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Respiratory Pathophysiology > Acid-Base Homeostasis > Flashcards

Acid-Base Homeostasis Flashcards

1
Q

what is the normal [H+] in blood?

A

0.0004mEq/L or 40x10-9 Eq/L or 40nEq/L

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2
Q

what is the [H+] range and pH range compatible with life?

A

25-100nEq/L
7.0-7.7

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3
Q

where does the daily acid load come from?

A

CO2 from oxidation of glucose and fatty acids during aerobic cellular metabolism
CO2+H2O<->H2CO3<->H++HCO3-

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4
Q

what are the three phases of defense against loss of acid base homeostasis?

A

buffering
compensation
correction

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5
Q

what is the order of action from the three phases of defense against loss of acid base homeostasis?

A

buffering: immediate
compensation: minutes to days
correction: days or more

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6
Q

what equation shows the equilibrium relationship of carbonic acid dissociation?

A

Henderson-Hasselbalch

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7
Q

what are the buffers?

A

H2CO3/HCO3-
inorganic phosphates and plasma proteins
major intracellular is hemoglobin

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8
Q

how can the lungs regulate pH?

A

effectively removes H+ by blowing CO2 off

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9
Q

what receptors lead to a change in ventilation?

A

chemoreceptors in medulla, carotid body, and aortic arch

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10
Q

how does the renal system contribute to buffering?

A

regulates Na+ and Cl- loss
H2O
reabsorption filtered HCO3-
excrete H+ (titratable acid or ammonia)

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11
Q

what are the normal ranges of pH, PCO2, and base excess [HCO3-] in an arterial blood gas?

A

7.37-7.43
36-44 mmHg
22-26 mEq/L

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12
Q

what are the two indirect methods for determination of [HCO3-]?

A

Siggard-Andersen nomogram using pH and PCO2
biochemical measurement of total blood CO2

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13
Q

what is base excess?

A

mEq of acid that would be needed to bring 1 L of blood in the sample to a pH of 7.4, if PCO2 held at 40 mmHg
evaluation of non-respiratory component of acid-base

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14
Q

what is anion gap?

A

estimates amount of strong anions in plasma not accounted for by inorganic ions measurement

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15
Q

what does an increased anion gap indicate?

A

unmeasured anions present: ketoacids, lactate, sulfates, phosphate, albumin

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16
Q

what are normal anion gaps?

A

with K+: 17-19 mEq
without K+: 12-14 mEq

17
Q

what is metabolic acidosis with a normal anion gap?

A

changes in [Cl-] usually

18
Q

what is respiratory acidosis due to (not disease processes)?

A

impaired pulmonary elimination of CO2 due to alveolar hypoventilation

19
Q

what can cause respiratory acidosis?

A

pulmonary disease
impaired chest wall or respiratory muscle function
severe CNS depression
inadequate ventilation during anesthesia

20
Q

how does renal compensation work with respiratory acidosis?

A

increased H+ excretion

21
Q

what is respiratory alkalosis due to?

A

inappropriate CO2 elimination due to hyperventilation

22
Q

what can cause respiratory alkalosis?

A

hypoxia, pain or fear, gram negative sepsis, strenuous exercise, overzealous assisted ventilation, hyperthermia, hypoxemia, hypotension

23
Q

what does renal compensation of respiratory alkalosis consist of?

A

diminished HCO3- recovery

24
Q

what can cause metabolic acidosis?

A

diarrhea or renal failure leading to HCO3- loss
renal failure
increased endogenous acid production
exogenous acid load

25
Q

what is metabolic acidosis due to?

A

HCO3- loss
retention of acid

26
Q

how does the respiratory system compensate for metabolic acidosis?

A

increased CO2 removal

27
Q

what is metabolic alkalosis due to?

A

acid loss
HCO3- retention

28
Q

what can cause metabolic alkalosis?

A

vomiting: acid loss
volume depletion, K+ wasting diuretics

29
Q

how can the respiratory system compensate for metabolic alkalosis?

A

hypoventilation

30
Q

what is the normal range for bicarbonate?

A

22-26 mEq/L

31
Q

what is the normal range for pH?

A

7.37-7.43

32
Q

what is the normal range for PCO2?

A

36-44 mmHg

33
Q

do we routinely measure inorganic ions in plasma?

A

yes, but not organic ions

34
Q

what does a positive base excess indicate?

A

alkalemia

35
Q

what is the equation for the equilibration for the concentration of hydrogen ions in plasma?

A

[H+]=24*PCO2/[HCO3-]

36
Q

how much carbonic acid does alveolar ventilation remove daily?

A

24,000 mEq

37
Q

how can the kidneys regulate acid loss?

A

titratable acid
ammonia

Respiratory Pathophysiology (22 decks)

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