Clinical Case Conference - black and white

Clinical Case Conference - black and white -...

Info iconThis preview shows pages 1–4. Sign up to view the full content.

View Full Document Right Arrow Icon
Renal Physiology Acid base clinical case conference I. David Weiner, M.D. Professor of Medicine and Physiology Page 1 Clinical Case Conference: Acid base disorders I. David Weiner, M.D. Professor of Medicine and Physiology How do you “measure” renal new bicarbonate generation? Two things increase new bicarbonate generation, titratable acids and ammonia One thing decreases new bicarbonate generation, failure to reabsorb luminal bicarbonate Net acid excretion (NAE) = urinary titratable acids + urinary ammonia – urinary bicarbonate NAE = U TA V + U Amm V–U HCO3 V Case 1 A patient presents with metabolic acidosis with a pH 7.20, HCO 3 12 and pCO 2 32 mmHg. How can you tell if this is results from: Renal failure to generate “new” bicarbonate, or Bicarbonate losses from diarrhea?
Background image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Renal Physiology Acid base clinical case conference I. David Weiner, M.D. Professor of Medicine and Physiology Page 2 Case 1–Answer Major component of NAE (new bicarbonate formation” is: Ammonia metabolism and excretion. Glutamine metabolism: With urinary ammonia excretion 1 mmol new HCO 3 per mmol of ammonia excreted Without urinary ammonia excretion Glutamine converted to urea Case 1–answer How do you measure urinary ammonia? Bad news … Lab can, but won’t Trick, Urinary cations – Na + , K + , and NH 4 + Urinary anions–C l and HCO 3 If urine pH 6.5, urinary HCO 3 inconsequential Urine doesn’t cause lightning Urinary cations = urinary anions Lab will measure urinary Na + , K + , and Cl If urinary Na + + K + Cl , then minimal NH 4 + Renal tubular acidosis If urinary Na + + K + >> Cl , then substantial NH 4 + Diarrhea Case 2 A 4 year old child presents for “failure to thrive.” His serum bicarbonate is 12 mmol/L and K + is 2.8 mmol/L. His urine pH is 6.1, and the urine does not contain glucose or amino acids. What is the diagnosis?
Background image of page 2
Renal Physiology Acid base clinical case conference I. David Weiner, M.D. Professor of Medicine and Physiology
Background image of page 3

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon
Image of page 4
This is the end of the preview. Sign up to access the rest of the document.

{[ snackBarMessage ]}

Page1 / 9

Clinical Case Conference - black and white -...

This preview shows document pages 1 - 4. Sign up to view the full document.

View Full Document Right Arrow Icon
Ask a homework question - tutors are online