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Phys 2 > Acid-Base > Flashcards

Acid-Base Flashcards

1
Q

What 7 things cause respiratory alkalosis:

A
  1. Hyperventilation
  2. Anxiety
  3. High altitudes
  4. Pregnancy
  5. Fever
  6. Hypoxia
  7. Initial stages of pulmonary emboli
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2
Q

What does pH and CO2 look like in respiratory alkalosis:

A

pH: increase
CO2: decrease

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3
Q

What does pH and HCO3 look like in metabolic alkalosis:

A

pH: increase
HCO3: increase

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4
Q

What does pH and CO2 look like in respiratory acidosis:

A

pH: decrease
CO2: increase

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5
Q

What does pH and HCO3 look like in metabolic acidosis:

A

pH: decrease
HCO3: decrease

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6
Q

What 3 things cause metabolic alkalosis:

A
  1. Loss of gastric juices
  2. Potassium wasting diuretic (loss of H)
  3. Overuse of antacids
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7
Q

What 6 things cause respiratory acidosis:

A
  1. Drugs overdose
  2. Pulmonary edema
  3. Chest trauma
  4. Neuromuscular disease
  5. COPD
  6. Airway obstruction
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8
Q

What 6 things cause metabolic acidosis:

A
  1. Shock
  2. Sepsis
  3. Diarrhea
  4. Renal failure
  5. Salicylate OD
  6. Diabetic ketoacidosis
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9
Q

A single unit pH change reflects how much in [H]?

A

10 fold change

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10
Q

Small changes in pH reflect relatively what changes in [H]?

A

Large changes

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11
Q

Physiological pH changes affect in what 2 ways?

A
  1. Protein activity (enzymes and transporters)

2. Membrane function

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12
Q

What are the 3 different physiological acids?

A
  1. Volatile acid (CO2)
  2. Metabolic intermediates
  3. Acidic, non-volatile end products
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13
Q

Complete oxidation of biological fuels produces CO2 which combines with water to form carbonic acid

A

Volatile Acid (CO2)

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14
Q

Many intermediates in fuel metabolism are carboxylic acid:

Lactic acid, acetoacetate, beta-hydroxybutyrate

A

Metabolic intermediates

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15
Q

Sulfuric acid and phosphoric acid

A

Acidic, non-volatile end products

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16
Q

Metabolic activity generates roughly how much H+ per day?

A

15,000 mmol H+

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17
Q

What is required in order to maintain serum and intracellular pH values what in acceptable ranges?

A

Buffers

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18
Q

What is the primary buffer system and where is it used?

A

Bicarbonate-carbonic acid - used in all extracellular fluids

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19
Q

Buffer is a mixture of what 2 things?

A

Weak acid and conjugate base

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20
Q

The kidney can do what with the bicarbonate buffer system?

A

Add or remove HCO3- or alter serum H+

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21
Q

Normal value of pH, PCO2, HCO3-, ion gap?

A

7.4/40/24/12

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22
Q

Will the concentration of anions always equal concentration of cations?

A

Yes

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23
Q

What is the major cation present in anion gap?

A

Na

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24
Q

What are the major anions in the anion gap?

A

Cl and HCO3

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25
Q

What is the anion gap?

A

Difference between [Na] and the sum of [Cl] and [HCO3]

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26
Q

What could be 6 other miscellaneous anions?

A
  1. L or D lactate
  2. Ketones
  3. Salicylate
  4. Pyroglutamate
  5. Metabolic products of toxic alcohols
  6. Retained non-volatile acids of renal failure
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27
Q

What 2 things happen when large quantities of non-volatile acids accumulate in serum like lactic acidosis and ketoacidosis?

A
  1. Reduce serum bicarbonate levels because protons that dissociate from weak acids combine with serum bicarbonate
  2. Conjugate bases of weak acids contribute as ‘other anions’ to ion gap
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28
Q

What is the result when large quantities of non-volatile acids accumulate in the serum?

A

Larger than normal ion gap

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29
Q

Is it normal for bicarb and CO2 to be synergistic?

A

No

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30
Q

4 causes of respiratory alkalosis (low PCO2)?

A
  1. Hyperventilation
  2. Hypoxia
  3. CNS disease
  4. Sepsis
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31
Q

4 causes of metabolic alkalosis (high HCO3)?

A
  1. Vomiting, nasogastric suction
  2. Diuretic use
  3. Excess mineralocorticoid activity
  4. Posthypercapnia (high serum CO2)
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32
Q

4 causes of respiratory acidosis (high PCO2)?

A
  1. Hypoventilation
  2. Neuromuscular disorders
  3. Acute airway obstruction
  4. Impaired lung function (severe pneumonia, pulmonary edema, thoracic cage injury, chronic lung disease)
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33
Q

4 causes of metabolic acidosis (low HCO3)?

A
  1. Ketoacidosis (diabetic, alcoholic)
  2. Lactic acidosis (anaerobic metabolism)
  3. Salicylates (secondary effect)
  4. GI bicarbonate loss (diarrhea)
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34
Q

What are the 3 anion gap metabolic acidoses?

A
  1. Ketoacidosis (diabetic, alcoholic)
  2. Lactic acidosis (anaerobic metabolism)
  3. Salicylates (2ndary effect)
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35
Q

Nonanion gap metabolic acidoses result from what?

A

Renal or GI loss of bicarbonate; will increased serum chloride levels

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36
Q

Presence of ion gap >20 mEq, even when a patient is alkalosis or has a normal serum pH, is high predictive of what?

A

Anion gap metabolic acidosis

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37
Q

What is the mnemonic for remembering causes of ion gap acidosis?

A

KULT
Ketoacidosis (DKA, alcoholic ketoacidosis, starvation)
Uremia (renal failure)
Lactic acidosis
Toxins (ethylene glycol, methanol, paraldehyde, isoniazid, salicylates)

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38
Q

What 3 things decrease in ESRD pts?

A
  1. Hematocrit
  2. HCO3
  3. pH
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39
Q

What are the death limits of pH?

A

6.8-7.8

40
Q

Metabolism of macronutrients produces what?

A

Significant volatile acid load (CO2) and smaller nonvolatile acid load

41
Q

The body principally uses what 3 systems to buff 15,000 mEq/d of acid

A
  1. Rapid buffering in the ECF by HCO3 and phosphate
  2. Rapid pulmonary exhalation of CO2
  3. Slow renal excretion of H using NH3 and phosphate as buffers
42
Q

What foods are alkali (2)?

A

Fruity and veggies

43
Q

What foods are acidic (3)?

A

Meat, grains, and dairy

44
Q

What system has the kidneys and lungs work together?

A

Bicarbonate buffer system (most abundant ECF physiochemical buffer)

45
Q

Bicarbonate buffer system is shifted in what direction to remove CO2 from lungs?

A

Left due to increased CO2.

46
Q

What do the kidneys do in the bicarbonate buffer system?

A

Filter HCO3 and combine it with secreted H

47
Q

Hederson-hasselbalch equation to determine the pH in buffer system by focusing on what relationship?

A

HCO3 and CO2

48
Q

What is the metabolic component in the Henderson-hasselbalch equation?

A

HCO3 (kidney)

49
Q

What is the respiratory component in the Henderson hasselbalch equation?

A

CO2 (lungs)

50
Q

Normal value of H?

A

40

51
Q

Normal value of pH?

A

7.4

52
Q

Normal value of PaCO2?

A

40

53
Q

Normal value of HCO3?

A

24

54
Q

What kind of disturbance with less time means generally less compensation?

A

Acute

55
Q

What kind of disturbance with more time means generally more compensation?

A

Chronic

56
Q

Compensation helps normalize pH but does it help to correct the original disturbance?

A

NO

57
Q

How much of the filtered load of HCO3 is typically excreted in the urine?

A

0%

58
Q

What 3 things promotes H secretion/HCO3 reabsorption?

A
  1. Acidosis (high PCO2 or H / low HCO3)
  2. Aldosterone or AngII / low ECFV (more Na/H activity)
  3. Hypokalemia
59
Q

Normal urine output is what pH?

A

Acidic (5.5)

60
Q

How much why is there no net aid secretion or generation?

A

Because hydrogen ions are continually recycled in this reclamation process

61
Q

What happens with bicarb and H in the kidneys?

A

Bicarb is reabsorbed and H is secreted

62
Q

PT and TAL secrete H how much?

A

~80%

63
Q

When is H secretion + filtered bicarb = carbonic acid used?

A

During normal or acidosis

64
Q

How does AngII affect the PT and TAL?

A

Increase Na/H transporter activity

65
Q

How does increased acid load affect PT and TAL?

A

Increase HCO3 transporters

66
Q

AngII is worried about Na reabsorption or H secretion?

A

Na reabsorption and permissive with H secretion

67
Q

What does the H-K-ATPase (type A intercalated cells) do in the collecting duct?

A

K reabsorbed and H secreted

68
Q

When is the H-K-ATPase pump used in collecting duct?

A

During normal and acidosis

69
Q

H-K-ATPase activity increase in states of what and what does it cause?

A

Hypokalemia and lead to alkalosis

70
Q

How does aldosterone affect the H-K-ATPase in collecting duct?

A

Increase H-ATPase, K/H exchanger and Na/K pump

More important when chronically elevated

71
Q

Increasing renal H secretion tends to promote what?

A

Hypokalemia

72
Q

Does bicarb serve as the renal base and why?

A

No because we need to reabsorb it and actually produce more of it

73
Q

Why is there little free H filtered from the glomerulus capillaries to Bowman’s space?

A

Because the normal [H] is 40

74
Q

Most H in the tubular lumen has built up from what?

A

Tubular secretion

75
Q

The removal of H is the biochemical equivalent of bicarbonate generation but we need somewhere to put the H that is secreted into the tubule. What 2 things can they get put into?

A
  1. Phosphate buffer

2. Ammoniagenesis

76
Q

Does phosphate and ammonia buffers increase or decrease during chronic acidosis?

A

Increase

77
Q

What are the 2 fixed (non-volatile) acid excretion?

A
  1. Filtered HPO4 to H2PO4 formation in the PT and CD

2. Secreted NH4 and NH3 to NH4 in the PT and CD

78
Q

What are the first line of defense, and are considered the primary filtered urinary buffers?

A

Phosphate and sulfate

79
Q

What adapts to meet demand and becomes the primary buffer?

A

Ammonia

80
Q

Large acid loads are excreted mainly in the form of what?

A

Ammonium

81
Q

Both systems of urinary buffers do what?

A

Free up bicarb for reabsorption

82
Q

Acid in the urine is mainly in the form of what 2 things?

A

Ammonium ions and phosphoric acid (~70 mEq/d of fixed acid)

83
Q

Renal venous blood contains more what than the renal arterial blood?

A

HCO3

84
Q

As GFR declines, the risk of what increases?

A

Metabolic acidosis

85
Q

If you want to excrete acid (normal and acidosis) what 5 things can occur?

A
  1. Freely filter HCO3 at glomerulus
  2. Reabsorb 80% of filtered HCO3 in PT
  3. Reabsorb additional 19% of HCO3 in TAC, DT, CD
  4. Secrete some H, H2PO4, and NH4 in DT, CD
  5. Excrete acidic urine containing H2PO4 and NH4
86
Q

If you want to excrete base (alkalosis) what 5 things occur?

A
  1. Freely filter HCO3 at glomerulus
  2. Reabsorb 80% of filtered HCO3 in PT
  3. Reabsorb less bicarb from HCO3 TAC, DT, CD (10%)
  4. Secrete some HCO3 in DT, CD
  5. Excrete alkaline urine containing more HCO3 than usual
87
Q

pH: <7.4
HCO3: <24

A

Metabolic acidosis

88
Q

pH: <7.4
HCO3: <24
PCO2: <40

A

Respiratory compensation

89
Q

pH: <7.4
PCO2: >40

A

Respiratory acidosis

90
Q

pH: <7.4
PCO2: >40
HCO3: >24

A

Renal compensation

91
Q

pH: >7.4
PCO2: <40

A

Respiratory alkalosis

92
Q

pH: >7.4
PCO2: <40
HCO3: <24

A

Renal compensation

93
Q

pH: >7.4
HCO3: >24

A

Metabolic alkalosis

94
Q

pH: >7.4
HCO3: >24
PCO2: >40

A

Respiratory compensation

95
Q

How would the kidneys deal with ECF fixed acid load?

A

Recover virtually all filtered bicarb

96
Q

The kidneys excrete acid by attaching secreted hydrogen ions to filtered or synthesized urinary bases like?

A

Phosphate (normally)

Ammonium (particularly during acidosis)

97
Q

During acidosis, most acid is excreted by converting what to what, and then what?

A

Glutamine to bicarb and ammonium then excreting the ammonium and returning the bicarb to blood

Phys 2 (5 decks)

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