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PAM Semester 3 > ABG's > Flashcards

ABG's Flashcards

1
Q

What is carbonic anhydrase reaction

A 
CO2 + H2O ←CA→ H2CO3 ↔ H+ + HCO3-
CO2 combines with H2O
and using carbonic anhydrase
makes carbonic acid
Carbonic acid then dissociates into H+ and bicarbonate
Occurs in the Red blood cells
This equation occurs in the tissues/capillaries
the reverse occurs in thelungs
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2
Q

What happens to the charge when HCO3- leaves the red blood cell

A

a Cl- ion enters to balance the charge

Known as chloride shift

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3
Q

What is chloride shift

A

when a HCO3 leaves a red blood cell and a cl- enters in order to balance the charge

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4
Q

where does this equation occur?

CO2 + H2O ←CA→ H2CO3 ↔ H+ + HCO3-

A

in the tissue/capillaries
Forward in lungs,
backwards in tissues
the reverse equation occurs in the lungs

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5
Q

Where does this equation occur?

H+ + HCO3- ↔ H2CO3 ←CA→ H2O + CO2

A

In the lungs
Forward in lungs,
backwards in tissues
the reverse occurs in the tissus/capillaries

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6
Q

What is reverse chloride shift

A

the HCO3 enters the red blood cell while a cl ion leaves

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7
Q

describe neural reflexes in the control of breathing

A

as CO2 goes up, minute vetilation goes up
(linear relationship, straight line)
CO2 is powerful stimulus for ventilation

O2 is not the same, it needs to drop a really long ways to have any changes in ventilation
(to around 40mmhg)

Central and peripheral chemoreceptors detect the changes
they respond to changes in arterial blood gases
and
H+ ion concentrations

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8
Q

Talk about the blood brain barriers role in ventilation

A

The BBB is impermeable to H+ and HCO3
It is permeable to CO2
this can cause rapid changes in acid base status
The more CO2, the more ventilation

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9
Q

CO2 in relation to ventilation

A

the more CO2 the more ventilation

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10
Q

A 9-ycar-old boy decided to find out for how long he could continue to breathe
into and out of a paper bag. After approximately 2 minutes, his friends noticed
that he was breathing very rapidly so they forced him to stop the experbnent.
What change in arterial blood gas composition was the most potent stimulus
for this boy’s hyperventilation?

A. Dcacased Pco2
B. Decreased Po2
C. Decreased pH
D. Increased Pco2
E. Increased Po2
F. lncrcaacd pH
A

D. Increased Pco2

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11
Q

A 22-year-old man was involved in a fight in which he received a severe blow
to the head. On arrival at the emergency department. he was unconscious and
initially received assisted ventilation via a manual bag-valve device. An analysis
of his arterial blood gases shows:
Po2 =45mmHg
Pco2 = 80 mm Hg
pH=7.05
HC0,-=27 mM
In what form was most col being transported in his arterial blood?

A. Bicarbonate ions
B. Carbaminohemoglobin comp

A

A. Bicarbonate ions

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12
Q

A 3-month-old infant presented with persistent vomiting and was lethargic.
Arterial blood gas analysis shomd the following results:
Pao2 = 88 mm Hg
Pacoi = 44 mm Hg
pH = 7.60
[HCO,-J = 36 mEq/L
Base excess = + 12 mEq/L
Which of the following primary acid-base disturbances is present?

A. Respiratory alkalosis
B. Respiratory acidosis
C. Metabolic alkalosis
D. Metabolic acidosill

A

C. Metabolic alkalosis

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13
Q 
The results of an arterial blood gas analysis of a 56-year-old man with a history
of heavy smoking are as follows:
Pao2 = 60 mm Hg
Paco2 = 60 mm Hg
pH = 7.33
[HCO,-J = 32mEq/L
Base excess = + 8 mEq/L
The patient has a partially compensated

A. mpiratory alkalosis
B. respiratory acidosis
C. metabolic alkalosis
D. metabolic acidosis

A

B. respiratory acidosis

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14
Q

What is an acid

A

any chemical that gives up a H+

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15
Q

What is a base

A

Any chemical that accepts a H+

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16
Q

What happens at ph of 6.8 and below

A

CNS depression
coma
death

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17
Q

What happens at ph of 8.0 or above

A 
excitation of the nercous system
muscle tetany
convulsions
respiratory arresst
death
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18
Q

what are 2 sources of acid

A

Respiratory Acid
CO2
H2co3

Nonvolatile acid / nonrespiratory acid
Lacric acid
ketones

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19
Q

What are 2 major buffering systems

A

Chemical buffering system
Bicarbonate (CO2) most importatn
phosphate
protein

Physiological buffering system
Respiratory CO2 excretion (quick)
Renal hydrgogen ion excretion (slow)

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20
Q

How do chemical buffers maintain the normal blood ph

A

respiratory
disposes of CO2
if we start to get acidic, we blow off CO2

Kidneys
elimniates H+ ions
if we start to get acidic 
we excrete H+ ions
form bicarb
put bicab bak into blood

Diet can effect ph

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21
Q

What do the kidneys excrete to help maintain acid base balance

A

acid

H+ ions

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22
Q

What are alpha intercalated cells for

A

they secrete H+ to the blood

a for acid

23
Q

What are Beta intercalated cells for

A

they secret bicarb

b for bicarb

24
Q

How do the kidneys play a general role in maintaining acid base homeostasis

A

the kidneys excrete excess acid

the kidneys regulate blood ph by reabsorbing filtered bicarbonate

25
Q

What does NH4+ do

A

gets rid of H+ ions in the urine

26
Q

describe ammonium ions

A

they get rid of H+ ions in the urine
they are formed rom glutamate
they ae secreted into the tubular urine

27
Q

What are factors that can lead to increased H+ secretion by the kidney tubule epithilium

A 
Decreased intracellular pH
increased arterila blood pco2
CA activity
sodium reabsorption
K+ decrease
increased aldosterone
28
Q

What is compensation mechanism for respiratory acidosis

A

kidneys increase H+ excretion

29
Q

What is compensation mechanism for respiratory alkalosis

A

kidneys increase HCO3- excretion

30
Q

What is compensation mechanism for metabolic acidosis

A

alveolar hyperventilation

kidneys increase H+ excretion

31
Q

What is compensation mechanism for metabolic alkalosis

A

Alveolar hypoventilation

kidneys increase HCO3- excretion

32
Q

Describe things that lead to metabolic acidosis

A 
Kidney failure, cant excrete acid
excess keytones, diabetes
accumulation of non respiratory acid
prolonged diahrrea
prolonged vomiting
33
Q

Describe things that lead to metabolic alkalosis

A

gastric drainage
vomiting
loss of acids

34
Q

What is metabolic acidosis

A

a condition in which the tissue and blood ph is abnormally low due to an increase in non volatile acids

35
Q

In the defense of acid-base balance, which of the following processes takes the longest time for completion?

A. Buffering by bone
B. Distribution and buffering in the extracellular fluid
C. Renal excretion of acid
D. Respiratory compensation

A

C. Renal excretion of acid

36
Q

Mixed venous blood has a lower pH than arterial blood (e.g., 7.35 vs. 7.40). The main reason for the lower pH of venous blood is its

A. higher bicarbonate concentration.
B. higher carbonic acid concentration.
C. higher oxygen content.
D. lower oxygen content.

A

B. higher carbonic acid concentration.

37
Q

You get your final exam result back and are over the moon with how well you did. To celebrate you gorge on lots of pizza and have a few too many alcoholic beverages. That night you throw up your stomach contents. As a result, you may be in a state of:

A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis

A

D. Metabolic alkalosis

38
Q

How is intracellular ph regulated

A

cellular ph is maintained by extruding H+ ions
must take in HCO3- at the same rate as H+ going out
Same as at systemic level

39
Q

What are respiratory acidosis and alkalosis caused by

A

altered levels of PaCO2

40
Q

things that can cause respiratory acidosis

A

begin to accumulate CO2
decreased rate of breathing
aiway obstruction
decreased gas exchange

41
Q

things that can cause respiratory alkalosis

A

Decrease in acids

decrease in CO2
anxiety
fever
poisoning
high altitude
hyperventilation

decrease in H2co3
Decrease in H+

42
Q

pH PCO2 HCO3-
Metabolic Acidosis ↓ ↓ ↓↓
Metabolic Alkalosis ↑ ↑ ↑↑
Respiratory Acidosis ↓ ↑↑ ↑
Respiratory Alkalosis ↑ ↓↓ ↓

A

pH PCO2 HCO3-
Metabolic Acidosis ↓ ↓ ↓↓
Metabolic Alkalosis ↑ ↑ ↑↑
Respiratory Acidosis ↓ ↑↑ ↑
Respiratory Alkalosis ↑ ↓↓ ↓

43
Q

What is the key physiological buffer

A

Bicarbonate carbon dioxide system

onley works in an open system
can remove CO2 through hyperventilation
kindeys excrete H+ ions
Kidneys put bicarb back into blood

44
Q

What is the bicarbonate system based on

A

the strong buffering capacity of the respiratory system

45
Q

Does the respiratory or chemical system neutralize more acid

A

Respiratory system neutralizes 2-3 times as much acid as chemical buffers can

46
Q

What are 3 methods of compensation

A

metabolic - immediate
quick acid relase

pulmonary - minutes to hours
CO2 expelled or retained

renal - hours to days
H+ increased to form acids
H+ excreted trhough ammonium

47
Q

Time period for respiratory compensation to a metabolic disorder

A

begins within 30 mintues
complete within 12 - 24 hours

PCO2 should move in same direction as bicarb

48
Q

metabolic compensation for respiratory disorders

A

immediate small change in HCO3
if porblem persists
much larger change in HCO3
takes 3-5 days

49
Q

What is delta ratio

A

Change in anion gap divided by change in bicarb
less than 1 normal metabolic acidosis
1 to 1 = uncompensated metabolic acidosis
1 to 2 or over 2 = metabolic alkalosis with metabolic acidosis

50
Q

what is the acid that doesnt effect anion gap

A

HCL

51
Q

What are causes of high anion gap over 30

A 
lactic acidosis
ketoacidosis
uremia
toxic alcohol ingestion
slicylate lactic acid
acetaminophen
pyroglutamic acid
fromic acid
oaxlic acid
ethlene glycol
52
Q

4 conditions that adversely effect anion gap

A

hypoalbuminemia
hypyerkalemia
hypermagneseia
hypercalcimeia

53
Q

which acid base disorder is anion gap typically asociated with

A

metabolic acidosis

54
Q

what is unmeasured but typically responsible for anion gap

A

albumin
use corrected anion gap whenalbumin is not normal
normal albumin is 4.5

PAM Semester 3 (8 decks)

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