Acid Base

Question 1

Below what pH are we in acidosis?

Answer 1

7.35

Question 2

Above what pH are we in alkalosis?

Answer 2

7.45

Question 3

What is the normal range for pH?

Answer 3

7.35 - 7.45 (ECF fluid pH)

Question 4

How do acids enter our body?

Answer 4

Ingestion (we eat a LOT more ACIDS than bases), normal cellular metabolism

Question 5

What’s the pathway of excess acids when they get into our body?

Answer 5

H+ first buffered by Bicarb & protein in ECF then H+ moves into ICF via H+/K+ exchanger where its buffered by phosphates (H2PO4) and protein, kidney secretes H+ ions in form of Titratable acids, ammonia (both of which each produce a new bicarb),
* Kidney also reabsorbs filtered bicarb

Question 6

What is the major buffer in ECF?

Answer 6

Bicarb (HCO3-) (it binds w/ H+ acids)

Question 7

What’s the major buffer in ICF?

Answer 7

Phosphates (H2PO4), proteins

Question 8

How does kidney hand le excess acids?

Answer 8

1. Reabsorption of filtered bicarb

2. Secretion of H+ ions via forming titratable acids and ammonium (which each produce a new bicarb)

Question 9

How does kidney hand le excess acids?

Answer 9

FIRST: Reabsorption of filtered bicarb
THEN: Secretion of H+ ions via forming titratable acids and ammonium (which each produce a new bicarb)

Question 10

Where does most of HCO3- reabsorption occur?

Answer 10

Proximal tubule

Question 11

Where can HCO3- reabsorption occur?

Answer 11

Proximal tubule, distal tubule

Question 12

Where can HCO3- reabsorption occur?

Answer 12

Proximal tubule (Na+/H+ and HCO3-Cl antiporter OR HCO3-Na symporter, distal tubule (K+/H+ and HCO3-Cl- antiporter OR HCO3-Na symporter)

Question 13

The Kidney breaks down glutamine into what 2 products?

Answer 13

NH4+ and Bicarb

Question 14

What’s the net acid excretion equation?

Answer 14

Bases - Acids
= Bicarb - (Titratable Acids + NH4+)
= HCO3- - (TA + NH4+)

Question 15

Is most excess acid is excreted as NH4+ or TA?

Answer 15

NH4+

Question 16

How do you determine what causes acidosis or alkalosis? i.e. how do you know if its respiratory vs. metabolic?

Answer 16

1. pH: is it below 7.35 (acidosis) or above 7.45 (alkalosis)?
2. pCO2: if above 40 = acidic, if below 40 = alkalosis
3. HCO3-: if below 24 = acidosis, above 24 = alkalosis
4. Which matches the pH? that determines respiratory or metabolic!

Question 17

If a disease/condition is recurrent, is it chronic or acute?

Answer 17

Chronic!

Question 18

What’s the normal range for anion gap?

Answer 18

8-12

Question 19

What does an anion gap of 13 or more tell you?

Answer 19

likely an acidosis

Question 20

If an individual has a normal anion gap, could it be causes by a base loss?

Answer 20

Yes! But, could NOT be caused by acid gain

Question 21

What does anion gap tell you,

why do we calculate it?

Answer 21

whether acidosis is caused by acid gain or base loss

Question 22

What’s the most prevalent titratable acids inside of tubules?

Answer 22

Phosphates (mainly H2PO4) so secreted into lumen of tubules!

Question 23

What is the liver product (AA) that is broken down to form ammonia?

Answer 23

Glutamine

Question 24

What equation helps you decide whether acidosis is create from an acid gain or base loss?

Answer 24

Anion Gap

Question 25

What's the typical plasma concentration of bicarb?

Answer 25

24 mm/L | Filtered Load = GFR x Px = 180 L/day * 24mm/L = 4320 mmol/day

Question 26

What hormone increases Na+ reabsorption by increasing the # of H+/Na+ transporters in the Proximal Tubule?

Answer 26

Angiotensin II

Question 27

What are 2 ways of reabsorbing the HCO3- across the basolateral membrane in the proximal tubule?

Answer 27

HCO3- Na+ SYMporter (Na+ & HCO3 go OUTSIDE cell) | HCO3- Cl- ANTIporter (Cl- goes INSIDE cell)

Question 28

What's the major difference between Type A/alpha and Type B/beta intercalated cells in Distal Tubule?

Answer 28

They both have the same transporters but in Type A intercalated cells have K+ (in)/H+(out) exchanger/antiporter OR H+ pump on apical membrane and HCO3-/Cl- antiporter on basolateral membrane In Type B = its vice versa where HCO3-/Cl antiporter is on apical membrane (so beta cells SECRETE HCO3-) and K+ (in)/H+ (out) antiporter OR H+ pump (ATP) is on basolateral membrane

Question 29

Under what acid-base conditions are Type A intercalated cells active?

Answer 29

acidosis

Question 30

Under what acid-base conditions are Type B intercalated cells active?

Answer 30

alkalosis

Question 31

Do we have Na+/HCO3- symporters in distal tubule?

Answer 31

No! Only have Na+/Cl-

Question 32

Where do we create and secrete ammonia?

Answer 32

Proximal tubule To make ammonia from glutamine, takes a long time (delay) even though its UNLIMITED

Question 33

Where do we create and secrete titratable acids?

Answer 33

Distal tubule

Question 34

What are different causes of acid gain?

Answer 34

1. Decreased respiration (due to airway obstruction e.g. COPD, emphysema) 2. ketoacids (diabetes) 3. renal failure (bec/ kidneys can't secrete acids) 4. Diarrhea = Base loss

Question 35

Diarrhea is a common cause of what condition?

Answer 35

Acidosis bec/ diarrhea is a base loss

Question 36

What is the anion gap equation?

Answer 36

AG = Na - (Cl- + HCO3-)

Question 37

Acid load acts as an unmeasured ______, unlike base loss bec/ when HCO3- lost, it's replaced by _______ . This is why Anion Gap is normal when we have a base loss.

Answer 37

anion, Cl-

Question 38

Vomiting and/or hyperventilating cause what condition?

Answer 38

Alkalosis (it's a loss of fixed acid) Alternatively, alkalosis can also be caused by base gain due to overdosing on base

Question 39

What are the 2 processes by which the kidneys regulate plasma concentration of HCO3?

Answer 39

1. Reabsorbing filtered bicarb (HCO3-) | 2. Producing new HCO3 by either forming and secreting Titratable acids or forming and secreting ammonium/ammonia

Question 40

Do titratable acids change pH of the blood or urine?

Answer 40

NO! TAs are neutral molecules

Question 41

Does Ammonium change the pH of blood or urine?

Answer 41

Yes

Question 42

What is azotemia?

Answer 42

excess nitrogenous waste in urine

Question 43

What is azotemia?

Answer 43

excess nitrogenous waste in blood

Question 44

Is 16 breaths/min a normal respiratory rate?

Answer 44

Yes. | Range = 12-20

Question 45

The higher the creatinine the lower the _____?

Answer 45

higher creatinine, lower GFR | bec/ creatinine is only filtered = so glomerulus is not working

Question 46

The higher the creatinine the lower the _____?

Answer 46

higher creatinine, lower GFR | bec/ creatinine is only filtered = so glomerulus is not working if creatinine is high

Question 47

How do you figure out GFR from plasma creatinine levels?

Answer 47

GFR = 1/Plasma Creatinine

Question 48

How do you figure out GFR from plasma creatinine levels?

Answer 48

GFR = 1/[Plasma Creatinine]

Question 49

If you go from laying down to standing up, what happens to your BP?

Answer 49

goes down (this is orthostatic hypotension)

Question 50

Vomiting causes what conditions?

Answer 50

alkalosis due to acid loss (H+ and Cl-), so low Cl- levels (hypocholerima), dehydration due to volume loss (dehydration decreases GFR and increases creatinine levels)

Question 51

What is indicated by loss of skin turgor and flat jugular veins?

Answer 51

Low BP due to low blood volume

Question 52

During hypokalemia, what happens to K+ and H+ ions?

Answer 52

H+ ions pumped out, K+ ions pumped in

Question 53

What are normal plasma Cl- levels?

Answer 53

105 mEq/L

Question 54

What are normal plasma Na+ levels?

Answer 54

135-145 mEq/L

Question 55

What are normal plasma K+ levels?

Answer 55

4 mEq/L