Blueprints: Medicine-Renal

Front 1

How do the kidneys maintain the bicarbonate buffer system?

Back 1

1.) reabsorption of HC03 in proximal tubles + distal tubules

2.) Generation of new bicarbonate: via proton secretion

Front 2

Stimuli for proton secretion?

Back 2

Acidosis + aldosterone secretion

Front 3

Stimuli for bicarbonate reabsorption?

Back 3

Hypercapnia, extracellular fluid contraction, and potassium depletion

Front 4

What are metabolic distrubances?

Back 4

Changes in concentration of bicarbonate

Front 5

What are respiratory disturbances?

Back 5

Changes in C02 concentration

Front 6

What are some causes of metabolic acidosis?

Back 6

1.) increased nonvolatile acid production
2.) decreased acid excretion from kidneys
3.) loss of alkalai (diarrhea)

Front 7

Define the equation for measuring anion gap:

Back 7

[Na]-([HC03]-[Cl])

Front 8

What causes anion gap acidosis?

Back 8

ONLY increaed production of nonvolatile acids. These acids are buffered by HC03, and in the process reduced HC03 concentration and lead to increased anion gap acidosis.

Normal 8-12 meq/L

Front 9

Causes of metabolic alkalosis?

Back 9

increased loss of acid (kidney/GI excretion)

Front 10

What is the differential diagnosis for metabolic acidosis with increased anion gap?

Back 10

1.) Lactic acidosis (hypoxia, hepatic faliure)
2.) ketoacidosis (type 2 diabetes, starvation, alcoholism)
3.) salicyclates, methanol, ethylene glycol
4.) renal faliure

Front 11

What is the differential diagnosis for metabolic acidosis with normal anion gap (8-12)?

Back 11

1.) renal tubular acidosis, K+ sparing diuretics, hypoaldosteronism
2.) loss of base (diarrhea, CA inhibitors, pancreatic fistula, ureterosigmoidoscopy)
3.) Excess acid intake (ammonium chloride)

Front 12

What is the differential for metabolic alkalosis?

Back 12

1.) Volume loss (vomiting, gastric drainage, diuretics, villous adenoma)
2.) Hypermineralocorticoid syndrome (cushings, exogenous steroids, 1 aldosternoism)
3.) Potassium deficiency
4.) Excess alkali intake (milk-alkali syndrome)

Front 13

What is the differential for respiratory acidosis?

Back 13

Basically, the following are the causes of decrease in ventilation:

1.) Drug intoxication or cardiopulmonary arrest
2.) Respiratory faliure (obesity, COPD, neurmoscular disorders...guillan-barre)

Front 14

What is the differential for respiratory alkalosis?

Back 14

Following are the casues of hyperventilation:

1.) hypoxia (asthma, pulmomary edema, pulmonary fibrosis, high altitude)

2.) increased respiratory drive (anxiety, salicylate intoxication, cerebral disease, fever)
3.) cirrhosis
4.) excessive mechanical ventilation