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30 Cards in this Set
- Front
- Back
Consequences of vomiting.
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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. |
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Consequence of K depletion.
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- intracellular acidosis -> decreased HCO3 secretion, increased H+ loss
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Serum levels of electrolytes as a result of vomiting.
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- metabolic alkalosis
- hypokalemia - increased renin, aldolsterone |
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Urine levels of electrolytes as a result of vomiting.
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- pH >7
- high K+ - Cl < 25 |
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What are some causes of metabolic alkalosis with Cl<25?
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pre-renal cause
- vomiting, nasogastric suction - diuretics (after effect has worn off) - post hypercapnea - cystic fibrosis - low Cl intake - Cl rich diarrhea |
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How to treat this?
- metabolic alkalosis with Cl<25 |
Cl- rich fluids and K+ supplement
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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 |
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How to treat this?
- metabolic alkalosis with Cl>40 |
treat underlying cause
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Consequences of Cl depletion as in vomiting?
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- increased Cl absorption and H+ secretion (type A intercalated cells)
- decreased Cl/HCO3 exchange (type B intercalated cells) |
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How does the lung compensate for metabolic alkalosis?
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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 |
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Can metabolic alkalosis mixed with non-anion gap acidosis?
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No, high anion gap acidosis only.
- in metabolic alkalosis, Cl is depleted |
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Which other acid/base problems can be mixed with metabolic alkalosis?
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- metabolic alkalosis with respiratory alkalosis
- metabolic alkalosis with metabolic acidosis (high anion gap) |
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What are some causes of metabolic alkalosis?
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- loss of acid
- gain of base - aldolsteronism |
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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) |
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GI origin of this:
- ECF contraction - normal BP - K+ deficiency - secondary hyperaldolsteronism |
- vomiting, NG suction
- congenital chloridiarrhea - villous adenoma |
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Causes of this:
- ECF expansion - HTN - K+ deficiency - minneralocorticoid excess - high renin |
- renal artery stenosis
- renin-secreting tumor - estrogen therapy - accelerated HTN |
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Causes of this:
- ECF expansion - HTN - K+ deficiency - minneralocorticoid excess - low renin |
- primary aldolsteronism
- adrenal enzyme defects - cushing syndrome |
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What is Bartter's syndrome and what does it cause?
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Loss of function in Na/Cl/K channel in TALH.
- cause Cl resistant metabolic alkalosis - hypokalemia - Cl- resistant metabolic alkalosis - JG hyperplasia - hyperreninemic hyperaldolsteronism |
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What is Gitleman's syndrome and what does it cause?
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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 |
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What is Liddle syndrome and what does it cause?
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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 |
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What are some possible cause of this?
- HTN - hypokalemia - alkalosis |
- mineralocorticoid excess
- diuretics |
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What are some possible cause of this?
- low plasma renin - normal urine Na and Cl |
mineralocorticoid excess if patient not on diuretics
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What are some possible cause of this?
- hypokalemia - alkalosis - non-edema |
- Bartter's, Gitelman syndrome
- Mg deficiency - vomiting - exogenous alkali - diuretics |
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What is the cause of this?
- alkaline pH - high Na, K+ in urine - low Cl in urine |
- active vomiting
- alkali ingestion |
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What is the cause of this?
- acid pH - low Na, K+ in urine - low Cl in urine |
- prior vomiting
- post hypercapnic state - previous diuretics |
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What is the cause of this?
- high urine Na, K, Cl |
- Mg deficiency
- Bartters/Gietleman - current diuretic administration |
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Which acid/base problem is this?
- CNS: weakness, confusion, seiaures - cardiac: aggravation of arrhythmias, hypoxemia - hypokalemia - hypophosphatemia |
metabolic alkalosis
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How to calculate anion gap?
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Na - Cl - HCO3
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What are some causes of anion-gap acidosis?
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- methanol, ethylene glycol
- ketoacidosis - lactic acidosis - uremic acidosis - salicylate |
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What are some causes of non-anion-gap acidosis?
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- 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 |