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Clinical Chemistry 2 (Lecture) > Acid-Base Balance (M) > Flashcards

Acid-Base Balance (M) Flashcards

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1
Q

What are the 2 principle of rxns (/ types) of anion gap?

A

1) Na^+ - (Cl^- + HCO3^-)

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

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2
Q

What is the expected anion gap of Na^+ - (Cl^- + HCO3^-)?

A

7 - 16 mmol/L

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3
Q

What is the expected anion gap of (Na^+ + K^+) - (Cl^- + HCO3^-)?

A

10 - 20 mmol/L

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4
Q

What are the causes of increased anion gap?

A

1) Uremia
2) Lactic acidosis
3) Ketoacidosis
4) Hypernatremia
5) Ingestion of methanol
6) Ethylene glycol
7) Salicylate

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5
Q

What is the other fxn of increased anion gap?

A

It is also used as an assessment of instrument errors

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6
Q

What are the causes of decreased anion gap?

A

1) Hypoalbuminemia

2) Hypercalcemia

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7
Q

What is a buffer?

A

It is a system that can resist change in pH

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8
Q

What is the characteristic of buffer?

A

It is composed of a weak acid or a weak base and its corresponding salt

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9
Q

What are the 4 buffer systems of clinical importance w/c exist in whole blood?

A

1) The bicarbonate-carbonic acid buffer system
2) The protein buffer system
3) The phosphate buffer system
4) The hemoglobin buffer system

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10
Q

What does the bicarbonate-carbonic acid buffer system use?

A

1) HCO1^-

2) H2CO3

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11
Q

What is the fxn of HCO1^- and H2CO3 (in bicarbonate-carbonic acid buffer system)?

A

To minimize pH changes in plasma and erythrocytes

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12
Q

What is the most impt buffer system in plasma?

A

The bicarbonate-carbonic acid buffer system

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13
Q

What does the protein buffer system use?

A

Plasma proteins

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14
Q

What is the fxn of plasma proteins (in the protein buffer system)?

A

To minimize pH changes in the blood

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15
Q

What are used by the phosphate buffer system?

A

1) HPO4^-2

2) H2PO4^-1

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16
Q

What is the fxn of HPO4^-2 and H2PO4^-1?

A

To minimize pH changes in plasma and erythrocytes

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17
Q

What does the hemoglobin buffer system use?

A

Hemoglobin

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18
Q

Where is the hgb (in the hemoglobin buffer system) present?

A

In RBCs

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19
Q

What is the fxn of hgb (in the hemoglobin buffer system)?

A

To minimize pH changes in the blood

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20
Q

What is the most impt intracellular buffer?

A

The hemoglobin buffer system

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21
Q

What is respiration?

A

It is the process to supply cells w/ O2 for metabolic processes and remove the CO2 produced during metabolism

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22
Q

What is partial pressure?

A

In a mixture of gases, it is the amt of pressure contributed by each gas to the total pressure exerted by the mixture

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23
Q

When does acidemia occur?

A

When arterial blood pH is < 7.35

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24
Q

When does alkalemia occur?

A

When arterial blood pH is 7.45 >

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25
Q

What is hypercapnia?

A

It is condition of increased blood PCO2

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26
Q

What is hypocapnia?

A

It is a condition of decreased blood PCO2

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27
Q

What is the meaning of PCO2?

A

Partial pressure of carbon dioxide

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28
Q

PCO2 is measured in blood as what?

A

mmHg

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29
Q

What is the meaning of cdCO2?

A

Concentration of dissolved carbon dioxide

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30
Q

cdCO2 includes what?

A

1) Undissociated carbonic acid (H2CO3)

2) CO2 dissolved in blood (represented by PCO2)

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31
Q

What is the meaning of ctCO2?

A

Concentration of total carbon dioxide

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32
Q

ctCO2 includes what?

A

1) Bicarbonate (HCO3^-)
2) Carbamino-bound CO2
3) Carbonic acid
4) Dissolved CO2

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33
Q

What is the primary component of ctCO2?

A

HCO3

34
Q

True or False

The pH of plasma is a fxn of 2 independent variables

A

True

35
Q

*What are the 2 independent variables where pH of plasma plays a fxn?

A

1) Partial pressure of carbon dioxide (PCO2)

2) Concentration of bicarbonate (HCO3)

36
Q

What organ is responsible for regulating the PCO2?

A

Lungs

37
Q

What is the mechanism (/ mechanism done by the lungs) done to regulate PCO2?

A

Respiratory mechanism

38
Q

What organ is responsible for regulating the concentration of HCO3?

A

Kidneys

39
Q

What is the mechanism (/ mechanism of kidneys) done to regulate the concentration of HCO3?

A

Renal mechanism

40
Q

CO2 is transported as / by what?

A

HCO3, carbamino compound, and dissolved CO2

41
Q

*A carbamino compound is bound to what?

A

1) Serum proteins

2) Hgb

42
Q

What is the other fxn of HCO3, carbamino compound, and dissolved CO2?

A

They also serve as buffers to maintain blood pH

43
Q

True or False

CO2, pH, and PCO2 are related accdg to Henderson-Hasselbalch equation

A

True

44
Q

*What is the Henderson-Hasselbalch equation?

A

pH = pK’ + log [HCO3^-]/ [H2CO3]

pH = 6.1 + log cHCO3^-/ cdCO2

45
Q

In connection to Henderson-Hasselbalch equation, cdCO2 is equal to what?

A

cdCO2 = PCO2 X ⍺ (solubility coefficient of CO2)

where ⍺ = 0.03 mmol/L per mmHg

46
Q

What is the reference range of pH for arterial blood gas analysis?

A

7.35 - 7.45

47
Q

What is the reference range of ctCO2 for arterial blood gas analysis?

A

22 - 26 mmol/L

48
Q

What is the reference range of PCO2 for arterial blood gas analysis?

A

35 - 45 mmHg

49
Q

Acid-base disorders are classified as what?

A

1) Metabolic acidosis
2) Metabolic alkalosis
3) Respiratory acidosis
4) Respiratory alkalosis

50
Q

Metabolic acid-base disorders primarily involve what?

A

HCO3 concentration

51
Q

Respiratory acid-base disorders primarily involve what?

A

Dissolved CO2 concentration

52
Q

What is the principle of metabolic acidosis (non respiratory)?

A

Primary HCO3 deficit

53
Q

What is the mechanism / principle present in metabolic acidosis?

A

The HCO3 concentration decreases, causing a decrease in the 20:1 ratio between cHCO3 and cdCO2, w/c results in a decrease in the blood pH

54
Q

What may be the causes of metabolic acidosis?

A

1) Organic acid production

2) When ingestion exceeds the excretion rate

55
Q

What are the disorders included in metabolic acidosis (non respiratory)?

A

1) Diabetic ketoacidosis
2) Lactic acidosis
2) Poisonings (such as salicylate, ethylene glycol, and methyl alcohol)
4) Reduced acid excretion
5) Loss of HCO3

56
Q

What is the cause of diabetic ketoacidosis?

A

Production of acetoacetic acid and β-hydroxybutyric acid

57
Q

What is the cause of lactic acidosis?

A

Production of lactic acid

58
Q

What is the cause of reduced acid excretion?

A

Renal failure or tubular acidosis

59
Q

What is the cause of loss of HCO3?

A

Diarrhea or excessive renal excretion

60
Q

What are the laboratory findings if pt has metabolic acidosis (non respiratory)?

A

1) ctCO2: decreased
2) PCO2: normal
3) pH: decreased

61
Q

In metabolic acidosis (non respiratory), what is the respiratory compensatory mechanism?

A

A decreased pH triggers hyperventilation that lowers PCO2 and results in an increase in pH. This increases the ratio between cHCO3 and cdCO2 to 20:1, w/c increases the blood pH

62
Q

In metabolic acidosis (non respiratory), what are the laboratory findings after / in compensation?

A

1) ctCO2: decreased
2) PCO2: decreased
3) pH: normal

63
Q

What is the principle of metabolic alkalosis (non respiratory)?

A

Primary HCO3 excess

64
Q

What is the mechanism / principle in metabolic alkalosis (non respiratory)?

A

The HCO3 concentration increases, causing an increase in the 20:1 ratio between cHCO3 and cdCO2, w/c results in an increase in the blood pH

65
Q

What may be the causes of metabolic alkalosis?

A

1) Ingestion of excess base
2) Decreased elimination of base
3) Loss of acidic fluids

66
Q

What are the disorders included in metabolic alkalosis (non respiratory)?

A

1) Ingestion of excess alkali (antacids)
2) Intravenous administration of HCO3
3) Renal HCO3 retention
4) Prolonged diuretic use
5) Loss of HCl from the stomach after:
a. Vomiting
b. Intestinal obstruction
c. Gastric suction
6) Glucocorticoid excess (present in Cushing syndrome)
7) Mineralocorticoid excess (as in hyperaldosteronism)

67
Q

What are the lab findings present for a pt w/ metabolic alkalosis (non respiratory)?

A

1) ctCO2: increased
2) PCO2: normal
3) pH: increased

68
Q

What is the respiratory compensatory mechanism done in metabolic alkalosis (non respiratory)?

A

The pH increase slows breathing (hypoventilation), thus increasing the amt of CO2, retained by the lungs. This increased CO2 retention causes an increase in H2CO3, w/c results in more dissolved CO2 in the blood. The carbonic acid lowers the pH. This decreases the ratio between cHCO3 and cdCO2 to 20:1, w/c decreases the blood pH

69
Q

What are the lab findings after / in compensation for metabolic alkalosis (non respiratory)?

A

1) ctCO2: increased
2) PCO2: increased
3) pH: normal

70
Q

What is the principle of respiratory acidosis?

A

Primary cdCO2 excess expressed as increase in PCO2 (hypercapnia)

71
Q

What is the mechanism / principle of respiratory acidosis?

A

Inability of a person to exhale CO2 through the lungs (hypoventilation) causes an increase of PCO2. The increased PCO2 causes an increase in the concentration of dissolved CO2, w/c forms carbonic acid in the blood. This decreases the 20:1 ratio between cHCO3 and cdCO2, w/c decreases the blood pH

72
Q

What may be the causes of respiratory acidosis?

A

1) Chronic obstructive pulmonary disease
a. Chronic bronchitis
b. Emphysema
c. Ingestion of narcotics and barbiturates
2) Severe infections of the CNS
a. Meningitis

73
Q

What are the lab findings present if a pt has respiratory acidosis?

A

1) ctCO2: normal
2) PCO2: increased
3) pH: decreased

74
Q

What is the renal compensatory mechanism done in respiratory acidosis?

A

The kidneys increase sodium hydrogen exchange, NH3 formation, and HCO3 retention. The increased HCO3 concentration aids the return of the 20:1 ratio, w/c raises the blood pH

75
Q

What are the lab findings after / in compensation for respiratory acidosis?

A

1) ctCO2: increased
2) PCO2: increased
3) pH: normal

76
Q

What is the principle in respiratory alkalosis?

A

Primary cdCO2 deficit expressed as decrease in PCO2 (hypocapnia)

77
Q

What is the mechanism / principle in respiratory alkalosis?

A

Decreased PCO2 results from an accelerated rate or depth of respiration, or a combination of both. Excessive exhalation of CO2 (hyperventilation) reduces the PCO2, causing a decrease in the concentration of dissolved CO2, w/c forms less H2CO3 in the blood (i.e., less hydrogen ions). This increases the 20:1 ratio between cHCO3 and cdCO2, w/c increases the blood pH

78
Q

What may be the causes of respiratory alkalosis?

A

1) Hypoxia
2) Anxiety
3) Nervousness
4) Excessive crying
5) Pulmonary embolism
6) Pneumonia
7) Congestive heart failure (CHF)
8) Salicylate overdose

79
Q

What are the lab findings if a pt has respiratory alkalosis?

A

1) ctCO2: normal
2) PCO2: decreased
3) pH: increased

80
Q

What is the action / aim of renal compensatory mechanism for respiratory alkalosis?

A

It corrects respiratory alkalosis by excreting HCO3

81
Q

What are the lab findings of a pt w/ respiratory alkalosis in / after compensation?

A

1) ctCO2: decreased
2) PCO2: decreased
3) pH: normal

Clinical Chemistry 2 (Lecture) (17 decks)

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