Acid Base

Question 1

“Thee” equation

Answer 1

H₂O + CO₂ ⇔ H₂CO₃ ⇔ H⁺ + CO₃^-

Question 2

Equation for determining [H⁺]

Answer 2

[H⁺] = (24*[pCO₂])/[HCO₃^-]

Question 3

Deep, slow, labored breathing

Answer 3

Kussmaul respirations

Question 4

Kussmaul Respirations

Answer 4

deep, slow, labored breaths

in response to acidosis

attempt to blow off excess CO₂

Question 5

Biggest buffer system in blood

Answer 5

HCO₃^-

Question 6

Proximal tubule

acid/base functions

Answer 6

reclaims HCO₃^-

excretes H⁺ as H⁺ and as NH₄⁺

(both using Na⁺ gradient)

Question 7

α-intercalated cell

acid/base function

Answer 7

H⁺ secretion via H⁺/K⁺ antiporter

H⁺ secretion via H⁺ ATPase

HCO₃^- generated to be pumped into interstitium

HCO₃^- antiported into interstitium via HCO₃^-/Cl^- antiporter

Question 8

β-intercalated cell

acid/base function

Answer 8

opposite of α-intercalated cell

excretes HCO₃^- via HCO₃^-/Cl^- exchanger

reabsorbs H⁺ via H⁺ ATPase

Question 9

Two basic types of acid/base “issues” can can have (ie acidosis, alkylosis)

Answer 9

respiratory

metabolic

Question 10

Compensation in respiratory acidosis/alkylosis

Answer 10

kidneys

Question 11

Compensation in metabolic acidosis

Answer 11

lungs

Question 12

Respiratory acidosis pathology

Answer 12

lack of ventilation

CO₂ + H₂O ⇔ H₂CO₃ ⇔ H⁺ + HCO₃^-

→ → → →

Question 13

Respiratory acidosis

ABG findings

Answer 13

low pH (ie high H⁺)

high CO₂

high HCO₃^-

Question 14

How do you compensate for respiratory acidosis?

Answer 14

Na⁺/H⁺ antiporter and Na⁺/NH₄⁺ antiporter in proximal tubule

increased H⁺ secretion via H⁺/K⁺ exchanger in α-intercalated cell

Question 15

2 basic pathologies of metabolic acidosis

Answer 15

CO₂ + H₂O ⇔ H₂CO₃ ⇔ H+ + HCO₃^-

<—————–

increased H⁺: lactate, ketones, salicylates, ethylene glycol, methanol, etc

CO₂ + H₂O ⇔ H₂CO₃ ⇔ H⁺ + HCO₃^-

—————–>

decreased HCO₃^-: diarrhea–loss of HCO₃^- in pancreatic fluids

Question 16

Respiratory compensation for metabolic acisosis

Answer 16

Kussmaul respirations

attempt to breath of excess CO₂

Question 17

Renal compensation for metabolic acidosis

Answer 17

reabsorb all HCO₃^-

excrete H⁺ in collecting duct and H⁺ transporters in proximal tubule

Na⁺/H⁺ antiporter and Na⁺/HCO₃^- antiporter

in both areas

Question 18

Anion gap is useful in differeniating

Answer 18

metabolic and respiratory acidosis

metabolic: large anion gap

respiratory: normal anion gap

Question 19

Causes of respiratory alkalosis

Answer 19

too much breathing!

pushing out CO₂, forcing equation away from HCO₃^- and towards CO₂

H⁺ + HCO₃^- ⇔ H₂CO₃ ⇔ H₂O + CO₂

→ → → →

Question 20

Compensation for respiratory alkylosis

Answer 20

renal:

β-intercalated cells appear in collecting duct, begin secreting HCO₃^- into urine

ultimately less NH₄⁺ put in urine

liver:

NH₃ + HCO₃^- → CO(NH₂)₂ (urea) + O₂

Question 21

Causes of metabolic alkalosis

Answer 21

hypokalemia

(may be 2˚ to emesis or another cause)

(H⁺/K⁺ charge buffer takes H⁺ into cells trying to secrete K⁺ to fix hypokalemia)

gastric suctioning

(iatrogenic)

Question 22

Compensation for metabolic acidosis

Answer 22

Respiratory:

breath off more CO₂ to pull off excess bicarb