Acid/Base Disturbances Flashcards

1
Q

What are volatile acids?

Some examples?

A

Form bicarbonate and H+ which can be eliminated

Glucose (under aerobic respiration)

Fat (under aerobic respiration)

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2
Q

What are fixed acids?

Some examples?

A

An acid produced in the body from sources other than carbon dioxide, and is not excreted by the lungs.

Glucose (under aerobic respiration) forming Lactate

Cysteine forming sulfate

Phosphoprotein forming phosphate

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3
Q

What change in pH will double or halve the concentration?

A

0.3

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4
Q

pH values of the following:

Arterial blood

Venous bloods and interstitial fluid

ICF

Urine

Gastric HCL

A
  1. 4
  2. 4

6 to 7.4

  1. 5 to 8
  2. 8
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5
Q

What are the buffer systems of the human body, and what are their pKa values.

A

Bicarbonate = 6.1

Plasma proteins = 6.7

Phosphate = 6.8

Hemoglubin = 7.3

BP pH

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6
Q

Breathing fast will result in what changes to CO2 and pH?

A

CO2 low = pH high

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7
Q

What is the Henderson Hasselbach equation?

A
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8
Q

What is the absorption of bicrbonate in the following regions of the nephron:

Proximal tubule

Thick scending limb

Collecting Duct

A

85%

10%

5%

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9
Q

How is bicarbonate transferred across the luminal cell’s basolateral membrane?

A

Na+/HCO3- cotransporter - Moves 3 HCO3- out with one Na+

HCO3-/Cl- antiporter

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10
Q

What are the secondary causes of H+ secretion in the proximal tubule?

A

Increase in filtered load of HCO3-

Decrease in ECF volume

Increase in angiotensin II

Hypokalemia

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11
Q

What are the secondary causes of H+ secretion in the collecting duct?

A

Increase in aldosterone

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12
Q

What is the primary cause of decrease [H+] secretion?

A

Increase in plasma HCO3- concentration

Decrease in partial pressure of O2

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13
Q

What acts as a bufffering agent in the tubular lumen?

A

NaHPO4- / NaH2PO4

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14
Q

What cells secrete bicarbonate?

A

Beta-intercalated cells

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15
Q

How is new bicarbonate synthesized.

A

H+ is bound to NH3+ and secreted as NH4.

Bicarbonate is reabsorbed

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16
Q

What is the net acid excretion equation?

What type of acid production should it be equal to in a normal healthy adult?

A

TA = titratable acids

Nonvolatile or fixed

17
Q

What are the normal levels of pH?

H+

PCO2

HCO3-?

A

7.4

40nEq/L

40 mm Hg

24 mEq/L

18
Q

Why do greater changes occur during acute respiratory acidosis/alkalosis in camparison to chronic respiratory acidosis/alkalosis?

A

The kidneys have more tie to respond, retaining more H+ or HCO3- depending on the situation.

19
Q

How do the kidneys correct for metabolic acidosis?

What about the lungs?

A

Kidneys = Increased generation of NH3+ or HPO4-.

Lungs = Hyperventalation

20
Q

How is anion gap calculated?

What is the normal?

A

Na+ - (Cl + Bicarbonate)

8-16 mEq/LCL

21
Q

What are causes of high metabilic acidosis?

A

MUDPILERS

Methanol

Uremia

DKA/Alchoholic KA

Paradehyde

Isoniazid - used to treat tuberculosis

Lactic Acidosis

EtOH / Ethylene Glycol

Rhabdomycin/Renal failure

Salicylates

22
Q

What are causes of non-anion gap acidosis?

A

HARDUPS

Hyperalimentation

Acetazolamide

Renal Tubular Acidosis

Diarrhea

Utero-pelvic shunt

Post-hypnocapnia

Spirolactone

23
Q

What are the causes of metabolic alkalosis?

A

Clever PD

Contraction

Licorice

Endo: Conn, Cushing, Bartter

Vomiting

Excess Alkali

Referring Alkalosis

Post-hypercapnia

Diuretics

24
Q

What causes acute respiratory acidosis?

A

CAANS

CNS depression

AIrway obstruction

Acute respiratory distress syndrome

Neuromuscular disorders

Severe pneumonia, embolism, or pulmonary edema

25
Q

What causes chronic respiratory acidosis?

A

COPD and anything that can lead to impaired ventalilation.

26
Q

What causes respiratory alkalosis?

A

CHAMPS

CNS disease

Hypoxia

Anxiety

Mechanical ventilation

Progesterone

Salicylates/Sepsis

27
Q

What is the equation for metabolic acidosis?

A

PaCO2 = 40 - (1.2 x 24 - [HCO3])

28
Q

What is the equation for metabolic alkalosis?

A

PaCO2 = 40 - (0.7 x 24 - [HCO3])

29
Q

What diseases feature metabolic acidosis with urine Cl- > 20 mEq/L?

A

Chloride resistant, hyperaldosterism, K+ loosing diuretics

30
Q

What are the equations fro respiratory acidosis?

A

Acute = 24 + (0.1 x (PaCO2 - 40))
Chronic = 24 + (0.4 x (PaCO2 -40))

31
Q

What are the equations fro respiratory alkalosis?

A

Acute = 24 - (0.2 x (40 - PaCO2))
Chronic = 24 - (0.5 x (40 - PaCO2))

32
Q

What is the mechanism behind Renal Tubular Acidosis Type 1?

What are the highlighted causes?

Where is it effecting?

A

Intercalated cells cannot secrete H+ by alpha intercalated cells

Urinary stone formation due to hypercalciuria with low urinary citrate and alkaline urine; bone deminieralization

The distal tubule

33
Q

What is the mechanism behind Renal Tubular Acidosis Type 2?

What are the highlighted causes?

A

Failed reabsorbtion of HCO3- by the proximal tubule.

Most often seen associated with Faconi syndrome

34
Q

What is the mechanism behind Renal Tubular Acidosis Type 4?

What are the highlighted causes?

Where is it effecting?

A

Deficiency of aldosterone (primary or hyporeninemic), or a resistance to its effects due to pseudomypoaldosteronism or drugs

NSAIDs, ACE inhibitors/ARB, and spironolactone or eplerenone

Adrenal Gland

35
Q

Which form of Renal Tubular Acidosis presents with hyperkalemia?

A

Type 4

36
Q

What is the most rare to most common renal tubular acidosis?

A

2 → 1 → 4