493 © Springer Science+Business Media LLC 2018 A.S. Reddi

Index

A endogenous acid, 312 ABG. See Arterial blood gas (ABG) endogenous base, 312 Absolute deficiency, 222 NAE, 320 Acetylsalicylic acid (ASA). See Aspirin pH, maintenance of, 314 Acid-base balance, 172 buffer, 312–314 Acid–base disorders definition, 311 − ABG kidneys (see Bicarbonate (HCO3 )) arterial vs. venous blood sample, 321 lungs, 314 evaluation, 322 Acquired hypoparathyroidism, 221

AG, 336–337 Active vitamin D3, 214, 255, 270, 287 − ∆AG/∆HCO3 , 326 Acute decompensated heart failure (ADHF), calculation, 323 66–67 causes of, 325 Acute Dialysis Quality Initiative clinical use, 324 (ADQI) group, 469 high AG metabolic acidosis, 325 Acute kidney injury (AKI), 237, 274, 340 hyperglycemia, 324 acid–base disorders, 471 low AG metabolic acidosis, 326 Ca imbalance, 471 low serum albumin, 326 definitions, 469 normal values, 324 fluid imbalance, 470 unmeasured anions and cations, 323 K imbalance, 470 AKI, 471 Mg imbalance, 471 analysis of, 334 phosphate imbalance, 471 characterization, 333, 335 Acute Kidney Injury Network (AKIN), 469 CKD, 477 Acute metabolic acidosis, 339 evaluation, 329, 330 Acute respiratory acidosis, 438, 455 Henderson–Hasselbalch equation, 322, 323 causes, 432, 433 hydration, 332–333 clinical manifestations, 432 liver disease diagnosis, 433 AG metabolic acidosis, 486 treatment, 434 hyperchloremic metabolic acidosis, 486 Acute respiratory alkalosis, 442, 447 metabolic alkalosis, 486 cardiovascular effects, 443 respiratory alkalosis, 486 causes, 442, 443 mixed acid–base disorders, 330, 331 CNS effects, 443 pathogenesis of, 328–329 diagnosis, 444 proximal RTA, 481 metabolic effects, 443 respiratory alkalosis, 491 secondary response, 442, 448 secondary response, 321, 327 Addison disease, 196, 197, 385 terminology, 322 Adrenal hyperplasia, 196 Acid–base physiology, 311–314 Adrenal insufficiency, 138

Adrenergic agonists, 71 treatment, 77 Adult respiratory distress syndrome Aspirin, 350, 355, 360 (ARDS), 44, 45, 353 Atorvastatin, 69, 89 AKI. See Acute kidney injury (AKI) Autoimmune hypoparathyroidism, 221 Albright’s hereditary osteodystrophy Autosomal dominant hypophosphatemic (AHO), 221 rickets (ADHR), 262, 270 Albumin, 38, 39, 42, 43, 46, 66, 78, 80–83, 90, Autosomal recessive hypophosphatemic 219, 223, 251, 326 rickets (ARHR), 262, 270 Alcoholic ketoacidosis, 348 Alcoholism, 231, 304 Aldosterone, 169, 171, 178, 179, 186–189, B 196, 197, 317, 423 Balanced electrolyte solution, 38 Aluminum hydroxide, 277 Bartter syndrome, 179, 296, 422–424 Amiloride, 29, 89, 172, 178, 186, 189, 301, Beer potomania, 117, 137 − 423 Bicarbonate (HCO3 ), 314–318, 407 Amphotericin B (Amp B), 304 drug-induced acid–base disorders, 464 Angiotensin II, 171 hyperchloremic metabolic acidosis, 393 + Anion gap (AG), 337 NH4 , 319–320 − ∆AG/∆HCO3 , 326 reabsorption calculation, 323 collecting duct, 317 causes of, 325 daily filtered load, 314 clinical use, 324 distal tubule, 316 diarrhea, 401 Henleʼs loop, 316 high metabolic acidosis, 325 proximal tubule, 315 (see also Metabolic acidosis) regulation, 317, 318 hyperglycemia, 324 renal mechanism, 407 low serum albumin, 326 titratable acid excretion, 317–319 metabolic alkalosis, 413, 417 Body fluid compartments, 7–10 mixed acid–base disorder, 449, 452–454, 457–459, 461 mnemonic for, 325 C normal values, 324 CA. See Carbonic anhydrase RTA, 384 (CA) deficiency unmeasured anions and cations, 323 Ca2+-sensing receptor (CaSR), 213, 221 Antidiuretic hormone (ADH), 171 Calcitonin, 214–215 actions, 101 Calcitriol, 227, 239, 268 mechanism, 100 Calcium (Ca2+), 211, 212, 215–217

receptor, 67 active vitamin D3, 214 release, control of, 98 calcitonin, 214 structure and synthesis, 98 factors Apparent mineralocorticoid excess Ca2+ transport, 216 (AME) syndrome, 178 TRPV5, 217 Aquaporins, 100 homeostasis, 212 Arginine vasopressin (AVP), 98 imbalance Arterial blood gas (ABG), 445 AKI, 471 acute respiratory acidosis, 434 CKD, 476 arterial vs. venous blood sample, 321 liver disease, 485 diarrhea, 401 PTH, 213 evaluation, 322 renal handling mixed acid–base disorder, 450, 452–455, collecting duct, 216 458, 459 distal and connecting tubule, 215 values for, 321 proximal tubul, 215 Ascites, 484 TAL, 215 formation of, 76–77 Calcium chloride, 225 Index 495

Calcium disorder Chronic obstructive pulmonary disease (COPD), hypercalcemia, 233 336, 437, 439, 440, 449, 454, 455 calcium-alkali syndrome, 237 Chronic respiratory acidosis, 439, 440, 455 clinical manifestations, 240 causes, 435 diagnosis, 240, 241, 245 clinical manifestations, 435–436 FHH, 236 diagnosis, 436 granulomatous diseases, 239 treatment, 436 Jansen’s disease, 236 Chronic respiratory alkalosis, 441 malignancy, 238 cardiovascular effects, 444 MEN type 1 and type 2a, 235 causes, 442, 443 neonatal severe CNS effects, 444 hyperparathyroidism, 236 diagnosis, 444 pathophysiology, 245 hyperventilation, 444 PHPT, 234 metabolic effects, 444 renal failure, 236 secondary response, 442, 448 treatment, 242–243 Chvostek’s and Trousseau’s signs, 302 vitamin D overdose, 239 Cinacalcet, 220, 243, 268, 280, 284 hypocalcemia, 219 Cirrhosis, 59, 82, 83 clinical manifestations, 225–226 clinical evaluation of, 75 diagnosis, 222–225 edema, treatment of, 75–77 hypoparathyroidism, 221–220 HRS, 79 PsHPT, 221–222 Cisplatin, 144, 294, 301, 302, 304 treatment, 225–227 Cisplatin-induced hyponatremia, 144 vitamin D deficiency, 222 Citrate toxicity, 230 Calcium gluceptate, 226 Cl− reabsorption, 25, 30 Calcium gluconate, 225 Clenbuterol, 188 Calcium pyrophosphate dehydrate Collecting duct, 29, 30, 100 (CPPD), 185 calcium, 216 Calcium-alkali syndrome, 237–238 CCD, 29, 168, 169 Carbonic anhydrase (CA) IMCD, 29, 169 deficiency, 371 Colloid, 35, 38 Cardiogenic shock, 44 Congenital chloride diarrhea, 411 Cardiorenal syndrome (CRS), 67–68 Congestive heart failure (CHF), 59, 63, 65–67 Cations, 3 clinical evaluation, 64 Central chemoreceptors, 430 CRS, 67 Central diabetes insipidus edema, management, 65–67 (CDI), 150, 157, 163 treatment, 65 Cerebral salt wasting (CSW), 113, 138 Conivaptan, 126 Chloroquine, 239, 249, 250 Connecting tubule (CNT), 27, 168, 215 Cholestyramine, 398 Continuous venovenous hemofiltration Chronic hyponatremia, 485 (CVVH), 364 Chronic kidney disease COPD. See Chronic obstructive pulmonary (CKD), 271, 274, 284 disease (COPD) acid–base disorders, 477–478 Copeptin, 98, 99, 113 Ca imbalance, 476 Cortical collecting duct (CCD), 29, 168, 169 definition, 473–474 Corticosteroids, 261, 268 K+ imbalance, 475 Countercurrent exchange, 102 Mg imbalance, 477 Countercurrent multiplication, 102 Na imbalance, 474 Crystalloid, 35–38 phosphate imbalance, 476–477 balanced electrolyte solutions, 38 RTA, 382 dextrose stages 4–5, 339, 341 saline, 38 water imbalance, 474 water, 36–37 Chronic metabolic acidosis, 478 NaCl solutions, 36–38 496 Index

Cysteine, 98 toluene ingestion, 377 Cytokines, 239 Distal tubule, 167, 215, 316 Diuresis, 50, 69, 126, 479 Diuretics, 65, 78, 409 D abuse, 399, 422 Dehydration, 91 classification, 51 causes, 92 clinical uses, 53–54 clinical evaluation, 93 complications, 54 treatment, 94 physiologic effects, 53–54 Demeclocycline, 485 potassium, 172 Developmental hypoparathyroidism, 221 resistance, 89 Dextrose DKA. See Diabetic ketoacidosis (DKA) saline, 38 Dobutamine, 71 water, 36 Drug-induced acid–base disorders Dextrose in water (D5W), 95, 129, 137 metabolic acidosis, 463, 464 Diabetes insipidus (DI), 16, 150–152, 157, metabolic alkalosis, 465 158, 162, 490 Diabetic ketoacidosis (DKA), 347, 382 Diarrhea E acidic urine pH, 399 Ecstasy, 116 complications, 400 Edema, 484 diagnosis, 395 ascites electrolyte and ABG pattern, 401 formation of, 76 mixed acid–base disorders, 396 treatment, 77 treatment, 397 diuretics, 78 types, 394–395 formation of, 60–61 water and electrolyte loss, 394 LVP, 78 Dichloroacetate, 346 management Diet, 277 ADH, inhibition of, 67 Dietary phosphate, 256 ADHF, 66 DiGeorges’s syndrome, 221 ambulatory patient, 65 Diluting segment, 26 renin–AII–aldosterone, inhibition of, 67 Dilutional acidosis, 382 sympathetic nervous system, inhibition Distal convoluted tubule (DCT), 27, 28, 32, of, 67 217, 290 refractory ascites, 79 Distal nephron, 31 salt restriction, 78 Distal renal tubular acidoses, 373–381 Effective arterial blood volume (EABV), 59, autosomal dominant inheritance, 386–387 63, 69, 95 hyperkalemia, 387–388 Effective osmolality, 6 causes of, 378, 379 EG. See Ethylene glycol (EG) characteristics, 378 Electrolyte therapy, 42 diagnosis, 379–381 Electrolyte-free-water clearance, 18, 104, 105 subtypes, 377 Endogenous acid, 312 − treatment, 381 Endogenous base (HCO3 ), 312 type IV with urine pH, 378 Epithelial Na+ channel (ENaC), 28 urine pH below 5.5, 378 Ethanol, 351 hypokalemia, 376 Ethylene glycol (EG) causes, 374, 375 clinical manifestations, 353 characterization, 373 diagnosis, 353 diagnosis, 375 lethal dose, 353 nephrocalcinosis, 376 oral ingestion, 352 nephrolithiasis, 376 oxalic acid, 362 pathophysiology, 374 sources, 352 treatment, 376–377 treatment, 353, 354 Index 497

Exercise-induced hyponatremia (EIH), 117 Gitelman syndrome, 179, 180, 185, 296, Extracellular buffering, 313 422–424 Extracellular fluid (ECF), 57–60, 63–68, 73, Glomerular filtration rate (GFR) 85–96 chronic respiratory acidosis, 436 CHF, 63–68 CKD, 474, 475 cirrhosis pregnancy, 489, 490 clinical evaluation of, 75 Glucocorticoid-remediable edema, treatment of, 75–77 hyperaldosteronism (GRH), 178, HRS, 79 425 compartment, 7, 8, 11, 13 Glutathione (GSH), 356, 357 contraction, 91–96 Glycine, 128, 139, 140 EABV, 59 Glycyrrhetinic acid, 178 edema, 60 Granulomatous diseases, 239 expansion, conditions, 59 formation of, 60 nephrotic syndrome, 85–90 H recognition, mechanisms, 57–59 HCMA. See Hyperchloremic metabolic acidosis (HCMA) Hemodialysis, 12, 13, 351, 356, 358 F Hemorrhagic shock, 44 Familial hyperaldosteronism type I, 425 Henderson–Hasselbalch Familial hypocalciuric hypercalcemia equation, 313, 322, 323 (FHH), 236, 247, 249 Henle’s loop, 316 Familial hypomagnesemia with hypercalciuria potassium, 166 and nephrocalcinosis (FHHNC), TAL, 26 295 TDL, 26 Familial hypomagnesemia with secondary water reabsorption, 30 hypocalcemia, 295 Hepatorenal syndrome (HRS), 79–81 Familial tumor calcinosis (FTC), 276 Hereditary hypophosphatemic rickets with Fanconi syndrome hypercalciuria (HHRH) causes, 372 type IIa mutation, 263 definition, 372 type IIc mutation, 262 diagnosis, 372 Heroin, 188 laboratory and clinical manifestations, 372 Highly active antiretroviral therapy treatment, 372 (HAART), 400 Fibroblast growth factor (FGF)-23, 254, 256 Homeostasis Fluid imbalance, 483 Ca2+, 212–213 Fluid therapy, 39, 44 magnesium, 287 ARDS, 44 phosphate, 252 cardiogenic shock, 44 Hydrochloric acid, 312 hemorrhagic shock Hydrochlorothiazide gastrointestinal bleeding, 44 (HCTZ), 134, 425, 427 trauma, 44 Hydrocortisone, 96 phases of, 45 11β-Hydroxysteroid dehydrogenase type 2 septic shock, 43 (11β-HSD2), 186 volume contraction, 43 Hypercalcemia, 234–239, 476 Fomepizole, 362 AKI, 471 Frank hyperphosphatemia, 476 causes Furosemide, 55, 69, 78, 88, 90, 438, 448 calcium-alkali syndrome, 237 FHH, 236 granulomatous diseases, 239 G Jansen’s disease, 236 Genetic hypoparathyroidism, 221 malignancy, 238 Gestational diabetes insipidus, 151 MEN type 1 and type 2a, 235 498 Index

Hypercalcemia (cont.) causes of, 307–309 neonatal severe hyperparathyroidism, CKD, 477 236 clinical manifestations, 307, 308 PHPT, 234 creatinine value, 309 renal failure, 236 definition, 307 vitamin D overdose, 239 Mg2+ intoxication, 309

clinical manifestations, 240 MgSO4, 309 diagnosis, 240, 245 preeclampsia, 307 mechanisms of, 480 treatment, 308, 309 pathophysiology, 245 Hypernatremia, 147, 155–157 patterens, 480 brain adaptation, 149 tertiary hyperparathyroidism, 480 causes, polyuria, 150–154 treatment, 242 diagnosis, 149 Hypercalciuria, 235, 381, 436, 471 history, 148 Hyperchloremia, 46 kidney transplantation, 480 Hyperchloremic metabolic acidosis (HCMA), liver disease, 485 391–393, 396–399, 445, 454, 477, mechanisms, 147–148 486 physical examination, 149 and hypokalemia, 358 pregnancy, 490 nonrenal causes, 391, 394 signs and symptoms, 150 cholestyramine, 398 treatment Cl−, intestinal secretion of, 393 acute, 156 diarrhea (see Diarrhea) chronic, 157 diuretic abuse, 399 fluid administration, selection and route HCMA, 399 of, 156 − HCO3 handling, in colon, 393 hypervolemic hypernatremia, 157 laxative abuse, 398 hypovolemic hypernatremia, 157 miliary and pancreatic fistulas, 397 normovolemic, 157 Na+ and Cl− transport, 392–393 underlying cause, correction, 155 urinary intestinal diversions, 397 volume status, 148, 156 villous adenoma, 397 water deficit, calculation, 155–156 volume and electrolytes, in GI fluids, water deficit/Na+ gain, 158 393 Hyperosmolality, 105, 470 water handling, 391 Hyperphosphatemia, 273, 274, 276, 277, 279, RTAs (see Renal tubular acidoses (RTAs)) 344, 486 Hyperglycemia, 324, 459 AKI, 274, 471 Hyperglycemic hyperosmolar syndrome, 161 causes Hyperkalemia, 377–379, 381, 388, 485 CKD, 274 AKI, 470 FTC, 276 causes of, 475 sodium phosphate use and, 276 distal RTA clinical manifestations, 276 causes of, 378, 379 diagnosis, 277 characteristics, 378 mechanisms for, 283 diagnosis, 379 treatment, 284 subtypes, 377 acute, 279 treatment, 381 chronic, 279 type IV with urine pH, 378 diet, 277 urine pH below 5.5, 378 phosphate binders, 277 drug-induced acid–base disorders, 464 Hypertonic contraction, 92 kidney transplantation, 480 Hypertonic hyponatremia, 110 liver disease, causes, 485 Hyperuricemia treatment, 475, 485 kidney transplantation, 481 Hypermagnesemia, 308 lactic acidosis, 344 AKI, 471 Hypervolemic hypernatremia, 157 Index 499

Hypervolemic hyponatremia dominant hypomagnesemia with kidney transplantation, 480 hypocalciuria, 296 liver disease, 484 familial hypomagnesemia with Hypoalbuminemia, 39, 85, 90, 326, 485 secondary hypocalcemia, 295 Hypoaldosteronism, 385 FHHNC, 295 Hypocalcemia, 219, 221, 222, 225–227 hypocalcemia, hypomagnesemia- AKI, 471 induced, 296–297 blood transfusion, 230 hypokalemia, hypomagnesemia- causes induced, 298 hypoparathyroidism, 221 IRH with normocalciuria, 296 PsHPT, 221 isolated dominant hypomagnesemia vitamin D deficiency, 222 with hypocalciuria, 296 CKD, 476 ocular manifestation, FHHNC with, clinical manifestations, 225 295 diagnosis, 222 clinical manifestations, 298 granulomatous diseases, 485 diagnosis, 299 kidney transplantation, 480 kidney transplantation, 480 management, 227 liver disease, 486 treatment, 485 treatment, 300, 302, 485 acute, 225–226 acute, 300–301 chronic, 226–227 chronic, 301 Hypocalciuria, 296, 424 Hypomagnesemia-induced hypocalcemia, 296 Hypodipsic hypernatremia, 154 Hypomagnesemia-induced hypokalemia, 298, Hypokalemia, 21, 230, 385, 395, 398, 400 304 causes Hyponatremia, 107–111, 113–118, 120–122, hypokalemic-hypertensive disorders, 124–126, 490 177 brain adaptation, 119–120 HypoPP, 176 causes, 111 clinical manifestations, 182, 183 beer potomania, 117 diagnosis, 180 CSW, 113 distal RTA, 376 ecstasy, 116 causes, 374, 375 EIH, 117 characterization, 373 NSIAD, 114 diagnosis, 375 poor oral intake, 117 nephrocalcinosis, 376 postoperative Hyponatremia, 118 nephrolithiasis, 376 reset osmostat, 115 pathophysiology, 374 SIADH, 111 treatment, 376 SSRIs, 116 drug-induced acid–base disorders, 464 thiazide diuretics, 116 Gitelman syndrome, 180 clinical manifestations, 123 liver disease complications, 120, 122 causes, 485 development of, 107, 130 treatment, 485 diagnostic test, 124 metabolic alkalosis, 416 dilutional and translocational causes, 139 mineralocorticoid receptor, 178 hypokalemia, 118 proximal RTA, 369 hypotonic, diagnosis, 119 Hypokalemic periodic paralysis ICF and ECF compartment, 161 (HypoPP), 176, 184 insulin administration, 162 Hypokalemic-hypertensive disorders, 177 management and prognosis, 124, 136 Hypokalemic-normotensive disorders, 179 asymptomatic hyponatremia, Hypomagnesemia hospitalized patients, 124–125 causes, 293–295 SIADH, asymptomatic chronic Bartter and Gitelman hyponatremia, 125 syndromes, 296 treatment, causes, 126 500 Index

Hyponatremia (cont.) Interstitium, 8 pathophysiology, 111, 112 Intracellular fluid (ICF) compartment, 7, 8 patient with Intravenous fluid (IF), 36, 38, 43–45 history, 108 colloid, 38 hypertonic, 110 crystalloid laboratory tests, 109 balanced electrolyte solutions, 38 physical examination, 108 NaCl solutions, 36 pseudo/factitious, 109 saline, dextrose, 38 serum osmolality measurement, 107 water, dextrose, 36 urine osmolality and Na+ concentration fluid therapy, 39 measurement, 108 phases of, 45 risk factors, 123 special conditions, 43–45 signs and symptoms, 119 intravascular compartment, distribution, 39–41 treatment, 120, 126, 127 maintenance fluid and electrolyte therapy, 42 acute symptomatic hyponatremia, Ions, 3 120–122 Isolated recessive hypomagnesemia (IRH), 296 chronic symptomatic hyponatremia, Isopropyl alcohol, 354 122 Isosmotic, 7, 30, 392 Hyponatremic hypertensive syndrome, 425 Isotonic hyponatremia, 110 Hypoosmolality, 105, 107, 470, 490 Isotonic volume contraction, 92 Hypoparathyroidism, 219, 221 Hypophosphatemia, 486 causes, 259–261 J ADHR, 262 Jansen’s Disease, 236 ARHR, 262 critical care units, 263 HHRH, type IIa mutation, 263 K HHRH, type IIc mutation, 262 Ketoacids, 312 RFS, 263 Kidney Disease Improving Global Outcomes TIO, 262 (KDIGO), 473 X-linked hypophosphatemia, 261 Kidney transplantation clinical manifestations, 263 acid-base changes, 481 diagnosis, 265–266 electrolyte abnormalities, 479–481 kidney transplantation, 480 volume changes, 479 treatment, 266–267 Klotho’s deficiency, 275 acute severe symptomatic hypophosphatemia, 266–267 chronic, 267 L Hyporeninemic hypoaldosteronism, 388 l-lactic acidosis Hypotonic hyponatremia, 118, 138 causes, 342–344 Hypotonic volume contraction, 92 diagnosis, 344 Hypovolemia, 18, 95, 97 dichloroacetate, 346 Hypovolemic hypernatremia, 157 hereditary/acquired enzymatic defects, 342 Hypovolemic hyponatremia, 141, 484 insulin, 346 Hysteroscopic myomectomy, 139 Na/H exchanger, inhibitors of, 346

NaHCO3 requirements, 345, 364 production, 341 I renal replacement therapies, 346 Ineffective osmolyte, 7 riboflavin, 346 Infectious diarrhea, 395 THAM, 345 Inflammatory diarrhea, 394 thiamine, 346 Inner medullary collecting duct treatment, 344 (IMCD), 29, 169 tribonat, 346 Insulin, 161, 162, 207, 346, 348, 459 Lanthanum carbonate, 278 Index 501

Large-volume paracentesis (LVP), 78 IRH with normocalciuria, 296 Laxative abuse, 398, 399, 412 ocular manifestation, FHHNC with, Licorice ingestion, 422 295 Liddle syndrome, 178, 186, 190, 422, 423 treatment, 300–301 Liposomal amphotericin B (L-AMP), 283 Magnesium sulfate (MgSO4), 231, 300, 301, Liquid silicone, 249 309 Lithium, 249 Maintenance fluid therapy, 42, 47 Liver disease Malignancy, 238–239 acid–base disorders, 486 Malignant hypertension, 177, 409 calcium imbalance, 485 Mannitol, 55 fluid imbalance, 483 Metabolic acid–base disorder, 314 K mbalance, 485 Metabolic acidosis Mg imbalance, 486 AKI, 340, 472 phosphate imbalance, 486 alcohol intoxication, 363 water imbalance, 484–485 alcoholic ketoacidosis, 347–348 CKD, 341, 477 clinical manifestations, 340 M DKA, 347–348 Magnesium (Mg2)+ d-lactic acidosis, 347 factors, 290–291 drug-induced acid–base disorders, 463, homeostasis, 287–288 464 imbalance lactic and pyroglutamic acids, 364, 365 AKI, 471 l-lactic acidosis CKD, 477 causes, 342–344 liver disease, 486 diagnosis, 344 renal handling, 288 dichloroacetate, 346 DCT, 290 hereditary/acquired enzymatic defects, proximal tubule, 289 342–344 TALH, 289–290 insulin, 346 Magnesium disorder Na/H exchanger, inhibitors of, 346

hypermagnesemia NaHCO3 requirements, 345, 364 asymptomatic patient, 308 production, 341 causes of, 307–309 renal replacement therapies, 346 clinical manifestations, 307, 308 riboflavin, 346 creatinine value, 309 THAM, 345 definition, 307 thiamine, 346 Mg2+ intoxication, 309 treatment, 344

MgSO4, 309 tribonat, 346 preeclampsia, 307 mixed acid–base disorder symptomatic patient, 308 and metabolic alkalosis, 456, 458 treatment, 309 hyperventilation, 458 hypomagnesemia, 293 metabolic alkalosis, 452 Bartter and Gitelman syndromes, 296 respiratory acidosis, 453, 456, 458 clinical manifestations, 298 respiratory alkalosis, 452, 456 diagnosis, 299 osmolal gap, 360, 361 dominant hypomagnesemia with PG, 364 hypocalciuria, 296 starvation ketoacidosis, 348 familial hypomagnesemia with topiramate, 361 secondary hypocalcemia, 295 toxin, 349 FHHNC, 295 5-oxoproline, 356 hypocalcemia, hypomagnesemia- EG, 352, 353, 362 induced, 296 ethanol, 351 hypokalemia, hypomagnesemia- isopropyl alcohol, 354 induced, 298 methanol (see Methanol) 502 Index

Metabolic acidosi (cont.) hemodialysis, 351 osmolal gap, 349 treatment, 350–351 paraldehyde, 359 sources, 349 PG, 353 toxic metabolites of alcohols, 350 salicylate intoxication, 355–356 Midodrine, 79–81 serum osmolality, 349 Mixed acid–base disorder, 330, 331 toluene, 358–360 alcohol abuse and pancreatitis, 460 Metabolic alkalosis definition, 449 acquired causes, 408–410 diarrhea, 396 Bartter syndrome, 422 factors, 450 causes of, 406 HIV/AIDS, 461 childhood disease, 426 in hospitalized patients, 451 classification, 406 metabolic acidosis clinical manifestations, 412, 413 and metabolic alkalosis, 452, 456, 458 course of, 403 hyperventilation, 458 definition, 403 respiratory acidosis, 453, 456, 458 diagnosis, 413 respiratory alkalosis, 452, 453, 456 diuretic abuse, 422 metabolic alkalosis drug-induced acid–base disorders, 465 respiratory acidosis, 454, 455, 457 generation phase, 403, 404 respiratory alkalosis, 453, 454, 456, 458 GI mechanisms renal failure, 458 congenital chloride diarrhea, 411 respiratory acidosis, 438, 440 laxative abuse, 412 triple acid–base disorders, 455 nasogastric suction, 410–411 type 1 diabetes and pancreatitis, 459 villous adenoma, 411 Multiple endocrine neoplasia (MEN) Type 1, vomiting, 410–411 235–236 Gitelman syndrome, 422 hypertension, 418–421, 423–425 hypokalemia, 416 N licorice ingestion, 422 Na+ reabsorption, 23–24 Liddle syndrome, 422 N-acetylcysteine (NAC), 358 liver disease, 486 NaCl transport mechanisms, inherited maintenance phase, 404–405 disorders, 32 mixed acid–base disorder NAE. See Net acid excretion (NAE) and metabolic acidosis, 452, 456 Nasogastric suction, 410–411 metabolic acidosis, 458 Natriuresis, 51, 90 respiratory acidosis, 454, 457 Neonatal severe hyperparathyroidism, 236 respiratory alkalosis, 453, 456, 458 Nephrocalcinosis, 370, 376 pathophysiology, 406 Nephrogenic diabetes insipidus (NDI), 151, pregnancy, 491 152, 158, 163 primary aldosteronism, 425 Nephrogenic syndrome of inappropriate recovery phase, 405 antidiuresis (NSIAD), 114 renal transport mechanisms, 406, 407 Nephrolithiasis, 376 respiratory response, 405–406 Nephron, 31, 32, 166, 170, 217, 303 serum with patient history, 424 Nephrotic syndrome treatment, 414–416 clinical evaluation, 86–87 urinary Cl− determination, 415 renal Na+ and water retention and edema urine electrolytes, 420, 424 formation, 86 Methanol treatment, 87–88 acetylsalicylate, 350 Net acid excretion (NAE), 320, 367 half-life, 350 Non-AG metabolic acidosis, 439 poisoning Nonelectrolytes, 3, 4 clinical manifestations, 350 Nonvolatile acids, 312 diagnosis, 350 Normocalciuria, 296 Index 503

Normokalemia, 344 HHRH, type IIa mutation, 263 Normovolemic hypernatremia, 157 HHRH, type IIc mutation, 262 RFS, 263 TIO, 262 O treatment, 266–268 Octreotide, 80 X-linked hypophosphatemia, 261 Omeprazole, 249 Phosphorus, 251 Oral sodium phosphate (OSP), 276 Plasma osmolality, 6, 7, 10, 105 Osmolal gap, 140, 349, 360, 361, 395 Polyglandular autoimmune syndrome type I, 221 Osmolality, 5, 15, 19, 97, 108 Polyuria, 144, 148, 150, 152–154 Osmolarity, 5–6 central DI, 150 Osmosis, 5 diagnosis, 152 Osmotic diarrhea, 394 hypernatremia, in elderly, 153 Osmotic diuresis, 126, 162 hypodipsic hypernatremia, 154 Osmotic diuretics, 56 solute diuresis, 152 Osmotic pressure, 5 gestational DI, 151 Outer medullary collecting duct (OMCD), 29, 169 nephrogenic DI, 151, 152 Posthypercapnic metabolic alkalosis, 409 Potassium (K) imbalance P AKI, 470 Paraldehyde, 359 CKD, 475 Parathyroid hormone (PTH), 213, 248 liver disease, 485 Pendred syndrome, 426 Potassium (K+), 165 Peripheral chemoreceptors, 430 acid-base balance, 172 PG. See Propylene glycol (PG) aldosterone, 171 Phosphate, 251 angiotensin II, 171 binders, 277 anions, 172 buffers, 313 antidiuretic hormone, 171 homeostasis, 252–253 connecting tubule, 168 imbalance cortical collecting duct, 168 AKI, 471 distal tubule, 167 CKD, 476 diuretics, 172 liver disease, 486 factor, 170 proximal tubule, 253 dietary intake and plasma, 170 renal handling, 253 urine flow rate and na+ delivery, 170 renal phosphate handling, regulation, 254–257 Henle’s loop, 166–167 Phosphate disorder hypokalemia, 175 hyperphosphatemia, 273 clinical manifestations, 182 acute, 279 diagnosis, 180–183 AKI, 274 Gitelman syndrome, 180 chronic, 279–280 hypokalemic-hypertensive disorders, CKD, 274–275 177–179 clinical manifestations, 276 HypoPP, 176–177 diagnosis, 277 mineralocorticoid receptor, 178–179 diet, 277 treatment, 182–184 FTC, 276 imbalance phosphate binders, 277–279 AKI, 470 sodium phosphate use and, 276 CKD, 475 hypophosphatemia, 259 liver disease, 485 ADHR, 262 inner medullary collecting duct, 169 ARHR, 262 outer medullary collecting duct, 169 clinical manifestations, 263 proximal tubule, 166 critical care units, 263 TK, 171 diagnosis, 265 transport, renal handling, 165 504 Index

Preeclampsia, 307 Renal tubular acidoses (RTAs), 179, 368–373, Pregnancy 381, 399, 481 acid–base disorder, 491 AG metabolic acidosis, 384–385 electrolyte abnormalities, 490–491 causes, 389 hemodynamic changes, 489 chronic kidney disease, 382 lab values, 491 diabetic ketoacidosis, treatment of, 382 plasma volume changes, 489–490 dilutional acidosis, 382 uric acid, 491 distal/type I (see Distal renal tubular Preprohormone, 98 acidoses) Primary aldosteronism, 177, 178, 188, 408, drug-induced acid–base disorders, 464 423, 425 NAE, 367 Primary hypercapnia. See Respiratory acidosis proximal RTA, 386, 478 Primary hyperparathyroidism (PHPT), 234, autosomal dominant, 371 235, 249, 270 autosomal recessive, 371 Primary hypocapnia. See Respiratory CA deficiency, 371 alkalosis causes, 370 Prohormone, 98 characteristics, 368 Propranolol, 187 clinical manifestations, 370–371 Propylene glycol (PG), 364 Fanconi syndrome, 372–373 clinical manifestations, 354 hypokalemia, 369 diagnosis, 354 pathophysiology, 369 Proteinuria, 88, 89 sporadic form, 371 Proton pump inhibitor (PPI), 249, 304 Sjögren’s syndrome, 389 Proximal tubule, 23, 26, 27, 315 SLE, 383 calcium, 215 topiramate, 387 Cl− reabsorption, 25 type III, 377 collecting duct, 29 type IV, 385 distal tubule, 27–28 types, 367

Henle’s loop UAG, 368, 384 TAL, 26–27 UOG, 368 TDL, 26 urine pH, 367–368 Na+ reabsorption, 23–25 UTIs, 384 phosphate, 253–254 Renin–AII–aldosterone system, inhibition, 67 potassium, 166 Reset osmostat, 115, 143 water reabsorption, 30 Respiratory acid–base disorder, 314 Pseudohyperkalemia, 193 Respiratory acidosis, 429–437, 453, 454, Pseudohyperphosphatemia, 273 456–458 Pseudohypocalcemia, 229 acute, 438 Pseudohyponatremia, 110, 143 causes, 432, 433 Pseudohypoparathyroidism (PsHPT), 221 clinical manifestations, 432 Pseudohypophosphatemia, 259 diagnosis, 433–434 Pyroglutamic acid, 355–358, 360 treatment, 433–434 Pyroglutamic acids, 364, 365 chronic, 439, 440 causes, 435 clinical manifestations, 435 R diagnosis, 436 Refeeding syndrome (RFS), 263, 272 treatment, 436–437

Refractory ascites, 79 CO2 excretion, 430 Renal artery stenosis, 177, 423 CO2 production, 429 Renal failure, 236–237 CO2 transport, 430 Renal replacement therapies, 346 COPD, 437, 440 Renal salt wasting syndrome. See Cerebral salt drug-induced acid–base disorders, 465 wasting (CSW) mixed acid–base disorder, 438–440 Renal transport mechanisms, 406, 407 metabolic acidosis, 453, 456, 458 Index 505

metabolic alkalosis, 454, 457 Sensors, 430 secondary physiologic response, 431 Septic shock, 43, 46 ventilation, CNS control of Sevelamer HCl, 278 effectors, 431 Sjögren’s syndrome, 389 medullary center, 431 SLE. See Systemic lupus erythematosus (SLE) sensors, 430 Sodium (Na) imbalance Respiratory alkalosis, 429, 452, 453, 456, 458, AKI, 470 486, 491 CKD, 474 ABG, 445 liver disease, 483–484 acute, 442, 443, 447 Sodium chloride (NaCl) solutions, 37 cardiovascular effects, 443 Solute diuresis, 152 causes, 442 Solute measurement, units of, 3–4 CNS effects, 443 Specific gravity, 19–20 diagnosis, 444 Spironolactone, 56, 78, 484 metabolic effects, 443 Starvation ketoacidosis, 348 secondary response, 447–448 Syndrome of inappropriate antidiuretic blood cultures, 446 hormone (SIADH), 111–113, 115, chest X-ray, 446 132 chronic, 443 Systemic lupus erythematosus (SLE), 383–384 cardiovascular effects, 444 causes, 442 CNS effects, 444 T diagnosis, 444 T-cell lymphoma, 246 hyperventilation, 444 Terlipressin, 81 metabolic effects, 444 Tertiary hyperparathyroidism, 237 secondary response, 448 Thiamine, 346 drug-induced acid–base disorder, 465 Thiazide diuretics, 116 furosemide, 448 Thick ascending limb (TAL) mixed acid–base disorder calcium, 215 metabolic acidosis, 452, 456 Henle’s loop, 26 metabolic alkalosis, 453, 456, 458 Thick ascending limb of Henle’s loop (TALH), secondary physiologic response, 441–442 33, 289 serum chemistry, 445 Thin descending limb (TDL), Henle’s loop, 26 treatment, 446 Tissue kallikrein (TK), 171 Rhabdomyolysis, 283 Titratable acidity, 319 Riboflavin, 346 Toluene, 358, 360, 377, 385 Ringer’s lactate, 38, 44, 47, 128 Tolvaptan, 67, 141 Risk, Injury, Failure, Loss, End-stage kidney Tonicity, 6, 10 disease (RIFLE), 469 Topiramate, 361, 387 Transient hypocalcemia, 221 Tribonat, 346 S Triple acid–base disorders, 455 Salicylate intoxication Tris-Hydroxymethyl Aminomethane (THAM), acute manifestations, 355 345 aspirin, 355 Tumor-induced osteomalacia (TIO), 262 chronic manifestations, 355 Two iron-binding agents, 278 diagnosis, 355 Type 2 cardiorenal syndrome, 71 metabolic effects, 355 treatment, 356 Secondary hyperparathyroidism, 236, 476 U

Secondary hypocapnia, 441 Urea nitrogen (FEUrea), 16 Secretory diarrhea, 394 Uric Acid (FEUA), 16, 20, 491 Selective serotonin reuptake inhibitor (SSRI), Urinary acidification, 320 116, 140 Urinary intestinal diversions, 397 506 Index

Urinary tract infections (UTIs), 303, 384 W

Urine anion gap (UAG), 17, 18, 21, 368, 384, Water balance, 98, 100, 101, 107 395 ADH

Urine creatinine (UCr), 17, 21 actions, 101 Urine electrolytes, 15 mechanism, 100–101

Urine osmolal gap (UOG), 368 release, control of, 98 Urine potassium (UK), 17, 21 structure and synthesis, 98 aquaporins distribution, 100 copeptin, 99 V disorders, 105 (see Hyponatremia) Vaptans, 141 electrolyte–free water clearance, Vascular calcification (VC), 281 104–105 Villous adenoma, 397, 411 thirst control, 97 Vitamin D, 216 urinary concentration and dilution, deficiency, 222, 228, 229, 271 102–104 overdose, 239 Water deficit, 162 Volatile acid, 312 Water imbalance Volume contraction, 92, 93 CKD, 474 clinical evaluation, 93 liver disease, 484 dehydration vs. volume depletion, 91 Water reabsorption causes, 92–93 distal nephron, 31 fluid loss, types of, 92 hormones, 31 treatment, 93 loop of Henle, 30 Volume depletion, 91, 94 proximal tubule, 30 causes, 92 clinical evaluation, 93 fluid loss, types of, 92 X treatment, 94 X-linked hypophosphatemia, 261