Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
30 Cards in this Set
- Front
- Back
|
Consequences of vomiting.
|
metabolic alkalosis with volume depletion
- volume depletion -> aldolsterone secretion: 1) increased H+ secretion, HCO3 absorption, 2) Na absorption -> lumen more negative -> further acidosis of urine - Cl depletion: increase Cl absorption, H+ secretion (typeA), decrease Cl/HCO3 exchanger (typeB) - K depletion -> intracellular acidosis, decreased HCO3 secretion, increase H+ loss. |
|
|
Consequence of K depletion.
|
- intracellular acidosis -> decreased HCO3 secretion, increased H+ loss
|
|
|
Serum levels of electrolytes as a result of vomiting.
|
- metabolic alkalosis
- hypokalemia - increased renin, aldolsterone |
|
|
Urine levels of electrolytes as a result of vomiting.
|
- pH >7
- high K+ - Cl < 25 |
|
|
What are some causes of metabolic alkalosis with Cl<25?
|
pre-renal cause
- vomiting, nasogastric suction - diuretics (after effect has worn off) - post hypercapnea - cystic fibrosis - low Cl intake - Cl rich diarrhea |
|
|
How to treat this?
- metabolic alkalosis with Cl<25 |
Cl- rich fluids and K+ supplement
|
|
|
What are some causes of this?
- metabolic alkalosis with Cl>40 |
renal cause
- primary mineralocortocoid excess (cushings, ACTH) - diuretics (early) - excess alkali (milk alkali syndrome) - Bartter's, Gietleman's syndrome - severe hypokalemia - Liddle syndrome |
|
|
How to treat this?
- metabolic alkalosis with Cl>40 |
treat underlying cause
|
|
|
Consequences of Cl depletion as in vomiting?
|
- increased Cl absorption and H+ secretion (type A intercalated cells)
- decreased Cl/HCO3 exchange (type B intercalated cells) |
|
|
How does the lung compensate for metabolic alkalosis?
|
hypoventilation
- PaCO2 increase 6mmHg for each 10mEq/L increase in [HCO3] - PaCO2 increase 0.75mmHg for each mEq/L increase in [HCO3] - PaCO2 = [HCO3]+15 |
|
|
Can metabolic alkalosis mixed with non-anion gap acidosis?
|
No, high anion gap acidosis only.
- in metabolic alkalosis, Cl is depleted |
|
|
Which other acid/base problems can be mixed with metabolic alkalosis?
|
- metabolic alkalosis with respiratory alkalosis
- metabolic alkalosis with metabolic acidosis (high anion gap) |
|
|
What are some causes of metabolic alkalosis?
|
- loss of acid
- gain of base - aldolsteronism |
|
|
Renal origin of this:
- ECF contraction - normal BP - K+ deficiency - secondary hyperaldolsteronism |
- diuretics, edematous states
- Mg deficiency, K depletion - hypercalcemia, hypoparathyroidism - Bartter and Gitleman syndrome - non-absorbable anions - recovery from lactic or ketoacidosis (overshoot) |
|
|
GI origin of this:
- ECF contraction - normal BP - K+ deficiency - secondary hyperaldolsteronism |
- vomiting, NG suction
- congenital chloridiarrhea - villous adenoma |
|
|
Causes of this:
- ECF expansion - HTN - K+ deficiency - minneralocorticoid excess - high renin |
- renal artery stenosis
- renin-secreting tumor - estrogen therapy - accelerated HTN |
|
|
Causes of this:
- ECF expansion - HTN - K+ deficiency - minneralocorticoid excess - low renin |
- primary aldolsteronism
- adrenal enzyme defects - cushing syndrome |
|
|
What is Bartter's syndrome and what does it cause?
|
Loss of function in Na/Cl/K channel in TALH.
- cause Cl resistant metabolic alkalosis - hypokalemia - Cl- resistant metabolic alkalosis - JG hyperplasia - hyperreninemic hyperaldolsteronism |
|
|
What is Gitleman's syndrome and what does it cause?
|
Loss of function in Na/Cl symporter in distal tubule.
- cause Cl resistant metabolic alkalosis - hypokalemia - Cl- resistant metabolic alkalosis - JG hyperplasia - hyperreninemic hyperaldolsteronism - Mg deficiency - hypocalciuria |
|
|
What is Liddle syndrome and what does it cause?
|
mutation in Na channel in collecting duct (always open): increases H+ and K+ secretion.
- cause Cl resistant metabolic alkalosis - low renin and aldosterone - HTN - renal K+ wasting |
|
|
What are some possible cause of this?
- HTN - hypokalemia - alkalosis |
- mineralocorticoid excess
- diuretics |
|
|
What are some possible cause of this?
- low plasma renin - normal urine Na and Cl |
mineralocorticoid excess if patient not on diuretics
|
|
|
What are some possible cause of this?
- hypokalemia - alkalosis - non-edema |
- Bartter's, Gitelman syndrome
- Mg deficiency - vomiting - exogenous alkali - diuretics |
|
|
What is the cause of this?
- alkaline pH - high Na, K+ in urine - low Cl in urine |
- active vomiting
- alkali ingestion |
|
|
What is the cause of this?
- acid pH - low Na, K+ in urine - low Cl in urine |
- prior vomiting
- post hypercapnic state - previous diuretics |
|
|
What is the cause of this?
- high urine Na, K, Cl |
- Mg deficiency
- Bartters/Gietleman - current diuretic administration |
|
|
Which acid/base problem is this?
- CNS: weakness, confusion, seiaures - cardiac: aggravation of arrhythmias, hypoxemia - hypokalemia - hypophosphatemia |
metabolic alkalosis
|
|
|
How to calculate anion gap?
|
Na - Cl - HCO3
|
|
|
What are some causes of anion-gap acidosis?
|
- methanol, ethylene glycol
- ketoacidosis - lactic acidosis - uremic acidosis - salicylate |
|
|
What are some causes of non-anion-gap acidosis?
|
- GI loss of HCO3
- renal tubular acidosis: typeII(loss of bicarb), typeI(inability to loose H+), typeIV(impaired NH4 synthesis) - acid loads: NH4Cl, dilutional acidosis, keruria, post-hypocapnic acidosis - addition of HCl - hungry bone syndrome: calcium bicarbonate re-enters bone |
