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Acid Base Balance Flashcards

1
Q

Metabolic Acidosis and Anion Gap

A

Metabolic acidosis accompanied by a higher than normal anion gap means that the body has accumulated an unusual fixed acid.

A metabolic acidosis accompanied by a normal anion gap means that the body has lost a greater than normal amount of base

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2
Q

What is the hydrogen ion concentration determined by?

A

The ratio of carbonic acid to bicarbonate in the extracellular fluid

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3
Q

What are some important sources of acids in the body?

A

HCl (stomach acid), cellular metabolism, CO2 in plasma- generates H+, skeletal muscle (lactic acid- anaerobic respiration), and fat breakdown (glycogen is broken down into glucose and produces acidic ketones).

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4
Q

What is one important base in the body and where is the majority found?

A

Bicarbonate (HCO3) which has a huge supply found in the intestine. it is produced by the pancreas to neutralize stomach acid.

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5
Q

Why does pH matter and what is the main element does it affect the most?

A

The proteins in our body (enzymes and hemoglobin included) are very sensitive to pH changes. A very small change can leave them non-functional. Our body needs to maintain homeostasis.

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6
Q

What are the 3 chemical buffer systems in the body?

A

Protein, Phosphate, and Carbonic Acid/Bicarbonate buffer system.

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7
Q

What are the 3 primary ways to control pH?

A

Chemical buffers, respiration, and kidneys (when respiration isn’t enough).

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8
Q

Where is the most water be found in our body?

A

Intracellular Fluid Compartment (ICF) which is inside the trillions of cells in our body. About 2/3 of all body water is found in the ICF.

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9
Q

Where are receptors located which can detect rising CO2 levels and/or rising H+ concentrations?

A

Medulla oblongata (center of respiratory measures)

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10
Q

How can the renal response to pH changes help?

A

If too acidic, the distal convoluted tubule in the nephron can secrete H+ and reabsorb bicarb while if too basic, it can secrete bicarb into the urine.

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11
Q

What are the metabolic acidosis symptoms?

A

Severe diarrhea wherein acid is in intestinal gastric juice and so you lose too much bicarbonate through stool. Another is the kidneys fail to get rid of acid.

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12
Q

What is a serious life-threatening condition of diabetes that occurs when your body produces high levels of blood acids called ketones?

A

Diabetic Ketoacidosis (DKA).

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13
Q

What are buffers?

A

It minimizes the changes in pH when acid or base is added to a solution. Hemoglobin and proteins are found intracellularly. Extracellularly we have bicarbonate, phosphate, and ammonia.

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14
Q

Where is most water in the body stored?

A

It is in the intracellular (in the cells).

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15
Q

What is osmotic pressure vs oncotic pressure?

A

Osmotic pressure is the pressure at the cell membrane while oncotic pressure is the pressure at the capillary membrane.

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16
Q

What are the major electrolytes?

A

Sodium, potassium, calcium, magnesium, chloride, bicarbonate, and phosphate.

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17
Q

What are the extracellular electrolytes?

A

Sodium, calcium, chloride, bicarbonate (SCCB)

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18
Q

What are the intracellular electrolytes?

A

Potassium, magnesium, and phosphate (PMP)

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19
Q

What are your cations (more acidic, positive charged electrolytes)?

A

Sodium, potassium, calcium, and magnesium

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20
Q

What are your anions (more basic and negative charged electrolytes)?

A

Chloride, CO2 (bicarb), phosphorus, sulfate, lactate, and protein.

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21
Q

What electrolyte regulates cell electroconductivity and is good for blood clotting (with vitamin K)?

A

Calcium

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22
Q

What is the body’s base?

A

Sodium

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23
Q

What is the major cation of extracellular fluid?

A

Sodium

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24
Q

What is the job of sodium and chloride?

A

It regulates ECF and plasma volume, nerve impulses, and muscle contraction

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25
What hormone balances sodium?
Aldosterone from the adrenal cortex which is stimulated by ACTH that comes from anterior pituitary.
26
What is the body’s acid?
Potassium
27
What is the major cation of intracellular fluid?
Potassium
28
What does potassium help you stay protected from?
High blood pressure
29
What is the job of potassium?
Water balance osmotic equilibrium, acid-base balance, neuromuscular activity, and cell growth.
30
What electrolyte is a major buffer?
Phosphorus
31
What is the role of phosphorus?
Energy metabolism of ATP (in phosphorylation reactions).
32
How to determine acid-base balance?
Hydrogens
33
What are your intracellular buffers?
Proteins and PO4
34
What are your extracellular buffers?
Bicarbonate and carbonic acid
35
What could cause respiratory acidosis and what conditions/diseases can cause it?
It is caused by an increased CO2. The conditions are decreased lung surface area, such as emphysema (damaged air sacs making it hard to breath), obstructive lung disease (asthma), and neuromuscular disease in which respiratory function is impaired (MS, ALS).
36
What happens with respiratory alkalosis and what causes it?
It causes losing too much CO2 and water from excessive breathing which decreases carbonic acid. The conditions: Early sepsis (blood poisoning), anxiety reactions, can be caused from intense exercise.
37
How do you get metabolic acidosis and what conditions are associated with it?
Cause: Decreased pH (increased H+) or decreased bicarb from extracellular fluid. Conditions: Diarrhea (loss water and bicarb), uremia (increased NH4), ketoacidosis from diabetes mellitus (type 1), high fat-low carb diet, and drugs (diuretics).
38
How do you get metabolic alkalosis and what conditions, or diseases are associated?
Decrease in H+ (increase pH), or increased bicarbonate from retention of base in ECF cause: Diuretics (thiazide), increased ingestion of alkali (fruit), loss of chloride, and vomiting (loss of stomach acid).
39
Hyperkalemia or hyponatremia could lead to?
Metabolic acidosis (K is an acid).
40
What will be the effect of hypokalemia or hypernatremia?
Metabolic alkalosis (sodium is a base).
41
What is the difference called between the normal buffer base and the actual buffer base in a whole blood sample?
Base excess (BE).
42
What is the buffer base?
The total blood buffer capable of binding hydrogen ions.
43
What is the normal blood buffer base range?
48–52 mEq/L
44
What is a titrable, nonvolatile acid called?
Fixed acid.
45
What does a fixed acid represent?
The by-product of protein catabolism.
46
What is an acid that can be excreted in its gaseous form called?
Volatile acid.
47
What is a physiological example of a volatile acid?
Carbonic acid.
48
What continuously generates H+?
Normal metabolism.
49
What property of H+ is the reason for the need to regulate its concentration?
It reacts readily with the protein molecules of vital cellular catalytic enzymes.
50
Why can H+ be dangerous?
It’s reactions with proteins can change their physical contour, rendering the enzyme inactive
51
What gas is carbonic acid (H2CO3) in equilibrium with?
Dissolved CO2.
52
What are the two major mechanisms responsible for maintaining a stable pH despite CO2 production?
Isohydric buffering and ventilation.
53
What disease can increase fixed acid production?
Diabetes
54
What can be done to correct respiratory acidosis and improve alveolar ventilation?
Bronchial hygiene, lung expansion, non-invasive positive pressure ventilation, intubation, and mechanical ventilation.
55
What are some signs of respiratory alkalosis?
Paresthesia, dizziness, headache, and hyperventilation.
56
What is a buffer solution?
A mixture of acids and bases that resist changes in pH when an acid or a base gets added to it.
57
How are blood buffers classified?
They are classified as either bicarbonate (open) or non-bicarbonate (closed) buffer systems.
58
What can be done to correct respiratory alkalosis?
Oxygen Therapy
59
What acids does a closed buffer system buffer?
Volatile and Fixed Acids
60
What acids does an open buffer system buffer?
Fixed, only when ventilation is not impaired, plus any individual H+ regardless of origin.
61
What is the normal anion gap range?
8-16
62
What does the buffering of a fixed acid produce?
CO2
63
What is the most important non-bicarbonate buffer system?
Hemoglobin because it is the most abundant.
64
What is the common blood fluid compartment that both open and closed buffer systems function?
Blood plasma.
65
What are the primary acid excreting organs?
The lungs and kidneys.
66
Which is faster at removing acid, the lungs or the kidneys?
The lungs.
67
Why is CO2 elimination crucial?
It reacts with H2O to form large quantities of H2CO3.
68
What is the anion gap?
It is the calculation of 4 electrolytes (Na+, Cl-, K+, and HCO3-).
69
What is the purpose of using the anion gap?
To eliminate the effects of respiratory involvement; i.e. to see what’s going on at the metabolic level.
70
What is indicated by an anion gap greater than 16?
Metabolic acidosis.
71
What are some of the symptoms of metabolic acidosis?
Dyspnea, hyperpnea, Kussmaul’s breathing, lethargy, and coma.
72
At what pH are severe cardiac arrhythmias likely?
Below 7.2.
73
What factor determines how much H+ is removed by the kidneys?
Blood pH.
74
In what 2 ways can metabolic alkalosis occur?
Loss of fixed acids or gain of blood buffer base; either one increases plasma HCO3.
75
What is the most complicated acid-base imbalance to treat?
Metabolic alkalosis; it involves fluid and electrolyte imbalances.
76
What is the goal of secreting less H+?
To increase the amount of HCO3- in the urine; increase the amount of H+ in the blood.
77
What is the goal of secreting more H+?
To increase the amount of HCO3- in the blood; decrease the amount of H+ in the blood.
78
What are some of the causes of metabolic alkalosis?
Vomiting, hypokalemia.
79
How do the lungs compensate for metabolic alkalosis?
By hypoventilating.
80
pH changes caused by PaCO2 are referred to as what?
Primary respiratory disturbances.
81
For an acute increase in PaCO2 what will HCO3 change by
For an acute increase in PaCO2 the plasma [HCO3-] increases by ~1 mEq/L for every 10 mmHg rise above 40 mmHg
82
What kind of acids do lungs and kidneys regulate
The lungs regulate the volatile acid content (CO2) of the blood, and the kidneys control the fixed acid concentration of the blood.
83
Open Bicarbonate Buffer System
In the open bicarbonate buffer system, H+ is buffered to form the volatile acid, H2CO3, which dissociates to form H2O and CO2; the CO2 is exhaled into the atmosphere.
84
Closed Bicarbonate Buffer System
In the closed non-bicarbonate buffer system, H+ is buffered to form fixed acids, which accumulate in the body.
85
Bicarbonate buffers and nonbicarbonate buffers can fixed what types of acids
Bicarbonate buffers can buffer only fixed acids, but nonbicarbonate buffers can buffer both fixed and volatile acids.
86
Hypochloremia
Hypochloremia forces the kidneys to excrete increased amounts of H+ and K+ to reabsorb Na+, causing alkalosis and hypokalemia.
87
Hypokalemia
Hypokalemia forces the kidneys to excrete increased amounts of H+ to reabsorb Na+, causing alkalosis.
88
For an acute increase in PaCO2 how much will [HCO3] increase
For an acute increase in PaCO2 the plasma [HCO3-] increases by ~1 mEq/L for every 10 mmHg rise above 40 mmHg
89
What type of acids do the lungs and kidneys regualte
The lungs regulate the volatile acid content (CO2) of the blood, and the kidneys control the fixed acid concentration of the blood.
90
Open Bicarbonate buffer system
In the open bicarbonate buffer system, H+ is buffered to form the volatile acid, H2CO3, which dissociates to form H2O and CO2; the CO2 is exhaled into the atmosphere. In the closed non-bicarbonate buffer system, H+ is buffered to form fixed acids, which accumulate in the body.
91
Bicarbonate Buffers
Bicarbonate buffers can buffer only fixed acids, but nonbicarbonate buffers can buffer both fixed and volatile acids.
92
Hypochloremia
Hypochloremia forces the kidneys to excrete increased amounts of H+ and K+ to reabsorb Na+, causing alkalosis and hypokalemia.
93
Hypokalemia
Hypokalemia forces the kidneys to excrete increased amounts of H+ to reabsorb Na+, causing alkalosis.

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