D LACTIC ACIDOSIS
Think of this in a pt with short bowel syndrome and recurrent episodes of encephalopathy. Normal lactate
Tx: NPO and IV dextrose
Think of this in a pt with short bowel syndrome and recurrent episodes of encephalopathy. Normal lactate
Tx: NPO and IV dextrose
METABOLIC ALKALOSIS
Bartter Syndrome: Hypokalemia, metabolic alkalosis and normal BP. Low Mg, High renin and aldosterone. Hypercalciuria "Looks like pt taking loop diuretic"
Gitelman: Low K, Low Mg, Hypocalciuria, chondrocaalcinosis. "looks like pt taking thiazide diuretic"
Bartter Syndrome: Hypokalemia, metabolic alkalosis and normal BP. Low Mg, High renin and aldosterone. Hypercalciuria "Looks like pt taking loop diuretic"
Gitelman: Low K, Low Mg, Hypocalciuria, chondrocaalcinosis. "looks like pt taking thiazide diuretic"
KIDNEY STONES:
* <5mm: can pass by itself. Tx: hydration and analgesics
* Extracorporeal shock-wave lithotripsy: stone >1cm, obstruction, stone not passing in 2-4weeks spontaneously, stone located in kidney or passing mid ureter.
* Flexible ureteroscopy: on stone located on distal ureter
* Percutaneous nephrostomy: staghorn calculus
* <5mm: can pass by itself. Tx: hydration and analgesics
* Extracorporeal shock-wave lithotripsy: stone >1cm, obstruction, stone not passing in 2-4weeks spontaneously, stone located in kidney or passing mid ureter.
* Flexible ureteroscopy: on stone located on distal ureter
* Percutaneous nephrostomy: staghorn calculus
NEPHROPATHY
Minimal change disease : can be secondary to Hodgkin lymphoma, NSAID or lithium use, mononucleosis, Presents with massive proteinuria , mildly elevated blood pressure, hypoalbuminemia, and anasarca.
Membranous nephropathy, Manifest as edema, nephrotic-range proteinuria, and hyperlipidemia. Subepithelial deposition of immune complexes on electron microscopy of a kidney biopsy specimen. Tx: Lisinopril
Minimal change disease : can be secondary to Hodgkin lymphoma, NSAID or lithium use, mononucleosis, Presents with massive proteinuria , mildly elevated blood pressure, hypoalbuminemia, and anasarca.
Membranous nephropathy, Manifest as edema, nephrotic-range proteinuria, and hyperlipidemia. Subepithelial deposition of immune complexes on electron microscopy of a kidney biopsy specimen. Tx: Lisinopril
immune complex–mediated glomerular nephritis.: increased serum creatinine level accompanied by
hypocomplementemia and dysmorphic erythrocytes and erythrocyte casts
seen on urinalysis Seen in Syphilis and hepatitis C
RENAL TUBULAR ACIDOSIS
* Proximal RTA (TYPE II): Defect on reabsorption of HCO3. Seen on Fanconi Sd, SLE, MM, Osteomalacia, Acetazolamide
Hypokalemia. urine Ph <5.5
Fanconi Sd: hypophos, hypouric, glycosuria, AAuria
* Distal RTA (TYPE IV): Defect on excretion of K & H. Seen on hypoaldosteronism and DM. Also on Cyclosporine, SC disease. Hyperkalemia and urine pH <5.5
* Classic Distal RTA (TYPE I): Defect on excretion H. Seen on Sjogrens. calcium phosphate stones.Obstruction.
Hypokalemia, Urine pH >5.5
Tx: K and HCO3 replacement
* Proximal RTA (TYPE II): Defect on reabsorption of HCO3. Seen on Fanconi Sd, SLE, MM, Osteomalacia, Acetazolamide
Hypokalemia. urine Ph <5.5
Fanconi Sd: hypophos, hypouric, glycosuria, AAuria
* Distal RTA (TYPE IV): Defect on excretion of K & H. Seen on hypoaldosteronism and DM. Also on Cyclosporine, SC disease. Hyperkalemia and urine pH <5.5
* Classic Distal RTA (TYPE I): Defect on excretion H. Seen on Sjogrens. calcium phosphate stones.Obstruction.
Hypokalemia, Urine pH >5.5
Tx: K and HCO3 replacement
- Isopropyl alcohol poisoning: is characterized by an increased osmolal gap in the setting of positive serum and urine ketones.
- Toluene, may cause confusion and disorientation, metabolic acidosis, hypokalemia, hypophosphatemia, rhabdomyolysis, and elevated creatine kinase level.