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Chemical Pathology > Acid Base Balance > Flashcards

Acid Base Balance Flashcards

1
Q

explain Acidosis

A

PH below the normal range, also known as acidemia

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2
Q

Explain alkalosis

A

PH above the normal range, also known as alkalemia

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3
Q

what is metabolic

A

renal component 1.e. HCO3-affected

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4
Q

what is respiratory

A

Lung component i.e. pCO2 affected

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5
Q

Normal metabolism produces which ions constantly

A

Hydrogen ion

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6
Q

Aerobic metabolism of fat and carbohydrates produces what?

A
  1. Produces carbon dioxide in solution it form carbonic acid
  2. Organic acids
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7
Q

Oxidative metabolism of proteins, nucleic acid and phospholipids produces what?

A

Phosphoric acid and sulphuric acid

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8
Q

Normal metabolic processes such as glucogenesis and oxidation of ketones removes the bulk of what?

A

hydrogen ions produced, however, 50 – 100 mmols of excess hydrogen produced everyday
is dealt with by excretion

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9
Q

Explain PH in sorenson formula

A

The negative log of hydrogen ion concentration pH= -log [H+]

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10
Q

One word

Solution that contains a conjugate acid-base pair, made up of a weak acid and its salt, whihc minimises the changes in pH.

A

Buffer

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11
Q

Give example of buffer chemical reaction

A

write your answer down

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12
Q

Under physiological buffers
Proteins, particulary haemoglobin has a high capacity for binding which ions?

A

Hydrogen ions

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13
Q

write down the equation of the most important buffer system in the extracellular fluid compartment

A
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14
Q

The henderson-hasselbalch equation is unique because?

A
  • Equilibrium is never reached, H2CO3 dissociates into H2O and CO2, which is exhaled
  • HCO3 is retained and regenerated by the kidneys
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15
Q

Understanding the henderson-hasselbalch
explain the respiratory part

A

CO2 is released and exhaled via the lungs
This creates a situation where equilibrium cannot
be reached at this end of the equation
Changes on this end of the equation happen at a
faster pace in the case of respiratory compensation
after a metabolic shift
Carbonic Anhydrase facilitates the breakdown of
H2CO3

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16
Q

Understanding the henderson-hasselbalch equation
Explain the metabolic component

A

HCO3 supply and hydrogen ion concentration determine
the equilibrium at this end of the equation
HCO3 is reabsorbed and regenerated in the kidney in order
to maintain supply
Changes on this end of the equation take place at a much
slower pace so metabolic (renal) compensation after a
respiratory shift

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17
Q

In oxygen/hemoglobic dissociation
The graph shift to the right when?

A

Increase in pCO2, [H+], temp, DPG
Decrease in pH, Sulf-Hb, HBSS
Decrease in oxygen affinity so increasing in oxygen unloading

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18
Q

The oxygen/hemoglobin dissociation curve shift to the left

A

Increase in oxygen affirnity so decreasing in oxygen unloading
Decrease in pCO2, [H+], temp, DPG
Increase pH
Decrease [pO42], met-Hb, CO-Hb, fetal-Hb

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19
Q

explain the Bohr effect

A

Effect of co2
Increase in carbon dioxide
Lowers pH
Reduces affinity for o2

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20
Q

The arterial or capillary sample is used to measure what?

A

Measure arterial pO2 and pCO2 values

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21
Q

The heparinised sample is used for what?

A

Most CO2 is carried in red blood cells so an anticoagulamted sample is required

22
Q

used a sealed syringe because?

A

To prevent O2 and CO2 diffusing out of the sample

23
Q

why the sample is put on the ice?

A

To prevent ongoing red cell metabolism generating lactic acidosis

24
Q

Assessment of blood gas results
The results you will obtain

A

The results you will obtain:
* pH 7.35 – 7.45
* pCO2 4.5 – 6.1 kPa
* HCO3- 22 – 26 mmol/l
* Actual
* Standard
* pO2

25
Q

explain the actual Bircarbonate

A

ACTUAL BICARBONATE:
The concentration found in the patient’s blood, calculated by the blood gas analyser from the
blood sample’s measured pH and pCO2, by using the Henderson-Hasselbalch equation

26
Q

explain what is the problem about actual bicarbonate

A

Problem:
It does not allow you to accurately assess whether or not a metabolic change is present or not
BECAUSE the bicarbonate is not only influenced by the renal mechanisms described, but is also
slightly influenced by a physiological shift. As pCO2 rises, HCO3 also rises slightly.

27
Q

what is the solution of the actual bicarbonate

A

Solution:
The blood sample in the blood gas analyser is exposed to a normal pCO2 concentration of
5.3kPa and the pH is measured again. This pH is then used to calculate a new bicarbonate
concentration which is known as the STANDARD BICARBONATE

28
Q

The standard bicarbonate is used to determine what?

A

whether a metabolic change is present or not

29
Q

explain what is meant by simple acid-base disturbance

A
  • Simple acid-base disturbance
  • Usually acute and simple and easy to determine disturbance
30
Q

explain what is meant by compensated acid-base disturbance

A
  • Compensated acid-base disturbance
  • Usually longer term/chronic particularly if metabolic component is the compensator as it
    takes time to initiate response
  • pH will trend towards normal and in some cases can be normal (full compensation)
31
Q

explain what is meant by mixed acid-base disturbance

A
  • Mixed acid-base disturbance
  • Multiple disease processes going on in a patient at the same time, causing abnormality
    with pH, pCO2 and HCO3- to varying degrees depending on duration and severity
  • pH can be normal or only slightly abnormal in these cases
32
Q

List types of acid base disturbances

A
  • Metabolic acidosis with or without compensation
  • Metabolic alkalosis with or without compensation
  • Respiratory acidosis with or without compensation
  • Respiratory alkalosis with or without compensation
33
Q

List the common causes of metabolic acidosis

A

Diarrhea
Diabetic ketoacidosis
Lactic acidosis
Chronic renal failure

34
Q

less common causes of metabolic acidosis

A

renal tubular acidosis

35
Q

causes can be categorised as what in metabolic acidosis

A

Gain of hydrogen ion
Loss of bicarbonate

36
Q

Anion gap assists in derteming reasons for what?

A

Metabolic acidosis

37
Q

List the clinical effects of metabolic acidosis

A

Clinical Effects of metabolic acidosis:
1. Hyperventilation – deep, rapid and
gasping known as KASSMAUL
breathing
2. Hyperkalemia – hydrogen displaces
potassium from inside the cells
3. Neuromuscular irritability – secondary to
hyperkalemia
4. Depressed level of consciousness – can
lead to coma and death

38
Q

List the management of metabolic acidosis

A

Management:
1. Treat the primary cause
2. Correct hydration and hyperkalemia
3. Treat acidosis with bicarb if severe

39
Q

what is meant by saying blood is always electroneutral?

A

Blood is always electroneutral, even when there is an acid – base disturbance, i.e. it always contains an
equal amount of positive cations and negative anions

40
Q

We do not commonly measure all the ?

A

electrolytes

41
Q

how to get an anion gap?

A

When we subtract COMMONLY measured anions from COMMONLY measured cations, we find an
anion gap of 10 – 20 mmol/l

42
Q

The anion gap reflect what?

A

The anion gap reflects the concentration of anions that are present in the serum but are NOT routinely
or commonly measured

43
Q

what is meant by a big anion gap?

A

If the anion gap is bigger than usual, it is because one or more of these unmeasured anions has increased

44
Q

what are common causes of metabolic alkalosis

A

Vomiting
Increased renal hydrogen loss
Diurectics
Excess mineralocorticoids

45
Q

Causes of metabolic alkalosis can be categorised as?

A

Gain of bicarbonate
Loss of hydrogen ions

46
Q

List the clinical effects of metabolic alkalosis

A
  1. Hypokalaemia – due to distal
    tubular hydrogen ion secretion
  2. Tetany
47
Q

List the manangement of metabolic alkalosis

A

Management:
1. Treat the primary cause
2. Correct hydration and hypokalaemia
3. Treat hypochloraemia with normal
saline

48
Q

In respiratory acidosis the primary cause is alveolar hypoventilatin which can be due to

A

The primary cause is alveolar
hypoventilation which can be due to:
1. Decreased respiratory rate
2. Integrity of the chest wall compromise
3. Patency of the airways compromise
4. Decreased Integrity of the lung tissue
Can be acute or chronic. This will impact on
the amount of compensation that is
present.

49
Q

List the management of respiratory acidosis

A

Management:
1. Treat the underlying cause i.e. remove
the obstruction and ensure patent
airway
2. Improve alveolar ventilation –
physiotherapy, bronchodilators,
antibiotics, assisted ventilation
3. Improve hypoxia
– acute conditions: increase oxygen
concentration, flow rate and consider
assisted ventilation
– Chronic conditions: removing
hypoxia may remove respiratory drive
stimulus!! Dangerous!

50
Q

Management of respiratory alkalosis

A

Treat the underlying cause

51
Q

Under respiratory alkalosis there is always a decrease in pCO2 but not always accompanied by?

A

Hypoxia

52
Q

what are causes respiratory alkalosis

A

Caused by:
1. Direct stimulation of the respiratory
centre e.g. drugs, anxiety, brain stem
disease
2. Mechanical overventilation
3. Hypoxia
1. High altitude
2. Anaemia
3. Pulmonary Oedema

Chemical Pathology (1 decks)

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