Objectives

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Acute Renal Failure

The patient is an 85 year old female who was transported to the emergency room by mast ambulance. She was transported due to a reported decrease in her level of consciousness (LOC) and cheyne-stokes respirations.

Lab Values
Cr	Na	K	Cl	BUN	Ca	AG (Anion Gap)
2.6	145	5.8	115	95	8.1	15
2.1	147	5.3	112	92	7.5	15

Blood Gases on 50%:

7.31/31/84 What is the calculated HCO₃^- level using the modified Henderson-Hasselbalch equation?

7.34/38/95 Metabolic acidosis What is the HCO₃^- level now?

Chest X-ray - Right hemidiaphragm is slightly obscured secondary to a small pleural effusion.

Case Study

Normal Kidney Function

Objectives and References

Questions/ Ready to Take Test

In the example of metabolic acidosis above, the carbonic anhydrase inhibitor, acetazolamide, blocks the reabsorption of HCO₃^- by inhibiting the breakdown of carbonic acid. HCO₃^- stays in the tubular fluid and is lost in the urine resulting in hyperchloremic acidosis.

In the second example, distal tubule injury blocks H⁺ secretion which in turn enhances K⁺ secretion. The decreased Na⁺ absorption in exchange for H⁺ is partially compensated by an increased reabsorption of Cl^-.