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Physiology II > Acid Base (8-10) > Flashcards

Acid Base (8-10) Flashcards

1
Q

Normal pH range?
Normal pCO2 range?
Normal HCO3 range?

A

pH = 7.35-7.45
pCO2 = 35-45
HCO3 = 22-26

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2
Q

Anion gap is ___ +/- ____

A

Anion gap is 12 +/- 4 (8-16)

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3
Q

What is the most important blood buffer? Why is it effective?

A

Bicarbonate buffer system
- High HCO3 concentration

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4
Q

What is the second most effective blood buffer?

A

Hb

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5
Q

Plasma proteins have an ideal pKa, but they are not good blood buffers. Why?

A

Low concentration in the blood

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6
Q

Bone buffers are particularly important in which type of condition?

A

Chronic metabolic acidosis

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7
Q

True or False: During chronic metabolic acidosis, osteoclasts in the bone are activated and release additional calcium carbonate and calcium phosphate into extracellular fluid

A

True

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8
Q

True or False: During chronic metabolic acidosis, excess hydrogens are exchanged with Ca, Na, and K associated with carbonate on the bone surface

A

True

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9
Q

What is the primary intracellular buffer? Why are they effective?

A

Proteins, organic/inorganic phosphates
- high intracellular concentrations

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10
Q

Is intracellular bicarbonate an effective buffer? Why or why not?

A

NO - low intracellular [bicarbonate]

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11
Q

Common cause of metabolic acidosis?
Common cause of respiratory acidosis?

A

Metabolic acidosis = Diarrhea
Respiratory acidosis = COPD

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12
Q

How is metabolic acidosis buffered?

A

HCO3 (extracellular buffer)

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13
Q

How is metabolic acidosis compensated?

A

Increase ventilation and reducing pCO2

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14
Q

Why is bicarbonate NOT an effective buffer for respiratory acidosis?

A

HCO3 cannot buffer H2CO3 because combination of H+ and HCO3 would result in regeneration of carbonic acid (H2CO3)

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15
Q

How is respiratory acidosis buffered?

A

Intracellular buffers

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16
Q

Transcellular Exchange of Ions during acidosis vs. alkalosis?

A

Acidosis
- H + influx
- K + efflux

Alkalosis
- K + influx
- H+ efflux

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17
Q

How do renal cells respond to alterations in intracellular [H]?

A

Changing expression of CA and activity of Glutaminase

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18
Q

With acidosis, the increase in H+ activates promoter region on DNA for _____; the increase then increases rate of ____ and ___

A

carbonic anhydrase; bicarbonate recovery and new bicarbonate production

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19
Q

How does hyperkalemia affect K and H levels?
Common causes of hyperkalemia?

A

K influx
H efflux

Cause = acute renal failure (urinary retention)

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20
Q

How does hypokalemia affect K and H?

A

H influx
K efflux

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21
Q

To diagnose a patient with ______, we need to know if change in [HCO3] is due to ___ or ___

A

mass action; metabolic compensation

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22
Q

Metabolism of carbs and fats produce ___, which combines with water in RBC’s to form carbonic acid. This reaction is facilitated by Carbonic Anhydrase.

A

CO2

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23
Q

Carbonic acid dissociates to form ___ and ___

A

HCO3 and H+

24
Q

Metabolism of cysteine and methionine generates ___ while metabolism of lysine produces ____

A

sulfuric acid; HCl

25
Q

In which part of the kidney is: carbonic anhydrase use to make “new” HCO3 and the secreted H+ is neutralized by non-bicarbonate buffers?
A. medullary collecting duct
B. proximal convoluted tubule
C. loop of henle

A

A. medullary collecting duct

26
Q

In the medullary collecting duct, “new” bicarbonate is made by non-bicarbonate buffer is also use, which means there is a ratio of ____

A

1:0 (bicarbonate: non-bicarbonate buffer)

27
Q

In which part of the kidney is: glutamine metabolized to form new bicarbonate and ammonium?
A. medullary collecting duct
B. proximal convoluted tubule
C. loop of henle

A

B. proximal convoluted tubule

28
Q

In which part of the kidney is bicarbonate “recovered”?

A

PCT

29
Q

Which of the following best describes bicarbonate recovery?
A. Low Capacity, High Gradient, 1:0
B. Low Capacity, Low Gradient, 1:1
C. High Capacity, Low Gradient, 1:1
D. High Capacity, High Gradient, 1:0

A

C. High Capacity, Low Gradient, 1:1

30
Q

Summarize bicarbonate recovery in the PCT in four steps:

A

1) CO2 and water move from circulation/tubular lumen into the epithelial cells to interact with CA
2) CA converts CO2 and water to H+ and HCO3
3) HCO3 gets pumped into circulation via symporter (Na/HCO3) and co-transporter (Cl-/HCO3)
4) H+ gets pumped into lumen via: Na/H exchanger* and H ATPase, where it binds to filtered bicarbonate, and is converted back H2CO3→CO2+H2O→Excreted

31
Q

What contributes to the high capacity of bicarbonate recovery?

A

High [Na] in the PCT

32
Q

The predominant mechanism for H+ secretion in the proximal tubule is dependent upon the ______

A

Na/H Exchanger

33
Q

In bicarbonate recovery, Ang II increases the activity of what two transporters?

A

1) Apical Na/H
2) Na/HCO3 co-transporter

34
Q

True or False: During bicarbonate recovery, in the tubular lumen, CA keeps H+ concentrations low, therefore: optimizing gradient for additional H+ secretion

A

True

35
Q

When new bicabonate is made in the PCT, what is consumed in the buffering process?

A

NaHCO3

36
Q

Summarize the formation of new bicarbonate via glutamine metabolism in the PCT:

A

1) Glutamine diffuses from circulation and is transporter (via Na/Glutamine) from tubular lumen INTO the epithelial cells
2) In the epithelial cells, GLS converts glutamine to: 2 bicarbonate and 2 ammonium (NH4)
3) HCO3 enters circulation via symporter (HCO3/Na)
4) NH4 enters tubular lumen via anti-porter (Na/NH4)
5) Filtered ammonia (NH3) buffers H+ secreted into the tubular lumen to make NH4+ (diffusion trapping)

37
Q

True or False: Retention of new bicarbonate in PCT is dependent upon ammonium (NH4) secretion by Na exchange

A

True

38
Q

If NH4 were not secreted into the tubular lumen and, instead, were returned to circulation, what would happen?

A

NH4 would be metabolized by the liver to form urea and H+ (this would negate new bicarbonate formation)

39
Q

The positive charge on NH4 (ammonium) prevents ____ in the proximal tubule

A

reabsorption

40
Q

Ammonium secretion in the proximal tubule increases markedly in what condition?

A

Chronic acidosis

41
Q

What stimulates glutaminase activity?

A

Acidosis

42
Q

An increase in NH4+ excretion could be in response to what condition?

A

Severe acidosis

43
Q

How does hyperkalemia affect glutaminase?

A

Hyperkalemia inhibits glutaminase

44
Q

Which statement best describes production of new bicarbonate via non-bicarbonate buffers?
A. High Capacity, High Gradient
B. Low Capacity, Low Gradient
C. High Capacity, Low Gradient
D. Low Capacity, High Gradient

A

D. Low Capacity, High Gradient

45
Q

Summarize production of “new” bicarbonate in the medullary collecting tubule via non-bicarbonate buffers:

A

1) Water and CO2 are in the epithelial cell and are converted into HCO3 and H+ via CA
2) HCO3 enters circulation via anti-porter (HCO3/Cl-)
3) H+ enters into the tubular lumen via H+ ATPase
4) Secreted H+ is buffered by non-HCO3 buffers (e.g HPO4)

46
Q

How does increased plasma CO2 affect H+ production and H+ secretion?

A

ELEVATED plasma CO2 will…
INCREASE H+ production and increase H+ secretion

47
Q

How will DECREASED HCO3 affect H+ secretion?

A

DECREASED HCO3 will INCREASE H+ secretion

48
Q

How will respiratory acidosis affect H+ excretion?

How will metabolic acidosis affect H+ secretion?

A

Respiratory acidosis will INCREASE H+ excretion

Metabolic acidosis will INCREASE H+ secretion and excretion

49
Q

Acidosis will increase activity of CA, which favors production of ___ and ___, as well as secretion and excretion of ___

A

HCO3/H+; H+

50
Q

How will an increase in plasma K+ affect HCO3 recovery?

A

Increase in plasma K+ will reduce HCO3 recovery

51
Q

The only limitation to H+ secretion is the production of __ in the renal tubular cells

A

H

52
Q

Another name for the condition in which a patient has metabolic acidosis with a NORMAL anion gap is _______

A

hypercholremic acidosis

53
Q

Main causes of normal anion gap + metabolic acidosis?

A

1) Diarrhea (loss of HCO3)
2) Renal failure

54
Q

What is the most common cause of metabolic acidosis + widened anion gap?

A

Diabetic ketoacidosis

55
Q

Other causes of: metabolic acidosis + widened anion gap?

A

1) Ingesting metahanol
2) Inhaling toluene (sniffing glue)

56
Q

How is respiratory acidosis corrected vs. compensated?

A

Corrected: Increase RR
Compensated: More HCO3 made in kidney

Physiology II (23 decks)

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