03-25-2016, 01:47 PM
@saromizingboy,
Measurement in the pee & AG is very helpful for us of to make Dx type I RTA. So, when you have acidosis lots of NH4 excreted (ammonia its buffer that extend had to remove H) it’s difficult to measure NH4 directly so instead we Urinary AG ( as u recall ( Na + K – Cl) is a surrogate don’t mix up the formula we use for Urinary AG different for plasma AG. The reason the it changes bz high level of NH4 take “Cl” with them so make the pee UAG become NEG when lots of H bing excreted -> So, in setting acidosis you should have UAG NEG when lots of acid/H being excreted. So in GI metabolic acidosis/diarrhea-> UAG tattoo the NEG because u excreting lot of NH4 with Cl-> urine Cl conc goes UP and that means UAG become NEG.
In contrast in RTA distal scenario, pat have POSITIVE UAG ( UAG should not be POS in the setting a massive dose ) but this happen bz to type RTA because the kidneys can’t excrete H-> NH4 & Cl don’t INC -> Pee UAG/Na + K- Cl does not become NEG as it should in acidosis u see.
You understand the pat painted with Sjögren's in stem as I just dissected for you RTAs have POS UAG right from the back you can eliminate choice C & D. Which you didn’t know BUT NOW YOU KNOW.
Go over other Q that I post that will clear you fog. Try to get involve in my Qs and ans 72sec if you can.
Measurement in the pee & AG is very helpful for us of to make Dx type I RTA. So, when you have acidosis lots of NH4 excreted (ammonia its buffer that extend had to remove H) it’s difficult to measure NH4 directly so instead we Urinary AG ( as u recall ( Na + K – Cl) is a surrogate don’t mix up the formula we use for Urinary AG different for plasma AG. The reason the it changes bz high level of NH4 take “Cl” with them so make the pee UAG become NEG when lots of H bing excreted -> So, in setting acidosis you should have UAG NEG when lots of acid/H being excreted. So in GI metabolic acidosis/diarrhea-> UAG tattoo the NEG because u excreting lot of NH4 with Cl-> urine Cl conc goes UP and that means UAG become NEG.
In contrast in RTA distal scenario, pat have POSITIVE UAG ( UAG should not be POS in the setting a massive dose ) but this happen bz to type RTA because the kidneys can’t excrete H-> NH4 & Cl don’t INC -> Pee UAG/Na + K- Cl does not become NEG as it should in acidosis u see.
You understand the pat painted with Sjögren's in stem as I just dissected for you RTAs have POS UAG right from the back you can eliminate choice C & D. Which you didn’t know BUT NOW YOU KNOW.
Go over other Q that I post that will clear you fog. Try to get involve in my Qs and ans 72sec if you can.