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Renal > Renal Acidosis > Flashcards

Renal Acidosis Flashcards

1
Q

What are buffers?

A

Weak acids

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2
Q

What organ has the largest buffering capacity?

A

Bone

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3
Q

What is the most important buffer in the ECF?

A

Bicarbonate

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4
Q

What is the purpose of buffering?

A

To prevent major shifts in hydrogen ions

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5
Q

What ions mediates intracellular buffering?

A

Hemoglobin, phosphate, protein

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6
Q

What is the chronic effect of acidosis on bone?

A

Osteoporosis

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7
Q

What are the two types of acids contribute to your acid load?

A
  1. Carbonic

2. Non-carbonic

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8
Q

What type of acid created by the body will become volatile (i.e. excreted by the lungs)

A

Carbonic acids

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9
Q

Metabolism of what macro-nutrients creates carbonic acids?

A

Fat and Carbohydrate metabolism

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10
Q

How are carbonic acids excreted?

A

Eliminated by the lungs after conversion to CO2

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11
Q

Metabolism of what macronutrients leads to non-carbonic acid formation?

A

Protein, ingested sulfate, phosphate, inorganic acid

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12
Q

How are non-carbonic acids excreted?

A

Non-volatile therefore excreted via kidneys

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13
Q

Patient presents with pH 7.25, pCO2 30mmHg, what type of acidosis?

A

Metabolic acidosis

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14
Q

How do you calculate the anion gap?

A

Na + K - Cl - HCO3 = 12-14 normally

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15
Q

Why is the anion gap not zero?

A

Albumin is an anion that is not measured

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16
Q

What is the name of metabolic acidosis with an anion gap of <14?

A

Carbonic/volatile acid = Non-Anion Gap Metabolic Acidosis (NAGMA)

17
Q

What is the name of metabolic acidosis with anion gap of >14?

A

Non-Volatile/Non-Carbonic acid = Wide Anion Gap Metabolic Acidosis (WAGMA)

18
Q

What do you do with a patient with a wide anion gap?

A

Look for anions - ingested or intrinsic

19
Q

What is the differential for a WAGMA?

A 
MUDPILES
M - methanol/metformin
U - uremia
D - DKA
P - paraldehyde
I - iron, infection, isoniazid, isopropyl alchohol
L - lactate
E - Ethylene glycol
S - salicylates
20
Q

What do you do with a patient with a normal anion gap acidosis?

A

Think…

  1. Bicarbonate loss
  2. Volatile acid gain
  3. Unable to make bicarbonate
21
Q

How is bicarbonate reabsorbed?

A

90% in proximal tubule, 10% in thick ascending LoH. (follows Na reabsorption

22
Q

How does the kidney excrete the necessary 50-100 mEq of H+/day?

A

Energy dependent ATPase and hiding the proton in diet-derived titratable acid

23
Q

What is the purpose of glutamine metabolism in the context of acid/base balance

A

Formation of two NH4+ and two HCO3- (bicarb formation for buffering)

24
Q

What are the non-renal causes of bicarbonate loss?

A 
Diarrhea
Post hypocapnea (kidneys overcorrecting)
Drugs (acetazolamide=carbonic anhydrase i)
25
Q

What are the non-renal causes of acid retention/reabsorption?

A 
Urinary diversions (i.e. to colon)
Drugs (spironolactone - blocks acid secretion)
26
Q

What are the non-renal causes of inability to make ammonium or bicarb?

A

Total parenteral nutrition

27
Q

Which amino acid is needed to create bicarb?

A

Glutamine

28
Q

How can the presence/absence of NH4+ in the urine be diagnostic?

A

Determines the nature of acid/base problem

  • proximal bicarb uptake problem=NH4+ in urine
  • distal H+ secretion problem=no NH4+ in urine
  • problem making/transporting NH4+ = no NH4+ in urine, corrected with exogenous titratable acid
29
Q

When would ammonium be present in the urine?

A

When the body needs to excrete acid

30
Q

How are urine ammonium levels measured?

A

Charge balance…
NH4+ = Cl - Na - K
NH4+ = 0 to 40

31
Q

Define an osmole

A

Discrete particles in solution that cause water movement to balance gradients. i.e. NaCl - 2 osmoles, CaCl2 - 3 osmoles

32
Q

How do you measure urine osmolar gap?

A

Measured Osm - calculated Osm

33
Q

What is the formula for the calculated urine osmolality?

A

2Na + 2K + 2(NH4) + glucose + urea

34
Q

How do you measure NH4+ from the urine osmolar gap?

A

NH4 = (mOsm - 2Na - 2K - glucose - urea) / 2

35
Q

When is the osmolar gap inaccurate?

A

When patient has uncharged osmoles like alcohol in the urine

36
Q

Which NAGMA presents with urine NH4?

A

Bicarb loss

37
Q

Which NAGMAs present with no urine NH4?

A

H+ retention - urine pH stable giving titratable acid

Can’t make NH4/HCO3 - urine pH drops with titratable acid

Renal (11 decks)

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