Nephron Schematic Map - Colombia Nephrology #Nephron #Nephrology #Pathophysiology #Overview #Tubules #Duct #LoopOfHenle #Diuretics #Schematic #Map

Distal Renal Tubular Acidosis (RTA) Type 1 Totally scuppers the kidney's acidification mechanism. Will be much easier to diagnosis with direct urine ammonium assay. What is it Failure to acidify urine in distal tubular Consequent impaired NH4+ secretion Cannot lower pH <5.5 - Dr. John Booth https://twitter.com/ThePeanutKidney #RTA #Type1 #Distal #Diagnosis #Management #Nephrology #Causes #Differential #RenalTubular #Acidosis

Acid Base Disorders - Blood Gas Interpretation Steps for Blood Gas Interpretation: 1. Acidemia or Alkalemia? 2. Respiratory or Metabolic? 3. Compensated? Acute or chronic? 4. Anion gap? Delta-delta? 5. Differentials? ABG And BMP Normal Values • pH: 7.35-7.45 • PaCO2: 35-45 mmHg • PaO2: 80-100 mmHg • HCO3 (on BMP): 22-26 mmol/L Step 1 - Acidemia or Alkalemia: • pH <7.35 = Acidemia • pH >7.45 = Alkalemia Step 2 - Respiratory or Metabolic: pH pCO2 ↓ ↓ Metabolic Acidosis ↑ ↑ Metabolic alkalosis ↓ ↑ Resp Acidosis ↑ ↓ Resp Alkalosis Step 3 - Compensation, Acute vs Chronic: • Metabolic compensation • Respiratory compensation Step 4 - Anion gap, Delta-delta: Anion Gap (AG) = {Na - (Cl + HCO3)} Normal = 12 +/- 2 Corrected Anion Gap = AG + 2.5(4-albumin) Delta: Delta = (AG-12) / (24-HCO3) Delta: Delta Interpretation For Metabolic Acidosis <0.4 Pure Normal AG metabolic acidosis 0.4-0.8 Normal + High AG metabolic acidosis 0.8-2.0 Pure High AG metabolic acidosis >2.0 Metabolic acidosis with superimposed Metabolic alkalosis/Resp acidosis Step 5 - Differential Diagnosis: Causes of High Anion Gap Metabolic acidosis: G Glycols - ethylene glycol “antifreeze” and propylene glycol (present in IV benzodiazepines) O Oxoprolin (associated with acetaminophen dosing) L L-lactate (common form of lactate) D D-lactate (short bowel syndrome, intestinal bacterial overgrowth, propylene glycol) M Methanol A Aspirin (salicylates) R Renal failure (uremia) K Ketoacidosis (starvation, diabetic) Causes of Normal Anion Gap Metabolic acidosis: - Diarrhea - Renal tubular acidosis/Chronic renal failure - Adrenal insufficiency - Rapid saline infusion - Acetazolamide Causes of Metabolic Alkalosis: - Vomiting, NG suction - Volume depletion (diuresis) - Mineralocorticoid excess Causes of Respiratory alkalosis: - Hyperventilation (Anxiety, pain, fever, hypoxia) - “Classically” noted with pulmonary embolism (with associated hypoxia) - Salicylates Causes of Respiratory acidosis: - CNS depression (sedation, narcotics, CVA) - Neuromuscular weakness (GBS, Myasthenia gravis) - Obstructive or restrictive lung disease (COPD, OSA, Asthma, Obesity hypoventilation) - Airway obstruction (foreign body, aspiration) M. Daniyal Hashmi, MD @MDaniyalHashmi1 #AcidBase #disorders #Interpretation #Diagnosis #Summary #Nephrology #ABG #bloodgas #Acid #Base #Gas #VBG #differential