key Try Dr. O'Callaghan's QUIZ: What are millimoles, milliequivalents, and milliosmoles? How is the formula for osmolarity computed? How is dextrose different from glucose in terms of molecular weight? What is the difference between BUN and urea?

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Palmer  

Electrolyte/Acid-Base Emergencies in the ICU
(Biff Palmer, MD. ASN Board Review Course 2007).
Case 1: Hyponatremia after traumatic subarachnoid hemorrhage. What is the cause? Case 2: Hyponatremia after trans-urethral resection of the prostate gland. What is the etiology? Why did symptoms worsen with treatment? Case 3. Anion gap metabolic acidosis in a patient with apparently (but not really) compromised bowel. Case 4. Anion gap acidosis in a ventilated patient on lorazepam infusion. Case 5. Extreme hyperkalemia post-operatively in a patient receiving coronary artery bypass surgery. Case 6. Acute renal failure in a post-operative patient after volume expanders. Case 7. Malignant hyperthermia intra-operatively. Case 8. Acute renal failure, anion-gap acidosis, and hyperkalemia post-operatively. Case 9. Hyperkalemia and profound weakness in a post-operative patient. Already know the answers? The CME post-test for this activity will be posted in the coming week.
(more...)


Palmer

Literature Review: Non-Potassium Fluid-Electrolyte and Acid-Base Disorders
(Biff Palmer, MD; ASN Renal Week, 2005)

Why and when do marathon runners become hyponatremic? How much should they drink? What should then drink? Are NSAIDs a risk factor? What is the nephrogenic syndrome of inappropriate diuresis, and what is its molecular and genetic basis? How does sildenafil act on aquaporins to increase water transport in the kidney? How does "ecstasy" cause hyponatremia? How can we use CRRT to safely treat extreme hypernatremia? How to thiazolidinediones cause edema? What is pyroglutamic acidosis? How can medication containing propylene glycol cause acidosis? How does acidosis affect protein synthesis in the kidney? What is hensin and how can it explain cyclosporine caused metabolic acidosis? How to topamax, linezolid, and propofol cause acidosis? How does bicarbonate ingestion boost athletic performance? (more...)

Updated: September 02, 2008 (S02)
S02 Think your fiance will make the perfect husband? Better first check his vasopressin receptor genotype!
J26 Fist-clenching prior to phlebotomy can raise sample potassium levels.
J22 Ice-tea aficionado develops kidney stones
J22 Woman who claimed water-loading diet caused brain damage due to seizures wins lawsuit.
J21 Adding calcium hydroxide to seawater may reverse global warming.
J25 African Americans excrete less potassium in the urine, and it's not all due to dietary intake.
M05 ASN Renal Week abstract archives 2003-2006 now available on-line in .pdf format.
A03 JASN review article in the news: Questions the health benefits of drinking lots of water.
F09 Paradigm shift: Non-osmotic, inflammation-generating accumulation of sodium in the skin
D04 FDA warns of hyponatremia, seizures, when desmopressin used to treat nocturnal enuresis.
N08 New nonsteroidal natriuretic hormone identified in human urine.
O17 Vaprisol (conivaptan) study shows increase in serum sodium in euvolemic hyponatremia.
A23 Scientist warns marathon runners: Water won't help you keep your cool
M30 Function of Rh blood proteins discovered: link to ammonia excretion.
M27 New blood thinner may work without bleeding risk
Industry Advances Emphasis
archive
Magnesium Balance: Hypomagnesemia and Hypermagnesemia (Coyne) ASN Board Review 2006
Current Concepts in Neurohormones: Vasopressin and the Kidney (Schrier, Sterns) ASN Renal Week 2005
Acid-Base Enigmas: New Observations (Oh, Lanken, Kraut) ASN Renal Week 2005 (audio only)
Nephrology Quiz & Questionnaire: Fluids and Electrolytes (Halperin) ASN Renal Week 2005 (audio only)
Permissive Hypercapnia in Acute Pulmonary Disorders: Morbidity and Mortality and Treating the Respiratory Acidosis (Lanken) ASN Renal Week 2005
Literature Review: Non-Potassium Fluid-Electrolyte and Acid-Base Disorders (Palmer) ASN Renal Week 2005
Workshop Cases - Non-Anion Gap Acidosis (Alexander) ASN Board Review 2005
Case Discussions of Hyponatremia and Hypernatremia (Berl and Gluck) ASN Board Review 2005
Calcium and Phosphorus: Key Physiologic Principles (Bushinsky) ASN Board Review 2004
Literature review: A year in nephrology - fluids and electrolytes (Arruda) ASN Renal Week
Anion gap metabolic acidosis . Part one of two. (Emmet) ASN Annual Board Review Course
Anion gap metabolic acidosis . Part two of two. (Emmett) ASN Annual Board Review Course
Potassium : Key physiologic principles; hypokalemic and hyperkalemic disorders . Part 1 of 2 (Palmer) ASN Annual Board Review Course
Potassium : Key physiologic principles; hypokalemic and hyperkalemic disorders . Part 2 of 2 (Palmer) ASN Annual Board Review Course
Issues of volume regulation . Case studies. Part two of two (Weisberg) ASN Annual Board Review Course
Issues of volume regulation . Case studies. Part one of two (Weisberg) ASN Annual Board Review Course
Renal water handling : A summary of practical physiology (Sterns) ASN Annual Board Review Course
Edema states, pathosphysiology and therapy. Part one of two: Pathophysiology (Weisberg) ASN Annual Board Review Course
Regulation of sodium balance: A summary of pratical physiology (Schuster) ASN Annual Board Review Course
Distal renal tubular acidosis: from the ammonium chloride test to genetic analysis (Wrong) NKF Illinois Special Symposium
Hypercalcemia and hypocalcemia: Associated disorders and therapy (Suki) ASN 2002 Renal Week
Renal tubular acidosis (Arruda) ASN 2002 Board Review Course
Disorders of potassium metabolism: Case discussions (Arruda) ASN 2002 Board Review Course
Metabolic alkalosis (DuBose) ASN 2002 Board Review Course
Lactic acidosis (Szerlip) ASN/ISN 2001 Meeting
Renal tubular acidosis: Basics of proximal and distal RTA (Arruda) ASN 2001 Board Review
Renal tubular acidosis: Case Presentations (Arruda) ASN 2001 Board Review
Potassium physiology and pathophysiology (Alpern) ASN 2000 Board Review
Syndromes of hypo- and hypermagnesemia (Goldfarb) ASN 2000 Board Review
Calcium and phosphorus regulation: Gut, parathyroid glands, and kidney (Moe) ASN 2000 Board Review
Management of hyperkalemia in ESRD (Allon) ASN 1998 Annual Meeting
Pathogenesis and diagnosis of hypo- and hypernatremia (Ayus) ASN 1998 Board Review Course
Treatment of hypo- and hypernatremia (Berl) ASN 1998 Board Review Course
Introduction to metabolic acidosis (Narins) ASN 1998 Board Review Course
Distal renal tubular acidosis: a simplified pathophysiologic approach to diagnosis (DuBose) NY Soc Nephrol Lecture Series

Hyperkalemia Caused by Penicillin (Thiele and Rehman) Am J Med (Aug 2008)
When is it appropriate to order an ionized calcium? (Calvi and Bushinsky) JASN (Jul 2008)
Sensing tension: epithelial sodium channel/acid-sensing ion channel proteins in cardiovascular homeostasis Hypertens (2008)
Idiopathic membranous nephropathy: diagnosis and treatment Clin J Am Soc Nephrol (May 2008)
WNK kinases and renal sodium transport in health and disease: an integrated view Hypertens (Mar 2008)
Changes in the potassium content of different potato varieties after cooking J Ren Nutr (Mar 2008)
The utility of the transtubular potassium gradient in the evaluation of hyperkalemia J Am Soc Nephrol (Mar 2008)
24-h uric acid excretion and the risk of kidney stones Kidney Int (Feb 2008)
Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study Brit Med J (Feb 2008)
Cerebral salt wasting versus SIADH: What difference? J Am Soc Nephrol (Feb 2008)
Metabolic acidosis inhibits soft tissue calcification in uremic rats Kidney Int (Feb 2008)
Fatal hyperammonemic encephalopathy after gastric bypass surgery Am J Med (Jan 2008)
Thiazide-induced subtle renal injury not observed in states of equivalent hypokalemia (Reungjui et al) Kidney Int (Dec 2007)
Hyponatremia, arginine vasopressin. dysregulation, and vasopressin receptor antagonism (Rai et al) Am J Nephrol (Dec 2007)
Management of hyperkalemia in dialysis patients (Putcha et al) Semin Dial (Oct 2007)
Is there an unrecognized epidemic of primary aldosteronism? (debate) (Calhoun & Kaplan) Hypertens (Sep 2007)
Use of the {delta}AG/{delta}HCO3- Ratio in the diagnosis of mixed acid-base disorders (Rastegar) J Am Soc Nephrol (Sep 2007)
Hospital-acquired hyponatremia - why are hypotonic parenteral fluids still being used? (Moritz et al) Nature Clin Pract Nephrol (Jul 2007)
Hypophosphatemia: clinical consequences and management (Brunelli et al) J Am Soc Nephrol (Jul 2007)
Vasopressin receptor antagonists Dial Transplant (Jul 2007)
Hospital-acquired hyponatremia—why are hypotonic parenteral fluids still being used? (Moritz ML and Ayus JC) Nature CP Nephrol (Jul 2007)
Neurologic effects of hyponatremia and its treatment (Widdess-Walsh P et al) Cleveland Clinic J Med (May 07)
Hypomagnesemia in patients with type 2 diabetes (Pham et al) CJASN (03-2007)
Serum anion gap: its uses and limitations in clinical medicine (Kraut, Madias) CJASN (01-2007)
Electrolyte disturbances in the intensive care unit (Sedlacek , Schoolwerth, Remillard) Sem Dial 12-06
Hyponatremia, arginine vasopressin. dysregulation, and vasopressin receptor antagonism (Rai et al) Am J Nephrol 12-06
Acid-base transport by the renal proximal tubule (Boron). JASN 09-06
ACID-BASE LINKS
Normal values
Moles and molarity
Henderson-Hasselbach
HDCN Topic Pages (KEY)
Acidosis
Alkalosis
Hyponatremia
Hypernatremia
Hypokalemia
Hyperkalemia
Hypomagnesemia
Hypermagnesemia
Hypocalcemia
Hypercalcemia
Polyuria
MORE LINKS
Composition of Body Fluids
Calculating osmolarity
Overview of acid-base disturbances
Acid-Base Chemistry
Periodic table
The anion gap

Dr. Chris O'Callaghan, M.D.
BA, BM, BCh, MA, MRCP (UK), DPhil
Medical Research Council Clinician Scientist
Institute of Molecular Medicine and, Nuffield Department of Clinical Medicine University of Oxford, John Radcliffe Hospital, Oxford, UK