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Renal > 05.07 - Acid Base (Wall) - PP + Handout, No reading, Not watched > Flashcards

05.07 - Acid Base (Wall) - PP + Handout, No reading, Not watched Flashcards

1
Q

Expected HCO3, pCO2 changes for Acute Respiratory Alkalosis

A

HCO3 decreases 2 mEq for each 10 mm decrease in pCO2

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2
Q

Type 1 (Distal) RTA is caused by __ and causes ___

A

Defective H-ATPase, decreased acid secretion

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3
Q

Metabolic Acidosis is ___ Bicarb

A

Decreased

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3
Q

For simple acid-base disorders, pC02 and HCO3 always

A

change in same direction

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4
Q

Acid Base disorder caused by Hyperaldosteronism

A

Metabolic Alkalosis

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5
Q

2 disorders with elevated Bicarb (>30)

A

Metabolic Alkalosis and Chronic Respiratory Acidosis (with kidney compensation)

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6
Q

How does plasma anion gap change with respiratory disorders

A

Doesn’t

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7
Q

Urine anion gap is an indirect estimate of

A

Urinary NH4+ excretion

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7
Q

__ % of Bicarb is reabsorbed in PT via __

A

90% via Na-H antiporter (Na is driving force)

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8
Q

Why is Citrate given in acid base

A

Metabolized to Bicarb

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8
Q

Normal Urine Anion Gap

A

Positive, 10 mEq/L

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8
Q

If PAG is normal in Metabolic acidosis

A

Might be kidney not making NH4+, or Losing Bicarb by Diarrhea

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9
Q

Why can you tell the difference b/t acute and chronic respiratory disorders

A

Takes kidneys hours to days to compensate

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9
Q

What inhibits Na channel in principal cell of cortical collecting duct?

A

Amiloride, Triamterene

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10
Q

Isohydric principle

A

All buffers change in same direction

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11
Q

Metabolic Alkalosis is ___ Bicarb

A

Increased

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12
Q

What must accompany NH4+ in urine

A

Chloride

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12
Q

What is synonymous with send a bicarb into blood

A

Proton pumped into urine that came from intracellular Carbonic Anhydrase

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13
Q

How does renal failure affect acid base balance

A

Reduced GFR - Decreased Ammonium excretion

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14
Q

What is invariably present in Simple Acid-Base disorders

A

Compensation

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16
Q

pH and H+ ranges

A

6.8-7.8; 16-160 neq/L

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16
Q

When A- from HA is excreted into urine

A

Normal Plasma Anion gap, increased plasma chloride

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16
Q

Anion Gap if you lose Bicarb directly in stool

A

None b/c there’s no unmeasured anion

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17
Q

Etiology of Metabolic Alkalosis

A

Loss of H+ into GI or into urine

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19
Q

Respiratory Acidosis is __ CO2

A

Increased CO2

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20
Q

What must be present in simple acid-base disorders

A

Secondary physiologic compensation

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20
Q

When will you have lower or negative UAG

A

If you’ve lost bicarb by diarrhea, ammonium increases in urine, and chloride accompanies it

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21
Q

Major extracellular buffer

A

Bicarb

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22
Q

If Na concentration stays constant, but Chloride conc. changes, then

A

an acid base disorder is present

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23
Q

What acid base disorder can dietary protein intake cause

A

Acidosis

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23
Q

What puts bicarb back into urine

A

Cl/Bicarb (Pendrin) in beta-intercalated cells

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24
Q

Cl responsive in Metabolic Alkalosis means

A

Urine Cl

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25
Q

Patient with lower GFR develops more severe acidosis following acid load b/c

A

can’t secrete NH4+ as well

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26
Q

Expected pH changes for Chronic Respiratory Acidosis

A

HCO3 increases 4 mEq for each 10 mm increase in pCO2

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28
Q

Timeframe of H+ excretion, Bicarb reabsorption, and Bicarb generation

A

Hours to days

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29
Q

Expected pH Changes for Acute Respiratory Acidosis

A

HCO3 increases 1 mEq for each 10 mm increase in pCO2

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30
Q

Type 4 (Hypoaldosteronism) RTA is caused by ___ and causes ___

A

Impaired proton and K secretion, decreased acid secretion

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31
Q

What drug inhibits sodium bicarb reabsorption in proximal tubule

A

Acetazolamide (CAi)

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32
Q

Speed and effectiveness of 2 buffering routes in respiratory acidosis

A

(1) Plasma: rapid but limited, 1-2 mEq/L increase in Bicarb; (2) Kidney excretes NH4, generating new bicarb, delayed 2-3 days

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33
Q

Acid Base disorder caused by Loop or Thiazides

A

Metabolic Alkalosis

33
Q

How long does it take kidney to generate new bicarb ions

A

2-3 days

33
Q

Bicarb transporter in beta-intercalated cells

A

Cl/Bicarb (Pendrin)

35
Q

Normal HCO3-

A

22-26 (24mEq/L)

35
Q

Acute Respiratory acid base disorders always have __ change in pH than chronic b/c __

A

Greater change, b/c kidney is slow in compensating

37
Q

Changes in HCO3 and pCO2 in Metabolic Alkalosis

A

Both increase

37
Q

Changes in HCO3 and pCO2 in Respiratory Acidosis

A

Both increase

38
Q

How does CO2 in alpha-intercalated cells affect H secretion/reabsorption

A

CO2 binds with OH- to form bicarb that is reabsorbed instead of secreted; H+ is the secreted instead of bonding with the OH-

39
Q

When A- from HA is reabsorbed by kidney or retained in plasma

A

Unmeasured Anion - Increased Plasma Anion Gap, minimal change in plasma Chloride

41
Q

HCO3 in Respiratory Alkalosis

A

Slightly decreased

42
Q

If PAG increases in metabolic acidosis, it’s

A

Lactic Acidosis or some other renally conserved acid anion

43
Q

How does plasma Na change with acid base disorders

A

Doesn’t

44
Q

Where is Bicarb primarily reabsorbed

A

PT and LOH

45
Q

Cl resistance in Metabolic Alkalosis means

A

Urine Cl >20 mEq/L (usually >50 mEq/L)

46
Q

Urine Anion Gap =

A

Na + K - Cl (in urine)

47
Q

Primary acid we produce

A

CO2 from metabolism of fats and carbs

49
Q

Timeframe of intracellular fluid buffer systems

A

2-4 hours

51
Q

Which RTA results from Decreased Acid Excretion?

A

Type 1 (Distal) and Type 4 (Hypoaldosteronism)

52
Q

Every proton proton pumped into the urin had to come from

A

Intracellular Carbonic Anhydrase

53
Q

Most common form of chronic alkalosis where the kidney compensates

A

Pregnancy - Alkalemic

54
Q

2 major buffers of urine

A

NH4+ and Phosphate

55
Q

Pregnant women acid base

A

Slightly Alkalemic

57
Q

Changes in HCO3 and pCO2 in Respiratory Alkalosis

A

Both decrease

58
Q

Decreased Acid excretion is synonymous with

A

Impaired NH4+ excretion

60
Q

Trick for converting [H+] to pH

A

80 - decimal digits of pH

61
Q

How to distinguish b/t Acute and Chronic

A

Look at Bicarb: Small change (1-2), then acute; Larger change (4-5) then kidney has compensated and chronic

63
Q

pKa of Bicarb

A

6.1

64
Q

Normal pCO2

A

36-44 (40mmHg)

64
Q

Diarrhea results in loss of

A

Bicarb –> Metabolic Acidosis

66
Q

Acid Base Disorder caused by Hypokalemia

A

Metabolic Alkalosis

67
Q

Final excretion of daily aci load occurs primarily in

A

CD

68
Q

Where are non-Carbonic acids eliminated?

A

Combined with buffers and secreted by kidneys

69
Q

Indirect estimate of urinary NH4+ excretion

A

Urine Anion Gap

70
Q

Why is NH4+ trapped in urinary lumen

A

Lipid soluble

71
Q

Expected pH changes for Chronic Respiratory Alkalosis

A

HCO3 decreases 5 mEq for each 10 mm decrease in pCO2

72
Q

Compensation for Respiratory disorders occurs by

A

Alterations in Bicarb concentration

73
Q

Normal Plasma Bicarb

A

24 mEq/L

74
Q

In simple acid-base disorders, the compensatory mechanisms

A

Must be present, Never fully correct pH

75
Q

Respiratory Alkalosis is __ CO2

A

Decreased CO2

76
Q

Metabolic Disorders are processes that directly alter

A

Bicarb Concentration

77
Q

Urine AG becomes less positve/more negative with

A

Increasing urinary NH4+ –> Cl must accompany NH4+

78
Q

How to get Bicarb from Total CO2

A

Subtract 1-1.5

80
Q

How does plasma Cl change with plasma HCO3

A

Changes equally and inversely

81
Q

How much does Total CO2 exceed plasma bicarb?

A

By 1-1.5 mEq/L

82
Q

Plasma Cl is altered in which Acid Base Disorders

A

All except increased Plasma AG Metabolic Acidosis

84
Q

pH of 7.4 = what [H]

A

40 nEq/L

85
Q

Action of Acetazolamide

A

CA inhibitor - Inhibits Na Bicarb reabsorption in PT

86
Q

How does low pH alon drive bicarb reabsorption

A

More CO2 in blood freely enters tubular cell - Meaning more reactant to form H+ that goes into Na-H Antiporter

87
Q

Changes in HCO3 and pCO2 in Metabolic Acidosis

A

Decrease in HCO3- and pCO2

88
Q

[H+] =

A

24 x pCO2 / [HCO3]

89
Q

HCO3 in Respiratory Acidosis

A

Slightly increased

90
Q

Only caveat to Urine Chloride in Metabolic Alkalosis

A

If just took Loop diuretic, urine Cl can’t be low b/c block reabsorption

91
Q

Why is Isohydric principle useful

A

If we know what Bicarb is doing, we know what others are doing (all change in same direction)

92
Q

Acid Base Cells in Collecting Duct

A

Intercalated cells

93
Q

Where is Carbonic Acid eliminated?

A

Lungs

94
Q

Which RTA results from Loss of Bicarb

A

Type 2 (Proximal) RTA

95
Q

Respiratory compensation vs Metabolic Compensation

A

Respiratory compensations is rapid; Metabolic compensation (by kidneys) is slower over 1-2 days

97
Q

3 Etiology Categories of Metabolic Acidosis

A

Decreased Renal Acid Excretion; Direct Bicarb Losses; Increased Acid Generation

98
Q

Total CO2 concentration =

A

Dissolved CO2 + Bicarbonate concentration in venous sample; 25-26 mEq/L

99
Q

Normal Chloride

A

105

Renal (31 decks)

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