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Patho > Acid Base Disorders > Flashcards

Acid Base Disorders Flashcards

1
Q

Metabolic activities of the body require precise regulation of ________________ which is reflected by the _____________ of the extracellular fluid

A

acid/base balance, pH

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2
Q

pH is a measure of ____________________

A

hydrogen ion concentration

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3
Q

pH of extracellular fluid is _________ - _________

A

7.35- 7.45

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4
Q

Acid can __________ and _________ H+

A

dissociate, release

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5
Q

Base can ______ or _______ with H+

A

accept, combine

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6
Q

_____________ are continuously generated as by-products of metabolic processes.

A

acids

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7
Q

What are the two categories of acids?

A
  1. volatile H2CO3 acid
    -H2CO3 is in equilibrium with CO2
    - H2CO3 <—-> CO2 + H20
    -CO2 leaves body by lungs
    - H2CO3 concentration is determined by the lungs and their capacity to exhale CO2
  2. non volatile acids (phosphoric, sulfuric, HCL)
    -not eliminated by the lungs
    - buffered by body proteins or extracellular buffers then eliminated by the kidney
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8
Q

Henderson-Hasselbach Equation:
Increasing the acid, _______ pH
Increasing base, _______ pH
Decreasing pco2, _________ pH
Increasing HCO3, __________pH

A
  1. lowers
  2. raises
  3. raises
  4. raises
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9
Q

What are the three major mechanisms that regulate pH?

A
  1. chemical buffer systems that combine with excess acids or bases to prevent large changes in pH
  2. the lungs control the elimination of Co2
  3. the kidneys eliminate H+ and both reabsorb and generate HCO3
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10
Q

What are the buffer systems that quickly regulate pH?

A
  1. Protein
  2. Plasma Potassium Hydrogen exchange
  3. Bicarbonate
  4. Bone
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11
Q

What is the largest buffering system of the body?

A

protein

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12
Q

The protein buffering system is amphoteric, what does this mean?

A

acts as an acid/base

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13
Q

What are the characteristics of the protein buffering system?

A
  1. Amphoteric
  2. Has many ionizable groups that can release and bind H+
  3. Protein buffers are located in the cells, H+ and Co2 they diffuse across the cell membranes for buffering
  4. Albumin and plasma globulins are major protein buffers in the vascular compartment
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14
Q

What is the primary extracellular buffer?

A

bicarb

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15
Q

Which buffer is efficient because of the readily buffering components?

A

bicarb

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16
Q

What are the characteristics of the bicarb buffering system?

A
  1. Primary extracellular buffer
  2. Efficient bc of readily available buffering components
  3. H2CO3 is converted to HCO3 which is used to buffer acids
  4. CO2 is readily available, carried by:
    -hemoglobin
    -dissolved in plasma
    -HC03
  5. HCO3 can be conserved or formed by the kidney
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17
Q

What are the characteristics of the bone buffering system?

A
  1. Excess H+ can be exchanged for
    -Na+
    -K+
    -Ca+
    and dissolution of bone minerals will release compounds such as NaHCO3 and CaCO3 which can be used for buffering excess acids.
  2. In chronic acid disorders, bone releases calcium
  3. Long term effects can be:
    - bone demineralization
    -renal calculi
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18
Q

What are the characteristics of the Transcellular Potassium Hydrogen Exchange?

A

H+ and K+ move freely across the cell membrane in opposite directions.
1. If acid/base disturbance:
-Acidosis: H+goes into the cell forcing K+ out of the cell (increase in K+)
Alkalosis: H+ moves out of the cell and K+ goes into the cell (decreases K+)
2. If potassium disturbance
-Hypokalemia: K+ moves out of the cell and H+ moves into the cell causing alkalosis

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19
Q

What are the characteristics of the respiratory buffer system?

A
  1. Increased ventilation= decreasing PCO2
  2. decreasing ventilation= increases PCO2
  3. Chemoreceptors sense changes in pH and CO2
  4. Rapid response within minutes, max over 12-24 hours
  5. Does not fully normalilze pH
  6. Only about 50-75% effective as a buffer
20
Q

What are the characteristics of the renal buffer system?

A

The kidney regulate pH through 3 mechanisms:
1. Elimination of H+ in urine
2. Reabsorption of filtered HCO3
3. Production of new HCO3
Renal mechanisms cannot adjust the pH within minutes but they continue to function for days until the pH has returned to normal

21
Q

Lab Studies

A
  1. ABG
  2. PCO2
  3. O2
  4. pH
  5. Bicarb
  6. Oxygen saturation
22
Q

The anion gap is the difference between the ________ of the major measured _________ (Na+) and the sum of the measured ________ (Cl- and HCO3)

A

serum concentration, cation, anions

23
Q

What does the difference in the anion gap represent?

A

the concentration of unmeasured anions (phosphates, sulfates, proteins, organic acids)

24
Q

What is a normal anion gap measure

A

8-12

25
Q

Anion gap is increased in things like __________ and __________ and result in a decrease in ____________

A

lactic acidosis, ketoacidosis, decrease in HCO3

26
Q

What are the two types of acid-base disorders?

A
  1. Metabolic
    -produce an alteration in the serum HCO3
    -results from the addition of loss of nonvolatile acid or alkali to or from extracellular fluid
  2. Respiratory
    -involves alterations in the PCO2
    -reflect an increase or decrease in alveolar ventilation
27
Q

Metabolic acidosis is a _______ in HCO3 and a ________ in pH. What is the pH?

A

decrease, decrease.

pH < 7.35, HCO2 < 22

28
Q

In metabolic acidosis, how does the body compensate for decreases in pH?

A

it increases the respiratory rate in an effort to decrease PCO2 and H2CO3

29
Q

Anion Gap Acidosis

A

“MUD PILES”
methanol
uremia
DKA
propylene glycol
infection
lactic acidosis
ethylene glycol/ethanol ketoacidosis
salicylates

30
Q

Lactic acidosis and ketocaidosis are major causes of ___________________

A

metabolic acidosis

31
Q

What is lactic acidosis?

A

excess production or diminished removal of lactic acid from the blood caused by inadequate oxygen delivery (shock, severe hypotension, cardiac arrest, intense excercise)

32
Q

What is ketoacidosis?

A

caused when carb stores are inadequate or inaccessible for fuel. Body uses fatty acids from adipose tissues and delivers to the liver where they are converted to ketones for fuel. Ketoacidosis occurs when > use

33
Q

What are the 3 components of nongapped metabolic acidosis?

A
  1. Hyperchloremic- increased levels of CL- causes the gap to be normal even if bicarb is decreased
  2. Bicarb losses- usually accompanied by increases in Cl-. severe diarrhea, intestinal sunctioning, ileostomy drainage
  3. Chloride retention- renal tubular acidosis, parenteral nutrition
34
Q

What are the manifestations of metabolic acidosis?

A

anorexia, nausea, vomiting, abdominal pain, weakness, lethargy, malaise, headache, confusion, coma

vasodilation

35
Q

Neuromuscular excitability is __________________ is acidosis

A

decreased

36
Q

In metabolic acidosis, a fall in pH to _____ will cause fatal _________

A

7.1, dysrhythmias

37
Q

What are the two conditions you are likely to see in chronic acidosis?

A

bone disease, kidney stones

38
Q

Metabolic alkalosis is an _________ in bicarb and a ________ of acid. What is the pH?

A

increase, loss
pH > 7.45, HCO3 > 26

39
Q

In metabolic alkalosis, how does compensation work?

A

increase in retaining CO2 with increased renal excretion of HCO3

40
Q

What is metabolic alkalosis caused by?

A

ingesting base, loss of acid via stomach, diuretic med

41
Q

What are the manifestations of metabolic alkalosis?

A

confusion, hyperactive reflexes, tetany, convulsions, dysrythmias

42
Q

Neuromuscular activity is _____________ in alkalosis

A

increased

43
Q

Those who have respiratory acidosis mostly tend to be ______________

A

hypoxemic

44
Q

What are the manifestations of respiratory acidosis?

A

vasodilation of cerebral vessels, headaches, blurred vision, weakness, confusion, depression, lethargy, drowsiness, hallucinations, paralysis, coma

45
Q

In respiratory alkalosis, there is a _______ in PCO2 (hypocapnia). What is the pH?

A

decrease,

pH > 7.45, PCO2 < 35

46
Q

What is respiratory alkalosis caused by?

A

hyperventilation
-ventilated pts, panic attacks, anxiety, pain, pregnancy/labor, fever, sepsis, encephalitis

47
Q

What are the manifestations of respiratory alkalosis?

A

decreased cerebral blood flow, lightheadedness, dizziness, tingingling/numn of fingers/toes, sweating, palpitations

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