Blueprints: Medicine-renal
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- How do the kidneys maintain the bicarbonate buffer system?
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1.) reabsorption of HC03 in proximal tubles + distal tubules
2.) Generation of new bicarbonate: via proton secretion - Stimuli for proton secretion?
- Acidosis + aldosterone secretion
- Stimuli for bicarbonate reabsorption?
- Hypercapnia, extracellular fluid contraction, and potassium depletion
- What are metabolic distrubances?
- Changes in concentration of bicarbonate
- What are respiratory disturbances?
- Changes in C02 concentration
- What are some causes of metabolic acidosis?
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1.) increased nonvolatile acid production
2.) decreased acid excretion from kidneys
3.) loss of alkalai (diarrhea) - Define the equation for measuring anion gap:
- [Na]-([HC03]-[Cl])
- What causes anion gap acidosis?
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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 - Causes of metabolic alkalosis?
- increased loss of acid (kidney/GI excretion)
- What is the differential diagnosis for metabolic acidosis with increased anion gap?
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1.) Lactic acidosis (hypoxia, hepatic faliure)
2.) ketoacidosis (type 2 diabetes, starvation, alcoholism)
3.) salicyclates, methanol, ethylene glycol
4.) renal faliure - What is the differential diagnosis for metabolic acidosis with normal anion gap (8-12)?
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1.) renal tubular acidosis, K+ sparing diuretics, hypoaldosteronism
2.) loss of base (diarrhea, CA inhibitors, pancreatic fistula, ureterosigmoidoscopy)
3.) Excess acid intake (ammonium chloride) - What is the differential for metabolic alkalosis?
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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) - What is the differential for respiratory acidosis?
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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) - What is the differential for respiratory alkalosis?
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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