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Renal Lecture 5- Metabolic Disturbances
Terms in this set (30)
What are some causes of alkalosis?
H and Cl- depletion (vomiting, prolonged NGT)
Cushing's syndrome (excess cortisol causes hypokalemia)
*major GI bleed ABOVE duodenum
diuretics (loop, thiazide)
What are some causes of acidosis?
what part of the renal system reabsorbs filtered HCO3?
For every 1 mEq/L increase in bicarb, the arterial PaCO2 increases by ____
0.5 to 0.7 mmHg
Metabolic alkalosis is assoc w HYPO- or HYPER- ventilation?
T or F: metabolic alkalosis has a HIGH mortality rate.
pt HYPOventilate to retain more CO2 but at the same time, they're retaining less O2
T or F: an elevate bicarb >35 mEq/L is most likely primary met alkalosis rather than compensatory.
When you lose volume (ex: major bleed) are you likely to become acidotic or alkalotic?
volume is composed mostly of Cl-, so when you are volume depleted you lose Cl- causing an increase in bicarb
V. cholera can cause a massive loss of Cl- that would lead to ?
"rice water diarrhea"
In a state of alkalosis, the calcium affinity to albumin increases or decreases?
more Ca will bind to albumin, causing a decrease in FREE Ca. the total Ca will be unaffected
How do we tx metabolic alkalosis?
tx the cause
istonic sodium chloride solution
peritoneal or hemodialysis
what does a high anion gap metabolic acidosis indicate?
what are some examples?
Loss of HCO3 d/t increase in unmeasured anions (PO4, SO4, acetoacetate)
Propylene glycol (diazepam/lorazepam)
what are some examples of normal anion gap acidosis?
Addison's (adrenal insufficiency)
ammonium chloride, bile acid sequestrate
What is the purpose of the urine anion gap?
What is the equation?
determines if kidneys appropriately acidify urine
represents unmeasured NH4
(Na + K) - Cl
with URINE anion gap, you are looking to see if
the number is positive or negative
if you do a urine anion gap and the number is negative, what are you thinking?
the kidneys are getting rid of H+
(and retaining K+)
if you do a urine anion gap and the number is positive, what are you thinking?
kidneys NOT getting rid of H+ (but rather K+)
How do you work up metabolic acidosis?
UA (ketones, salicylates)
what are kussmaul respirations?
what condition are they most commonly assoc with?
which metabolic condition are they most assoc with?
rapid, deep, labored breathing
When would you do a urine anion gap?
if you did a serum anion gap that came back normal
accumulation of acid due to the failure of the kidneys to acidify urine
Type I RTA is characterized by?
and seen it what populations?
failure of acid secretion by distal tubules
Type II RTA is characterized by?
and seen it what populations?
failure of HCO3 reabsorption by proximal tubules
Type IV RTA is characterized by?
and how would it present?
HYPOaldosteronism causing a physiological reduction in the proximal tubular ammonium excretion
presents as hyperkalemia
How would you tx metabolic acidosis?
get the pH > 7.1
Tx the hyperkalemia!!
280 - 300
what is the osmolar gap equation?
what is the normal value?
2(Na) + (Glu/18) + (BUN/2.8)
>11 very abnormal!
How do you determine a "pure gap" acidosis?
a. calculated anion gap - 12 (normal gap)
b. take the number, add it your measured HCO3
-if THAT value is WNL = pure gap acidosis!!
-if THAT value is LOWER -> additional metabolic acidosis
-if THAT value is HIGHER -> addtl. metabolic alkalosis
What is Winter's Formula and what is it used for?
1.5(HCO3) + 8 (+/- 2)
evaluate the respiratory compensation for a primary metabolic acidosis
calculated > expected : primary resp acidosis is also present!
calculated < expected : primary resp alkalosis is also present!
reabsorption of bicarb and the generation of new bicarc occurs where?
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