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Medical Physiology > Acid Base Physiology > Flashcards

Acid Base Physiology Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the normal blood pH?

A

~7.4

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2
Q

in the body, what is considered basic and what is considered acidic?

A

pH > 7.6 is basic

pH

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3
Q

What is the major source of volatile acids?

A

oxidative metabolism of carbohydrates and triglycerides

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4
Q

what does the oxidative metabolism to produce volatile acids also produce?

A

CO2 converted to carbonic acid (H2CO3) and back to CO2 to be secreted by lungs

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5
Q

what are two exceptions of oxidative metabolism for volatile acids?

A

carbohydrate oxidation in hypoxia (lactic acid)

fat oxidation in diabetes mellitus (ketoacids)

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6
Q

what is the chemical reaction that occurs when CO2 and H2O mix?

A

create H2CO3 that then creates H+ and HCO3

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7
Q

what is the ratio of free H to free HCO3? what does this mean?

A

1:600000

a shift to the right has a much greater effect on H than HCO3

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8
Q

descrive non volatile acids

A

excreted by the kidneys

form non carbonic acids, sulfuric, and hydrochloric acids

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9
Q

what molecule do you lose from the following body functions?

1) vomiting
2) diarrhea
3) urine

A

vomit - H+ loss
diarrhea - HCO3 loss
urine - HCO3 loss

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10
Q

what molecule do you lose from the following body functions?

1) vomiting
2) diarrhea
3) urine

A

vomit - H+ loss
diarrhea - HCO3 loss
urine - HCO3 loss

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11
Q

what is the difference between volatile and non volatile acids?

A

volatile metabolism produces CO2 that is excreted by the lungs whereas non-volatile metabolism does not produce CO2 to be excreted in lungs

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12
Q

what is the difference between volatile and non volatile acids?

A

volatile metabolism produces CO2 that is excreted by the lungs whereas non-volatile metabolism does not produce CO2 to be excreted in lungs

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13
Q

what is the henderson hasselbach equation?

A

relationship between pH, CO2, and HCO3

pH proportional to concentration of HCO3 and inversely proportional to dissolved CO2

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14
Q

what is the henderson hasselbach equation?

A

relationship between pH, CO2, and HCO3

pH proportional to concentration of HCO3 and inversely proportional to dissolved CO2

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15
Q

what is the significant of buffers in the body?

A

acute control of pH and prevent large shifts in pH

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16
Q

what are 2 blood buffers?

A

plasma

erythrocytes

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17
Q

what kind of buffers does plasma contain?

A

bicarbonate and phosphate buffers

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18
Q

what kind of buffer does RBCs contain?

A

bicarbonate buffer

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19
Q

what are 2 tissue buffers?

A

skeletal muscle

bone

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20
Q

where is a large percentage of the total body HCO3 contained?

A

skeletal muscle

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21
Q

how does bone offer a buffering system?

A

large store of carbonate

main source for neutralizing non carbonic acid

22
Q

what is associated with bone breakdown?

A

long term non carbonic acidosis

23
Q

what is associated with bone breakdown?

A

long term non carbonic acidosis

24
Q

how does the respiratory system regulate pH

A

eliminates CO2 from the blood and shift equilibrium away from H2CO3 (and vice versa)

25
Q

what happens to pH if you incr. or decr. resp rate?

A

decr RR - decr pH

incr RR - incr pH

26
Q

what are 3 renal mechanisms for responding to pH changes?

A

1) bicarbonate reabsorption
2) formation of new bicarbonate/ ammonium:ammonia
3) excretion of hydrogen ions (ammonia/phosphate)

27
Q

where does bicarbonate reabsorption occur in the kidneys?

A

proximal tubule mostly

also in collecting ducts

28
Q

where does bicarbonate reabsorption occur in the kidneys?

A

proximal tubule mostly

also in collecting ducts

29
Q

How is HCO3 produced in proximal tubule?

A

glutamine converted to NH4 and HCO3

30
Q

what happens to NH4 and HCO3?

A

HCO3 reabsorbed

NH4 secreted into tubule lumen

31
Q

what is the ultimate goal of converting glutamine to NH4 and HCO3? where does the HCO3 go?

A

to put NH3 into the interstitum for later use

HCO3 goes to peritubular plasma

32
Q

what are the 3 parts to net acid secretion (NAE)? which is most important

A

UNH4V - urine ammonium excretion (important)
UTAV - titratable acid secretion
UHCO3V - bicarbonate secretion

33
Q

what is the NAE equation?

A

NAE = (UNH4V + UTAV) - UHCO3V

34
Q

what causes little excretion of H from distal tubule?

A

concentration gradient from plasma to tubule lumen limits amount that can be excreted

35
Q

which direction does H move in distal tubule? why does this occur?

A

H moves into tubule

HCO3 buffers the H in tubule lumen

36
Q

what back up bufferers are in place if all HCO3 is used up?

A

phosphate and ammonia

37
Q

what hormone stimulates H secretion?

A

aldosterone

38
Q

which buffer is more effective at higher pH?

A

phosphate

39
Q

which buffer is more effective at higher pH?

A

phosphate

40
Q

what are the 3 responses from the kidney in the case of acidosis? what is the ultimate goal?

A

goal: incr NAE
1) incr H secretion and incr HCO3 reabsorption to 100%
2) incr NH3 production and loss of NH4
3) generate new HCO3 from glutamine

41
Q

what are 2 responses from the kidney in the case of alkalosis? what is the ultimate goal?

A

goal: decrease NAE
1) decr. H secretion
2) decr HCO3 reabsorption

42
Q

what are 2 responses from the kidney in the case of alkalosis? what is the ultimate goal?

A

goal: decrease NAE
1) decr. H secretion
2) decr HCO3 reabsorption

43
Q

how do you determine if someone is acidotic/alkalotic due to respiratory issues or metabolic issues?

A

if pH is consistent with CO2 or HCO3 levels
CO2 - resp
HCO3 - meta

44
Q

how do you calculate anion gap?

A

Na - (HCO3 + Cl)
Na = major extracellular cation
HCO3 and CL = majority of anions associated with Na

45
Q

what is the anion gap in a normal person?

A

11mEq/L

46
Q

what causes metabolic acidosis?

A

gain of acid through production or ingestion or loss of HCO3 (ex: diarrhea)

47
Q

what could be causes of increased acid production or ingestion?

A

prod - lactic/ketoacidosis (diabetes)

ing - methanol, ethanol, aspirin

48
Q

what happens to the ion gap when HCO3 is depleted? why?

A

nothing

Cl compensates for loss of HCO3

49
Q

what is hyperchloremic metabolic acidosis?

A

loss of HCO3 causes there to be too much Cl in the body but shows a normal anion gap

50
Q

what are two causes of hyperchloremic metabolic acidosis?

A 
loss of HCO3 from GI tract
renal impairment (renal tubular acidosis)(RTA)
51
Q

what is RTA? what are the 3 different kinds?

A

RTA - unable to excrete acid load
Type 2 - proximal type (reduced ability to reabsorb HCO3)
Type 1 - distal nephron (late nephron unable to secrete H)
Type 4 - hypoaldosteronism (unable to secrete H)

Medical Physiology (15 decks)

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