Renal Rules
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H20 + CO2  H+ + HCO3Acute Respiratory Disturbance: ∆pH = 0.008 for every ∆pCO2
Chronic Respiratory Disturbance: ∆pH = 0.003 for every ∆pCO2
Anion Gap = Na+ - (HCO3- + Cl-)
Anion gap goes ↓2.5 meq/L for every ↓ in albumin of 1 gm/dL
Excess/∆∆ gap = actual anion gap – 10 [normal AG]
Corrected/Potential HCO 3 - = ΔΔ Anion Gap + Serum HCO 3 Metabolic acidosis: ΔpCO 2 = 1.2 x ΔHCO 3 Metabolic alkalosis:
ΔpCO 2 = 0.7 x ΔHCO 3
Respiratory Acidosis:
a. Acute: Δ HCO 3 - = 1 mEq/L↑/10mmHg↑pCO 2
b. Chronic: Δ HCO 3 - = 3 mEq/L↑/10mmHg↑pCO 2
Respiratory Alkalosis:
a. Acute: Δ HCO 3 - = 2 mEq/L↓/10mmHg↓pCO 2
b. Chronic: Δ HCO 3 - = 4 mEq/L↓/10mmHg↓pCO 2
Acute <24 hours; Chronic ≥ 3 days
ΔNa + for glucose = Na + ↓2.4 mEq/L/100 mg/dL↑ for gluc >
100mg/dL
Δ Ca++ for albumin = ↓0.8 mg/dL Ca ++ for every ↓1 gm/dL alb
Renal Rules
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Renal Rules
Renal Rules
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
H20 + CO2  H+ + HCO3Acute Respiratory Disturbance: ∆pH = 0.008 for every ∆pCO 2
Chronic Respiratory Disturbance: ∆pH = 0.003 for every ∆pCO 2
Anion Gap = Na+ - (HCO3- + Cl-)
Anion gap goes ↓2.5 meq/L for every ↓ in albumin of 1 gm/dL
Excess/∆∆ gap = actual anion gap – 10 [normal AG]
Corrected/Potential HCO 3 - = ΔΔ Anion Gap + Serum HCO 3 Metabolic acidosis: ΔpCO 2 = 1.2 x ΔHCO 3 Metabolic alkalosis:
ΔpCO 2 = 0.7 x ΔHCO 3
Respiratory Acidosis:
a. Acute: Δ HCO 3 - = 1 mEq/L↑/10mmHg↑pCO 2
b. Chronic: Δ HCO 3 - = 3 mEq/L↑/10mmHg↑pCO 2
Respiratory Alkalosis:
a. Acute: Δ HCO 3 - = 2 mEq/L↓/10mmHg↓pCO 2
b. Chronic: Δ HCO 3 - = 4 mEq/L↓/10mmHg↓pCO 2
Acute <24 hours; Chronic ≥ 3 days
ΔNa + for glucose = Na + ↓2.4 mEq/L/100 mg/dL↑ for gluc >
100mg/dL
Δ Ca++ for albumin = ↓0.8 mg/dL Ca ++ for every ↓1 gm/dL alb
H20 + CO2  H+ + HCO3Acute Respiratory Disturbance: ∆pH = 0.008 for every ∆pCO 2
Chronic Respiratory Disturbance: ∆pH = 0.003 for every ∆pCO 2
Anion Gap = Na+ - (HCO3- + Cl-)
Anion gap goes ↓2.5 meq/L for every ↓ in albumin of 1 gm/dL
Excess/∆∆ gap = actual anion gap – 10 [normal AG]
Corrected/Potential HCO 3 - = ΔΔ Anion Gap + Serum HCO 3 Metabolic acidosis: ΔpCO 2 = 1.2 x ΔHCO 3 Metabolic alkalosis:
ΔpCO 2 = 0.7 x ΔHCO 3
Respiratory Acidosis:
a. Acute: Δ HCO 3 - = 1 mEq/L↑/10mmHg↑pCO 2
b. Chronic: Δ HCO 3 - = 3 mEq/L↑/10mmHg↑pCO 2
Respiratory Alkalosis:
a. Acute: Δ HCO 3 - = 2 mEq/L↓/10mmHg↓pCO 2
b. Chronic: Δ HCO 3 - = 4 mEq/L↓/10mmHg↓pCO 2
Acute <24 hours; Chronic ≥ 3 days
ΔNa + for glucose = Na + ↓2.4 mEq/L/100 mg/dL↑ for gluc >
100mg/dL
Δ Ca++ for albumin = ↓0.8 mg/dL Ca ++ for every ↓1 gm/dL alb
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
H20 + CO2  H+ + HCO3Acute Respiratory Disturbance: ∆pH = 0.008 for every ∆pCO 2
Chronic Respiratory Disturbance: ∆pH = 0.003 for every ∆pCO 2
Anion Gap = Na+ - (HCO3- + Cl-)
Anion gap goes ↓2.5 meq/L for every ↓ in albumin of 1 gm/dL
Excess/∆∆ gap = actual anion gap – 10 [normal AG]
Corrected/Potential HCO 3 - = ΔΔ Anion Gap + Serum HCO 3 Metabolic acidosis: ΔpCO 2 = 1.2 x ΔHCO 3 Metabolic alkalosis:
ΔpCO 2 = 0.7 x ΔHCO 3
Respiratory Acidosis:
a. Acute: Δ HCO 3 - = 1 mEq/L↑/10mmHg↑pCO 2
b. Chronic: Δ HCO 3 - = 3 mEq/L↑/10mmHg↑pCO 2
Respiratory Alkalosis:
a. Acute: Δ HCO 3 - = 2 mEq/L↓/10mmHg↓pCO 2
b. Chronic: Δ HCO 3 - = 4 mEq/L↓/10mmHg↓pCO 2
Acute <24 hours; Chronic ≥ 3 days
ΔNa + for glucose = Na + ↓2.4 mEq/L/100 mg/dL↑ for gluc >
100mg/dL
Δ Ca++ for albumin = ↓0.8 mg/dL Ca ++ for every ↓1 gm/dL alb
Anion Gap
Metabolic
Acidosis
GOLD
MARK
Glycols
(Ethylene &
Propylene)
Oxoproline
L-Lactate
D-Lactate
Methanol
Aspirin
Renal Failure
Ketoacidosis
(EtOH,
Starvation,
DKA)
Anion Gap
Metabolic
Acidosis
GOLD
MARK
Glycols
(Ethylene &
Propylene)
Oxoproline
L-Lactate
D-Lactate
Methanol
Aspirin
Renal Failure
Ketoacidosis
(EtOH,
Starvation,
DKA)
Non-Gap
Metabolic
Acidosis
ACCRUED
Acid load
Carbonic
Anhydrase
Inhibitors
Chronic Kidney
Disease (Renal
Failure)
Renal Tubular
Acidosis
Ureteroenterostomy
Expansion
(Volume)
Diarrhea
Non-Gap
Metabolic
Acidosis
ACCRUED
Acid load
Carbonic
Anhydrase
Inhibitors
Chronic Kidney
Disease (Renal
Failure)
Renal Tubular
Acidosis
Ureteroenterostomy
Expansion
(Volume)
Diarrhea
Acute Respiratory
Acidosis
Metabolic
Alkalosis
Respiratory
Alkalosis
CHOMPP
CLEVER PD
CHAMPS
Contraction
Licorice
Endo Conn’s,
Cushing’s &
Bartter’s
Vomiting
E: Excess
Alkali
Refeeding
Alkalosis
Posthypercapnea
Diuretics
CNS disease
Hypoxia
Anxiety
Mechanical
ventilators
Progesterone:
Pregnancy and
Liver Disease
Salicylates &
Sepsis
Acute Respiratory
Acidosis
Metabolic
Alkalosis
Respiratory
Alkalosis
CHOMPP
CLEVER PD
CHAMPS
Contraction
Licorice
Endo Conn’s,
Cushing’s &
Bartter’s
Vomiting
E: Excess
Alkali
Refeeding
Alkalosis
Posthypercapnea
Diuretics
CNS disease
Hypoxia
Anxiety
Mechanical
ventilators
Progesterone:
Pregnancy and
Liver Disease
Salicylates &
Sepsis
CNS depression
Hemothorax
(pneumothorax)
Obstruction
(airway)
Myopathy
Pneumonia
Pulmonary edema
Anything that
causes
Hypoventilation or
Chronic respiratory
acidosis (COPD
and restrictive lung
disease)
CNS depression
Hemothorax
(pneumothorax)
Obstruction
(airway)
Myopathy
Pneumonia
Pulmonary edema
Anything that
causes
Hypoventilation or
Chronic respiratory
acidosis (COPD
and restrictive lung
disease)
Anything that
causes hyperventilation
Anything that
causes hyperventilation
Anion Gap
Metabolic
Acidosis
GOLD
MARK
Glycols
(Ethylene &
Propylene)
Oxoproline
L-Lactate
D-Lactate
Methanol
Aspirin
Renal Failure
Ketoacidosis
(EtOH,
Starvation,
DKA)
Anion Gap
Metabolic
Acidosis
GOLD
MARK
Glycols
(Ethylene &
Propylene)
Oxoproline
L-Lactate
D-Lactate
Methanol
Aspirin
Renal Failure
Ketoacidosis
(EtOH,
Starvation,
DKA)
Non-Gap
Metabolic
Acidosis
ACCRUED
Acid load
Carbonic
Anhydrase
Inhibitors
Chronic Kidney
Disease (Renal
Failure)
Renal Tubular
Acidosis
Ureteroenterostomy
Expansion
(Volume)
Diarrhea
Non-Gap
Metabolic
Acidosis
ACCRUED
Acid load
Carbonic
Anhydrase
Inhibitors
Chronic Kidney
Disease (Renal
Failure)
Renal Tubular
Acidosis
Ureteroenterostomy
Expansion
(Volume)
Diarrhea
Acute Respiratory
Acidosis
Metabolic
Alkalosis
Respiratory
Alkalosis
CHOMPP
CLEVER PD
CHAMPS
Contraction
Licorice
Endo Conn’s,
Cushing’s &
Bartter’s
Vomiting
E: Excess
Alkali
Refeeding
Alkalosis
Posthypercapnea
Diuretics
CNS disease
Hypoxia
Anxiety
Mechanical
ventilators
Progesterone:
Pregnancy and
Liver Disease
Salicylates &
Sepsis
Acute Respiratory
Acidosis
Metabolic
Alkalosis
Respiratory
Alkalosis
CHOMPP
CLEVER PD
CHAMPS
Contraction
Licorice
Endo Conn’s,
Cushing’s &
Bartter’s
Vomiting
E: Excess
Alkali
Refeeding
Alkalosis
Posthypercapnea
Diuretics
CNS disease
Hypoxia
Anxiety
Mechanical
ventilators
Progesterone:
Pregnancy and
Liver Disease
Salicylates &
Sepsis
CNS depression
Hemothorax
(pneumothorax)
Obstruction
(airway)
Myopathy
Pneumonia
Pulmonary edema
Anything that
causes
Hypoventilation or
Chronic respiratory
acidosis (COPD
and restrictive lung
disease)
CNS depression
Hemothorax
(pneumothorax)
Obstruction
(airway)
Myopathy
Pneumonia
Pulmonary edema
Anything that
causes
Hypoventilation or
Chronic respiratory
acidosis (COPD
and restrictive lung
disease)
Anything that
causes hyperventilation
Anything that
causes hyperventilation