Index

Index

Index

575

0.45% saline – alkalosis

adrenal insufficiency. See also acid maltase deficiency Addison's disease respiratory acidosis 412 0.45% saline 40 adrenal crisis 142 acid-base 0.9% NaCl 39. See also isotonic casue of hyponatremia 141 disorder saline cause of hyperkalemia 559 evaluation 272 treatment of diabetic ketoacidofalse positive sweat chloride test metabolic acidosis.See sis 347 187 metabolic acidosis 0.9% saline primary vs secondary 559 metabolic alkalosis.See proper use 159 primary vs. secondary vs. metabolic alkalosis 11 ß-hydroxylase tertiary 141 primary 263 inhibition by ketoconazole 514 adrenalectomy respiratory acidosis.See 11ß- hydroxysteroid dehydrogetreatment of adenoma 508 respiratory acidosis nase 509 adult respiratory distress syndrome respiratory alkalosis.See 11ß-hydroxylase deficiency 517 58, 420 respiratory alkalosis 14 gauge needle afterload 85 two disorders 274 treatment of pneumothorax 413 AIDS. See also HIV regulation 250 17a-hydroxylase deficiency 516 cause of lactic acidosis 332 The Chapter 249 21-hydroxylase deficiency 560 cause of SIADH 139 acidemia 250 25% saline 38 albumin acidosis 3% saline 41 gradient 61 definition 250 treatment of hyponatremia 169 plasma expander 43 effect on potassium 474 relationship to calcium 255 hyperkalemia 548 A relationship to net filtration metabolic. See metabolic pressure 57 acidosis A-a gradient. See alveolar-arterial albuterol 472 respiratory. See respiratory gradient hypokalemia 494 acidosis ABC’s of first-aid 123 treatment of asthma 435 ACTH abdominal bruit 518 diagnosis of excess mineralocor- alcohol dehydrogenase 358 abdominal pain role in ethylene glycol toxicity ticoid activity 391 in Addison's disease 141 361 in SIADH 141 ABG. See arterial blood gas role in methanol toxicity 360 plasma level 512, 513 accessory muscles of respiration alcohol withdrawal acute demyelinating 411 causing hypokalemia 494 polyneuropathy . See Guillain ACE. See angiotensin converting alcoholic ketoacidosis 340 Barré syndrome enzyme alcoholism acute tubular necrosis ACE inhibitor 73 cause of hypokalemia 488 urinary concentrating ability191 complication 518 aldosterone 77, 479 acute-on-chronic respiratory diabetes mellitus 73 dependence on distal flow 500 acidosis 430 in CHF 85 low levels 556 Addison's disease 559.See also in hyperkalemia 558 primary hyperaldosteronism 506 adrenal insufficiency myocardial infarction 73 role in potassium regulation 479 ADH. See antidiuretic hormone acetaminophen role in volume regulation 76 adjusted weight 4 molecular weight 18 stimulation by angiotensin II 75 adrenal crisis 142 acetate stimuli for release 78 adrenal gland cause of metabolic alkalosis aldosterone : renin ratio 507 adenoma 506 370 alkalemia 250 carcinoma 506 acetazolamide 129 destruction inAddison's disease alkalosis cause of proximal R TA 310 causing hypokalemia 492 141 acetoacetate 335 definition 250 hyperplasia 184, 506 acetone 335 effect on potassium 474 source of aldosterone 76 acetylsalicylic acid 353 target for angiotensin II 75

Numbers

576

allopurinol – banana

effect on pulmonary blood flow 459 metabolic. See metabolic alkalosis respiratory. See respiratory alkalosis allopurinol treatment of tumor lysis syndrome 547 alpha1-antitrypsin deficiency 420 ALS. See amyotrophic lateral sclerosis alveolar minute ventilation 402 alveolar-arterial gradient calculation 418 in evaluation of respiratory acidosis 434 use in respiratory alkalosis 460 alveoli role in respiration 417 amenorrhea, primary congenital adrenal hyperplasia 516 amiloride 129, 561. See also potassium sparing diuretics cause of distal RTA 313 aminoglycoside respiratory acidosis 412 amiodarone cause of hypothyroidism 140 interstitial lung disease 420 amitriptyline cause of SIADH 139 ammonia 301 amphotericin B cause of distal RTA 315 hypokalemia 521 ampule 37 ampulla of Vater 289 amylase in diabetic ketoacidosis 344 amyloidosis cause ofAddison's disease 141 cause of Fanconi's syndrome 309 interstitial lung disease 420 amyotrophic lateral sclerosis respiratory acidosis 407 anemia cause of lactic acidosis 331 cause of respiratory alkalosis

445 Fanconi’s 309 iron deficiency from clay 489 megaloblastic 491 sickle cell 238 anesthetic respiratory acidosis 407 angiotensin converting enzyme 72 levels 73 angiotensin I 72 angiotensin II deficiency in hypoaldosteronism 558 role in volume regulation 75 angiotensin II antagonists in hyperkalemia 558 anion 20 anion gap definition 21 plasma 281 urine 302, 321 anion gap metabolic acidosis complications 362 mechanism 326 plum seeds 327 The Chapter 325 treatment 363 ankylosing spondylitis interstitial lung disease 420 anorexia nervosa hypokalemia 488 ANP. See atrial natriuretic peptide anticholinergic drugs181 antidiuretic hormone 99,226 arginine vasopressin 102 coagulation factors 227 effect on collecting tubule 104 in water restriction test 243 production 102 role in hyponatremia 121 role in osmoregulation 94 role in volume regulation 80 stimuli for release 103,226 antifreeze 361. See also ethylene glycol antipsychotic medications cause of SIADH 139 effect on thirst 222 antithrombin III 131 anxiety cause of respiratory alkalosis

443, 448 apnea of prematurity 407 appropriateADH release 123 ARDS. See adult respiratory distress syndrome arginine vasopressin 102.See also antidiuretic hormone arrhythmias hyperkalemia 563 hypocalcemia 364,547 hypokalemia 528 metabolic acidosis 362 prevention with calcium 571 respiratory alkalosis 457 arterial blood gas 272 in A-a gradient 418 in diabetic ketoacidosis 344 in respiratory acidosis 434 respiratory alkalosis 461 asbestos interstitial lung disease 420 ascites 55 definition 61 evaluation by albumin gradient 61 aspiration pneumonia 415 aspirin 353 cause of hyperventilation 443 free vs. bound 354 molecular weight 359 treatment of overdose 356 assist control ventilator setting 450 asthma 415, 472 cause of SIADH 139 definition 416 respiratory alkalosis vs. acidosis 416 treatment 435 atelectasis 420 cause of SIADH 139 ATP 329 atrial natriuretic peptide 81 Avogadro’s number 10 AZT 332

B B-12 475 banana potassium content 488

577

baroreceptor – catecholamine

baroreceptor dyspnea 447 relationship to osmoreceptor 69 Bartter’s syndrome 501 causing metabolic alkalosis 381 Bayer aspirin 353 Becker’s muscular dystrophy 412 bed-wetters 244 benzodiazepines respiratory acidosis 407 beta-2 receptors effect on Na-K-ATPase activity 494 beta-agonists.See also albuterol potassium regulation 472 treatment of hyperkalemia 568 beta-blocker 472 hyperkalemia 550 in CHF 85 ß-hydroxybutyrate 335 hypokalemia 519 bicarbonate buffer 256, 259 from lactate 42 handling in distal nephron 299 handling in proximal tubule 298 in lactated Ringer's 42 in renal failure 351 measurement on chem-7 272 potassium content of oral solutions 543 bicarbonate therapy cause of intracellular acidosis 364 cause of metabolic alkalosis 371 cause of respiratory alkalosis 453 in aspirin toxicity 356 in distal RTA 316 in hyperkalemia 568 in metabolic acidosis 363 in proximal RTA 311 bile electrolyte composition 289 biochemistry waste of time 328 blood pressure 67.See also hypotension as part of effective circulating volume 64

578

hypotension.See hypotension C in evaluation of excess mineraloC3PO 431 corticoid activity 390 relationship to plasma volume cadmium cause of Fanconi's syndrome 70 309 blood transfusion caffeine 407 cause of metabolic alkalosis cagey clinician 370 early signs of sepsis 443 plasma expander 43 calcitriol 307 potassium content 544 calcium body surface area 45 absorption 307 body water compartments content in lactated Ringer's 42 intracellular vs. extracellular 5 evaluation of polydipsia 239 relative sizes 6 free vs. ionized 255 body weight generation of metabolic alkalosis adjusted weight 4 381 hypothalamic regulation 91 hypercalcemia. See hypercalceideal weight 4 mia to calculate IVF 44 hypocalcemia.See also bone hypocalcemia buffer 256 treatment of aminoglycoside destruction in chronic renal toxicity 412 failure 351 treatment of hyperkalemia 571 destruction with distalTA R 316 calcium channel BOOP. See bronchiolitis obliterans role in periodic paralysis 495 organizing pneumonia caloric expenditure method botulinus toxin 412 IVF calculation 44 breast cancer captopril 73 cause of tumor lysis syndrome carbamazepine 547 cause of SIADH 139 breath holding 448 carbenicillin brine, salty 105 causing metabolic alkalosis 381 bronchiolitis obliterans organizing carbon dioxide 259 pneumonia 420 daily production 400 bronchoconstriction 416,472 narcosis 431 brown paper bag regulation of respiration 406 treatment of hyperventilation relationship to minute volume 462 402 buffalo hump 511 role in respiratory acidosis 400 buffering 256 role in respiratory alkalosis 440 by bone in chronic renal failure total on the chem-7 272 351 carbon monoxide poisoning 331 in respiratory acidosis 424 carbonic anhydrase 259 in respiratory alkalosis 452 action in proximal tubule 298 bulbar palsy 155 role in proximal R TA 310 bumetanide 129 cardiac output 67 BUN. See urea carotid bodies 405 Burkitt’s lymphoma cause of tumor lysis syndrome catecholamine cause of hypokalemia 494 547

cation – cortisol

decreased response with acidosis 362 cation 20 cation exchange resin.See also Kayexalate® treatment of hyperkalemia 569 cell destruction effect on potassium 475 cell membrane 5 permeability 29 central diabetes insipidus 231 diagnosis 240 treatment 244 central hypoventilation 443 central lines potassium repletion 534 central pontine myelinolysis 154 central sleep apnea 409 cerebral adaptation in hypernatremia 207 in hyponatremia 152 cerebral blood flow regulation 458 cerebral dehydration in hypernatremia 206 in nonketotic hyperosmolar syndrome 348 cerebral edema from hyponatremia 151 from treatment of diabetic ketoacidosis 346 from treatment of hypernatremia 208 treatment with mannitol 196 CF. See cystic fibrosis chem-7 272 in acid-base evaluation 272 in diabetic ketoacidosis 344 in respiratory acidosis 434 in respiratory alkalosis 461 chemotherapy cause of proximal TRA 308 hyperkalemia 475, 546 CHF. See congestive heart failure child abuse salt ingestion 182 chloride deficiency and metabolic alkalosis 385 in respiratory acidosis 427 in respiratory alkalosis 461

intake and metabolic alkalosis 381 molecular weight 38 urine concentration 388 chloride exchange resin cause of non-anion gap metabolic acidosis 293 cholestyramine 293 chlorpropamide cause of SIADH 139 cholera 190 hypokalemia 497 cholestyramine cause of non-anion gap metabolic acidosis 293 chronic bronchitis 415,422 chronic obstructive pulmonary disease 415, 422 effect on steps of respiration 421 signs and symptoms 432 chronic respiratory acidosis 426 compensation 426 hypoxia 408 cimetidine interaction with metformin 333 cirrhosis.See also liver disease cause of increased hydrostatic pressure 55 causing hyponatremia 130 cisplatin cause of Fanconi's syndrome 309 citrate cause of metabolic alkalosis 370 role in stone formation 307, 316 classic distal R TA 314 Clostridium botulinum 412 collecting tubule effect of mineralocorticoids 503 effect of potassium sparing diuretics 129 response toADH 101, 104, 228 role in potassium regulation 476 role in volume regulation 65 colligative properties 15 colon cancer 291 colonic villous adenoma 374

combined acid-base disorders. See mixed acidbase disorders compensation 264 metabolic acidosis 284 metabolic alkalosis 392 renal 268 respiratory 266 respiratory acidosis acute 425 chronic 428 respiratory alkalosis acute 453 chronic 455 compulsive water drinking.See psychogenic polydipsia concentration of urine 228 mechanism 101 conducting airways 403 confusion. See third-year medical student congenital adrenal hyperplasia 515 11ß-hydroxylase 517 17α-hydroxylase deficiency 516 21-hydroxylase deficiency 560 cause of hyperkalemia 560 cause of hypokalemia 515 diagnosis 391 congenital hypothyroidism 140 congenital nephrogenic diabetes insipidus 235 congestive heart failure 55,56 cause of hyponatremia 130 cause of respiratory alkalosis 445 formation of edema 84 from DDAVP 227 treatment 73, 85 conscious hyperventilation 448 contraction alkalosis 373 COPD. See chronic obstructive pulmonary disease cor pulmonale 432 corrected bicarbonate 285 corticotropin-releasing hormone 141 cortisol 337, 509 adrenal insufficiency 141 counter-regulatory hormone 337 Cushing's syndrome 510

579

cortisone – Duchenne’s muscular dystrophy

in dexamethasone suppression test 512 cortisone 509 cosyntropin stimulation test 142 cough side effect ofACE inhibitor 73 counter-regulatory hormones 337 CPM. See central pontine myelinolysis creatinine 100 in renal artery stenosis 518 renal function 100 cretinism 140 Crohn’s disease 291 croup 415, 438 crush injuries hyperkalemia 546 Cushing’s disease definition 510 Cushing’s syndrome definition 510 diagnosis 391, 513 mechanism 509 cyanide 332 cyclophosphamide cause of SIADH 139 cyclosporine in hyperkalemia 558 cysteine daily acid load 296 cystic fibrosis 187 cystinosis 308 cause of Fanconi's syndrome 309

dead space 402 anatomic vs alveolar 403 deicing solutions 358.See also methanol delirium tremens causing hypokalemia 494 ∆F508 187 delta-delta 285 demeclocycline 166 nephrogenic diabetes insipidus 234 deoxycorticosterone 516 depolarizing agent 412 dexamethasone 142 suppression test 512 dexamethasone suppression test high dose 513 low dose 512 dextrose concentration in IVF 35 relationship to glucose 34 solutions 34 use 37 diabetes insipidus cause of hypokalemia 521 central 231 central and nephrogenic 230 definition 197, 225 due to hypokalemia 529 generation of hypernatremia 193 nephrogenic 234 diabetes mellitus cause of nephrotic syndrome 131 D definition 35 due to CF 187 D-lactic acidosis 334 hyporeninemic hypoaldosterdaily acid load 296 onism 557 in renal failure 351 metformin 333 in RTA 296 role of ACE inhibitors 73 daily solute load 100,116 diabetic ketoacidosis 342 and diabetes insipidus 225 hyperkalemia 549 treatment of SIADH 166 hypokalemia 493, 519 DDAVP 241. See also antidiuretic lab findings 344 hormone signs and symptoms 343 and coagulation factors 227 treatment 347 chronic bed-wetters 244 diaphragm 411 side effects 227 paralysis 407 treatment of central diabetes diarrhea insipidus 244 congenital chloride 374

580

definition 290 hypernatremia 188 hypokalemia 497 infants 192 metabolic alkalosis 374 non-anion gap metabolic acidosis 290 osmotic 188 secretory 190 stool osmolar gap 189 diffusion defect respiratory acidosis 417 digoxin hyperkalemia 550 dilution of urine 96 minimum urinary concentration 116 distal flow 499 potassium secretion 481 relationship with aldosterone 500 role in hyperkalemia 555 distal nephron.See collecting tubule; distal convoluted tubule distal RTA 312 complications 316 diagnosis 319 hyperkalemia 313 hypokalemia 521 voltage-dependent 313 distal tubule effect of thiazide diuretics 128 role in diluting urine 96 role in formation of dilute urine 96 diuretics 129 cause of metabolic alkalosis 379 hyponatremia 126 in CHF 85 in the treatment of NDI 245 sudden cardiac death 494 divalent ions 19 DKA. See diabetic ketoacidosis donuts 10 dopamine use with acidemia 362 Dreser, Hermann 353 Duchenne’s muscular dystrophy 412

earthquakes – glycogen

E

exudate 59

earthquakes 252 edema, peripheral causes 55 edema, peripheral formation 83 effective circulating volume definition 64 role in hyperkalemia 555 role in hyponatremia 123 role in metabolic alkalosis 384 effective plasma osmolality 120 effusion, pleural 59 EKG changes with hyperkalemia 563 with hypokalemia 528 elderly. See geriatric population electrolyte 8 electrolyte panel 272.See also chem-7 electroneutrality 20,474 elliptocytosis cause of distal RTA 314 emphysema 422 respiratory acidosis 415,420 enalapril 73 encephalitis cause of SIADH 139 enterohepatic circulation 293 enteropathies, protein losing cause of edema 57 enuresis 244 epiglottitis respiratory acidosis 415 equivalent 19 ethanol molecular weight 18 respiratory acidosis 407 treatment for methanol ingestion 360 ethylene glycol 361 cause of lactic acidosis 332 molecular weight 361 eukalemia definition 468 excess mineralocorticoid activity. See mineralocorticoid activity extracellular compartment 5 solutes 29

F

G

galactosemia cause of Fanconi's syndrome factor VIII 227 309 familial periodic paralysis 495 gallbladder 289 Fanconi’s garbage mashers 431 anemia vs. syndrome 309 gas exchange fasting state 337 step 4 in respiration 417 fat 4 gentamicin effect of insulin 336 respiratory acidosis 412 glucose uptake 333 geriatric population role in ketoacidosis 366 hypokalemia 488 role in starvation 339 predisposition to hypernatremia fed state 336 200 fetal breathing 407 total body water 3 fever 91 GI fluid loss.See also cause of hyperventilation 443 diarrhea; vomitting effect on insensible water loss contraction alkalosis 374 44 hypernatremia 188 filtration pressure, net 53 hypokalemia 497 first order kinetics 354 hyponatremia 126 fistula metabolic acidosis 289 casue of non-anion gap metabolic alkalosis 374 metabolic acidosis 291 Gitelman’s syndrome 501 cause of hypokalemia 497 glaucoma flail chest 412 treatment with acetazolamide fludrocortisone 560 310 fluid restriction glucagon 336, 337 treatment of hyponatremia 164 gluconeogenesis 329 fluphenazine starvation 339 cause of SIADH 139 glucose folic acid 475 cause of pseudohyponatremia fontanels 113 delayed closure 140 concentration in IVF 35 formaldehyde 358 in diabetic ketoacidosis 344 formic acid 358 in nonketotic hyperosmolar fraction of oxygen syndrome 348 ventilator setting 450 molecular weight 11 fractional excretion of bicarbonate relationship to dextrose 34 322 use as primary fuel 336 free flow glucosuria.See also hyperglycestep 3 in respiration 414 mia fresh frozen plasma 43 osmotic diuresis 195 front porch 433 specific gravity 106 furosemide 129. See also loop glue sniffing. See also toluene diuretic complications 519 in the treatment of hyponatremia glycerol 339 169 glycogen treatment of CHF 56 glycogenolysis 339 role in starvation 339

581

glycogen storage diseases – hypertension

glycogen storage diseases cause of Fanconi's syndrome 309 respiratory acidosis 412 glycolic acid 361 glycolysis 329 glycyrrhetinic acid cause of pseudohyperaldosteronism 509 Goodpasture’s syndrome cause of nephrotic syndrome 131 gram negative sepsis cause of respiratory alkalosis 443 grams percent 13 green top tube 551 grey clay 489 growth hormone 337 Guillain-Barré syndrome cause of SIADH 139 respiratory acidosis 407

hemorrhagic cystitis 139 Henderson-Hasselbalch equation 261 heparin cause of hyperkalemia 561 herniation, cerebral 196, 458. See also cerebral edema hetastarch plasma expander 43 high altitude residence 445 hippurate 349, 519 HIV. See also AIDS cause ofAddison's disease 141 cause of SIADH 139 Hoffman, Felix 353 Holiday-Segar method 44 hydrochlorothiazide 129.See also thiazide hydrocortisone 142 hydrogen ion concentration compatible with life 251 effect on free calcium 255 H free vs. bound 254 normal concentration 253 Haemophillus influenza sponges 256 in epiglottitis 415 hydrostatic pressure 50 haloperidol definition 26 cause of SIADH 139 net 51 Hashimoto thyroiditis 140 – hyperaldosteronism HCO3 . See bicarbonate hypernatremia 183 heart rate hypokalemia 506 component of cardiac output 67 primary 506 hematocrit 7 pseudohyperaldosteronism 509 in chronic bronchitis 422 renovascular hypertension 518 in evaluation of respiratory hypercalcemia. See also calcium alkalosis 460 causing metabolic alkalosis 381 hemodialysis causing polyuria 237 as cause of hypernatremia 182 hypercarbia 400 aspirin toxicity 357 hypercholesterolemia ethylene glycol toxicity 361 nephrotic syndrome 131 hyperkalemia 570 hypergammaglobulinemia methanol toxicity 360 cause of distal RTA 314 tumor lysis syndrome 547 hyperglycemia.See also glucose hemoglobin cause of osmotic diuresis 195 intracellular buf fer 256, 452 cause of pseudohyponatremia sickle cell 238 113 hemolysis in sick infants 192 pseudohyperkalemia 551 with diabetic ketoacidosis 342 hemophilia 227 hyperkalemia

582

compensation vs correction 541 decreased renal excretion 552 definition 468, 540 diagnosis 564 in diabetic ketoacidosis 344 mechanism 542 oral intake 543 renal tubular acidosis 317 signs and symptoms 562 The Chapter 539 treatment 567 voltage-dependent distal TA R 313 hyperlipidemia cause of pseudohyponatremia 112 hypermagnesemia respiratory acidosis 412 hypernatremia definition 178 diagnosis of generation 203 diagnosis of maintenance 205 excess mineralocorticoid activity 183 generation 181 generation vs. maintenance 180 in infants 192 maintenance 198 rate of correction 213 relationship to hyperosmolality 178 signs and symptoms 206 The Chapter 177 treatment 209 hyperosmolality causing polydipsia 220 consequences 89 in diabetic ketoacidosis 346 relationship with hypernatremia 179 hyperphosphatemia from tumor lysis syndrome 547 hyperproteinemia cause of pseudohyponatremia 112 hyperreninism 518 diagnosis 391 hypertension due to sleep apnea 409 in congenital adrenal hyperplasia 516

hypertonic saline – hypoxia

in Cushing's syndrome 51 1 in primary hyperaldosteronism 506 in renal artery stenosis 518 not a cause of edema 55 portal 61 pseudohyperaldosteronism 509 pulmonary 432 in newborn 459 role in diagnosis of metabolic alkalosis 390 side effect ofADH 227 treatment withACE inhibitor 73 treatment with beta-blockers 472 treatment with thiazides 129 hypertonic saline 41 cause of hypernatremia 182 treatment of hyponatremia 169 hyperuricemia from tumor lysis syndrome 547 hyperventilation 441 conscious control 448 effect on caloric consumption 44 in metabolic acidosis 284 mechanical, in metabolic acidosis 363 treatment 462 hypervolemia 82 signs and symptoms 147 hypoalbuminemia 57 nephrotic syndrome 131 hypoaldosteronism 556 adrenal insufficiency 559 hyperkalemia 556 hyporeninemic 557 renal tubular acidosis 317 hypocalcemia cause of proximal TRA 308 complication of proximalTA R 307 from tumor lysis syndrome 547 in the presence of acidemia 255 relationship to pH 255 hypocapnia 440 hypoglycemia alcoholic ketosis 340 role in starvation 339 symptom of adrenal insuf ficiency 142

symptoms 337 treatment 37 hypokalemia ammoniagenesis 525 cause of metabolic alkalosis 374 cause of polyuria 237,529 caused by medications 523 definition 468,486 diagnosis by flow chart 524 effect on urinary ammonia 320 in diabetic ketoacidosis 344 in distal RTA 314 in proximal RTA 306 maintenance of metabolic alkalosis 385 respiratory acidosis 412 signs and symptoms 525 The Chapter 485 treatment 530 causing hyperkalemia 544 rate 535 total body deficit 531 hypomagnesemia 308 cause of metabolic alkalosis 381 in Gitelman's syndrome 501 in hypokalemia 530 hyponatremia acute vs. chronic 153 cerebral compensation 152 definition 10 from nephrotic syndrome 131 hypovolemic 126 in diabetic ketoacidosis 344 in renal failure 19 relationship with hypoosmolality 110 signs and symptoms 151 The Diagnosis andTreatment Chapter 145 The Pathophysiology Chapter 109 treatment 156 hypoosmolality consequences 89 relationship with hyponatremia 110 hypoparathyroidism 308 hypophosphatemia 412 cause of respiratory acidosis

412 in diabetic ketoacidosis 344 in respiratory alkalosis 461 hyporeninemic hypoaldosteronism 557 hypotension cause of respiratory alkalosis 445 in adrenal crisis 142 in diabetic ketoacidosis 343 in severe acidosis 362 hypothalamic adipsia 201 dysfunction in hypernatremia 201 hypothalamus 91 production ofADH 102 role inAddison's disease 141 role in osmoregulation 90 hypothermia hyperkalemia 546 hypothyroidism hyponatremia 140 respiratory acidosis 407 hypotonic saline 40 hypoventilation.See also respiratory acidosis definition 401 metabolic alkalosis 392 hypovolemia effect on urine pH 320 in hyperkalemia 555 in hyponatremia 126 in hyponatremia vs. hypernatremia 127 in metabolic alkalosis 373 maintenance of metabolic alkalosis 384 signs and symptoms 147 treatment 159 use of the term in this book 64 hypoxia cause of lactic acidosis 331 cause of respiratory alkalosis 445 control of respiration 406 in chronic respiratory acidosis 408 in metabolic alkalosis 392

583

I:E ratio – lithium

compartment 5 solutes 29 I:E ratio. See inspiratory:expiratory intracranial pressure 458 ratio intravenous fluids 32.See also iatrogenic 181 dextrose ideal TBW, calculation 212 solutions;maintenance ideal weight 4 IV; saline solutions ifosfamide 308 intravenous potassium 534 IL-1 91 inverse ratio immunoglobulin ventilator setting 450 cause of pseudohyponatremia ion trapping 356 112 isoniazid 332 ineffective osmole 120 isotonic saline 39 infection 58 proper use 159 botulism 412 treatment of diabetic ketoacidocause of fistulas 291 sis 347 cause of hypernatremia 186 J cause of pleural ef fusion 60 cause of SIADH 138 juxtaglomerular apparatus 72,518 CNS, cause of diabetes insipidus 231 K trigger for DKA 342 urinary tract 221,320 Ka 257 inferior petrosal sinus sampling bicarbonate 260 513 kaluresis insensible fluid loss definition 468 generation of hypernatremia Kayexalate®. See also cation 186 exchange resin inspiratory:expiratory ratio treatment of hyperkalemia 569 ventilator setting 450 treatment of RTA 318 insulin ketoacidosis effects 336, 337 alcoholic 340 hypokalemia 493 cause of metabolic acidosis 335 potassium regulation 473 cause of metabolic alkalosis treatment of DKA 347 371 diabetic 342 treatment of hyperkalemia 568 due to aspirin 355 intercalated cell 504 effect on potassium 474 aldosterone activity 77 starvation 339 role in hydrogen secretion 300 treatment with glucose 341 intern treatment with insulin 347 overaggressive 154 ketoconazole overeager 208 treatment of Cushing's syninterstitial compartment 5 drome 514 interstitial lung disease 420 ketones 335 intestine kidney electrolyte composition of role in acid-base compensation secretions 289 265 intracellular role in osmoregulation 96,101 acidosis, complication of role in potassium regulation 476 bicarbonate therapy 364 role in volume regulation 65 buffers 452

I

584

kidney stones 316 KingArthur 489 Krebs cycle 329 Kussmaul respirations 343 kyphoscoliosis 412

L lactate in IV fluids 42 relationship with bicarbonate 42 lactated Ringer’s 42 cause of metabolic alkalosis 370 lactic acidosis cause of metabolic acidosis 330 cause of metabolic alkalosis 371 contraindication for lactated Ringer 42 dextro- 334 due to aspirin 355 effect on potassium 474 mechanism 330 type A 331 type B 332 lactose intolerance 191 large intestine electrolyte composition of secretions 289 laryngomalacia 415,438 laryngotracheobronchitis 415 laxative 191 abuse 148 lead toxicity cause of Fanconi's syndrome 309 leukemia pseudohyperkalemia 551 pseudohypokalemia 496 tumor lysis syndrome 547 licorice pseudohyperaldosteronism 509 lipids pseudohyponatremia 12 1 lisinopril 73 lithium cause of distal RTA 314 cause of hypothyroidism 140 cause of nephrogenic diabetes insipidus 234

liver – mixed acid-base disorders

liver electrolyte composition of secretions 289 liver disease.See cirrhosis ascites 57 cause of hyperventilation 443 cause of hypoalbuminemia 57 cause of hyponatremia 130 effective circulating volume 70 nitroprusside toxicity 332 logarithmic scale 252 loop diuretics 129 cause of hyponatremia 128 cause of metabolic alkalosis 379 cause of polyuria 237 treatment of hyperkalemia 569 treatment of hypoaldosteronism RTA 318 loop of Henle Bartter's syndrome 501 function 101, 228, 237 role in concentrating urine 105 role in dilute urine 96 Lou Gerig’s Disease 407 Lp 52 lung cancer cause of SIADH 139 cause of tumor lysis syndrome 547 lupus cause of distal RTA 313, 314 lymphatic fluid 5 lymphatic system 54 obstruction leading to edema 83

malignant hypertension 518 malignant hyperthermia relationship with periodic paralysis 495 malnutrition alcoholic ketoacidosis 340 cause of edema 57 cause of thiamine deficiency 332 hypokalemia 488 in CF 187 predisposition to CPM 155 mannitol as a diuretic 129 cause of osmotic diuresis 196 cause of pseudohyponatremia 113 treatment of cerebral edema 196 Mantra, The 262 maximum daily urine volume161 mechanical ventilation 449 cause of metabolic alkalosis 380 cause of respiratory alkalosis 449 in metabolic acidosis 363 in respiratory acidosis 435 meconium ileus 187 medullary interstitium 105 megaloblastic anemia 475 membrane characteristics 50 mental status changes role in maintenance of hypernatremia 200 mercury poisoning M cause of Fanconi's syndrome 309 magnesium. See also hypermamesenteric ischemia gnesemia; hypomagnesemia cause of lactic acidosis 331 importance in treatment of metabolic acidosis 263 hypokalemia 530 compensation 284 molecular weight 11 complications 362 maintenance IV 40 definition 278 calculating amount 44 due to renal failure vs. TRA 350 cause of hyperkalemia 544 mechanism 279 malignancy mixed acid-base disorders 285 cause of membrane damage The Anion Gap Chapter 325 and edema 58 The Introduction Chapter 277 exudative pleural ef fusion 60 The Non-Anion Gap Chapter predisposition to CPM 155 287

treatment 363 treatment causing respiratory alkalosis 444 metabolic alkalosis definition 368 diagnosis 387 generation 370 maintenance 382 mixed acid-base disorders 394 The Chapter 367 metformin 333 methanol ingestion 332, 358 molecular weight 359 treatment 360 methionine daily acid load 296 metolazone 129 Microbiology Companion 412 milk-alkali syndrome 381 milligrams per deciliter 12 conversion to mmol/L 17 millimole 10 millimoles per liter 12 mineralocorticoid mechanism of action 503 mineralocorticoid activity , excess 503 cause of hypernatremia 183 cause of hypokalemia 502 cause of metabolic alkalosis 377 diagnosis 391, 512, 524 maintaining metabolic alkalosis 383 of cortisol 509 minimum daily urine volume in diabetes insipidus 229 minimum urinary concentration 116, 163 treatment of SIADH 166 minute ventilation 402 mirthless laughter , spasmodic 155 mitochondria 329 mitral valve disease cause of respiratory alkalosis 447 mixed acid-base disorders with metabolic acidosis 285 with metabolic alkalosis 395 with respiratory acidosis 429

585

mixed sleep apnea – panic attacks

with respiratory alkalosis 456 mixed sleep apnea 409 mode ventilator setting 450 mole 10 molecular weight 11 moon facies 511 morphine treatment of CHF 56 MRI in diagnosis of CPM 155 multiple myeloma cause of distal RTA 314 cause of proximal R TA 308 cause of pseudohyponatremia 112 multiple sclerosis cause of SIADH 139 muscles and motion step 2 in respiration 410 myasthenia gravis respiratory acidosis 412 myoglobinuria 527

nephrotic syndrome 131 consequences of disregulation cause of edema 57 89 cause of Fanconi's syndrome methods of control 92 309 normal for plasma 88 net filtration pressure 53 of dextrose solutions 34 nitroprusside 332 of saline solutions 38 non-anion gap metabolic acidosis urine 106 diagnosis 285, 319 osmolar gap 18 diagnostic algorithm 320 methanol toxicity 359 mechanism 288 stool 189 The Chapter 287 osmolytes 152 nonelectrolytes 8 osmoreceptor 90 nonketotic hyperosmolar syndrome osmoregulation 123 348 definition 88 nonosmotic release of ADH The Chapter 87 103, 123 osmotic cerebral demyelinating nonresorbable anions syndrome. See central effect on potassium secretion pontine myelinolysis 482 osmotic diarrhea 188,191 hypokalemia 519 osmotic diuresis 194,224 nonsteroidal anti-inflammatory generation of hypernatremia drugs 193 in hyperkalemia 558 in diabetic ketoacidosis 345 norepinephrine 337 osmotic pressure 28,50 N use with acidemia 362 colligative property 15 normal saline.See isotonic saline net 51 Na-K-2Cl ATPase pump 237, 529 NSAID. See nonsteroidal antiovarian cancer Na-K-ATPase pump 29 inflammatory drugs cause of tumor lysis syndrome role in potassium regulation 471 547 NAD 329 O oxalic acid 361 nanomole 251 oxidative phosphorylation narcotics oat cell carcinoma definition 329 respiratory acidosis 407 cause of SIADH 139 oxygen 405. See also hypoxia nasogastric suction obesity hypoventilation syndrome causing respiratory arrest 408 cause of hypokalemia 520 407 ventilator setting 450 cause of metabolic alkalosis obstructive sleep apnea 409 oxytocin 375 obstructive uropathy cause of SIADH 139 nausea cause of distal RTA 313 cause of SIADH 139 odor P negative log 252 fruity 343 nephrogenic diabetes insipidus offensive 352 packed red blood cells.See blood 234 Ondine’s curse 407 transfusion congenital 235 oral hypoglycemic medications pain diagnosis 240 cause of SIADH 139 cause of hyperventilation 443 from psychogenic polydipsia orange juice cause of SIADH 139 222 cause of acute hyperkalemia pancreas prefered diet 246 543 electrolyte composition of sickle cell disease 238 potassium content 488,540 secretions 289 treatment 245 osmolality 14 panic attacks nephrolithiasis calculated vs measured 18 cause of respiratory alkalosis in distal RTA 316 calculation 16 448

586

paper bag – primary adrenal insufficiency

paper bag treatment of hyperventilation 462 paraldehyde 352 paralysis ALS 407 depolarizing agents 412 diaphragmatic 438 familial periodic 495 from cerebellar pontine myelinolysis 155 Guillain-Barré syndrome 407 hypokalemia 526 in treatment of respiratory alkalosis 462 paraventricular nuclei 226 parietal cells 375 parietal pleura 60 partial pressure 272 PCO2 265. See carbon dioxide PEEP ventilator setting 450 penicillin causing metabolic alkalosis 381 hypokalemia 519 potassium content 544 pentamidine cause of hyperkalemia 561 perfusion defect respiratory acidosis 417 periodic paralysis hypokalemic 495 respiratory acidosis 412 peripheral edema 55 formation 83 nephrotic syndrome 131 peripheral vascular resistance 67 in CHF 85 in liver disease 82 peritoneal dialysis treatment of hyperkalemia 570 persistent fetal circulation 459 persistent pulmonary hypertension of the newborn 459 petrosal sinus sampling 513 pH 252. See also HendersonHasselbalch calculation with HendersonHasselbalch equation 261 compatible with life 253 determination withABG 272

effect on potassium 474 pheochromocytoma 514 phosphate. See hyperphosphatemia; hypophosphatemia acute renal failure 547 buffer 256 in diabetic ketoacidosis 344 intracellular buf fers 452 tumor lysis syndrome 547 phrenic nerve 407 Pickwickian syndrome respiratory acidosis 407 pilocarpine in sweat chloride test 187 piperacillin hypokalemia 521 Pitocin® cause of SIADH 139 pituitary posterior lobe 226 secondary adrenal insuf ficiency 559 storage ofADH 102 pKa 258 bicarbonate 261 plasma 7 compartment 5 expander 43 osmolality , normal 88 volume as part of effective circulating volume 64 relationship to blood pressure 70 plasma cell tumor 308 plasmapheresis treatment of myesthenia crisis 412 pleural effusion exudate vs. transudate 60 plum seeds 327 Pneumocystis carinii treatment 561 pneumonia cause of respiratory acidosis 420 cause of respiratory alkalosis 447 cause of SIADH 139 pneumothorax 413 cause of SIADH 139

complication of CF 187 PO2. See oxygen polio post-polio syndrome 407 polydipsia 221 definition 220 relationship with polyuria 221 The Chapter 219 polygelatins plasma expander 43 polyuria cause of hypokalemia 521 diagnosis 239 from hypokalemia 529 relationship with polydipsia 221 The Chapter 219 post-obstructive diuresis 196 potassium compared to sodium 468 hyperkalemia. See hyperkalemia hypokalemia. See hypokalemia in diabetic ketoacidosis 344 in lactic acidosis 331 in respiratory alkalosis 461 IV supplementation 534 oral supplementation 533 regulation 470 renal secretion 477 role in diagnosis of TRA 319 The Chapter 467 total body distribution 469 treatment of diabetic ketoacidosis 347 potassium-sparing diuretics cause of hyperkalemia 561 PRBC. See also blood transfusion plasma expander 43 potassium content 544 pre-capillary sphincters 55 precocious puberty 560 prednisone mineralocorticoid activity 151 pregnancy induced diabetes insipidus 232 pressure natriuresis 183,505 primary adrenal insuf ficiency. See also Addison's disease hyperkalemia 559 hyponatremia 141

587

primary alveolar hypoventilation – RTA

primary alveolar hypoventilation 407 primary amenorrhea 516 primary hyperaldosteronism 506 diagnosis 391 metabolic alkalosis 377 principle cell 503 aldosterone activity 77 role in hydrogen secretion 300 progesterone cause of hyperventilation 443 prostaglandin E2 temperature regulation 91 proteinuria nephrotic syndrome 131 proximal RTA 303 hypokalemia 521 treatment 311 proximal tubule effect of acetazolamide 129 effect of angiotensin II 75 role in bicarbonate resorption 297 role in glucose resorption 195 pseudobulbar palsy 155 pseudohermaphroditism 516 pseudohyperaldosteronism 509 pseudohyperkalemia 551 pseudohypokalemia 496 pseudohyponatremia 11 1 in DKA 344 psychogenic polydipsia 220 cause of hyponatremia 18 1 hypokalemia 521 pulmonary disease cause of respiratory alkalosis 445 cause of SIADH 139 pulmonary edema respiratory acidosis 420 pulmonary embolism respiratory acidosis 420 pulmonary fibrosis 420 interstitial lung disease 420 pulmonary function test in COPD 422 pulmonary hypertension cause of respiratory alkalosis 447 in the newborn 459 pulmonary stenosis

588

plasma levels 507 renin-angiotensin II-aldosterone system role in volume regulation 72 renovascular hypertension.See renal artery stenosis respiration 4 step process 401 respiratory acidosis 263 acute 425 R acute-on-chronic 430 and metabolic alkalosis 380 racemic epinephrine 415 chloride 427 radiation therapy 420 chronic 428 interstitial lung disease 420 hypoxia 408 radiocontrast dye.See x-ray dye compensation 423 rate definition 400 ventilator setting 450 diagnosis 433 red clay 489 mixed acid-base disorders 429 redistribution hypokalemia 491 relationship with respiratory renal artery stenosis 518 alkalosis 446 diagnosis 391 symptoms and signs 431 renal compensation 268 The Chapter 399 respiratory acidosis 426 treatment 435 respiratory alkalosis 451 respiratory alkalosis 263 renal failure acute 453 anion gap metabolic acidosis chronic 455 349 compensation 451 cause of hyponatremia 19 1 definition 440 definition 100 diagnosis 460 from tumor lysis syndrome 547 due to aspirin 355 hyperkalemia 554 lab values 461 hyponatremia with increased mixed acid-base disorders 456 osmolality 120 relationship with respiratory maintenance fluids in 44 acidosis 446 renal tubular acidosis 294 signs and symptoms 457 difference from renal failure 350 The Chapter 439 distal. See distal RTA treatment 462 hypoaldosteronism.See respiratory compensation 267 hypoaldosteronism TRA metabolic acidosis 284 hypokalemia 519, 521 metabolic alkalosis 392 proximal. See proximal RTA respiratory control center 405 type 1 RTA. See distal RTA respiratory insuf ficiency 400. See type 2 RTA. See proximal RTA also respiratory acidosis type 4 RTA. See hypoaldostercause of lactic acidosis 331 onism RTA response to aldosterone 76 renin rheumatoid arthritis levels in Cushing's syndrome interstitial lung disease 420 511 rickets 307 levels in hyporeninemic right to left shunt 459 hypoaldosteronism 557 RTA. See renal tubular acidosis cause of respiratory alkalosis 447 pulse. See heart rate Purkinje system 528 pyelonephritis cause of distal RTA 314 pyridostigmine treatment of myasthenia crisis 412

S – tetracycline

Sjögren’s syndrome cause of distal RTA 314 S 52 cause of Fanconi's syndrome s 52 309 salicylic acid 353 sleep 91 molecular weight 355 sleep apnea 409 saline small cell cancer solutions 38 cause of SIADH 139 saline responsive metabolic small intestine alkalosis 387 electrolyte composition of salt substitute secretions 289 source of potassium 533 smoke inhalation 415 sarcoidosis smoking ACE levels 73 COPD 422 cause ofAddison's disease 141 sodium interstitial lung disease 420 compared to potassium 468 sarcomas content of sweat 186 cause of tumor lysis syndrome handling by proximal tubule 75 547 handling by the principle cells schizophrenia 77 psychogenic polydipsia hypernatremia.See hypernatre118, 222 mia sclerotherapy 38 hyponatremia.See hyponatresecretory diarrhea 190 mia semi-permeable membrane 25 in diabetic ketoacidosis 344 sensible fluid loss molecular weight 11 generation of hypernatremia pressure natriuresis 183 186 relationship to plasma volume sensing and signaling 65 in respiratory alkalosis 441 urine 76. See also urine step 1 in respiration 405 sodium sepsis sodium bicarbonate.See bicarcause of lactic acidosis 331 bonate cause of respiratory alkalosis solute drag 549 443 specific gravity 106 causing membrane damage and spinal cord injury edema 58 respiratory acidosis 407 sexual infantilism 516 spironolactone 129,561. See Sheehan’s syndrome 231 also potassium-sparing shellac 358. See also methanol diuretics shock in CHF 85 cause of lactic acidosis 331 treatment of adrenal adenoma SIADH 132 508 etiologies 138 sponges, hydrogen ion 256 four characteristics 133 Starling’s law iatrogenic 244 equation 53 treatment 166 in peripheral edema 83 sickle cell anemia membrane characteristics 52 cause of distal RTA 313, 314 The Chapter 49 nephrogenic diabetes insipidus starvation 339 238 steady state

S

in proximal RTA 304 sterno 358. See also methanol stool osmolar gap 189 stress cause of SIADH 139 potassium regulation 472 stroke cause of SIADH 139 stroke volume component of cardiac output 67 subacute thyroiditis 140 subarachnoid hemorrhage cause of SIADH 139 subdural hemorrhage cause of SIADH 139 succinyl choline 412 sudden cardiac death diuretics 494 sulfonylureas 333 surface area, body 45 surgery cause of DKA 342 surgical drains cause of non-anion gap metabolic acidosis 291 hypokalemia 497 sweat 186 sweat chloride test 187 sweet sixteen 13 sympathetic activity in volume regulation 79 synchronized intermittent mandatory ventilation 450 syndrome of apparent mineralocorticoid excess 509 syndrome of inappropriate ADH. See SIADH systemic lupus erythematosus.See lupus

T T waves peaked 563 tachyphylaxis 227 TCA cycle 329 temperature, body 91 tension pneumothorax 413 tetracycline cause of Fanconi's syndrome 309

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thiamine – volume regulation

thiamine alcoholism 341 deficiency 332 thiazide diuretic 129 cause of hyponatremia 128 cause of metabolic alkalosis 379 similarity to Gitelman's syndrome 501 treatment of NDI 245 thioridazine cause of SIADH 139 third-year medical student.See confusion thirst defense against hyperosmolality 98 role in osmoregulation 94 thoracic duct 54 threshold of maximum tubular resorption. See Tm thrombocytosis cause of pseudohyperkalemia 551 thymic cancer cause of SIADH 139 thymic carcinoid cause of Cushing's syndrome 514 ticarcillin causing metabolic alkalosis 381 hypokalemia 521 tidal volume 402 ventilator setting 450 titratable acid 301 Tm 195 bicarbonate 303 glucose 195 mannitol 196 tobramycin 412 respiratory acidosis 412 tolbutamide cause of SIADH 139 toluene cause of distal RTA 314 hypokalemia 519 total body potassium deficit 531 total body water 2 distribution 5 effect of body fat 4 with dehydration 21 1

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total carbon dioxide 272 total parenteral nutrition cause of hypernatremia 182 cause of metabolic alkalosis 370 tracheomalacia 415 transsphenoidal microsurgery 514 transudate 59 trauma causing membrane damage and edema 58 hyperkalemia 475, 546 triamterene 129, 561. See also potassium-sparing diuretics cause of distal RTA 313 tricarboxylic acid cycle 329 tricyclic antidepressants effect on thirst 222 trimethoprim cause of hyperkalemia 561 trypsin 420 tuberculosis cause ofAddison's disease 141 tumor lysis syndrome 547 type 1 RTA. See distal RTA type 2 RTA. See proximal RTA type 4 RTA. See hypoaldosteronism RTA tyrosinosis cause of Fanconi's syndrome 309

U ulcerative colitis 291 univalent ions 19 urate 349 nephropathy,from tumor lysis syndrome 547 urea 100 cause of osmotic diuresis 196 ineffective osmole 120 molecular weight 11 tablets 166 uremia platelet dysfunction 227 ureteroileostomy 292 ureterosigmoidostomy 292 uric acid in lactic acidosis 331 in tumor lysis syndrome 547

urinary frequency as opposed to polyuria 221 urinary tract infections association with hypernatremia 200 cause of urinary frequency 221 effect on pH 320 urinary tract obstruction cause of distal RTA 313 urine analysis 106 anion gap 302, 321 chloride 388 cortisol 512 dilution 96 maximum concentration 105 pH in proximal RTA 305 potassium 522 sodium 148, 149, 150 in hypernatremia 204 in metabolic alkalosis 388

V vaporization method 15 varicose veins 38 varnish 358. See also methanol vasopressin.See antidiuretic hormone vasopressinase 232 vecuronium 412 ventilation 265 defect, respiratory acidosis 417 definition 401 ventilator. See mechanical ventilation villous adenoma hypokalemia 497 metabolic alkalosis 374 vincristine SIADH 139 vipomas hypokalemia 497 visceral pleura 60 vitamin B-12 475 vitamin D 307, 308 voltage-dependent distal TA R 313 volume regulation determination of volume status 147 The Chapter 63

volume rules – Zollinger-Ellison syndrome

three steps 68 activity at target organs 74 monitoring 69 signals 71 volume rules 123,384 vomiting cause of metabolic alkalosis 375, 386 hypokalemia 519, 520 von Willebrand disease 227

W water ingestion and hyponatremia151 role in osmoregulation 199 water deficit calculation 210 water excess calculation 161 water resorption relationship to plasma volume 65 role in osmoregulation 97 role ofADH 104 water restriction test 241 Wegener’s granulomatosis interstitial lung disease 420 weight adjusted 4 ideal 4 in the treatment of CHF 84 Wernicke-Korsakof f syndrome 332 Wernicke’s encephalopathy 341 Wilson’s disease cause of distal RTA 314 cause of Fanconi's syndrome 309

X x-ray dye specific gravity 106 xanthine in tumor lysis syndrome 547

Z zero order kinetics 354 zidovudine 332 Zollinger-Ellison syndrome 190

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