Acid-base Balance3

Question 1

mention two classifications of acid-base disturbances

Answer 1

1. Metabolic acidosis/alkalosis
2. Respiratory acidosis/alkalosis

Question 2

What is metabolic acidosis readily detected by a decrease in what?

Answer 2

By a decrease in plasma bicarbonate levels.

Question 3

What causes decrease in plasma bicarbonate

Answer 3

1. production of organic acids that exceeds the rate of elimination
2. Reduced excretion of acids (H+) as occurs in renal failure
3. Excessive loss of bicarbonate due to increased renal excretion

Question 4

What primarily causes metabolic acidosis?

Answer 4

1. Production of organic acids (such as in ketoacidosis) that exceeds the rate of elimination.
2. Reduced excretion of acids (H⁺), which occurs in conditions like renal failure and some renal tubular acidosis (RTAs).
3. Excessive loss of bicarbonate, either due to increased renal excretion or excessive loss from the duodenum.

Question 5

What does ketoacidosis refer to?

Answer 5

Ketoacidosis refers to the production of organic acids (such as ketone bodies) that exceeds the rate at which they are eliminated.

Question 6

How does reduced excretion of acids lead to metabolic acidosis?

Answer 6

Reduced excretion of acids (H⁺) in conditions like renal failure and RTAs results in an accumulation of acid that consumes bicarbonate, leading to metabolic acidosis.

Question 7

What can cause an excessive loss of bicarbonate

Answer 7

1. Increased renal excretion
   2.Excessive loss from the duodenum (part of the small intestine).

Question 8

What physiological response is stimulated by the resulting drop in pH due to metabolic acidosis?

Answer 8

Stimulates respiratory compensation via hyperventilation. This process lowers the partial pressure of carbon dioxide (PCO₂) and raises the pH.

Question 9

How can metabolic acidosis be categorized?

Answer 9

1. Increased anion gap acidosis (organic acidosis)
2. Normal anion gap acidosis (inorganic acidosis)

Question 10

What are some causes of increased anion gap metabolic acidosis?

Answer 10

1. Methanol poisoning
2. Uremia of renal failure
3. Ketoacidosis
4. Paraldehyde toxicity
5. Lactic acidosis
6. Salicylate intoxication

Question 11

what causes normal anion gap metabolic acidosis

Answer 11

It is caused by the loss of bicarbonate rich fluid from the kidney or GIT

Question 12

what happens when bicarbonate is lost

Answer 12

More cl- ions are absorbed with Na + or k+

Question 13

normal acid gap acidosis can be divided into 2. namely?

Answer 13

1. Hypokalemic normokalemic
2. Hyperkalemic acidoses

Question 14

What causes normal anion gap metabolic acidosis

Answer 14

Normal anion gap metabolic acidosis is caused by the loss of bicarbonate-rich fluid from the kidney or the gastrointestinal tract.

Question 15

How can normal anion gap acidosis be divided

Answer 15

Normal anion gap acidosis can be divided into hypokalemic, normokalemic, and hyperkalemic acidoses.

Question 16

What happens as bicarbonate is lost

Answer 16

As bicarbonate is lost, more chloride ions (Cl⁻) are reabsorbed along with sodium (Na⁺) or potassium (K⁺) ions

Question 17

What is the average Anion gap value in healthy individuals?

Answer 17

In healthy individuals, the average Anion gap value is 12 mmol/L.

Question 18

when does metabolic alkalosis occur (3)

Answer 18

1. when excess base is added into the system
2. When base elimination is decreased
3. When acid rich fluids are lost

Question 19

What occurs during metabolic alkalosis

Answer 19

Metabolic alkalosis occurs when there is an excess base added to the system, base elimination is decreased, or acid-rich fluids are lost.

Question 20

What can lead to a primary bicarbonate excess?

Answer 20

Conditions such as excess base addition, decreased base elimination, or loss of acid-rich fluids can lead to a primary bicarbonate excess.

Question 21

What will a patient do in response to metabolic alkalosis?

Answer 21

In response to metabolic alkalosis, the patient will hyperventilate to raise PCO2 (partial pressure of carbon dioxide), thereby lowering the pH toward normal.

Question 22

What is Respiratory acidosis?

Answer 22

Respiratory acidosis is a condition that results from an increase in carbon dioxide (CO2) through the lungs, leading to an elevated level of CO2 in the blood.

Question 23

How does Respiratory acidosis occur?

Answer 23

It occurs due to lung conditions that cause an accumulation of carbon dioxide. These conditions can be either acute or chronic

Question 24

How can conditions leading to Respiratory acidosis be classified?

Answer 24

1. acute
2. chronic.

Question 25

What are some ways that these conditions affect the body?

Answer 25

These conditions can depress the respiratory center, affect the respiratory apparatus, or cause mechanical obstruction of the airway.

Question 26

what are the factors that directly depress the respiratory centre

Answer 26

1. Drugs e.g narcotics ad barbiturates
2. Infections of the CNS e.g encephalitis and meningitis
3. Comatose states such as cerebralvascular accident due to intracranial hemorrhage and primary central hypoventilation

Question 27

Conditions that Affect the Respiratory Apparatus (“Factors that Impact the Respiratory System)

Answer 27

1. Chronic obstructive pulmonary disease (most common cause), Severe pulmonary fibrosis
2. Disease of the upper airways such as laryngospasm or tumor, Pulmonary infection (severe)
3. Pneumothorax, Adult respiratory distress syndrome, Chest wall disease and chest wall deformity
4. Neurologic disorders affecting the muscles of respiration

Question 28

What are the two conditions listed under pulmonary disorders that involve the lungs’ air sacs

Answer 28

Pneumonia and Interstitial lung disease

Question 29

What condition is characterized by a PCO2 level less than 50 mm Hg?

Answer 29

Large right-to-left atrial shunt.

Question 30

Which disorder is associated with the body’s response to correct an imbalance in blood pH?

Answer 30

Respiratory compensation after correction of metabolic acidosis

Question 31

Mention 5 non-pulmonary stimulation of respiratory center

Answer 31

1. Anxiety, hysteria, Febrile state
2. Gram-negative septicemia
3. Metabolic encephalopathy (e.g., due to liver disease)
4. Central nervous system infection such as meningitis,
   Encephalitis, Cerebrovascular accident
   5.Intracranial surgery, Hypoxia
5. Drugs and agents such as salicylates, catecholamines, and
6. Progesterone, Hyperthyroidism
   Pregnancy, mainly third trimester (↑ progesterone?)