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Master the boards: Nephrology > Acid-Base Disturbances > Flashcards

Acid-Base Disturbances Flashcards

(74 cards)

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1
Q

What is Renal Tubular Acidosis?

A

Metabolic Acidosis with a normal Anion Gap

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2
Q

How do you calculate the anion gap?

A

Na - (Cl + HCO3)

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3
Q

What is a normal anion gap?

A

6-12

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4
Q

What are the most important causes of a metabolic acidosis with a normal anion gap?

A

RTA

Diarrhea

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5
Q

Why is the anion gap normal in RTA and Diarrhea?

A

Chloride rises

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6
Q

What is another name for Type I RTA?

A

Distal (Type I) RTA

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7
Q

What is the Distal Tubule Reponsible for?

A

Generating new bicarbonate under the influence of aldosterone

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8
Q

What are common causes of damage to the distal tubule?

A

Amphotericin, autoimmune diseases: SLE, Sjogren

Topiramate

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9
Q

What drug is highly associated with Distal (Type I) RTA?

A

Topiramate

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10
Q

What happens in Distal (Type I) RTA?

A

The distal tubules are damaged and Bicarbonate cannot be generated at the distal tubule: this means acid cannot be excreted into the tubule and the pH of urine raises (akaline)

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11
Q

What is increased in Alkaline Urine?

A

Formation of kidney stones from Calcium Oxalate

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12
Q

What is the best initial diagnostic test for Distal (Type 1) RTA?

A

UA looking for high pH >5.5

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13
Q

What is the most accurate test for Distal (Type I) RTA?

A

infuse acid into the blood with ammonium chloride
-healthy pt with excrete the acid and decrease urine pH
-Type I Distal RTA cannot excrete acid and urine pH will remain high

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14
Q

How do you treat Distal (Type I) RTA?

A

Replace bicarbonate which will be reabsorbed at the proximal tubule
and correct the acidosis

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15
Q

What is the Proximal Tubule responsible for?

A

Resorbtion of Filtered Bicarbonate

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16
Q

What is the Defect in Proximal (Type II) RTA?

A

Damage to the Proximal tubule decreases the kidney’s ability to resorb most of the filtered bicarbonate, phosphate, glucose and citrate. Bicarbonate is lost in the urine until the kidney can absorb the rest: urine pH will become low <5.5

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17
Q

What are common causes of damage to the Proximal Tubule seen in Type II RTA?

A

Amyloidosis, Myeloma, Fanconi Syndrome, Acetazolamide, heavy metals

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18
Q

What is an adverse effect of chronic metabolic acidosis seen in Proximal (Type II) RTA?

A

Calcium is leached out of the bones and they soften (Osteomalacia)

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19
Q

What is the most accurate test to diagnose Proximal (Type II) RTA?

A

Give bicarbonate and evaluate urine pH
-urine pH will rise when Bicarb is given because the kidney cannot absorb it

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20
Q

How do you treat Proximal (Type II) RTA?

A

Vigorous bicarbonate replacement and thiazides
-thiazides cause volume depletion to enhance Bicarbonate resorption

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21
Q

What disease Is Type IV RTA most common in?

A

Diabetes

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22
Q

What is the defect in Type IV RTA?

A

Either the amount of effect of aldosterone at the kidney tubule is abnormally low: leading to loss of sodium and retention of Potassium and Hydrogen

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23
Q

How do you test for Type IV RTA?

A

Persistently high urine sodium despite a sodium-depleted diet

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24
Q

How do you treat Type IV RTA?

A

Fludrocortisone

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25
What is the urine pH in Proximal (type II) RTA?
variable
26
What is the blood Potassium in Proximal (Type II) RTA?
low
27
Do you commonly see stones in Proximal (type II) RTA?
no
28
What is the diagnostic test for Proximal (Type II) RTA?
Administer Bicarbonate
29
How do you treat proximal (Type II) RTA?
Thiazides
30
What is the urine pH in Distal (Type I) RTA?
High >5.5
31
What is the blood potassium level in Distal (Type I) RTA?
low
32
Are there commonly stones in Distal (Type I) RTA?
yes
33
What is the diagnostic test for Distal (Type I) RTA?
Administer Acid
34
What is the treatment for Distal (Type I) RTA?
Bicarbonate
35
What is the urine pH in Type IV RTA?
Low <5.5
36
What is the blood potassium level in Type IV RTA?
High
37
Are there commonly stones in Type IV RTA?
no
38
What is the diagnostic test for Type IV RTA?
Urine salt loss
39
How do you treat Type IV RTA?
Fludrocortisone
40
What is the urine anion gap used for?
Distinguish between Diarrhea and RTA as the cause of normal anion gap metabolic acidosis
41
How is the Urine Anion gap calculated?
Na - Cl
42
What is acid excreted by the kidney buffered off as?
NH4Cl (ammonium chloride)
43
What happens to the Urine Anion gap in RTA?
There is a defect in acid excretion into Urine so Cl in urine is diminished: this creates a (+) urine anion gap value
44
What happens to the urine anion gap in Diarrhea?
Kidney tries to compensate by increasing acid excretion which increases the amount of Cl in urine creating a more (-) urine anion gap
45
What are common causes of Increased anion gap in metabolic acidosis?
Lactate, Ketoacids, oxalic acid, formic acid, uremia, salicylates
46
What causes increased Lactate?
Hypotension or Hypoperfusion
47
How do you test for Increased Lactate?
Blood lactate level
48
How do you treat an increased lactate level?
Correct Hypoperfusion
49
What causes increased ketoacids?
DKA, starvation
50
How do you test for increased ketoacids?
Acetone level
51
How do you treat increased ketoacids?
Insulin and fluids
52
What causes an increase in Oxalic Acid?
Ethylene glycol Overdose
53
How do you test for increased Oxalic acid level?
Crystals on UA
54
How do you treat an increase in Oxalic Acid level?
Fomepizole or dialysis
55
What causes an increase in Formic Acid?
Methanol Overdose
56
How do you test for an increase in Formic Acid?
Inflamed retina
57
How do you treat an increase in Formic Acid?
Fomepizole or dialysis
58
What causes Uremia?
Renal Failure
59
How do you test for Uremia?
Bun, Cr
60
How do you treat Uremia?
Dialysis
61
What causes an increase in Salicylates?
Aspirin Overdose
62
How do you test for increased Salicylates?
Aspirin level
63
How do you treat increased Salicylate level?
Alkalinize urine
64
BY definition What must metabolic alkalosis have?
Increased serum bicarbonate
65
What is the compensatory mechanism for metabolic alkalosis?
Respiratory acidosis: relative hypoventilation to increase pCO2
66
What are common causes of Metabolic Alkalosis?
GI Loss Increased aldosterone Diuretics Milk-alkali syndrome Hypokalemia
67
What will an Arterial Blood gas show in Metabolic Alkalosis?
pH >7.40 Increased pCO2: respiratory acidosis as compensation Increased Bicarbonate
68
How do you calculate Minute ventilation?
Respiratory rate x tidal volume
69
What is seen in Respiratory alkalosis?
Decreased pCO2 with increased minute ventilation
70
What is the compensation for Respiratory alkalosis?
Metabolic acidosis
71
What are common causes of Respiratory Alkalosis?
Anemia, Anxiety, Pain, Fever Interstitial Lung disease, Pulmonary emboli
72
What is seen in Respiratory Acidosis?
Increased pCO2 with decreased minute ventilation
73
What is the compensatory mechanism in Respiratory acidosis?
Metabolic alkalosis
74
What are common causes of Respiratory Acidosis?
COPD/Emphysema Drowning Opiate overdose Alpha-1 antitrypsin deficiency Kyphoscoliosis Sleep apnea/morbid obesity

Master the boards: Nephrology (14 decks)

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