics - Dialysis
40
Acid-base regulation
Body pH maintained 7.35-7.45 - Essential for functioning of proteins, enzymes etc - Large net acid production - 1 mmol H+/kg
41
What regulates co2 tension
Resp system
42
What regulates HCO3 tension
Kidneys
43
Major sites of hCO3 recovery and H+ excretion
- Proximal tubule NaHCO3 reabsorption | - Secretion of H+ in the alpha intercalated cell of the cortical collecting duct
44
Sodium bicarbonate in severe metabolic acidaemia
- Depends on underlying cause - Generally safe to give isotonic NaHCO3 1.26% - If pH<7.2, adverse effects of acidaemia may manifest - Removing stimulus to production of lactate/ketones will allow oxidative mechanisms to metabolise excess anion - Diarrhoea and ingestions: NaHCO3 may be of use if acidaemia severe, and adverse effects are present - Exogenous Na load can exacerbate fluid overload and HTN
45
What might metabolic alkalosis be due to
Excess alkali - kidney responds rapidly to this, so is usually transient - K+ depletion - Cl- depletion
46
Calcium
- Serum calcium tightly controlled levels 2.2-2.6mmol/l - Absorbed by the gut - Excreted in the urine/reabsorbed in the loop of henle and distal tubule - Released by bone - Controlled by PTH
47
Phosphate
- 0.85 to 1.6mmol/l - Excreted by the kidneys - Rises in renal failure/less nephrons less excretion
48
What are phosphate levels a good indicator of
- Malnutrition
49
What are high phosphate levels associated with
- Itchy skin - Extraosseal calcification - Soft tissues and arteries
50
Vitamin D and Ca and Phosphate
- Vitamin D3 from diet and skin --> liver--> 25-0H-D3 --> Kidneys --> 1,25-(OH)2-D3 --> Bone mineralisation, decrease in PTH, increase in Ca/P Gut
51
AKI
- Normal Na - High K - low bicarb - low pH - high urea - high creatinine - oliguria - +/- fluid overload - normal calcium, phosphate, PTH levels
52
What happens in ESRF
Hyperkalaemic and acidotic - Treatment restrict K containing foods - Sodium bicarbonate tablets Lack of vitamin D - Low calcium - Treatment activated vitamin D tablets Hyperphosphataemia - Lack of phosphate excretion from the kidney - Extraossial calcification - Diet and phosphate binding tablets

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