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VET 409: Renal > Acid/Base Balance > Flashcards

Acid/Base Balance Flashcards

1
Q

what does pH measure

A

free hydrogen ion concentration

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2
Q

alkalosis

A

high blood pH

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3
Q

acidosis

A

low blood pH

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4
Q

HCO3/CO2 buffer system

A

pH = HCO3 / CO2

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5
Q

what is pCO2 regulated by

A

lungs

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6
Q

what is HCO3 regulated by

A

kidneys

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7
Q

metabolic acidosis

A

low HCO3

loss of HCO3 or gain of acid

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8
Q

metabolic alkalosis

A

high HCO3

gain of HCO3 or loss of acid

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9
Q

respiratory acidosis

A

high pCO2

hypoventilation

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10
Q

respiratory alkalosis

A

low pCO2

hyperventilation

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11
Q

what does TCO2 measure

A

proxy for HCO3

measures metabolic a/b abnormalities

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12
Q

standard base excess

A

estimates how much acid/base is missing/in excess

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13
Q

what does SBE = 0 indicate

A

normal health

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14
Q

what does SBE > range indicate

A

alkalosis

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15
Q

what does SBE < range indicate

A

acidosis

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16
Q

when does respiratory compensation occur

A

immediately

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17
Q

when does metabolic compensation occur

A

starts in hours, finishes in days

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18
Q

does compensation completely normalize pH

A

NO

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19
Q

what is a mixed a/b abnormality

A

both respiratory and metabolic abnormalities

20
Q

can mixed abnormalities normalize pH

A

YES

21
Q

causes of respiratory acidosis/alkalosis

A

lung or brain/nervous system disease

22
Q

causes of metabolic alkalosis

A

loss of acid - renal or gastric
gain of bicarb - iatrogenic

23
Q

causes of metabolic acidosis (high AG)

A

D: diabetic ketoacidosis
U: uremic acidemia
E: ethylene glycol toxicity
L: lactic acidosis

24
Q

causes of metabolic acidosis (normal AG)

A

loss of bicarbonate - renal or intestinal

25
Q

anion gap

A

unmeasured anions

AG = (Na + K) - (HCO3 + Cl)

26
Q

what is the function of the kidneys in acid/base balance

A
  1. reabsorb filtered bicarbonate
  2. excrete daily acid load (carnivores)
  3. excrete excess bicarbonate (herbivores)
27
Q

is losing a bicarbonate the same as gaining a hydrogen ion

A

YES

28
Q

where does the majority of HCO3 reabsorption occur

A

PCT and loop of henle

(constant amount)

29
Q

where does the regulation of HCO3 reabsorption occur

A

DCT

30
Q

is HCO3 directly reabsorbed

A

no - does not cross luminal membrane

combines with H+ and undergoes carbonic anhydrase reaction to form CO2 + H2O which transports into tubule epithelial cell, then undergoes another CA reaction to reform HCO3

HCO3 gets reabsorbed and H+ gets pushed back out to the tubule lumen

31
Q

is HCO3 reabsorption acid/base neutral

A

YES

for every 1 HCO3 filtered at glomerulus there is 1 HCO3 getting reabsorbed

32
Q

what drives HCO3 reabsorption

A

gradients established by Na/K ATPase

33
Q

how does the DCT regulate HCO3 reabsorption

A

two types of intercalated cells (type A and B)

34
Q

intercalated A cells

A

push acid (H+) out into lumen
reabsorbs bicarb (HCO3) into blood

35
Q

intercalated B cells

A

push bicarb (HCO3) out into lumen
reabsorbs acid (H+) into blood

36
Q

if H+ excretion = HCO3 filtration at glomerulus, what is the net HCO3 loss/gain

A

NO loss or gain

for every 1 H+ excreted –> 1 HCO3 gets reabsorbed

so if H+ excretion is equal to HCO3 filtration, then no net change in A/B balance

37
Q

how does H+ excretion change in ALKALOSIS

A

do not want to reabsorb all HCO3 because there is already excess in the blood

decrease H+ excretion until H+ excretion < HCO3 filtration

causes net loss of HCO3

38
Q

how does H+ excretion change in ACIDOSIS

A

need to generate new bicarbonate to raise pH

increase H+ excretion until H+ excretion > HCO3 filtration

excess H+ cannot be freely excreted –> must bind to buffers to avoid changing urine pH

39
Q

urinary buffers

A
  1. phosphate
  2. ammonium
40
Q

how does phosphate help during acidosis

A

combines with free H+ in tubule for excretion

allows reabsorption of a new HCO3 ion –> net gain HCO3 –> increases pH

41
Q

how does ammonium help during acidosis

A

NH4 is produced by glutamine metabolism in PCT –> metabolism gets up-regulated during acidosis

every 1 NH4+ excreted = 1 H+ excreted = 1 HCO3 generated –> increases pH

42
Q

how does the kidney respond to alkalemia

A
  1. decrease H+ excretion by inhibiting intercalated A cells
  2. increase HCO3 excretion by stimulating intercalated B cells
  3. down regulate glutamine metabolism
43
Q

what is acute kidney injury

A

decrease in GFR –> kidney failure

44
Q

what acid/base changes are common in AKI in carnivores

A

metabolic acidosis w/ high anion gap

protein metabolism –> increase acids –> unable to excrete daily load

45
Q

what acid/base changes are common in AKI in herbivores

A

metabolic alkalosis

carbohydrate metabolism –> increase bicarb –> unable to excrete daily load

OR

metabolic acidosis w/ high AG due to uremic acid accumulation

46
Q

sign of renal tubular acidosis

A

metabolic acidosis w/ normal AG

NOT in kidney failure - GFR is normal

VET 409: Renal (21 decks)

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