Mixed Acid–Base Disorders
Acid–base disorder Clinical setting pH pCO2 a Na+ K+ Cl− HCO3 −a AG Double acid–base disorders Metabolic acidosis and metabolic alkalosis Renal failure (CKD 4 and 5), diabetic ketoacidosis, lactic…
Disorders of Potassium: Physiology
Fig. 14.1 Handling of K+ by various segments of the nephron; 60–80 % of K+ is reabsorbed by the proximal convoluted tubule (PCT) and about 25 % by the medullary thick ascending limb…
Interpretation of Urine Electrolytes and Osmolality
Electrolyte Use Na+ To assess volume status Differential diagnosis of hyponatremia Differential diagnosis of AKI To assess salt intake in patients with hypertension To evaluate calcium and uric acid excretion…
High Anion Gap Metabolic Acidosis
From the above reaction, excess lactate production can be expected by the following pathophysiologic processes: 1. Increased pyruvate production caused by intravenous (i.v.) glucose or epinephrine infusion, and metabolic or…
Disorders of Potassium: Hyperkalemia
Cause Mechanism 1. Exogenous intake Oral Excess oral intake High K+—containing foods (fruits, salt substitutes, KCl supplements, river bed clay, burnt match heads, raw coconut juice) Herbal medications (horsetail, noni…
Hyperchloremic Metabolic Acidosis: Nonrenal Causes
Intestinal Diarrhea Biliary fistula Pancreatic fistula Villous adenoma Gastrointestinal (GI)–ureteral connections Ureterosigmoidostomy Ureterojejunostomy Ureteroileostomy Drugs Laxatives Cholestyramine Before we discuss the pathophysiology of diarrhea, it is essential to understand water…
Disorders of ECF Volume: Volume Contraction
Extrarenal loss Renal loss Gastrointestinal losses Na + loss by the normal kidney Vomiting Diuretics Diarrhea Adrenal insufficiency Nasogastric suction Decreased renin production Fistulas Na + loss by the abnormal…
Renal Handling of NaCl and Water
Fig. 3.1 Cellular model for Na+ entry into the first half (early part) of the proximal tubule. Note that many of these mechanisms are also present in the second half…
Disorders of Magnesium: Physiology
Fig. 23.1 Mg2+ homeostasis in an adult subject. (Filtered load of Mg2+ equals plasma free Mg2+ concentration of 1.1 mg/dL times GFR of 180 L/day; i.e., 180 L × 11 mg/L = 1,980 mg/day. Note that the intake of…
Disorders of Phosphate: Hypophosphatemia
Cause Mechanism Shift from extracellular to intracellular compartment Glucose Transcellular distribution Insulin Transcellular distribution Catecholamines Transcellular distribution Hyperalimentation Glucose-induced cellular uptake Respiratory alkalosis Transcellular distribution Refeeding syndrome Glucose and insulin-induced…
