Renal Tubular Acidosis: Types & Acid-Base Summary

by Thad Wilson, PhD

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    00:01 Of course, you can have a metabolic acidosis without an elevated plasma ion gap.

    00:08 And some of the best examples of those happen in the kidney.

    00:11 These are Renal Tubular Acidosis of which there are three types that we need discuss.

    00:16 Type 1, Type 2 and Type 4.

    00:20 To compare this, the best thing to do is to think about where does the problem lie.

    00:26 It just so happens that Type 1 Renal Tubular Acidosis is a problem with acid secretion.

    00:32 While Type 2 Renal Tubular Acidosis is impaired by carbonate secretion.

    00:37 And Type 4 is also impaired acid secretion.

    00:42 If you can keep this as straight as possible, you’re hopefully be able to better diagnose what your Renal Tubular Acidosis might be.

    00:51 So, 1 and 4 impaired acid secretion, type 2 bicarbonate secretion.

    00:58 The disorders that are associated with these can be numerous.

    01:02 Many of them involve some genetic disorder.

    01:06 Rheumatoid arthritis is often times associated with Type 1 Renal Tubular Acidosis.

    01:12 Some drugs such as carbonic anhydrase inhibitors are associated with Type 2 Renal Tubular Acidosis.

    01:19 And for Type 3 Renal Tubular Acidosis, Addison’s disease is a great example of trying to tie those together to a clinical condition.

    01:29 All of them will respond with a Renal Tubular Acidosis, is metabolic acidosis.

    01:38 You noticed we didn’t mentioned Type 3, right? You won’t see it.

    01:44 To summarize, the acid base disturbances we can utilize this type of a chart.

    01:52 A respiratory acidosis always involves a decrease in pH, a small increase in bicarb and a large increase in carbon dioxide.

    02:06 A respiratory alkalosis is an increase in pH, a small decrease in bicarb and a large decrease in C02.

    02:19 Metabolic acidosis is a decrease in pH, a large change in bicarb with no change in CO2.

    02:31 A metabolic alkalosis is an increase in pH, a large increase in bicarb with really no change in PCO2.

    02:42 The other thing to keep in mind with summarizing this acid base disorders, you have an initial disorder and then, you might have a response to it.

    02:53 If you think about the diagrams it will always help you try to predict what the compensation is gonna be.

    03:01 So, you have your four primary disorders that we’ve just covered in the table.

    03:05 You have a respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis.

    03:12 How are you going to try to fix this problems? Well, a partial fix usually involves the opposite system.

    03:21 So, if you have a respiratory acidosis, you try to fix it with a metabolic alkalosis.

    03:29 If you have a metabolic acidosis, you try to fix it with a respiratory alkalosis.

    03:36 If you have a metabolic alkalosis, you try to fix it with a respiratory acidosis.

    03:42 And finally, if you have a respiratory alkalosis, you try to fix it with a metabolic acidosis.

    03:51 Partial compensation, means you are moving your pH back towards normal.

    04:00 but you may not have reached normal yet.

    04:02 Once you reached normal, it’s called perfectly compensated.

    04:07 I would like to say that we usually become perfectly compensated but life is not perfect.

    04:14 Usually, you partially compensate and eventually are trying to move back to normal ranges and often times you never get there but you’re trying to do that process.

    04:26 The last type of disorder that I’m just going to bring up as a problem that happens is if the disorders are mixed.

    04:35 Mixed or compound disturbances mean that you have more than one problem.

    04:40 And these are very serious conditions.

    04:43 A type when you could have a respiratory acidosis and a metabolic acidosis at the same time.

    04:50 Those are very hard to fix because both systems are moving pH in the same way.

    04:57 Just like if you had a metabolic alkalosis with a respiratory alkalosis at the same time.

    05:07 Again, very hard to fix because you have multiple compound problems.

    About the Lecture

    The lecture Renal Tubular Acidosis: Types & Acid-Base Summary by Thad Wilson, PhD is from the course Acid-Base Balance.

    Included Quiz Questions

    1. Anion-gap metabolic acidosis.
    2. Non-Anion-gap metabolic acidosis.
    3. Cation gap metabolic acidosis.
    4. Non-Cation-gap metabolic acidosis.
    5. Cannot be calculated.
    1. ...High anion gap metabolic acidosis.
    2. ...Normal anion gap metabolic acidosis.
    3. ...Low anion gap metabolic acidosis.
    4. ...Normal anion gap respiratory acidosis.
    5. ...High anion gap respiratory acidosis.
    1. Mixed acid-base disease
    2. Metabolic acidosis
    3. Metabolic alkalosis
    4. Respiratory acidosis
    5. Respiratory alkalosis
    1. Kussmaul’s respirations
    2. Glucose 110mg
    3. Hypoventilation
    4. Neuro-excitability
    5. Increased heart rate
    1. Type 2 renal tubular acidosis is associated with impaired acid secretion.
    2. Renal tubular acidosis is commonly of three types, type1, type2 and type4.
    3. Renal tubular acidosis is an example of metabolic acidosis.
    4. Type 1 renal tubular acidosis is associated with rheumatoid arthritis.
    5. Type 3 renal tubular acidosis is associated with Addison's disease.

    Author of lecture Renal Tubular Acidosis: Types & Acid-Base Summary

     Thad Wilson, PhD

    Thad Wilson, PhD

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    And easy and comprehensive review
    By iutzi o. on 10. July 2017 for Renal Tubular Acidosis: Types & Acid-Base Summary

    I loved the whole course! I finally could understand a topic that is so frustrating for me to understand and also remember in time! Dr Tad is an awesome lecturer! I lo ve the way he explains everything

    Could have used slighlty more detail
    By Rhys A. on 06. March 2017 for Renal Tubular Acidosis: Types & Acid-Base Summary

    Good lecturer, though compared to common youtube lectures, most of the material is covered too superficially to really retain much, although the gnome chart was helpful for myself. Future lectures could give just a bit more detail to help the bigger picture ideas stick.