Memory Joggers: Kidney Kard
METABOLIC ACIDOSIS
Plasma anion gap
= Na-[Cl+HCOc] Nml=12+-2
<12 = diarrhea, RTA, CaCl2 or other
acids
>15 = MUDPALES = Methanol,
Uremia,Diabetic ketoacidosis,
Paraldehyde, Alcoholic ketoacidosis,
Lactic acidosis,Ethylene glycol,
Salicylates
Urine anion gap
= UNa+UK-UCl
-Gap = GI HCO3 Loss; NH4+ present
+Gap = Renal HCO3 Loss; No NH4+ present
UNH4+ = UCl - [UNa + UK] + 80 mEq/L
Osmolar gap norm=10
= measured osm - calculated osm
= measured osm - (1.87 Na + BUN/2.8 +
glucose/18 + 9)
>10 = ethanol(4.4 mg%/mOsm/L), methanol(3), ethylene glycol(6),
isopropanol(5.7), sorbitol, mannitol, X-Ray dye
METABOLIC ALKALOSIS
Urine CL < 10 mEq/L = saline responsive
=emesis,diuretics,posthypercapnea
Urine CL > 10 mEq/L = mineralocorticoids,
alkali intake, K depletion
RENAL TUBULAR ACIDOSIS
|
Proximal |
Classical Distal |
Type 4 |
Hyperkalemic Distal |
| Prevalence |
Rare |
Rare |
Very Common |
Common |
| Plasma K |
Low |
Low |
High |
High |
| Urine pH |
<6 |
>6 |
<6 |
Variable |
| Urine NH4+ |
Normal |
Low |
Low |
Low |
| Defect |
Dec.High Capacity
HCO3 transport |
Dec.H Pump |
Dec.NH3 generation
Dec.aldo effect |
Dec.Distal Na Transport |
| Rx |
Diuretic |
HCO3 |
Diuretic |
HCO3 |
| Examples |
Acetazolamide |
Amphotericin |
Diabetes |
Obstruction |
HYPONATREMIA
UNa < 10 mEq/L = Incr. ECF volume(CHF,
cirrhosis, nephrotic)
=Dec. ECF volume
UNa > 10 mEq/L = Normal ECF volume;
RATS=Renal,Adrenal, or Thyroid
insufficiency, or SIADH: CNS,
pulmonary, or psychiatric disorder,
drugs, nausea, ADH-secreting tumors
HYPOKALEMIADecreased intake
Increased shift into cells:
glucose, insulin, B agonists, alkalosis
or HCO3 Rx
Increased loss:
Renal: diuretics; high flow; Inc.aldo,
RTA
GI: emesis, diarrhea, laxatives
HYPERKALEMIAArtifact: hemolysis, WBC>50,000,
tourniquet+exercise inc. platelets
Increased intake: hemolysis,
rhabdomyolysis, transfusion,
salt substitutes
Increased shift out of cells: acidosis,
0 insulin, dig toxicity,
B blockers, hyperalimentation
Decreased renal excretion: Decr. GFR,
Decr. aldo, tubular defects, drugs
ABG CHART
| HEMODYNAMICS |
|
|
Systolic
|
Diastolic
|
Mean
|
| RA, mmHg |
|
|
1-7
|
| RV, mmHg |
15-25
|
0-8
|
|
| PA, mmHg |
15-20
|
8-15
|
10-20
|
| PCWP, mmHg |
|
|
6-12
|
| CO, L/min |
|
|
3.5-5.5
|
MAP = diast. BP + 1/3[syst. - diast.]
SVR = 80 X [MAP - CVP] / CO (L/min)
=Nml 900-1200 dyne/sec/cm2 |
| DRIPS |
| |
PCWP
|
SVR
|
HR
|
BP
|
CO
|
| Dobutamine 2.5-15 ug/kg/min |
dec
|
+-
|
+-
|
inc
|
inc
|
| Dopamine 0.5-2.0 ug/kg/min |
Renal dose: no effect on systemic hemodynamics
|
| Dopamine 2-20 ug/kg/min |
+-
|
inc
|
inc
|
inc
|
inc
|
| Epinephrine 0.01-0.1 ug/kg/min |
inc
|
+-
|
inc
|
+-
|
inc
|
| Isoproteronol 0.01-0.1 ug/kg/min |
dec
|
dec
|
inc
|
+-
|
inc
|
| Nitroglycerine 0.3-5 ug/kg/min |
dec
|
dec
|
inc
|
dec
|
inc
|
| Nitroprusside 0.2-5 ug/kg/min |
dec
|
dec
|
inc
|
dec
|
inc
|
| Norepinephrine 2-10 ug/min |
inc
|
inc
|
dec
|
+-
|
inc
|
| Phenylephrine 20-200 ug/min |
+-
|
inc
|
inc
|
inc
|
+-
|
|
|
