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Acid-Base Balance Flashcards

1
Q

what is the normal systemic arterial blood pH?

A

7.4

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2
Q

what is considered a basic pH?

A

greater than 7.4

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3
Q

what is considered an acidic pH?

A

less than 7.4

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4
Q

Compensation

A

the attempt of renal and respiratory mechanisms to reestablish a normal pH

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5
Q

correction

A

the reestablishment of a normal systemic arterial blood pH, bicarbonate concentration, and carbonic acid concentration

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6
Q

what happens is pH is out of the normal range?

A

alterations in ion balance
alterations in membrane potentials
changes in the conformation of proteins (enzymes)

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7
Q

which pH range is not compatible with life?

A

less than 6.8 and greater than 7.8

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8
Q

Acidosis _______ the plasma concentration of calcium. Why?

A

increases

bc H+ displaces Ca from protein which increases blood Ca

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9
Q

what are the effects of acidosis?

A

depression of the CNS

coma and death

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10
Q

alkalosis _____ the plasma concentration of Ca.

A

decreases

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11
Q

what are the effects of alkalosis?

A

hyper-excitability of the CNS

convulsions and death

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12
Q

what are some extracellular buffers?

A

Bicarbonate

ammonia

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13
Q

what are some intracellular buffers?

A

protein

phosphate

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14
Q

What would happen with an increase in CO2?

A

the production of H+ would increase

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15
Q

what is the main driver of respiration?

A

the need to exhale carbon dioxide

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16
Q

what is a respiratory mechanism for adjusting body pH?

A

changing rate and depth of breathing

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17
Q

what are the 5 renal/metabolic mechanisms?

A

1-secretion of hydrogen into the urine and the recovery of bicarbonate from the urine
2-creation of new bicarbonate from the kidney by secretion of H+
3-buffering of secreted H+ by phosphate
4-creating bicarbonate by producing ammonium
5-buffering of H+ by ammonia

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18
Q

explain active secretion of H+ into the urine and recovery of bicarbonate from the urine

A

the net result of a hydrogen being secreted into the urine is a bicarbonate being recovered from the urine.

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19
Q

how much bicarbonate is usually recovered from the kidneys?

A

over 90%

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20
Q

explain the creation of new bicarbonate by primary active secretion of H+

A

hydrogen is secreted into the urine which increases the H+ concentration which then decreases pH. Because ATP is present, it allows H+ to go against its gradient (keep getting pumped out even though it’s concentration is high) new bicarbonate is synthesized rather than uptaken

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21
Q

what is the lowest urine pH?

A

4.5

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22
Q

describe the creation of new bicarbonate through buffering of secreted hydrogen by phosphate

A

hydrogen pumped into the urine combines with buffers in the urine. the NaHPO4- is converted into NaH2PO4. Bicarbonate can then be synthesized.

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23
Q

what does converting NaHPO4- to NaH2PO4 enable?

A

we are then able to trap more H+ in the urine and thus produce more bicarbonate

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24
Q

describe creation of new bicarbonate through direct production of ammonium

A

when arterial blood pH is low, glutamine is converted to ammonium and bicarbonate. the ammonium is transported into the urine which results in an ammonium increase in urine.

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25
describe the production of new bicarbonate through the buffering of ammonia
this occurs in the collecting ducts. we have ATP mediated transport of H+ into the urine which allows it to combine with ammonia and then more can be pumped out. one new bicarbonate ion is synthesized as the result of pumping out one H+.
26
what is the source of intracellular H+?
anaerobic (non-mitochondrial) metabolism of glucose. ATP hydrolysis (big source of H+) excessive formation of ketones
27
what about the excessive formation of ketones?
it reduces pH they are produces in the liver by converting acetyl-CoA to ketones which are acidic. insulin inhibits ketogenesis
28
how do we correct changes in pH?
chemical buffering respiratory compensation renal compensation
29
chemical buffering
occurs almost instantly
30
what is important considering buffers are rapidly exhausted?
this requires the elimination of hydrogen ions to remain effective
31
respiratory compensation
the respiratory center in the brainstem responds rapidly t changes in CSF pH. So, a change in plasma pH or pCO2 results in change in ventilation within minutes.
32
renal compensation
the kidneys respond to acid base balance changes by altering the amount of bicarbonate reabsorbed and hydrogen ions excreted. but, this takes a while. It can take up to 2 days for bicarbonate concentration to reach a new equilibrium.
33
pCO2 of arterial blood is basic if
pCO2 is less than 35-45 mmHg
34
pCO2 of arterial blood is acidic if
pCO2 is greater than 35-45 mmHg
35
HCO3- of arterial blood is acidic if
HCO3- is lesst han 24-28 mM
36
HCO3- of arterial blood is basic if
greater than 24-28mM
37
the problem is respiratory if
pCO2 matches pH
38
the problem is Metabolic (renal) if
HCO3- matches pH
39
how do you know which system is compensating for a change?
you determine which if opposing pH
40
what happens during respiratory acidosis?
there is a carbonic acid accumulation | hypercapnia (pCO2 > 40 mmHg)
41
what conditions can induce respiratory acidosis?
depression of respiratory center-drugs of head trauma paralysis or trauma of respiratory or chest muscles. chronic pulmonary disease (emphysema)
42
what are the symptoms of respiratory acidosis?
change in awareness and muscle control | respiration rate is initially high although ventilation is low (shallow breathing)
43
what are some symptoms during early respiratory acidosis?
restlessness | apprehension
44
what are some symptoms during middle respiratory acidosis?
lethargy | muscle twitching tremors
45
what are some symptoms during severe respiratory acidosis?
coma | death
46
what happens when metabolic compensation kicks in during respiratory acidosis?
conservation of HCO3- an increase in HCO3- synthesis elimination of H+ in the urine
47
how do you treat respiratory acidosis?
ventilation and treat cause of condition | bicarbonate IV infusion if pH is less than 7
48
what happens during respiratory alkalosis?
there is a deficit of carbonic acid | hypocapnia (pCO2<35 mmHg)
49
what is the most common acid base imbalance?
respiratory alkalosis. | hypocapnia (pCO2<35 mmHg)
50
what are some conditions that can induce respiratory alkalosis?
``` O2 deficiency at high altitudes (low paO2) fever acute anxiety (hyperventilation) ```
51
what are some symptoms of respiratory alkalosis?
dizziness confusion tinglng of extremities coma (late)
52
How do we compensate for respiratory alkalosis?
excrete HCO3- reduce HCO3- synthesis conserve H+
53
how do we treat respiratory alkalosis?
treat cause of condition | have the patient re-breathe respiratory gases
54
metabolic acidosis
bicarbonate deficit | HCO3- < 24mM
55
what are some conditions that can induce metabolic acidosis?
diabetic ketoacidosis (kidneys likely suffering) extreme prolonged exercise renal failure severe diarrhea
56
what are some symptoms of metabolic acidosis?
``` headache lethargy coma (late) deep and rapid respiration nausea vomiting diarrhea ```
57
what is respiratory and metabolic compensation for metabolic acidosis?
increase ventilation (to reduce pCO2-kussmaul breathing) increase HCO3- recovery (if kidneys are functional) increase HCO3- synthesis increase H+ excretion
58
how do you treat metabolic acidosis?
treat cause of condition | if pH is less than 7, infuse with bicarbonate
59
disorders that cause you to hyperventilate could cause a
change in pH
60
Metabolic Alkalosis
bicarbonate excess | HCO3 >28 mM
61
what are conditions that can induce metabolic alkalosis?
loss of gastric juices due to vomiting or suction of stomach excess bicarbonate ingestion or infusion
62
what are some symptoms of metabolic alkalosis?
``` weakness muscle cramps hyperactive reflexes respiratory slow and shallow confusion convulsions ```
63
what is the respiratory and metabolic compensation for metabolic alkalosis?
reduce ventilation (increase pCO2) decrease HCO3- recovery (if kidneys functional) decrease HCO3- synthesis decrease H+ excretion
64
how do you treat metabolic alkalosis?
treat cause of condition | if severe, HCl infusion
65
Respiratory failure that resulted in decrease delivery of oxygen to the tissues of the body and decreased removal of carbon dioxide from the body can result in
a combined metabolic and respiratory acidosis
66
normal
pH-7.4 pCO2-40 HCO3- 24
67
respiratory acidosis
ph-7.1 acidic pco2- 80 acidic bicab 24 normal
68
respiratory alkalosis
ph 7.5 basic pco2 30 basic bicarb 42 normal
69
metabolic acidosis
ph 7.2 acidic pco2 40 normal bicarb 20 acidic
70
metabolic alkalosis
ph 7.8 basic pco2 40 normal bicarb 60 basic
71
respiratory alkalosis with metabolic compensation
ph 7.5 basic pco2 20 basic bicarb 16 acidic
72
combines respiratory and metabolic acidosis
ph 7.2 acidic pco2 48 acidic bicarb 18 acidic

Pathohysiology (16 decks)

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