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Colin Renal Final > Acid-Base Regulation > Flashcards

Acid-Base Regulation Flashcards

1
Q

What is the normal pH of the ECF?

A

7.4

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2
Q

Which reactants form volatile (CO2-derived) H+/HCO3- and where are these products eliminated?

A

Aerobic Glucose metabolism
Aerobic Fat Metabolism

Eliminated in the lungs

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3
Q

Which reactants form fixed (non-CO2-derived) H+ and where is the acid eliminated?

A

Anaerobic Glucose metabolism (forms H+ and Lactic acid)

Aerobic Cystein metabolism (produces H+ and Sulfate)

Aerobic Phosphoprotein metabolism (produces H+ and Phosphate)

Eliminated in the Kidney

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4
Q

What is the normal pH range for ICF?

A

6.0 - 7.4

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5
Q

What is the normal pH range for Urine?

A

4.5 - 8.0

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6
Q

What is normal pH of gastric HCl?

A

0.8

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7
Q

What are the four buffer systems?

A

Bicarbonate
Hemoglobin
Phosphate
Plasma Proteins

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8
Q

What is the pK value of the bicarbonate buffer system and what does it mean?

A

The pK value of te bicarbonate buffer system is 6.1. This means at a pH of 6.1, the amounts of HCO3- and H2CO3 are equal

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9
Q

What role does the lungs have on pH regulation?

A

Regulates retention of CO2, therefore controlling the presence of H2CO3 (carbonic acid)

Rate: minutes-hours

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10
Q

What is the role of Ionic shifts in pH regulation?

A

Controls the exchange of Na+ and K+ for H+

Rate: 2-4 hours

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11
Q

What is the role of the kidneys in pH regulation?

A

Bicarbonate reabsorption and regeneration, ammonia formation, phosphate buffering

Rate: hours to days

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12
Q

What is the role of Bone in pH regulation?

A

Exchanges calcium and phosphate, and release of carbonate

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13
Q

How does ionic shifts buffer in response to Acidemia

A

Acidemia is acidic blood (<7.35)

H+ are exchanged for K+, causes ICF to take in more H+

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14
Q

How does ionic shifts buffer in response to Alkalemia

A

Alkalemia is alkaline blood (>7.45)

K+ is exchanged for H+, causing ICF to take in more K+ in exchange for H+

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15
Q

What is the henderson hasselbach equation?

A

pH = pka + log ([Base]/[Acid])

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16
Q

What should you know when applying the henderson hasselbach equation to the Bicarbonate buffer system?

A

pH = pka + log ([Base]/[Acid])

pH = 6.1 + log ([HCO3-]/[H2CO3])

Note that the HCO3- concentration is regulated by the kidneys and the the H2CO3 concentration is regulated by the lungs

H2CO3 concentration = 0.03 * Pco2 {plasma CO2 concentration}

If the Base/Acid ratio is equal to 20, then the pH will equal 7.4

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17
Q

What happens to pH when you hold your breath? What happens when you breath quickly?

A

Hold breath -> Acidosis

Breath quickly -> Alkalosis

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18
Q

What segments are involved in Bicarbonate reabsorption?

A

Proximal Tubule (85%)

Thick Ascending limb of The Loop of Henle (10%)

Collecting Duct (4.9%)

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19
Q

Describe how Bicarbonate is reabsorbed in the Proximal Tubule (include the channels involved)

A

Na/H Exchanger and H-ATPase bring H+ into the lumen

Filtered HCO3- binds with the H+ to form H2CO3

H2CO3 is converted to CO2 and H2O via Carbonic Anyhydrase on apical membrane

CO2 and Water diffuse into the tubule cell where intracellular carbonic anhydrase converts CO2 and H2O into H2CO3

H2CO3 splits into HCO3- and H+

HCO3- Leaves the cell via a Na-HCO3 Symporter (which carries 3 HCO3 and 1 Na+ into the interstitium) or a HCO3-Cl exchanger (which sends HCO3- to the interstitium and sends Cl- into the cell)

20
Q

What factors directly increase H+ secretion as a result of Acid/Base regulation?

A

Decreased serum HCO3-

Increased Serum CO2 levels

21
Q

What factors directly decrease H+ secretion as a result of Acid/Base regulation?

A

Increased serum HCO3-

Decreased serum CO2 levels

22
Q

How does hypokalemia affect H+ secretion?

A

Hypokalemia increases H+ secretion

K+ reabsorption occurs as H+ secretion occurs

23
Q

How does hyperkalemia affect H+ secretion?

A

Hyperkalemia decreases H+ secretion

K+ reabsorption parallels H+ secretion.

Hyperkalemia reduces K+ reabsorption, thus H+ secretion decreases

24
Q

How does a decrease in ECF volume affect H+ secretion?

A

Decreased ECF volume increases H+ secretion

25
Q

How does an increase in ECF volume affect H+ secretion?

A

Increased ECF volume decreases H+ secretion

26
Q

How does increased Angiotensin II affect H+ secretion?

A

Increased angiotensin II increases H+ secretion.

Aldosterone promotes acid secretion in Alpha Intercalated cells

27
Q

How does decreased Angiotensin II affect H+ secretion?

A

Decreased Angiotensin II decreases H+ secretion.

Aldosterone promotes H+ secretion in alpha intercalated cells.

Less Angiotensin means less aldosterone, which means less H+ secretion

28
Q

How does increased Aldosterone affect H+ secretion?

A

Aldosterone promotes H-ATPase presence on apical membrane of alpha intercalated cells.

H-ATPases pump H+ into the lumen of the tubule, increasing H+ secretion

29
Q

How does decreases aldosterone affect H+ secretion?

A

Aldosterone promotes H-ATPase presence on apical membrane of alpha intercalated cells

30
Q

How does an increase in HCO3- filter load affect H+ secretion?

A

Increased HCO3- filtered load causes an increase in H+ secretion

31
Q

How does a decrease in HCO3- filter load affect H+ secretion?

A

Decreased HCO3- filter load causes a decrease in H+ secretion

32
Q

Where does the phosphate buffer system exist and how does it work?

A

Exists in the tubule lumen, and Phosphate Binds with Na+ to become sodium phosphate.

Sodium Phosphate Then Binds to H+ secreted in the lumen and carries the H+ to the urine (helps control urinary pH)

33
Q

Explain how NH3/NH4+ travel through nephron

A

NH3/NH4+ are produced from glutamine metabolism.

NH3 diffuses into tubule lumen at the proximal tubule and binds with H+ secreted into the lumen via Na-H exachanger

NH4+ enters lumen in Proximal Tubule via NH4+/Na+ exchanger

NH4+ is reabsorbed in the ascending limb of the loop of henle via teh NKCC2 channels (replacing K+, which causes an increase in K+ excretion)

NH4+ in the renal interstitium has to convert to NH3 in order to be secreted back into the lumen int he collecting duct.

Once in the collecting duct, NH3 causes “ion trapping” by binding with H+ in lumen, forming NH4+, which promotes H+ excretion

NH3/NH4+ act as a buffer system

34
Q

What are the roles of alpha and beta intercalated cells?

A

Alpha intercalated cells secrete H+ into the lumen and reabsorb HCO3-

Beta intercalated cells secrete HCO3- and reabsorb H+

35
Q

What is the Net Acid Excretion equation?

A

NAE = [(Unh4+ * V) + (Uta+ * V) - (Uhco3- * V)]

36
Q

What are the normal pH, [H+], Pco2, and [HCO3-]?

A

pH: 7.4
[H+]: 40 nEq/L
Pco2: 40 mmHg
[HCO3-]: 24 mEq/L

37
Q

What ranges would you expect to find pH, Pco2, and [HCO3-] in Metabolic Acidosis with respiratory compensation?

A

pH <7.4
Pco2 < 40 mmHg
[HCO3-] < 24mEq/L

38
Q

What ranges would you expect to find pH, Pco2, and [HCO3-] in Respiratory Acidosis with renal compensation?

A

pH < 7.4
Pco2 > 40 mmHg
[HCO3-] > 24 mEq/L

39
Q

What ranges would you expect to find pH, Pco2, and [HCO3-] in Metabolic Alkalosis with respiratory compensation?

A

pH > 7.4
Pco2 > 40 mmHg
[HCO3-] > 24 mEq/L

40
Q

What ranges would you expect to find pH, Pco2, and [HCO3-] in Respiratory Alkalosis with renal compensation?

A

pH > 7.4
Pco2 < 40 mmHg
[HCO3-] < 24 mEq/L

41
Q

What is the normal value of anion gap?

A

8-16 mEq/L

42
Q

What is Type 1 RTA?

A

Type 1 Renal Tubular Acidosis is when distal tubule H+ secretion is inhibited in alpha intercalated cells

This causes severe acidosis as well as hypokalemia

43
Q

What is Type 2 RTA?

A

Type 2 Renal Tubular Acidosis is when the proximal tubule cells fail to reabsorb HCO3-

Also causes Hypokalemia

Less severe than type 1

44
Q

What is Type 3 RTA?

A

Type 3 Renal Tubular Acidosis is when you have deficiency in aldosterone or are resistant to its effects

Mild with normal anion gap

Causes Hyperkalemia

45
Q

What do you call the condition of patient with high [HCO3-], normal or slightly elevated Pco2, and a urinary [Cl-] less than 20 mEq/L?

A

Cl- Responsive Metabolic Alkalosis

Colin Renal Final (9 decks)

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