Renal Tubular Acidosis - CRASH! Medical Review Series
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- เผยแพร่เมื่อ 1 ต.ค. 2024
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Minor correction: At about 12:30, I referred to furosemide as a thiazide diuretic. It of course is not; it's a loop diuretic. Thiazide diuretics would include such drugs as hydrocholorothiazide.
(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention.)
12:16 Furosemide is not a Thiazide diuretic. It is a loop diuretic.
12:30 - See correction above.
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Thank you Dr Bolin, really great lectures!
Slightly confused with type 2. You mentioned that in type 2 the urine is already acidic by the time it reaches the collecting duct. But there are no H+ channels until the collecting duct, so I was wondering how that was possible.
Thank you very much for your video.
Could be because 80% of the bicarb is already reabsorbed, leaving 15 % to be reabsorbed distally, thus urine is relatively acid.
My prof. questioned this during bedside and this video really helps! Thank you Dr Bolin!
For RTA type 2:
By giving a thiazide diuretic there is small amount of Sodium loss, this in turn forces absorption of NaHCO3 proximally through hyper-plastic Sodium receptors
This is how it was explained to me
Thanks for sharing this! Wonder if you have any paper to read this up?
why in type 2the is low k in urine ,why not high just like type 1
For RTA type 2, is it possible that the mechanism by which thiazide diuretic treatment helps is by causing contraction alkalosis? (Or rather, reducing ECF volume to help w/ bicarb reabsorption)
Great video, thanks :)
Could you explain why the urinary pH is low in type IV? thanks!
+John Horak
Quote from www.anaesthesiamcq.com/AcidBaseBook/ab8_5.php
"The H+ pump in the tubules is not abnormal so patients with this disorder are able to decrease urine pH to < 5.5 in response to the acidosis"
At first it seemed strange to me, that you could have acidic urine and blood at the same time, but i guess the answer must be that the acidic urine is just not enough to keep up with the body's acid production (at least not when you have this disease)
+John Horak
Also he sorta explains the mechanism when he's talking about type II
Distal tubular acidification is based on 3 mechanisms : 1. Re- absorption of bicarbonate not previously reabsorbed into the proximal tubule (10%). 2. Titration of the dibasic phosphate which converts to a monoacid --this is commonly known as titrateable or measurable acid. 3. Conversion of NH3 to the nonabsorbable form NH4.
The sum of the titrateable acidity and ammonium minus the bicarb is what is better known as 'net acid excretion '.
Reference: Acidosis Tubular Renal. The researcher himself Funatim Unam --You Tube. My translation. Hope it helps.
@@Zumbador It does! Thanks!
@@xDomglmao Glad it helped@Domglmao. It's been a while. I was studying for my board recertification then. Good luck!