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Patho 1 > 3 - Acids and Bases > Flashcards

3 - Acids and Bases Flashcards

1
Q

What is an alkali?

A

Another word for a base

Molecule formed by an alkaline metal and a highly basic ion like hydroxyl

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2
Q

What are the alkali metals

A

Farthest left column of the periodic table

lithium, sodium, potassium

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3
Q

How does an alkali or base react with free H+?

A

The base portion of the molecules bind with H+ and remove it from the solution

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4
Q

What is a strong acid?

Give an example

A

rapidly dissociates and releases especially large amounts of H+ in a solution

Hydrochloric Acid (HCl)

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5
Q

What is a weak acid?

Give an example

A

Less likely to dissociate their ions, and release H+ much more slowly

Carbonic Acid (H2CO3)

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6
Q

What is a strong base?

Give an example

A

Reacts rapidly and strongly with H+ and quickly removes it from a solution

Hydroxide (OH-)

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7
Q

OH- reacts with H+ to form ______

A

water

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8
Q

What is a weak base?

Give an example

A

Binds weakly with H+

Bicarbonate (HCO3-)

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9
Q

At a normal pH of 7.4, what is the [H+]?

A

40 nEq/L

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10
Q

What are the upper and lower limits of pH in humans?

A

6.8 - 8.0

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11
Q

What is the pH of gastric HCl?

A

0.8!

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12
Q

Acid base regulation occurs in what three places?

A

The blood (buffers)

The lungs (respiration)

The kidneys (excretion of bicarb and H)

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13
Q

What is the function of the buffer system?

A

Do not effect the total amount of H+ in the body

They keep the H+ tied up until balance can be restored

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14
Q

What is the definition of a buffer?

A

Any substance that can reversibly bind H+

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15
Q

How is carbonic acid (H2CO3) formed?

A

CO2 + H2O ⇔ H2CO3

Carbonic anhydrase increases the speed of reaction

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16
Q

Where is carbonic anhydrase especially abundant?

A

Aveolar Walls

Renal Tubule Walls

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17
Q

In the buffering system, what is the primary reason the [H+] is so low?

A

H2CO3 is a very weak acid, so it holds onto almost all the

H+ it binds to

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18
Q

In buffering systems, what is K’ ?

A

The dissociation constant

The concetration of the acid relative to its dissociated ions

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19
Q

What is the calculation of K’ of H2CO3?

A

K’ = (H x HCO3) / (H2CO3)

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20
Q

The amount of CO2 dissolved in the blood is directly proportional to the amount of ______________

A

undissociated H2CO3

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21
Q

What is pK?

A

-log K

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22
Q

What is the Henderson-Hasslebach Equation?

What does it calculate?

A

pH = 6.1 + log [(HCO3)/(0.03 x PCO2)]

the pH of a solution if the molar concentration of HCO3 and the PCO2 are known

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23
Q

Any metabolic acid-base disorder is caused by

A

a primary change in the ECF [HCO3]

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24
Q

What is the pK of of the bicarb buffer system?

A

6.1

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25
Q

In the bicarb buffer system, if the pK is equal to the pH, what does that mean?

A

each of the components (HCO3 and CO2) are present in equal amount

50% of the total concentration of the system is HCO3

50% of the total concentration of the system is CO2

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26
Q

Given that the pKa of the bicarb buffer system is 6.1, why are the kidneys and lungs so important?

A

A system is most effective within 1 pH unit above or below the pKa

Since the pH of the ECF is about 7.4, the bicarb buffer system is operating outside of its optimal effect

The difference is made up by the lungs and kidneys

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27
Q

Where does the phosphate buffer system play a primary role?

Where does it not?

A

Renal tubular fluid and intracellular fluid

extracellular fluid

28
Q

What is the pK of the phosphate system?

A

6.8

29
Q

Why is the phosphate buffer system important in the kidneys?

A
  1. There’s an increase concentration of phosphate in the tubules
  2. the pH of the tubules is nearer 6.8
30
Q

Why is the phosphate buffer system important in the ICF?

A

The intracellular [PO4] is much highert than in the ECF

31
Q

It takes a long time for H+ and HCO3 to diffuse across a cell membrane, except in ________ cells

A

RBCs

32
Q

What percentage of chemical buffering occurs inside cells?

A

60-70%

33
Q

What is the isohydric principle?

A

A change in the balance of one buffer system effects the other

Buffer systems actually buffer one another by shifting H+ back and forth between them

34
Q

What is the relationship between CO2 and H?

A

Increased CO2 expulsion decreases H by mass effect

35
Q

Which is more effective: respiratory response to a low pH or a high pH?

A

low pH. Lungs don’t respond that much to increased pH

36
Q

How effective is respiratory control in moderating [H]?

A

about 50-75% effective

37
Q

If the pH falls from 7.4 to 7, the respiratory control can increase the pH to about

A

7.2 or 7.3

38
Q

Which is more effective: blood buffering or respiratory buffering?

A

Respiratory, but about 1-2x

39
Q

What are nonvolatile acids?

A

Non-carbonic acids that cannot be excreted by the lungs

40
Q

Why does the body produce nonvolatile acids?

A

Metabolism of proteins

41
Q

How are nonvolatile acids removed from the ECF?

A

THe kidneys

42
Q

What are the three mechanisms of kidney [H] regulation?

A
  1. secretion of H
  2. Reabsorption of HCO3
  3. Production of new HCO3
43
Q

In the kidneys, for each HCO3 that is reabsorbed, _________ must be secreted

A

Hydrogen

44
Q

Where does 90% of HCO3 reabsorption occur?

A

Proximal tubule

45
Q

What happens in the tubules if there is more H than HCO3?

A

All of the bicarb is reabsorbed, and the excess H if buffered and sent into the urine

46
Q

What happens in the tubules if there is more HCO3 than H?

A

Excess HCO3 cannot be reabsorbed, so it is left in the tubules and excreted by the urine

47
Q

How is the excretion of large amounts of H in the urine accomplished?

A

Combining H with buffers in the tubular fluid, usually phosphate and ammonia

48
Q

How is new bicarb synthesized in the tubules?

A

when H binds with phosphate or amoonia HCO3 is reabsorbed

49
Q

What happens when CO2 is combined with H2O in the tubule?

A

Forms carbonic acid, which is a weak acid and dissociates into H + HCO3.

The hydrogen is expelled from the cell and the HCO3 is reabsorbed

50
Q

In the setting of chronic acidosis, how do the kidneys make more HCO3?

A

Increased [H+] stimulates renal gulatime metabolism, increasing formation of NH4, which increases the amount of HCO3 that can be formed

51
Q

What are the most important stimuli for increasing H secretion by the tubules in acidosis?

A
  1. An increase in ECF PCO2 (respiratory)
  2. An increase in [H+] of the ECF (resp and metabolic)
52
Q

What happens to H secretion when Angiotensin II is increased?

Decreased?

A

Increased

Decreased

53
Q

What happens to H secretion when PCO2 is increased?

Decreased

A

Increased

Decreased

54
Q

What happens to H secretion when Aldosterone is increased?

Decreased?

A

Increased

Decreased

55
Q

What happens to H secretion when ECF volume is increased?

Decreased?

A

Decreased

Increased

56
Q

What happens to H secretion when K is increased?

Decreased?

A

Decrease

Increase

57
Q

Factors that stimulate Na reabsoprtion will have what effect of H and HCO3?

A

increase H secretion and HCO3 reabsorption

58
Q

Hyperkalemia decreases ________ and tends to cause _________

A

H secretion and HCO3 reabsorption

acidosis

59
Q

What is renal tubular acidosis?

A

impairment of HCO3 reabsorption

OR

inability of renal tubular H secretion to establish normal acidic urine

60
Q

What are some causes of renal tubular acidosis?

A

chronic renal failure

Addison’s Disease (insufficient aldosterone secretion)

Fanconi Syndrome

61
Q

Diarrhea is the most common cause of metabolic _______.

Why?

A

acidosis

GI secretions contain large amounts of bicarb, and motility is too rapid they can’t be reabsorbed

62
Q

Why does chronic renal failure cause acidosis?

A
  1. Buildup of nonvolatile acids
  2. Reduced excretion of phosphates and ammonia reduce amount of HCO3 produced
63
Q

What is the real anion gap in the plasma?

A

Zero!

The anion gap is only a diagnostic concept

64
Q

Causes of Increased Anion Gap Acidosis

A

Ketoacidosis

Uremia

Salicylate

Starvation

Methanol

Lactic Acidosis

65
Q

Causes of Normal Anion Gap Acidosis

A

Diarrhea

Renal tubular acidosis

carbonic anhydrase inhibitors

Addison Disease

Patho 1 (17 decks)

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