Acid Base Review

Question 1

Normal pH

Answer 1

7.35-7.44

Question 2

normal bicarb

Answer 2

24

Question 3

normal paco

Answer 3

40

Question 4

normal anion gap

Answer 4

12

Question 5

normal osmolar gap

Answer 5

10

Question 6

What does GOLD MARK stand for?

Answer 6

glycols 
5-oxoproline 
L lactate 
D lactate 
methanol 
aspirin 
renal failure 
ketoacidosis

Question 7

Winter’s formula

Answer 7

1.5xBicarb +8 +/- 2

Question 8

Anion gap formula

Answer 8

Na - (HCO3+Cl)

Question 9

Osmolar gap fomula

Answer 9

measured - calculated osmolarity

Question 10

Osmolarity equation

Answer 10

2*Na + glucose/18 + BUN/2.8

Question 11

Delta-delta gap equation

Answer 11

delta gap: Calculated anion gap - normal anion gap

delta bicarb: 24 - delta gap

if the measured bicarb was greater than what we calculated here, then theres metabolic alkalosis as well

if the measured bicarb was less than what we calculated here, then there’s NAGMA as well

Question 12

Diagnosis of osmolar gap mnemonic

Answer 12

ME DIE 
methanol 
ethanol 
diethylene glycol 
isopropyl alcohol 
ethylene glycol

Question 13

NAGMA diagnosis mnemonic

Answer 13

DURHAMM 
diarrhea 
ureteral diversion 
renal tubular acidosis 
hyperalimentation 
acetazolamide 
addisons disease 
miscellaneous

Question 14

What is the effect of acidosis and alkalosis on potassium levels?

Answer 14

acidosis - hyperkalemia

alkalosis - hypokalemia

Question 15

What is the difference in presentation between glomerular and non glomerular hematuria?

Answer 15

glomerular will have RBC casts, new proteinuria, elevated serum creatinine

non glomerular: more likely to have visible blood clots

Question 16

What is the first thing to consider in work-up of hematuria?

Answer 16

urine culture

Question 17

What are the features of IgA nephropathy?

Answer 17

IgA deposits in mesangium
hematuria associated with a viral infection
1-2 days after infection present with dark urine

Question 18

What are the clinical features of Renal Cell Carcinoma

Answer 18

gross hematuria
flank pain
mass
fever and weight loss

Question 19

What is the next step for imaging of RCC?

Answer 19

CT or MRI

Question 20

When is PSA and DRE not recommended for screening of prostate cancer?

Answer 20

when the man is asymptomatic

Question 21

what increases a patient’s risk for prostate cancer?

Answer 21

primary degree relative

Question 22

If you suspect urinary tract stone disease, what is the primary concern?

Answer 22

concomitant infection (surgical concern)

Question 23

How do you diagnose urinary tract stone disease?

Answer 23

flank pain, frequent UTIs, nausea/vomiting, stone on imaging

Question 24

What are the considerations in transient urinary incontinence?

Answer 24

DIAPPERS 
delirium 
infection 
atrophic vaginitis 
pharmaceuticals 
psychosocial/psychiatric 
excess urine 
stool impaction

Question 25

What are the common causes of fever?

Answer 25

infection autoimmune disease CNS disease (head trauma, mass lesion) malignancy (lymphoma, leukemia, RCC, liver cancer)

Question 26

How do you calculate urine anion gap?

Answer 26

(urine Na + Urine K) - Urine Cl

Question 27

What does it mean if UAG is positive?

Answer 27

the distal nephron is unable to acidify the urine.

Question 28

What does it mean if UAG is negative?

Answer 28

distal nephron is able to acidify the urine

Question 29

What is the etiology of proximal RTA Type 2?

Answer 29

primary - idiopathic/heriditary | secondary - cystinosis in children and fanconi syndrome in adults

Question 30

What are the clinical manifestations of proximal RTA?

Answer 30

``` NAGMA hypokalemia (mild compared to distal RTA type 1) ```

Question 31

How to diagnose proximal RTA?

Answer 31

urine pH can be high or low depending on serum bicarb. can have urine pH <5.5 UAG can be positive or negative

Question 32

What is the pathophysiology of Distal RTA type 1? 2 causes?

Answer 32

decreased secretion of H+ ions in distal nephron so distal RTA is unable to acidify the urine. - H/K ATPase and H ATPase - gradient defect - H flows back into tubular cell

Question 33

What is the etiology of Distal RTA type I?

Answer 33

- primary - idiopathic or hereditary | - secondary - sjogrens syndrome, or glue sniffing

Question 34

What is the clinical manifestation of distal RTA type I?

Answer 34

nephrolithiasis or nephrocalcinosis

Question 35

How can you diagnose distal RTA type I? (4 things)

Answer 35

- NAGMA - patients are unable to acidify their urine pH <5.5 - hypokalemia (severe) - UAG is positive

Question 36

What is hyperkalemic RTA type 4?

Answer 36

distal nephron dysfunction from impaired renal excretion of H and K causing a NAGMA and hyperkalemia

Question 37

What are the two etiologies of RTA type 4?

Answer 37

deficiency of circulating aldosterone - diabetes mellitis -drugs such as NSAIDS, ACEI aldosterone resistence in collecting ducts - interstitial renal disease (sickle cell nephropathy, obstructive uropathy, lupus) -drugs such as amiloride, triamterene, spironolactone

Question 38

What is the pathophysiology of hyperkalemic RTA type 4?

Answer 38

impaired Na reabsorption by principle cells leading to decrease in luminal negativity of CD, which impairs acidification as a result of decreased driving force of H secretion.

Question 39

What are the clinical manifestations of hyperkalemic RTA type 4? (theres 4)

Answer 39

asymptomatic NAGMA hyperkalemia history of diabetes or CKD

Question 40

Diagnosis of hyperkalemic RTA type 4?

Answer 40

Variable urine pH, usually >5.5 | UAG is positive