Term
Etiologies of Hypokalemia:
Trancellular shift into cells (5) |
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Definition
metabolic alkalosis
elevated insulin levels
beta adrenergic agonists
hypokalemic periodic paralysis
hypothermia |
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Term
| Etiologies of Hypokalemia (4 categories) |
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Definition
Trancellular shift into cells
GI losses
Decreased K intake
Increased Uriniary Losses |
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Term
| Causes of increased urinary losses of hypokalemia |
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Definition
Diuretics
Vomiting (increase in bicarb delivery to CTT stimulates aldo secretion)
yperalosteronism
Cushing's
Licorice
Renal tubular acidosis |
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Term
| Major etiologies of hyperkalemia(7 categories) |
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Definition
Fictitious (lab error, hemolysis)
Transcellular shift out of cells
Inhibition of tubular secretion (drugs)
Hypoaldosteronism
Acute or chronic kidney disease (esp tubulo-interstitial)
Severely decreased ECBV
Selective impairment of K secretion in CCT (pseudohypoaldosteronism) |
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Term
| Causes of transcellular shift of K out of cells |
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Definition
Metabolic acidosis
Insulin deficiency
Hyperosmolality (hyperglycemia in DM)
Beta adrenergic blockade (propanolol)
Exercise
Dititalis OD
Hyperkalemic periodic paralysis
Succinylcholine
Cell necrosis: hematoma, rhabdomyolysis, hemolysis, GI bleeding, tumor lysis |
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Term
| Causes of hypoaldosteronism |
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Definition
Ace inhibitors
Heparin
NSAID (prostaglandin inhibitor)
Beta blocker
Addison's (adrenal gland destruction)
Neoplasms of adrenal gland
21-Hydroxylase deficiency
Type IV renal tubular acidosis |
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Term
| Causes of metabolic acidosis ith normal anion gap and low or normal serum K |
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Definition
GI: diarrhea, pancriatic, intestinal or biliary fistula or drainage
Renal tubular acidosis (proximal or distal)
Ureteral diversion
Recovery phase of ketoacidosis
HCl administration |
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Term
| Causes of metabolic acidosis with normal anion gap and high serum K |
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Definition
Type IV RTA = hypoaldosteronism
Aldosterone deficiency - hyporenin/hypoaldo, Drugs (NSAIDs, ACE inhibitors, beta blockers, heparin), ADdison's
Aldosterone resistance: Chronic interstitial nephrities (SLE, Sjogren's), K sparing diuretics (amiloride), Cyclosporine, Trimethoprim, Pentamidine |
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Term
| Causes of Hypokalemic Distal (Type I)Renal Tubular Acidosis (6 categories) |
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Definition
Primary/idiopathic
Autoimmune (Sjogren's, Thyroiditis, Chronic active hepatitis, Primary biliary cirrhosis)
Drugs and Toxins (Isofamide, Amphotericin B, Toluene, Lithium)
Hypergammaglobulilnelmic States (Multiple myeloma, Amyloidosis, Cryoglobulinemia)
Genetic (Familial, Marfan's, Wilson's, Ehler-Danlos)
Abknormal Ca metabolism ((Idiopathic hypercalciuria, , chronic hyperparathyroidism, hypervitaminosis D) |
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Term
| Causes of Hyperkalemic Distal (Type I) Renal Tubular Acidosis |
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Definition
Urinary tract obstruction
Sickle cell nephropathy
SLE (lupus nephritis w/ tubulointerstitial nephritis)
Renal allograft rejection |
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Term
| Factors contributing to renal stone formation: |
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Definition
Increased urinary calcium and hoshorous due to their release from bone as retained H is buffered
Elevated urine pH which favors CaPO4 precipitation
Hypocitraturia |
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Term
| Hereditary causes of Proximal (Type II) Renal Tubular Acidosis |
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Definition
Cystinosis
Tryrosinemia
Wilson's
Glycogen storage disease type 1
Pyruvate carboxylase deficiency
Galactosemia |
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Term
| Acquired causes of Proximal (Type II) Renal Tubular Acidosis |
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Definition
Multiple myeloma
Amyloidosis
Renal allograft rejection
Sjogren's syndrome
Vitamin D deficiency
Toxins and Drugs: Ifosfamide, acetazolamide, streptozotocin, Pb, Cadmium, Hg, Ur, Cu (Wilson's), Outdated tetracycline |
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Term
| Normal acidification of the urine occurs via _____ chanel in the _____ membrane of ______ cells in the ______ |
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Definition
| H+ ATPase in luminal membrane of Type A intercalated cells in the cortical and medullary collecting tubules |
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Term
| Type 1 Renal Tubular Acidosis (where, what, and how?) |
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Definition
distal (collecting tubules)
can't maximally acidify the urine
Mechanism:
1. defect in H ion pump in intercalated cells
2. increased permeability of CT so large pH gradient can't be maintained because of back diffusion of H
3. reduced distal tubular Na reabsorption so electrical gradient favoring H secretion is reduced |
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Term
| classic feature of type I RTA |
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Definition
| hyperchloremic acidosis w/ urine pH persistently above 5.3 (often w/ hypokalemia) |
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