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renal final > Acid Base > Flashcards

Acid Base Flashcards

1
Q

which dissociate more: strong or weak acids

A

strong

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2
Q

what is a volatile acid

A

CO2. H2CO3. can be removed from body by ventilation

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3
Q

what is the other type of acid in the body

A

fixed acids, or nonvolatile

sulfuric, phosphoric etc

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4
Q

majority of the acid in our bodies comes from what

A

oxidative metabolism

CO2+H2O–>H2CO3–> H+ HCO3-

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5
Q

What are the 3 lines of defense against pH changes in the body

A

chemical buffers
respiration
kidneys

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6
Q

what is the main chemical buffer in the body

A

HCO3

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7
Q

what type of acids do the kidneys excrete

A

nonvolatile

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8
Q

what is the first line defense against an increase in H+

A

RBC taking it up and bind with Hb

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9
Q

why is the bicarb buffer system so powerful

A

HCO3 and CO2 are abundant

readily adjusted by respiration and renal function

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10
Q

Describe the response of bicarb to a strong acid addition

A

HCO3 binds some CO2
remove excess CO2 via respiration
kidneys add new HCO3 and excrete H

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11
Q

What happens when the renal system has excess acid

A

all of filtered HCO3 is reabsorbed and additional H is secreted as NH4

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12
Q

what is the renal response to excess base

A

incomplete reabsorption of filtered HCO3
decreased H secretion
secretion of HCO3 in collecting duct

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13
Q

H+ excess is excreted in which two ways

A

titratable acid–> conjugate bases like phosphate, urate and creatinine
or as ammonia, joins NH3 in lumen

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14
Q

how do we calculate H excretion

A

urinary excretion of titratable acid+ ammonium- HCO3

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15
Q

where in the nephron is hte urine most acidic

A

in collecting duct

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16
Q

What cells secrete H+ and HCO3 in collecting duct

A

alpha intercalated secrete H via H ATPase, also exchanges for a K+ to maintain charge
beta intercalated secrete HCO3 while reabsorbing Cl

17
Q

most of H secreted in proximal tubule serves what purpose

A

to reabsorb filtered HCO3

18
Q

does the pH change much in proximal tubule

A

no because majority H secreted binds HCO3 for reuptake

19
Q

reabsorption of HCO3 ultimately depends on what

A

the Na K ATPase to cause Na gradient for Na/H exchanger

20
Q

How are the kinetics set up for reabsorption of HCO3

A

saturable

21
Q

where does the NH4 excreted in urine come from

A

break down of glutamine that yields two NH4 and 2 HCO3 ultimately

22
Q

why do we increase NH4 in chronic acidemia

A

because will be excreted and also produces 2 HCO3 with it

23
Q

What factors control H secretion in renal system

A 
intracellular pH (lower pH higher excretion)
plasma pCO2( highger pCO2 higher excretion)
inhibiting carbonic anydrase leads to metabolic acidosis
increased Na reabsorption increases H secretion(volume changes)
increase EC K levels decrease excretion of H
increase aldosterone, increase H excretion
24
Q

describe the connection of diuretic abuse to alkalemia

A

RAAS system to increase aldosterone which stim K /H secretion and also diuretics cause K depletion leading to tubular secretion of H
all bicarb is reabsorbed

25
Q

what is the differense between acidosis and acidemia

A

acidosis produces acidemia

26
Q

What can cause metabolic acidosis

A

gain of fixed acids like ketones and lactic acid

loss of bicarb from diarrhea

27
Q

what can cause metabolic alkalosis

A

excessive vomiting

gain of strong base

28
Q

What is the formula for anion gap

A

Na- Cl- HCO3

29
Q

What is the normal range of anion gap

A

3-18

30
Q

what is the anion gap used to Dx

A

metabolic acidosis

31
Q

If the anion gap is normal in an acidotic patient what do you suspect

A

hyperchloremic acidosis

gain Cl for loss of HCO3-

32
Q

what is high anion gap acidosis

A

normochloremic
HCO3 is replaced by unmeasure anion
(lactate, ketoacidosis, poisoning)

33
Q

What is the pneumonic for high anion gap acidosis

A

E ELM PARK and MUDPILEs

34
Q

what are common causes for metabolic acidosis with a high anion gap

A

methanol, metformin, paraldehyde

aspiring, renal failure, ketones, ethanol

renal final (6 decks)

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