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MD 4910 NCP I > 4910: C8 Acid-Base Balance > Flashcards

4910: C8 Acid-Base Balance Flashcards

1
Q

acid-base balance

A

Maintenance of homeostasis between acidity and alkalinity within body systems

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2
Q

acidemia

A

Condition of excess acid in the blood consistent with a pH < 7.35

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3
Q

acidosis

A

Conditions that produce excess acid in the blood

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4
Q

alkalemia

A

Condition of excess base in the blood consistent with a pH > 7.45

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5
Q

alkalosis

A

Conditions that produce excess base in the blood.

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6
Q

anion gap (AG)

A

The difference between unmeasured anions and cations. Is important in distinguishing types of acid-base disorders. Anion gap (AG) = (serum Na⁺) - (serum Cl⁻ + HCO3⁻); normal AG = 12-14 mEq/L

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7
Q

electro-neutrality

A

State in which the sum of the charges of the anions equals the sum of the charges of the cations.

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8
Q

Henderson-Hallel back equation

A

A formula for calculating the pH of a buffer system such a blood plasma. pH = pKª + [H2CO3] / HCO3⁻]

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9
Q

hypercapnia

A

The term used to describe an excess of the blood gas carbon dioxide (CO2).

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10
Q

Kussmaul breathing

A

Rapid, deep, and labored breathing commonly seen in people who have ketoacidosis or who are in a diabetic coma; Kussmaul breathing is named for Adolph Kussmaul, the 19th century Dr who first noted it.

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11
Q

metabolic acidosis

A

Condition resulting from either loss of bicarbonate or retention of non-volatile acid

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12
Q

metabolic alkalosis

A

Condition resulting from either retention of bicarbonate or loss of non-volatile acid

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13
Q

pK

A

The constant degree of dissociation (the ability of an acid to release its hydrogen ions) for a given solution; this is a constant amount for any given solution

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14
Q

respiratory acidosis

A

Condition resulting from excess acid in the blood secondary to carbon dioxide retention.

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15
Q

respiratory alkalosis

A

Condition resulting from excess base in the blood secondary to increased carbon dioxide expiration.

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16
Q

Acid

A

Substance that can donate or give up hydrogen ions.

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17
Q

volatile acids

A

Acids that can be converted to a gaseous form and eliminated by the lungs.

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18
Q

nonvolatile acids

A

Inorganic acids that are formed during metabolism of CHO, PRO, and lipid. The lungs cannot eliminate nonvolatile acids. aka fixed acids

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19
Q

H2CO3

A

Carbonic acid. The most important volatile acid b/c produced in the largest amounts. Dissolves readily in solution to form CO2 + H2O. PaCO2 is used as an indirect measure of this acid.

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20
Q

base

A

Substance that can accept or receive a hydrogen ion.

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21
Q

HCO3⁻

A

Bicarbonate. Predominant base in human acid-base balance.

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22
Q

buffer

A

Substance or group of substances that reacts with either acid or base in order to decrease the effect of acid or base on the pH of a solution.

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23
Q

Normal serum pH range

A

pH 7.35-7.45

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24
Q

What are the three systems the body uses to maintain acid-base balance?

A

Chemical buffering. Respiratory regulation of pH. Kidney regulation of pH.

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25
bicarbonate-carbonic acid buffer system
Primary ECF buffer against non-carbonic acid changes.
26
Protein buffer system
Primary ICF buffer; also buffers ECF. Proteins accept H⁺, some proteins can release H⁺ if alkalinity increases.
27
Hemoglobin buffer system
primary buffer against carbonic acid changes.
28
phosphate buffer system
Important urinary buffer; also buffers ICF
29
disodium/monosodium phosphate buffer
Na2HPO4 + H⁺ ⇋ NaH2PO4 + Na⁺. Buffer system within RBCs and tubules of the kidney.
30
What is the most important buffer in blood?
Hemoglobin.
31
How does hemoglobin buffer the blood?
It binds H⁺. As CO2 enters the blood it combines with H2O to form carbonic acid (H2CO3). The carbonic acid dissolves in the blood releasing H⁺, which is taken up by hemoglobin.
32
When acidosis occurs respiratory rate ?
increases (hyperventilation) in an attempt to expire more CO2 and normalize pH
33
When alkalosis occurs respiratory rate?
decreases (hypoventilation) in an attempt to conserve CO2 and normalize pH
34
In alkalosis the kidney will?
Reduce the amount of HCO3⁻ reabsorbed.
35
In acidosis the kidney will?
Increase the secretion of H⁺ and increase the amount of HCO3⁻ reabsorbed.
36
Can the kidney excreted H⁺ & HCO3⁻ at the same time?
No. It must use dibasic phosphate and ammonium to buffer acidic urine.
37
NH3
Ammonia. A base.
38
NH4⁺
Ammonium.
39
How is NH3 formed in the kidney?
The renal tubular cells form ammonia for Glutamine
40
Why is ammonium always excreted in the urine?
It can not cross back across the cell membrane, so the H⁺ is trapped
41
One-third of H⁺ is excreted as?
Phosphoric acid (H2PO4) and sulfuric acid (H2SO4).
42
What ion moves in the opposite direction of bicarbonate (HCO3⁻).
Cl⁻. The electrolytes move in the opposite direction to maintain electro-neutrality.
43
Normal arterial blood gas (ABG) of pO2, mmHg
80-100 mmHg
44
Normal arterial blood gas (ABG) pCO2, mmHg
35-45 mmHg
45
Normal arterial blood gas (ABG) HCO3⁻
21-28 mEg/L
46
Normal base excess
-2.4 - +2.3
47
Anion gap, mEq/L
8-16 mEq/L
48
Os saturation %
> 95%
48
Uncompensated
Accompanied by a change in the pH of the blood
49
Compensated
Buffered so that there is no change in the pH of the blood
50
Symptoms of respiratory acidosis
Hyperventilation. Restlessness. Apprehension. Lethargy. Muscle twitching. Tremors. Convolutions & eventual coma.
51
Treatment of respiratory acidosis
Correct underlying causative condition. Administer oxygen, or mechanical ventilation.
52
Symptoms of respiratory alkalosis
pH > 7.45. Lightheadedness. Confusion. Anxiety. Seizures. In acute PaCO2 decreased. In chronic plasma HCO3- is low.
54
Treatment of respiratory alkalosis
Correct underlying cause. Oxygen therapy. If cause is psychological CO2 rebreathing can correct symptoms.
55
Common causes on metabolic acidosis
Loss of HCO3⁻: systemic or kidney. Chronic kidney disease. Diarrhea. Fistula drainage. Ketoacidosis: DM, alcoholism, starvation. Lactic acidosis - DM, salicylate overdose.
56
Symptoms of metabolic acidosis
Kussmaul breathing. Hypotension & dysrhythmias. Lethargy, stupor, eventual coma as pH falls in CSF. Growth failure in children & osteodystrophy in adults due to removal of carbonate from bone in chronic acidosis.
57
Treatment of metabolic acidosis
Treat underlying cause. Raise pH slowly to safe level.
58
Common causes of metabolic alkalosis
Loss of acid. Vomiting. Nasogastric suctioning. Hypokalemia. Excessive base. Intravenous therapy. Blood transfusion. Antacids. Fluid imbalance.
59
Symptoms of metabolic alkalosis
pH > 7.45. Elevated HCO3⁻. K⁺< 98. Signs and symptoms are determined by underlying cause.
60
Treatment of metabolic alkalosis
Correct fluid V with KCl⁻, if related to fluid V deficit. Treat underlying cause. If severe use carbonic anhydrase inhibitor to enhance HCO3⁻ excretion.
61
When should a mixed said-base disorder be suspected when examining ABGs?
When PaCO2 and HCO3⁻ are not consistant with the measured pH.
62
What is the ratio of base to acid in the body?
20:1
63
What is the largest source of acid in the body?
Carbonic acid.
64
How is acidity of the body measured?
Indirectly through the measurement of PaCO2.
65
What organ primarily regulates CO2 in the body?
The lungs.
66
The larges source of base is ?, which is regulated primarily by ?.
Bicarbonate (HCO3⁻), the kidneys.
67
Respiratory acidosis is a result of retention of ?
CO2. PaCO2 will be increased
68
Respiratory alkalosis is a result of ?
Hyperventilation and subsequent decrease in CO2 levels.
69
Metabolic acidosis occurs when there is retention of ?
fixed acids, or excessive loss of base.
70
Metabolic alkalosis is a result of excessive loss of
fixed acids or retention of bases.
71
What are the volatile acids of the body?
Carbonic acid
72
When consumed, which component of foods contributes the most to the production of acids in the body?
Proteins
73
What substance of the body has the lowest pH?
Gastric juice.
74
What is the primary acid-base buffering system of the ICF.
Protein buffer system
75
What organ is responsible for regulation of most fixed / non-volitle acid?
Kidney
76
As H+ and HCO3- are electrolytes, which anion will be most affected by acid-base imbalances so as to maintain electroneutrality?
Chloride (Cl⁻)
77
Which acid-base disorder is associated with a larger than normal anion gap?
Metabolic acidosis
78
In hyperventilation, what would you expect to happen initially to the body's pH and either the pCO2 or HCO3- concentration?
Increases pH, decreases pCO2
79
In respiratory alkalosis, what would you expect to be the body's compensatory mechanism?
The kidney will excrete more HCO3⁻
80
Which acid-base disorder is associated with uncontrolled diabetes mellitus or starvation adaptation?
Metabolic acidosis.
81
Which acid-base disorder is associated with hyperventilation, such as might occur after intense exercise or an anxiety episode?
Respiratory alkalosis
82
In metabolic acidosis, what would you expect to happen initially to the body's pH and either the pCO2 or HCO3- concentration?
Decreased pH, decreased HCO3⁻
83
In metabolic acidosis, what would you expect to be the body's compensatory mechanism?
The lungs will expire more pCO2.
84
In metabolic alkalosis, what would you expect to be the body's compensatory mechanism?
The lungs will retain more CO2.
85
Bicarbonate appears in what form in the ECF?
NaHCO3⁻. but can also be combined with K⁺, or Mg⁺
86
pH in the body is primarily a ratio of?
H2CO3:HCO3⁻. 1 part carbonic acid to 20 parts bicarbonate.
87
Isohydric principle
If [H⁺] is altered, the base to acid ratio of all buffer systems is altered. Therefore, the status of all buffer systems can reevaluated using the ration of HCO3:CO2.
88
Normal acid base balance is maintained by?
Chemical buffering. Respiratory control of CO2. Renal control of HCO3⁻.
89
Strength of chemical buffering systems?
Strength is related to ready availability of HCO3⁻, both components can be regulated, and HCO3⁻ is regenerated by kidney.
90
Minor buffering systems in the body
PO4. Proteins
91
How do lungs respond to changes in [H⁺]
By changing rate or depth (or both) of respirations.
92
Carbonic anhydrase
Enzyme in kidney responsible for conversion of HCO3⁻ to H2CO3 to CO2 & H2O and conversion of CO2 back to HCO3⁻.
93
What is kidneys main adaptive response for an increased acid load?
In order for kidneys to secrete H⁺, it combines with NH3 to form NH4 and thus the urine pH is not affected.
94
Symptoms of acute respiratory acidosis
weakness, respiratory distress, anxiety, confusion.
95
As compensation of respiratory acidosis occurs what happens in the body?
pH returns to normal, PaCO2 and HCO3 are increased.
96
Therapeutic interventions for Respiratory acidosis?
Bronchodilators. Mucolytics. Respiratory therapy. O2 therapy. Mechanical ventilation. Hydration.
97
Compensatory response for respiratory alkalosis
kidneys retain more H⁺ & excrete more HCO3.
98
Therapeutic intervention for respiratory alkalosis
Manage underlying cause: sedatives, anti-anxiety agents for hyperventilation related anxiety.
99
What is the impact of respiratory alkalosis on K, Ca and Cl⁻
K & Ca maybe decreased. Cl⁻ maybe increased due to exchange with HCO3⁻
100
Symptoms of metabolic acidosis
Tachypnea (Kussmaul breathing). Hypotension. Cold & clammy skin. Coma.
101
physiological response to metabolic acidosis
The kidneys conserve HCO3⁻. Compensatory response = deepened respirations to increase release of CO2.
102
What is the primary cause of metabolic alkalosis?
Loss of HCl.
103
Physiological response to metabolic alkalosis
Kidneys excrete HCO3 & retain H⁺. compensatory - respiration is suppressed - CO2 is retained.
104
Steps to determine acid/base imbalance
1. evaluate pH. 2. Assess PaCO2 3. Assess HCO3 4. Is compensation present? 5. Determine the primary imbalance: always go with pH first, then check the most deviant component: respiratory vs. metabolic.
105
Metabolic acidosis all arrow point?
down: pH, HCO3⁻, PCO2
106
metabolic alkalosis all arrows point
up
107
respiratory acidosis arrows point
down, up, up. pH, HCO3⁻, PCO2
108
Respiratory alkalosis arrows point
up, down, down. pH, HCO3⁻, PCO2

MD 4910 NCP I (15 decks)

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