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PHS 3300 > Acid Base Balance > Flashcards

Acid Base Balance Flashcards

1
Q

what happens to the pH as H+ increases

A

it decreases

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2
Q

what is the normal arterial pH

A

7.40

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3
Q

what is the normal range of arterial pH

A

7.35-7.45

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4
Q

what is the normal HCO3-

A

24mM

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5
Q

what is the normal H2CO3

A

1.2mM

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6
Q

what is the ratio of HCO3 to H2CO3

A

20:1

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7
Q

pCO2 x solubility in water = what

A

moles of carbonic acid

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8
Q

what is the formula to determine moles of carbonic acid

A

pCO2 x solubility in water = moles

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9
Q

what produces bicarbonate in the body

A

kidney

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10
Q

what are the 2 ways the kidney produces bicarbonate

A

1) convert buffered acids into more acid salts
2) produce new HCO3-

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11
Q

glutamine becomes what

A

NH4 and HCO3-

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12
Q

a drop in the pH stimulates what in the lungs

A

ventilation to drop CO2

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13
Q

what is the metabolic component in acid base balances

A

HCO3-

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14
Q

what is the respiratory component in acid base balance

A

dissolved carbon dioxide

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15
Q

what is the normal range of plasma HCO3-

A

22-28mM

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16
Q

when does metabolic acidosis occur

A

under 22 mM of HCO3-

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17
Q

when does metabolic alkalosis occur

A

when plasma HCO3- is over 28 mM

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18
Q

name 3 reasons metabolic acidosis occurs

A

decreased HCO3- production (kidney)
loss of base
increase addition of fixed acid

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19
Q

what is the anion gap

A

difference between the measured cations and the measured anions in plasma

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20
Q

what is the formula for anion gap

A

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

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21
Q

what is the normal anion gap

A

6-16 mmol/L

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22
Q

what is the anion gap used to determine

A

if metabolic acidosis is due to an accumulation of non-volatile acids OR a net loss of biocarbonate

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23
Q

what are some causes of a normal anion gap metabolic acidosis

A

gut bicarbonate loss
Renal bicarb loss

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24
Q

how does the body compensate for a renal bicarbonate loss

A

rise in plasma chloride (kidneys try to reabsorb more chlorine)

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25
Q

what is an increased anion gap metabolic acid

A

an addition of an acid that increase the anion gap

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26
Q

what are the 2 causes of increased anion gap metabolic acidosis

A

addition of acid
failure of acid secretion

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27
Q

at what level of GFR does the kidney struggle to excrete H+ and retain acid anions

A

under 20 mL/min

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28
Q

what is the normal pCO2 and the normal range

A

range - 35-45 mmHg
pCO2 - 40 mmHg

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29
Q

when does resp acidosis occur

A

PCO2 over 45 mm Hg

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30
Q

when does resp alkalosis occur

A

when PCO2 is under 35 mm HG

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31
Q

Pulmonary hypoventilation is a big cause of:

A

resp acidosis

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32
Q

what causes pulm hypoventilation

A

asthma
rib fractures
tumors
emphysema
edema

lots of things

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33
Q

what is pulm hyperventilation caused by

A

anxiety
salicylate ingestion
extreme pain

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34
Q

at what level of pH are seizures a risk

A

7.8

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35
Q

what is the normal range of plasma potassium

A

3.5-5 mM

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36
Q

plams (K) under 3.5mM is

A

hypokalemia

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37
Q

plasma (K) over 5 mM is

A

hyperkalemia

38
Q

what does aldosterone do with regards to sodium

A

activates ENaC to bring Na into the cell

39
Q

will aldosterone be secreted for high or low potassium levels

A

high

40
Q

what has the greatest effect on membrane potential

A

changes in ECF potassium

41
Q

what would you see on an ECG with hyperkalemia

A

widened QRS
peaked T wave

42
Q

what would you see on an ECG with hypokalemia

A

flattened T wave
U wave appears

43
Q

what is a big heart danger with hyperkalemia

A

cardiac arrest

44
Q

what is a big heart danger with hypokalemia

A

fatal arrythmias

45
Q

what effect does insulin have on potassium

A

stimulates uptake

46
Q

what do catecholamines do with potassium

A

stimulate uptake

47
Q

what releases catecholamines

A

sympathetic nerves
adrenal medulla

48
Q

how do you treat hyperkalemia if K is over 6.5 and only has peaked T waves

A

decrease K intake
remove the cause
stop K-sparing diuretics

49
Q

name 3 most serious electrical effects of hyperkalemia

A

sustained gradual depolarization

inactivation of Na channels

Renders the heart virtually unexcitable

50
Q

name 3 ways to treat hyperkalemia if K is over 6.5 with an abnormal ECG or if K is over 8

A

antagonise electrical effects
redistribute K
Remove K from the body

51
Q

name 3 of the most serious electrical effects of hypokalemia

A

sustained hyperpolarization causes full activation of Na channels
Conduction abnormalities
prolonged repolarization

52
Q

what effect does sustained hyperpolarization have on QRS complex

A

it shortens it

53
Q

what percent of sodium reabsorption is each part of the nephron responsible for

A

proximal - 65
ascending limb - 25
distal - 7
collecting duct - 3

54
Q

what diuretic affects the ascending limb

A

loop

55
Q

what diuretic affects the distal tubule

A

thiazides

56
Q

what diuretic affects the collecting duct

A

amiloride

57
Q

mutations in genes that code for what type of cell can cause bartters syndrome

A

sodium potassium chloride cotransporters

58
Q

mutations in genes that inactivate sodium potassium chloride transporter cause what kind of syndrome

A

Bartters

59
Q

Bartters syndrome affects what part of the nephron

A

ascending limb

60
Q

gitelman’s syndrom affects what part of the nephron

A

distal tubule

61
Q

Pseudohypoaldosteronism affects what part of the neprhon

A

collecting duct

62
Q

Gitelman’s syndrome affects what cotransporter

A

Sodium chloride

63
Q

pseudohypoaldosteronism affects what channel

A

ENaC

64
Q

what ion builds up in the blood with pseudohypoaldosteronism

A

K

65
Q

what is the normal sodium plasma

A

137-145 mmol/L

66
Q

what happens to cells in a hypertonic ECF expansion

A

they shrink - water leaves cells to dilute the ECF

67
Q

does volume of ECF in a hypotonic expansion inc or dec

A

increase

68
Q

what does ADH do

A

acts on nephrons to stimulate water reabsorption

69
Q

what is hyponatremia

A

too little sodium

70
Q

what is the major solute in the ECF

A

sodium

71
Q

what are some clinical features of hyponatremia

A

brain edema:
lethargy
confusion
agitation
seizures

72
Q

what is hypovolemic hypernatremia due to

A

loss of water from the kidneys

73
Q

what is isovolemic hypernatremia due to

A

diabetes insipidus

74
Q

what is hypervolemic hypernatremia due to

A

renal retention de to hyperaldosteronism

75
Q

what are some clinical features of hypernatremia

A

brain cells shrink due to water leaving:
muscle twitches and seizures

76
Q

what is diabetes insipidus

A

a deficient in signaling to the aquaporin channels causing lack of water retention

77
Q

what 2 things does PTH stimulate

A

Ca uptake in kidneys
Ca release from bones

78
Q

what does active vitamin D stimulate

A

Ca uptake in intestines

79
Q

as blood calcium levels go up, what happens to phosphate

A

it goes down

80
Q

why does an increase in calcium lower phosphate levels

A

because it inhibits the release of PTH (which releases phosphate)

81
Q

why does an increase in phosphate dec calcium levels

A

because phsophate binds to calcium reducing the amount of free calcium available

82
Q

what are 2 main causes of hypercalcemia

A

hyperparathyroidism
malignancy

83
Q

what are some treatments of hypercalcemia

A

loop diuretics
surgery to remove PT tissue if PTH is too high

84
Q

what are some clinical features of hypercalcemia

A

lethargy
depression
kidney stones
nauseau
Shorter QT interval

85
Q

name 3 causes of hypocalcemia

A

vit d deficiency
hypoparathyroidism
hyperphosphatemia

86
Q

what are some clinical features of hypocalcemia

A

neuromuscular irritability
muscle cramps
prolonged QT interval

87
Q

what is bone disease in CRF due to

A

loss of calcium phosphate from bone that cannot be replaced due to deficiency of active vit D

88
Q

PTH (inc or dec) as GFR (inc or dec)

A

increases as GFR decreases

89
Q

what is the trade off hypothesis

A

how PTH increases as GFR decreases

90
Q

what are 3 treatments for bone disease in CKD

A

reduce phosphate intake
GI phsophate binders
inject active vit D

PHS 3300 (19 decks)

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