Renal Exam #2 Flashcards
(20 cards)
this is an acid-base question, what does each compartment mean?
7.35/35/99/22
pH/CO2/O2/HCO3-
RO
ME
respiratory = opposite
metabolic = everything same
what’s the anion gap formula? normal range?
AG = (Na+) - (Cl- + HCO3-)
normal AG is 12 or less
steps to calculating acid-base disorders?
- pH
- HCO3-
- CO2
- compensation
what are the 2 main types of metabolic acidosis?
explain each to me
anion gap metabolic acidosis & non-metabolic acidosis
AGMA = non-chloride acids release their protons, our bicarb joins with those protons to neutralize, our bicarb gets used up, this affects our equation
Non-AGMA = hypercholremia happens as a way to compensate for bicarb loss probably d/t GI tract or renal tubular acidosis
what condition is an anion gap specific to?
metabolic acidosis ONLY
what can cause the anion gap equation to give us a false reading of the true cation/anion comparision?
low albumin
this is an anion gap question. what does each compartment mean?
140/4.0/106/22
Na/K/Cl/HCO3
what does winter’s formula tell you?
whether the lungs are compensating as expected for whatever condition. If it is an abnormal compensation, this could indicate a mixed metabolic disorder with 2 primary things going on
ex:
low expected CO2 = maybe resp. alkalosis
high expected CO2 = maybe resp. acidosis
what are the m/c causes of anion-gap metabolic acidosis? mnemonic?
- endogenous
- exogenous
“LCD screens inside, MEAT outside”
- endogenous: LCD (lactic, CKD, DKA)
- exogenous: MEAT (methanol. ethylene glycol, ASA, toluene)
Treatments for the different forms of anion gap metabolic acidosis (endo/exo-genous)?
DKA
Lactic acidosis
Alcoholic
Salicylate overdose
Methanol Intoxication
DKA
- IV fluids
- IV K if less than 3.3
- IV insulin immediately if K is greater than 3.3. If K is less than 3.3, then treat with IV fluids and K FIRST)
Lactic acidosis
- primary = reverse underlying
- if pH < 7.1 and serum bicarb <6 = IV NaHCO3-
Alcoholic
- IV/IM Thiamine FIRST
- D5
- other replacements as needed
Salicylate overdose
- judicuous use of NaHCO3-
Methanol Intoxication
- fomepizole
diff treatments for non-anion gap metabolic acidosis?
- diarrhea: replenish fluids and electrolytes
- RTA type 1: tx underlying, potential bicarb replacement
- RTA type 2: hi-dose bicarb
- RTA type 4: K restriction, k-binders, diuretics (loop/thiazide)
if you suspect that a pt has metabolic alkalosis, what is your next step?
check their chloride levels, then prep to do a saline challenge
logic behind saline challenge?
well, metabolic alkalosis means low HCO3-
Cl- and HCO3- are in balance
low Cl- might cause bicarb compensation
saline responsive = back to normal once Cl- is given
saline unresponsive = excess mineralocorticoid or severe hypokalemia, both d/t high aldosterone
why do we give acetazolamine and/or spironolactone to someone who has metabolic alkalosis?
acetazolamide = dumps extra HCO3-
spironolactone = stop the dumping of H+/K+
where is most of out TBW?
men’s v. women’s weight % of TBW?
how do you caclulate TBW?
inside our cells (2/3)
outside our cells (1/3)
men = 60%, women = 50%
men = weight(kg) * 0.6
women = weight(kg) * 0.5
osmolarity
osmolality
tonicity
diffusion
osmosis
osmolarity = “think water,” solute in a liter of solution, measures volume, this is H2O so it changes with temp.
osmolality = solute in mass of solvent, this is weight so it doesn’t change based on temp.
tonicity = shrinking or swelling of a cell (focus is what the solution does to the cell)
diffusion = passive movement of stuff, high to low
osmosis = movement of water from low to high
most abundant extracellular ion?
most abundant intracellular ion?
EXtra: Na+
INtra: K+
steps to assess hyponatremia?
- serum Na+ (mild, mod, severe)
- serum osmolality (iso/hypo/hyper-tonic)
- urine osmolality (dilute = <100 /concentrted = >300)
- urine Na+ (renal = >20, non-renal = <20)
