Acid-Base Imbalance (CHP 8) Flashcards

Describe the intracellular and extracellular mechanisms for buffering changes in body pH. Compare the roles of the kidneys and respiratory system in regulation of acid-base balance. Differentiate between respiratory and metabolic alkalosis; and respiratory and metabolic acidosis. Describe causes of respiratory and metabolic acidosis; and metabolic and respiratory alkalosis. Compare and contrast the etiology and clinical manifestations of metabolic and respiratory acidosis and of metabolic and re

1
Q

______ and ________ = ECF

A

interstitial
plasma

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2
Q

intracellular water is found in …

A

cells

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3
Q

what is the body’s extracellular pH

A

7.35 - 7.45

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4
Q

acids and bases exist as _________ pairs/systems

A

buffer

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5
Q

acids are generated as ___________ of metabolic processes

A

byproducts

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6
Q

how do volatile acids exit the body?

A

lungs

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7
Q

how do nonvolatile/ fixed acids exit the body?

A

kidneys

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8
Q

the pH is regulated by: (3)

A
  1. chemical buffer systems (combine As and Bs to neutralize)
  2. lungs (get rid of CO2)
  3. kidneys (eliminate H+ & reabsorb/eliminate HCO3-)
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9
Q

the chemical buffer systems in the body, don’t do well with _______ changes

A

big

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10
Q

where are chemical buffer systems located?

A

within the ICF and ECF

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11
Q

buffer systems trade a strong acid for a ______ base OR trade a weak ______ for a strong base

A

weak
acid

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12
Q

what are the 3 main buffer systems?

A

bicarbonate buffer system

proteins

transcellular H+/K+ exchange system

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13
Q

the bicarbonate buffer system acts by __________ combining _____ & ______ to prevent changes in ____

A

immediately
A B
pH

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14
Q

transcellular H+/K+:
1. if plasma is acidic (too much _____)
2. H+ moves _____ cells, as ____ moves out
3. at risk for _________

why?

A

H+
in, K+
hyperkalemia

the ICF can be acidic (temporarily) but the ECF needs to stay between 7.35 - 7.45

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15
Q

________________ recognize changes in pH and tell the respiratory system to fix changes

A

chemoreceptors

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16
Q

pH above 7.45

A

alkalotic

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17
Q

pH below 7.35

A

acidic

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18
Q

increased ventilation = _______ PCO2

A

decreased

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19
Q

decreased _______ = increased PCO2

A

ventilation (RR)

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20
Q

lungs are the ___________ response, but can not be maintained indefinitely

A

fastest

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21
Q

what are the 3 roles of the kidneys in regulating pH?

A
  1. excretion of H+ (urine)
  2. reabsorption of HCO3-
  3. production of new HCO3-
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22
Q

pH changes with the kidneys take _______ but continue for ______ until pH returns to normal

A

hours
days

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23
Q

if the pH is too high, the kidneys will _________ or produce new ________ to lower the pH to normal

A

reabsorb
HCO3-

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24
Q

why does the body excrete H+?

A

to prevent hyperkalemia

(get rid of excess H+, K+ can go back into cell)

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25
Q

what are the 4 renal control mechanisms?

A
  1. H+ elimination and HCO3- conservation
  2. tubular buffer system
  3. K+/H+ exchange
  4. Cli-/HCO3- exchange
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26
Q

the tubular buffer system stops eliminating _____ (dangerous to kidneys) and pairs them with _______ and then restarts excretion

A

H+
buffers

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27
Q

pH < 7.35 (acidosis)
H+ elimination:
K+ elimination:
plasma [K+]
_______kalemia

A

increases
decreases
increases
hyper

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28
Q

pH > 7.45 (alkalosis)
H+ elimination:
K+ elimination:
plasma [K+]
_______kalemia

A

decreases
increases
decreases
hypo

29
Q

pH > 7.45 (alkalosis)
Cl- elimination:
HCO3- elimination:

A

decreases
increases

30
Q

pH < 7.35 (acidosis)
Cl- elimination:
HCO3- elimination:

A

increases
decreases

31
Q

why is renal regulation of pH more efficient?

A

they have more mechanisms that can be tailored to fixing the issue

32
Q

what is the range for PCO2?
this is the _______ component

A

35 - 45 mmHg
respiratory

33
Q

what is the range for HCO3-?
this is the _______ component

A

22 -26 mmol/L
kidney

34
Q

why do we use an artery for ABGs?

A

more accurate to the systemic issues of the body

(venous is dependent on the metabolic demands of surrounding tissue)

35
Q

base excess =

A

metabolic alkalosis

36
Q

base deficit =

A

metabolic acidosis

37
Q

what does the anion gap measure?

A

difference between plasma concentrations of major cations (Na/K) and sum of measured anions (Cl- /HCO3-)

38
Q

what is the normal anion gap value?

A

8 - 16 mEq/L

39
Q

if the anion gap is high …

A

there are more negative ions in the body, which means the body has kidney issues

40
Q

metabolic

41
Q

R
O
M
E

A

respiratory
opposite
metabolic
equal

42
Q

pH and HCO3- for: metabolic acidosis

A

low and low

43
Q

respiratory compensation for metabolic acidosis:

A

increase RR (to decrease PCO2)

44
Q

pH and HCO3- for: metabolic alkalosis

A

high and high

45
Q

respiratory compensation for metabolic alkalosis:

A

decrease RR (to increase PCO2)

46
Q

renal compensation for metabolic alkalosis:

A

decrease H+ excretion
decrease HCO3- reabsorption

47
Q

renal compensation for metabolic acidosis:

A

increase H+ excretion
increase HCO3- reabsorption

48
Q

pH and PCO2: respiratory acidosis

A

low pH
high PCO2

49
Q

pH and PCO2: respiratory alkalosis

A

high pH
low PCO2

50
Q

renal compensation for respiratory acidosis:

A

increase in H+ excretion
increase in HCO3- reabsorption

51
Q

renal compensation for respiratory alkalosis:

A

decrease in H+ excretion
decrease in HCO3- reabsorption

52
Q

__________ mechanisms: Provides a means to control pH when correction is impossible or cannot be achieved immediately

A

compensatory

53
Q

what is an example of mixed acid-base disorders?

A

someone having COPD
and then
getting into a car crash and injuring a kidney

(both systems are impaired and can’t regulate pH)

54
Q

what is an example of a single acid-base disorder?

A

getting into a car crash and injuring a kidney

(lungs still available to regulate pH)

55
Q

etiology of metabolic acidosis: (4)

A
  1. increased production of acids (meds)
  2. inability of kidneys to excrete acids
  3. excessive loss of bicarb through kidneys or GI tract (upper GI all alkaline)
  4. increased plasma [Cl-] (high Cl = low HCO3)
56
Q

causes of metabolic acidosis: (3)

A

lactic acidosis
ketoacidosis (alcoholic + diabetic)
kidney failure/destruction

57
Q

manifestations of metabolic acidosis (6)

A

N and V
weakness
confusion
peripheral vasodilation
decreased HR
cardiac arrhythmias

58
Q

signs of metabolic acidosis compensation

A

increased RR (kussmaul)
hyperkalemia
acid urine
increased ammonia in urine

59
Q

etiology of metabolic alkalosis: (3)

A
  1. gain of base (oral or IV = antacids)
  2. loss of fixed acids from the stomach (vomiting)
  3. maintenance of increased bicarbonate levels by contraction of ECF volume, hypokalemia, hypochloremia (excessive diuretics)
60
Q

causes of metabolic acidosis: (3)

A

excessive gain of bicarb (antacids)

excessive loss of H+ ions (vomiting or gastric suction)

diuretic therapy

61
Q

manifestations of metabolic acidosis (5)

A

confusion
hyperactive reflexes
tetany
hypotension
arrhytmias

62
Q

signs of metabolic alkalosis compensation (2)

A

decreased rate and depth
increased urine pH

63
Q

etiology of respiratory acidosis: (2)

A

acute or chronic conditions (decreased respiratory drive, lung disease, disorders of chest wall and respiratory muscles)

64
Q

causes of respiratory acidosis: (4)

A

depression of respiratory center

lung disease

airway obstruction or disorders of chest wall (paralysis of resp m, chest injuries)

breathing air with high CO2

65
Q

manifestations of respiratory acidosis (3)

A

dilation of cerebral vessels
depression of neural function
stupor and coma

66
Q

etiology of respiratory alkalosis (1_

A

hyperventilation

67
Q

causes of respiratory alkalosis (2)

A

hyperventilation and fever

68
Q

manifestations of respiratory alkalosis (3)

A

CONSTRICTION of cerebral vessels

dizziness, panic, light-headed

numbness and tingling of fingers/toes