Acid - Base Dr. Falls Part I

Front 1

not excreted by the lungs

Back 1

A nonvolatile acid (also known as a fixed acid or metabolic acid)

Front 2

modified HH equation

Back 2

H + = 24 x pCO2 /HCO 3

Front 3

• Buffer systems provide immediate defense name me

Back 3

– *Bicarbonate/carbon dioxide
– Proteins
– Phosphate ions
– Bone
– Hemoglobin

Front 4

changes in nonvolatile acid production lead to changes in pH and HCO3 which alters

Back 4

alveolar vent

Front 5

Law of electrical neutrality mandates excretion with an anion (Cl‐ )

Back 5

NH4 excretion

Front 6

What is the equation for calculating the compensatory response seen in metabolic acidosis

Back 6

pCO2 = HCO3 x 1.5 + 8

Front 7

Accounts for excretion of half of ones acid load

Back 7

NH4

Front 8

what cell is particularly important for allowing hydrogen to be secreted into the lumen

Back 8

Intercalated cell

Front 9

the main titratable acid

Back 9

Phosphate

Front 10

• Decreased cardiac contractility
• Central venous vasoconstriction
• Decreased arterial blood pressure

Back 10

– Cardiovascular effects of acidosis

Front 11

3 mechanisms of Metabolic acidosis

Back 11

1. lose bicarb (diarrhrea)
2. Addition of acid (e.g. diabetic ketoacidosis)
3. Failure of the kidney to excrete acid (e.g. renal
failure)

Front 12

The differential diagnosis of metabolic acidosis is
approached by consideration

Back 12

of the anion gap

Front 13

Normal Anion Gap =

Back 13

12

Front 14

main unmeasured anion

Back 14

Albumin main unmeasured anion

Front 15

Anion gap ranges between

Back 15

8 and 12 mEq/L

Front 16

If plasma Cl ‐ increases in proportion to the fall
in HCO 3

Back 16

the anion gap will remain normal (hyperchloremic or normal anion gap metabolic acidosis)

Front 17

Causes of Normal Anion Gap
Metabolic Acidosis

Back 17

– *Diarrhea
– *Recovery from diabetic ketoacidosis
- *Renal tubular acidosis
- • Ingestion of Cl ‐ acids (hyperalimentation)

Front 18

people with Renal Tubular Acidosis (RTA) usually have

Back 18

normal renal fxn actually

Front 19

Renal Tubular Acidosis (RTA) hallmark is?

Back 19

– Inability to excrete H +
– Inappropriate reabsorption of HCO3
• 3 types → Type I, II and IV

Front 20

selective deficiency of alpha intercalated cells describes which RTA

Back 20

Distal type I

Front 21

people with this RTA are usually hypokalemic and there urinary NH4+ is decreased, also they have a positive urine anion gap

Back 21

Distal RTA I (where the problem is the intercalated cells

Front 22

does distal RTA I have a positive UAG

Back 22

yes

Front 23

Hypokalemic, alpha-intercalated cell problem, and Hiagh UAG

Back 23

Type-I distal RTA

Front 24

Nephrocalcinosis and nephrolithiasis associated with what RTA

Back 24

the Hypokalemic, UAG positive RTA-1

Front 25

systemic diseases associated with the Hypokalemic, UAG positive RTA-1

Back 25

– Sjogren’s syndrome
– Systemic lupus erythematosis

Front 26

drugs associated with the hypokalemic UAG positive, alpha intercalated malfunctioning RTA-I

Back 26

• Drugs/Toxins
– Amphotericin B
– Toulene

Front 27

• Drugs/Toxins
– Amphotericin B
– Toulene

Back 27

drugs associated with the hypokalemic UAG positive, alpha intercalated malfunctioning RTA-I

Front 28

Urine pH > 5.5

Back 28

RTA 1

Front 29

what is the urinary pH in the hypokalemic RTA I

Back 29

greater than 5.5 usually 7 because these people can acidify there urine

Front 30

Tubulointerstitial disease can cause what

Back 30

RTA - 1

Front 31

abscence of Hydrogen ATPase transporters of the alpha-intercs associate with RTA-1 caused by

Back 31

Sjogren’s syndrome

Front 32

what drug causes type two RTA

Back 32

Acetozolamide

Front 33

– Urine pH initially > 7
– Urine pH < 5.5 at steady state

Back 33

type II RTA

Front 34

Defect in proximal tubular bicarbonate reabsorption describes what type of RTA

Back 34

proximal type II

Front 35

Fanconi’s syndrome causes what type of RTA

Back 35

II-

Front 36

– Decreased reabsorption of most solutes in PCT
– HCO 3
‐ loss
– Amino aciduria
– Glucosuria
– Phosphaturia
– Uricosuria

what does all this sound like

Back 36

RTA-II caused by fanconis looks like this

Front 37

RTA-II caused by fanconis looks like this

Back 37

– Decreased reabsorption of most solutes in PCT
– HCO 3
‐ loss
– Amino aciduria
– Glucosuria
– Phosphaturia
– Uricosuria

Front 38

Drugs
• Ifosfamide (chemotherapeutic agent)
• Cidofovir (anti‐retroviral agent)

what are these drugs associated with?

Back 38

RTA-II

Front 39

what drugs are associated with RTA-II

Back 39

Acetozolamide
cidofovir
Ifosfamide

Front 40

not uncommon to see as a cause of RTA-II

Back 40

Multiple myeloma

Front 41

– Multiple myeloma
– Wilson’s disease

Back 41

can cause a fanconis syndrome therefore RTA-II

Front 42

Hyperkalemic RTA

Back 42

RTA-IV

Front 43

Hyporeninemic hypoaldosterone state where the Defect is aldosterone deficiency or resistance

Back 43

RTA-IV (a hyperkalemic RTA)

Front 44

Causes of Type IV RTA (a hypoaldo state)

Back 44

Diabetes, Tubulointerstitial disease, AIDS and HTN nephrosclerosis

Front 45

this test is an indirect measure of NH4 excretion

Back 45

UAG

Front 46

Cl increases in the urine cause the UAG to

Back 46

remain normal