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Respiratory acidosis

low pH, high PCo2 + HCO3
pH < 7.4, PCo2 > 40 mmHg, HCO3 > 22.


airway obstruction, acute/chronic lung disease, opiods, narcotics, sedatives, weakening of respiratory muscles.

Metabolic acidosis with compensation


low pH, PCO2 + HCO3.
pH < 7.4, PCo2 < 40 mmHg

check anion gap = Na - (Cl + HCO3)


inc anion gap (> 12)
met acidosis (pH<7.4, PCo2 < 40 mmHg)

Methanol (formic acid)
Diabetic ketoacidosis
Paraldehyde or Phenformin
Iron tables or INH
Lactic acidosis
Ethylene glycol (oxalic acid)

Respiratory alkalosis

high pH, low pCo2, low HCO3
pH > 7.4, PCo2 < 40 mmHg


early high altitude exposure, aspirin ingestion early.

Metabolic alkalosis with compensation


high pH, pCO2, HCO3.
pH > 7.4, PCo2 > 40mmHg.

diuretic use (loop + thiazides), vomiting, antacid, hyperaldosteronism

aspirin overdose

mixed disorder

Low pH, HCO3 and PCo2

1. respiratory alkalosis from hyperventilation --> PCo2 < 40
2. metabolic acidosis due to accumulation of organic acid -- low HCO3 < 22.

RBC casts in urine

glomerulonephritis, ischemia, or malignant hypertension.

presence of casts indicates that hematuria/pyuria is of renal origin

WBC casts

tubulointerstitial inflammation, acute pyelonephritis, transplant rejection.

granular "muddy brown" casts

acute tubular necrosis

waxy casts

advanced renal disease, chronic renal failure

hyaline casts


RBCs, no casts

bladder cancer, kidney stones

WBCs, no casts

acute cystitis.

sedative overdose

mixed. metabolic and respiratory acidosis.

low pH, high pCO2, low HCO3.

metabolic acidosis normal anion gap

Normal anion gap (8-12 mEq/L)

Diarrhea, glue sniffing, renal tubular acidosis, hyperchloremia

RTA type 1 "distal"

Defect in CT ability to excrete H. Assoc with hypokalemia, and risk for Ca containing kidney stones

RTA type 2 "proximal"

Defect in proximal tubule HCO3 reabsorption. Assoc with hypokalemia and hypophosphatemic rickets

RTA type 3 "hyperkalemic"

Hypoaldosteronism or lack of CT response to aldosterone --> hyperkalemia --> inh of ammonia excretion in proximal tubule. Leads to dec urine pH (acid!) due to dec buffering capacity (lack of base)

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