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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
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. medullary collecting duct
26
In the medullary collecting duct, "new" bicarbonate is made by non-bicarbonate buffer is also use, which means there is a ratio of ____
1:0 (bicarbonate: non-bicarbonate buffer)
27
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
B. proximal convoluted tubule
28
In which part of the kidney is bicarbonate "recovered"?
PCT
29
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
C. High Capacity, Low Gradient, 1:1
30
Summarize bicarbonate recovery in the PCT in four steps:
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
What contributes to the high capacity of bicarbonate recovery?
High [Na] in the PCT
32
The predominant mechanism for H+ secretion in the proximal tubule is dependent upon the ______
Na/H Exchanger
33
In bicarbonate recovery, Ang II increases the activity of what two transporters?
1) Apical Na/H 2) Na/HCO3 co-transporter
34
True or False: During bicarbonate recovery, in the tubular lumen, CA keeps H+ concentrations low, therefore: optimizing gradient for additional H+ secretion
True
35
When new bicabonate is made in the PCT, what is consumed in the buffering process?
NaHCO3
36
Summarize the formation of new bicarbonate via glutamine metabolism in the PCT:
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
True or False: Retention of new bicarbonate in PCT is dependent upon ammonium (NH4) secretion by Na exchange
True
38
If NH4 were not secreted into the tubular lumen and, instead, were returned to circulation, what would happen?
NH4 would be metabolized by the liver to form urea and H+ (this would negate new bicarbonate formation)
39
The positive charge on NH4 (ammonium) prevents ____ in the proximal tubule
reabsorption
40
Ammonium secretion in the proximal tubule increases markedly in what condition?
Chronic acidosis
41
What stimulates glutaminase activity?
Acidosis
42
An increase in NH4+ excretion could be in response to what condition?
Severe acidosis
43
How does hyperkalemia affect glutaminase?
Hyperkalemia inhibits glutaminase
44
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
D. Low Capacity, High Gradient
45
Summarize production of "new" bicarbonate in the medullary collecting tubule via non-bicarbonate buffers:
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
How does increased plasma CO2 affect H+ production and H+ secretion?
ELEVATED plasma CO2 will... INCREASE H+ production and increase H+ secretion
47
How will DECREASED HCO3 affect H+ secretion?
DECREASED HCO3 will INCREASE H+ secretion
48
How will respiratory acidosis affect H+ excretion? How will metabolic acidosis affect H+ secretion?
Respiratory acidosis will INCREASE H+ excretion Metabolic acidosis will INCREASE H+ secretion and excretion
49
Acidosis will increase activity of CA, which favors production of ___ and ___, as well as secretion and excretion of ___
HCO3/H+; H+
50
How will an increase in plasma K+ affect HCO3 recovery?
Increase in plasma K+ will reduce HCO3 recovery
51
The only limitation to H+ secretion is the production of __ in the renal tubular cells
H
52
Another name for the condition in which a patient has metabolic acidosis with a NORMAL anion gap is _______
hypercholremic acidosis
53
Main causes of normal anion gap + metabolic acidosis?
1) Diarrhea (loss of HCO3) 2) Renal failure
54
What is the most common cause of metabolic acidosis + widened anion gap?
Diabetic ketoacidosis
55
Other causes of: metabolic acidosis + widened anion gap?
1) Ingesting metahanol 2) Inhaling toluene (sniffing glue)
56
How is respiratory acidosis corrected vs. compensated?
Corrected: Increase RR Compensated: More HCO3 made in kidney

Physiology II (23 decks)

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