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Renal Physiology > Acid-Base - Wall > Flashcards

Acid-Base - Wall Flashcards

1
Q

What are the two main categories of acids?

A

carbonic acid and non-carbonic acids

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2
Q

what is the key organ for acid removal? how much does it eliminate per day?

A

the lungs

15,000 mmol/d

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3
Q

What is the main form of elimination of non-carbonic acids?

A

the kidneys

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4
Q

how much non-carbonic acids are eliminated each day?

A

50-100 meq/d

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5
Q

what are the extremes of ph compatible with human life?

A

6.8-7.8

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6
Q

what is the normal plasma bicarbonate concentration?

A

24 meq/l

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7
Q

in terms of pH levels, define the following:

acidemia
alkalemia

A

acidemia - reduced pH

alkalemia - increased pH

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8
Q

What is the chemical equation for the bicarbonate buffer system?

A

CO2 + H20 <> H2CO3 <> H+ + HCO3-

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9
Q

what is the normal HCO3?

A

24

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10
Q

what equation did he list as the determinants of pH, showing why only 4 cardinal acid-base disorders?

A

(pH) x H = 24 x CO2 / HC03

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11
Q

How can you estimate the H concentration from the pH?

A

[H] = 80 - decimal digits of pH

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12
Q

What is the normal:

pH

pCO2

HCO3

A

pH - 7.4

pCO2 - 36-44 mm Hg

HCO3 - 22-26 meq/L

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13
Q

In metabolic acidosis, do you have increased or decreased bicarbonate?

A

decreased bicarbonate

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14
Q

In metabolic alkalosis, increased or decreased bicarbonate?

A

increased bicarbonate

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15
Q

In respiratory acidosis, do you have increased or decreased C02?

A

Increased c02

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16
Q

in respiratory alkalosis, do you have increased or decreased c02?

A

decreased

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17
Q

What is the major extracellular buffer?

A

hco3

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18
Q

do buffers have an immediate or delayed effect?

A

immediate

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19
Q

what si the isohydric principle?

A

all buffers change in the same directoin

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20
Q

Where are the following buffer systems seen in the body:

bicarbonate
phosphate
ammonia
protein

A

bicarbonate - ecfv
phosphate - urine
ammonia - urine
protein - non-specific

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21
Q

What are secondary, compensatory mechanisms for acid-base disorders?

A

Lungs - start helping instantly

Kidneys - slower but more powerful than lungs

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22
Q

How do you lungs compensate for metabolic disorders?

A

altering c02 levels

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23
Q

how do the kidnesy correct respiratory disorders?

A

alterations in bicarbonate levels (1-2 days)

24
Q

Explain the four stages of buffer mechanisms in order of soonest to last

A

Buffer systems (primarily bicarb.) ECF, immediate

Increased rate & depth of breath to decrease co2 - Lungs - minutes to hours

Buffers of phosphate, protein and bicarb - Intracell Fluid - 2-4 horus

Hydrogen Ion excretion, bicarb reabsorption and bicarb generation - kidneys - hours to days

25
Q

What do the pH, HCO3 and pCO2 do in metabolic acidosis?

A 
pH decreases
HCO3 decreases (primary)
pCO2 decreases (compensatory)
26
Q

What do the pH, HCO3 and pCO2 do in metabolic alkalosis?

A 
pH increases
HC03 Increases (primary)
pCO2 increases (compensatory)
27
Q

What do the pH, HCO3 and pCO2 do in respi. acidosis?

A 
pH decreases
hc03 increases (compensatory)
pc02 increases (primary)
28
Q

What do the pH, HCO3 and pCO2 do in resp alkalosis?

A 
ph INCREASES
hco3 decreases (compensatory)
pco2 decreases (primary
29
Q

What are the golden rules of simple acid-base disorders?

A
  1. pC02 and HC03 always change in the same direction
  2. The secondary physiologic compensatory mechanisms must be present
  3. The ompensatory mechanims never fully correct pH
30
Q

What is metabolic acidosis?

A

process that reduces plasma bicarbonate concentration

31
Q

What is the etiology of metabolic acidosis?

A

decreased renal acid excretion, direct bicarbonate losses or increased acid generation (ie aspirin or methanol) (i.e. lactic acid and ketoacid)

32
Q

What are the ways you can get decreased acid excretion?

A

renal failure/reduced gfr (leadings to decreased ammonium excretion)
type I distal renal tubular acidosis
type 4 renal tubular acidosis (hypoaldosteronism)

33
Q

What induces respiratory acidosis?

A

hypercapnia (decreased alveolar ventilation)

34
Q

what are the actions of the buffering mechanisms in respiratory acidosis?

A

raise plasma bicarbonate (compensatory) it’s a rapid but limited response
kidneys then minimize change in extracellular pH by increasing acid excretion generating new bicarbonate ions (delayed response)

35
Q

what are some acute causes of respiratory acidosis?

A 
general anasthesia
sedative overdose
cardiac arrest
pneumothorax
pneumonia
basically anything that results in decreased oxygen intake that'll cause a build up of lactic acid
36
Q

what are chronic causes of respiratory acidosis?

A 
obstructive pulmonary disease
primary alveolar hypoventilation
brain tumor
respiratory nerve damage
scleroderm
prolonged pneumonia
37
Q

what is the common reason for respiratory alkalosis?

A

too much breathing

reduced co2 due to increased alveolar ventilation

38
Q

what does the buffering process do in respiratory alkalosis?

A

lowers plasma bicarb concentration (rapid but limited response)
kidney response is to reduce net acid excretion (delayed 1-2 days)

39
Q

what are causes of respiratory alkalosis?

A 
anxiety, hysteria
fever
cns disease
congestive heart failure
hypoxia
40
Q

do acute or chronic respiratory acid base disorders cause a great change in the pH?

A

acute (kidney hasn’t had the time to compensate)

41
Q

How does plasma Cl- change in relation to plasma HCO3

A

Equally but inversely

42
Q

Does the plasma anion gap change with respiratory disorders?

A

no

43
Q

how is plasma sodium affected by respiratory disorders?

A

it is not directly altered

44
Q

what occurs in metabolic alkalosis?

A

raising of the plasma bicarb concent

45
Q

what is the etiology of metabolic alkalosis?

A

loss of hydrogen ion from the GI tract (vomiting) or into the urine (diuretic therapy) or through xs acid excretion

46
Q

what are the major causes of metabolic alkalosis?

A

GI loss (vomiting) or urinary loss (thiazide type diuretics)

47
Q

because bicarbonate is raised in metabolic alkalosis, what is necessarily decreased that isn’t part of the overall important chemical equation?

A

chlorine

48
Q

when you have been vomiting and excreting pure hcl, what is the urine concentration going to be of chlorine?

A

it will be extremely low because they will want to keep everything that they can.

49
Q

What causes an increased plasma anion gap?

A

when the A- is reabsorbed by the kidneys and reatined in the plasma, as an unmeasured anion

50
Q

what causes a normal anion gap?

A

when the A- is filtered and excreted by the kidneys

51
Q

What makes up the majority of the unmeasured cations?

A

albumin, normally around 10 meq/L

52
Q

what can cause an increase anion gap?

A

renal failure - phosphate, sulfate urate hippurate

53
Q

where does final excretion of daily acid load occur priamrily?

A

in the collecting duct

54
Q

what is the law of electroneutrality?

A

if sodium concentration stays constant but chloride conc changes, an acid base disorder is present

55
Q

t or f: sodium concentration is directly altered by an acid-base disorder

A

fasle, sodium conc is not directly altered by acid base disorder

56
Q

t or f: chlorine is altered in all acid base disorders (except decreased plasma anion gap metabolic acidosis)

A

false: chlorine concentration is altered in all acid-base disordes except with DECREASED plasma anion gap metabolic acidosis

Renal Physiology (26 decks)

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