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Renal System > Acid-Base Physiology > Flashcards

Acid-Base Physiology Flashcards

1
Q

Golden Rules of Simple Acid-base disorders

A
  1. PCO2 and HCO3 always change in the same direction
  2. The secondary physiologic compensatory mech must be present
  3. The compensatory mechs never fully correct pH
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2
Q

Acid-base disorder that reduces plasma bicarbonate

A

Metabolic Acidosis

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3
Q

Causes of Metabolic Acidosis

A
  1. Increased acid generation:
    - Lactic acidosis, Ketoacidosis, ingestion (aspirin, ethylene glycol, methanol), dietary protein intake (animal source)
  2. Loss of Bicarbonate:
    - Gastrointestinal (diarrhea, intestinal fistulas)
    - Renal: type 2 proximal renal tubular acidosis
  3. Decreased Acid excretion:
    - impaired NH4+ excretion
    - Renal failure (reduced GFR) decreased ammonium excretion
    - Type I (distal) renal tubular acidosis
    - Type 4 renal tubular acidosis (hypoaldosteronism)
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4
Q

Acid-base disorder characterized by excessive plasma CO2

A

Respiratory Acidosis

  • induced by hypercapnia (inadequate alveolar ventilation)
  • can be acute or chronic
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5
Q

Common causes of acute respiratory acidosis?

A
  • General anesthesia
  • Sedative overdose
  • Cardiac arrest
  • Pneumothorax
  • Pulmonary edema
  • severe pneumona
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6
Q

Common causes of chronic respiratory acidosis?

A
  • COPD
  • Primary alveolar hypoventilation
  • Brain tumor
  • Respiratory nerve damage
  • myopathy involving respiratory muscles
  • restrictive disease of the thorax (scleroderma)
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7
Q

Acid-base disorder characterized by reduced CO2 (due to increased alveolar ventilation)

A

Respiratory Alkalosis

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8
Q

Acid-base disorder characterized by increased plasma bicarbonate

A

Metabolic Alkalosis

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9
Q

T or F: Acute respiratory acid base disorders always have a greater change in pH than chronic resp. disorders

A

True

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10
Q

How does plasma Cl change in relation to plasma HCO3 in respiratory disorder

A

Equally and inversely

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11
Q

How does the plasma anion gap change in respiratory disorders?

A

It does NOT change

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12
Q

T or F: Plasma sodium is directly altered in acid base disorders

A

False

- Plasma sodium in INDIRECTLY altered

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13
Q

Causes of Metabolic alkalosis?

A
  1. Loss of hydrogen ions from GI tract:
    - Vomiting
  2. Loss of hydrogen ions from the urine
    - diuretics
  3. excessive urinary acid excretion
    - hyperaldosteronism
  4. Movement into the cells
    - hypokalemia
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14
Q

Normal Arterial pH?

A

7.4

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15
Q

Metabolic alkalosis with:

- Urine Cl- conc > 30 mmol/l

A

Chloride-resistant (metabolic alkalosis)

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16
Q

Metabolic alkalosis with:

- Urine Cl- conc

A

Chloride-resistant (metabolic alkalosis)

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17
Q

Metabolic alkalosis with:

- Urine Cl- conc

A

Chloride-responsive (metabolic alkalosis)

18
Q

Normal plasma bicarbonate levels

A

24 meq/L

19
Q

Normal plasma CO2 concentration

A

40 mmHg

20
Q

Metabolic Acidosis with:

  • increased [Cl-]
  • low plasma [bicarbonate]
A

Metabolic acidosis w/ Normal Anion Gap

21
Q

Metabolic Acidosis with:

  • normal [Cl-]
  • low plasma [bicarbonate]
  • increased unmeasured anions
A

Metabolic acidosis w/ Increased Anion Gap

22
Q

Clinical signs:

Tachypnea (hyperventilation) think…

A

Respiratory Alkalosis

high bicarb => high CO2

23
Q

Clinical signs:

obstruction of airway or inability to breath think…

A

Respiratory Acidosis

24
Q

Clinical signs:

Nausea and vomiting, think….

A

Metabolic Alkalosis

  • (Chloride depletion)
25
Q

Clinical signs:

Diarrhea, think…

A

normal anion gap metabolic
acidosis

  • due to direct bicarbonate loss from gut
26
Q

Clinical signs:
Type I diabetic off his insulin

think…

A

suggests ketoacidosis, which is a cause of increased anion gap metabolic
acidosis.

27
Q

Normal Plasma [Na+]

A

140 meq/l

28
Q

Norma plasma [Cl-]

A

104 meq/l

29
Q

Equation for calculating URINE anion gap

A

UAG = (Na + K) - (Cl)

30
Q

AG - normal
Urine Anion Gap = Positive

What is the cause of the non-anion gap Metabolic acidosis?

A

Renal = cause (RPGN)

UAG = (Na + K) - (Cl)

  • positive because Cl- is not being excreted which means H+/NH4+ is not being excreted (it’s building up)
  • Type I RTA (distal tubular)
31
Q

AG - normal
Urine Anion Gap = Negative

What is the cause of the non-anion gap Metabolic acidosis?

A

GI = Cause (RPGN)

  • due to diarrhea
32
Q

When do you use the Urine Anion gap?

A

When there is a non-gap metabolic acidosis

33
Q

Equation for calculating the pCO2 from bicarbonate?

When is this used?

A

PCO2 = 1.5 (HCO3-) + 8

  • only for Metabolic acidosis
34
Q

In ACUTE respiratory alkalosis,

how much does the bicarbonate increase for every 10mmHg pCO2 increase?

A

2 meq/L for every 10mmHg increase of pCO2

35
Q

In CHRONIC respiratory alkalosis,

how much does the bicarbonate increase for every 10mmHg pCO2 increase?

A

4 meq/L for every 10mmHg increase of pCO2

36
Q

In CHRONIC respiratory acidosis,

how much does the bicarbonate increase for every 10mmHg pCO2 increase?

A

3.5 meq/L for every 10mmHg increase of pCO2

37
Q

In ACUTE respiratory acidosis,

how much does the bicarbonate increase for every 10mmHg pCO2 increase?

A

1 meq/L for every 10mmHg increase of pCO2

38
Q

Compensation mechanism for metabolic Acidosis?

A

Hyperventilation (decreases pCO2)

39
Q

Compensation mechanism for metabolic Aklalosis?

A

Hypoventilation (Retains/increases pCO2)

40
Q

Compensation mechanism for respiratory acidosis?

A

Increase bicarbonate

  • increase bicarbonate reabsorption
  • increase H+ secretion
41
Q

Compensation mechanism for respiratory alkalosis

A

Decrease bicarbonate

  • decrease bicarbonate reabsorption
  • decrease bicarbonate secretion

Renal System (19 decks)

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