UTWB Week 5

Houston we have an Acid problem

100

What analyte is considered the same as HCO3-

TCO2

200

Explain the difference between acidemia and acidosis

• Acidemia refers specifically to a blood pH below the reference interval. It is an objective laboratory finding detected on arterial or venous blood gas analysis.
• Acidosis refers to the underlying clinical condition or disorder that drives acid accumulation or bicarbonate loss in the body

300

What analyte are seen in organic metaboloc acidosis vs inorganic metabolic acidosis

Organic-

Lactate- Accumulates during tissue hypoxia or ruminal acidosis

Ketone Bodies- Accumulate during negative energy states driving fat catabolism

Glycolate and Oxalate- ethylene glycol (antifreeze) ingestion

Inorganic-

Phosphate and Sulfate- reduced glomerular filtration and decreased renal excretion

400

What are the 3 primary causes of metabolic acidosis?

Decreased loss of H+

Increased H+ production-

Increased HCO3 loss- 

500

A 3-year-old Quarter Horse mare presents with acute onset colic from a suspected small intestinal volvulus. Her arterial blood gas and serum chemistry reveal:

• Arterial pH: 7.104 (Ref: 7.35 - 7.44)
• PaCO2: 33 mmHg (Ref: 36 - 43 mmHg)
• PaO2: 90 mmHg (Ref: 85 - 100 mmHg)
• Serum HCO3: 12 mEq/L (Ref: 27 - 36 mEq/L)
• Anion Gap: 32 mEq/L (Ref: 7 - 15 mEq/L)
• L-Lactate: 20 mmol/L (Ref: 0 - 2 mmol/L)

Identify the primary acid-base disorder, the compensatory response, the unmeasured anion, and the specific type of tissue hypoxia driving this panel

Primary High Anion Gap Metabolic Acidosis with compensatory Respiratory Alkalosis, driven by L-lactate accumulation secondary to stagnant tissue hypoxia

Guess that gas

100

How quickly do the respiratory and renal systems compensate for acid–base disturbances?

Renal- 2-5 days

Respiratory- Instant

200

How does hypoventilation affect acid–base balance?

Blowing off less CO2

Hypoventilation impairs alveolar carbon dioxide elimination and elevates arterial PCO2 (hypercapnia), shifting the carbonic acid equilibrium equation to generate excess hydrogen ions that lower blood pH into acidemia

300

Explain the difference between hypoxia and hypoxemia

Hypoxemia specifically refers to a deficiency of dissolved oxygen in arterial blood defined by a decreased partial pressure of arterial oxygen (PaO2), whereas hypoxia refers to oxygen starvation at the tissue and cellular level

400

A 4-year-old male German Shorthaired Pointer presents for sudden collapse, extremely pale mucous membranes, tachypnea, and tachycardia[1]. His laboratory panel reveals:

• HCT: 8% (Ref: 37 - 55%)
• Arterial pH: 7.397 (Ref: 7.31 - 7.42)
• PaCO2: 37 mmHg (Ref: 35 - 45 mmHg)
• PaO2: 96 mmHg (Ref: 85 - 100 mmHg)
• Serum HCO3: 22 mmol/L (Ref: 16 - 26 mmol/L)
• L-Lactate: 4.2 mmol/L (Ref: 0.0 - 2.0 mmol/L)

Identify whether this patient has hypoxemia, tissue hypoxia, or both, and state the specific mechanism

Hemoglobinemic tissue hypoxia WITHOUT hypoxemia

500

A 3-year-old male neutered cat presents with severe ataxia, hypothermia, and anuria 18 hours after disappearing into an auto repair shop. Laboratory panel reveals:

• BUN: 120 mg/dL (Ref: 15 - 34 mg/dL)
• Creatinine: 8.2 mg/dL (Ref: 0.8 - 2.3 mg/dL)
• Blood pH: 7.08 (Ref: 7.31 - 7.42)
• Serum HCO3: 8 mmol/L (Ref: 16 - 24 mmol/L)
• Anion Gap: 38 mEq/L (Ref: 10 - 20 mEq/L)
• Serum Osmolality: 345 mOsm/kg (Ref: 280 - 300 mOsm/kg)
• Urinalysis: USG 1.018; Calcium oxalate crystals present.

Identify the ingested toxin, the primary acid-base disturbance, and the pathophysiological mechanism of acute kidney injury

Ethylene Glycol toxicosis causing a primary High Anion Gap Metabolic Acidosis and acute calcium oxalate tubular necrosis?

Mineral Man

100

What are the 3 main regulartory process of maintaining K+

Intake

Renal Excertion

Shifting

200

Maintaining electroneutrality as hydrogen ions enter cells during inorganic metabolic acidosis forces what ion from intracellular to extracellular? 

Potassium

300

While dogs and cats with chronic renal failure develop hypocalcemia, horses with renal failure uniquely tend to develop hypercalcemia, especially when fed this high-calcium forag

Alfala

400

In dogs with chronic kidney disease, tubular damage impairs active Vitamin D (1,25-DHCC) synthesis, lowering ionized calcium and triggering this secondary endocrine compensatory response

Secondary renal hyperparathyroidism

500

A 5-year-old lactating beef cow is examined after being turned out onto a fast-growing lush spring pasture. The farm owner notes that the cow became unusually aggressive, uncoordinated, and fell to the ground with muscle twitching and rigid limbs. Labwork reveals the cow has hypomagnesemia. What disease does this cow have. 

Grass tetany

Kidney Komplications

100

What is azotemia, and what is the earliest indicator of declining renal function?

BUN and CREA

SDMA

200

What is pre-renal azotemia, and what findings define it

Characterized by decreased renal blood flow from conditions such as dehydration or shock, this classification of azotemia causes a reduced Glomerular Filtration Rate (GFR) with elevated serum urea nitrogen, creatinine, and SDMA, increased distal nephron reabsorption of urea driven by antidiuretic hormone (ADH), and appropriately concentrated urine with a Urine Specific Gravity exceeding 1.030 in dogs or 1.040 in cats

300

At what percentage of nephron loss does renal azotemia typically develop?

75%

400

What type of azotemia would you see a normal GFR with.

Post-renal azotemia due to uroperitoneum.

GFR remains intrinsically normal because the renal parenchyma and functional nephrons continue filtering blood as usual. The observed azotemia develops not from reduced glomerular filtration, but because urine containing high concentrations of urea and creatinine escapes into the extravascular peritoneal space and diffuses back down its concentration gradient across peritoneal membranes

500

6-year-old neutered male dog with 2-day lethargy, vomiting, anorexia, and moderate dehydration.

UN: 95 mg/dL (8-30)

Creatinine: 3.4 mg/dL (0.5-1.4)

SDMA: 22 ug/dL (0-14)

Phosphorus: 8.2 mg/dL (3.2-6.0)

Na+: 139 mEq/L (141-156)

Cl-: 90 mEq/L (109-124)

USG: 1.020 (1.015-1.045)

which of the following is the most likely classification and underlying cause of this patient's azotemia

Primary renal azotemia due to functional nephron loss

Listen Up Dipsticks

100

What tests are inaccurate on a urine dipstick

leukocytes, nitrites, urobilinogen and specific gravity

200

What type of urine to carnivores produce

Acidic

300

What is the only type of proteinuria that causes hypoalbuminemia 

Glomerular

400

What is the most likely explanation for a positive heme test with RBCs in the urine seiment

hematuria

500

A 2-year-old male intact Dalmatian presents with stranguria. A urinalysis reveals a pH of 6.0, mild hematuria, and numerous brown "thorn-apple" sphere crystals with spicules.

What is the primary predisposing mechanism for this crystal type in this breed?

Defective renal and hepatic uric acid transport leading to decreased conversion of uric acid to allantoin