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Circulation and Breathing > 023 Acid Base Balance > Flashcards

023 Acid Base Balance Flashcards

1
Q

What must our body pH be kept between physiologically? What about clinically?

A

Physiologically 7.35-7.45

Clinically 6.8-7.7

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2
Q

What does the henderson Hasselbalch equation suggest about H2CO3 as a buffer?

A

The pKa of bicarbonate is 6.1, which deviates far away from the physiological optimal of 7.4. This suggests that bicarbonate is actually not a very good buffer.

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3
Q

In the Henderson- Hasselbalch equation, what must the ratio be as pKa is 6.1?

A

The ratio between [HCO3-] and [0.03CO2] should be 20 to allow pH to be reached.

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4
Q

If [PCO2] increases in the Henderson-Hasselbalch equation, does that increase or decrease the pH? What about [HCO3-]?

A

When [HCO3-] increases, the log () also increases causing pH to rise, resulting in alkalosis. When [0.03CO2] increases, the log () decreases, causing pH to drop and resulting in acidosis.

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5
Q

How does the body compensate for this?

A

The body is able to compensate for this through excretion of acid by the kidney (100mEq/24 hours) and expiration of acid through the lungs (10000 mEq/ 24 hours). Values indicate that the lung is a much more effective and immediate method of compensation.

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6
Q

How is the concentration of bicarbonate and carbon dioxide determined?

A

Bicarbonate through reabsorption and release from kidneys. CO2 through hyper and hypo ventilation from the lungs.

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7
Q

What is optimal range of anion gap?

A

8-16 mEq/L

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8
Q

What is the normal [HCO3-]?

A

24mM, 22-26mEq/L)

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9
Q

What are the normal base excess levels?

A

-2 to +2

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10
Q

What is the normal PACO2 level?

A

40mmHg

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11
Q

What are the intracellular buffers?

A

Proteins and other phosphates

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12
Q

What are the extracellular buffers?

A

Phosphates and bicarbonate, haemoglobin

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13
Q

What factors determine the pH of our blood? List 3

A

CO2/HCO3- levels, excess weak acids e.g. in diabetic patients they produce and excrete excess B-hydroxybutyric acid and acetoacetic acid which are excreted as ketone bodies, anion gap between cations Na+ and anions Cl-.

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14
Q

What is the Isohydric principle?

A

It states that the change in one buffer system due to H+ concentration change will affect all other buffer systems too. The buffer system we use to measure acid base balance uses PACO2, arterial [HCO3-], and arterial pH.

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15
Q

How many mmoles of non volatile acid a day do kidneys excrete a day?

A

50 mmoles of non-volatile acid.

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16
Q

What is the normal urine produced per day? At what pH?

A

1.5-2L at pH 5-6

17
Q

How are the H+ excreted as? So how do you calculate fixed acid excreted by urine?

A

Ammonium created by ammonia genesis from metabolism of glutamine, or phosphate buffer combinations.

18
Q

What are the two axis for the davenport diagram (metabolic acidosis/alkalosis) ?

A

pH on x axis, Plasma [HCO3-] on y axis

19
Q

What acidosis/alkalosis does sepsis cause?

A

Metabolic acidosis

20
Q

What acidosis/alkalosis does obstruction to the airway cause?

A

Respiratory acidosis

21
Q

What acidosis/alkalosis does hypoventilation cause?

A

Respiratory acidosis

22
Q

What acidosis/alkalosis does accumulation of lactate cause?

A

Metabolic acidosis

23
Q

What acidosis/alkalosis does aspirin overdose cause?

A

Metabolic acidosis

24
Q

What acidosis/alkalosis does hyperventilation cause?

A

Respiratory alkalosis

25
Q

What acidosis/alkalosis does vomiting cause?

A

Metabolic alkalosis

26
Q

What acidosis/alkalosis does hypermetabolism cause?

A

Metabolic acidosis

27
Q

What acidosis/alkalosis does fever/inflammation cause?

A

Metabolic acidosis

28
Q

What acidosis/alkalosis does aldosterone excess cause?

A

Metabolic alkalosis

29
Q

What acidosis/alkalosis does hypoxia due to high altitude cause?

A

Respiratory alkalosis

30
Q

What acidosis/alkalosis does respiratory muscle weakness cause?

A

Respiratory acidosis

31
Q

How does compensated metabolic acidosis present as?

A

Base deficit below -2, low HCO3- concentration, low PaCO2 (increased ventilation)

32
Q

How does compensated metabolic alkalosis present as?

A

Normally cannot be compensated through respiration; very rare

33
Q

How does compensated respiratory acidosis present as?

A

Base excess above +2, high HCO3- concentration due to kidney retention, high PaCO2 due to decreased ventilaiton

34
Q

How does compensated respiratory alkalosis present as?

A

Base deficit below -2, Low PaCO2 (increased ventilation), low HCO3- due to kidney excretion

35
Q

How would you treat metabolic alkalosis?

A

Administering suitable acid to react with the base

36
Q

What is base excess defined as?

A

The amount of strong acid that must be added to a litre of olxygenated blood to return to pH 7.4 at temperature of 37 degrees celsius and pCO2 of 40mmHg

Circulation and Breathing (13 decks)

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