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Renal > Anesthesia and Renal Physiology > Flashcards

Anesthesia and Renal Physiology Flashcards

1
Q

What is normal ECF H+ concentration?

A

40nEq/L

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2
Q

T/F: Acid is a proton acceptor and base acts as proton donor?

A

False; Acid=proton donor

Base = proton acceptor

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3
Q

What equations describes the relationship between pH, PaCO2, and serum HCO3?

A

Henderson- Hasselbalch Equation

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4
Q

T/F: Buffers are least efficient when pH=pKa?

A

False. They are most efficient if pH=pKa

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5
Q

What are 5 examples of the body’s buffers?

A
  1. HCO3
  2. Hgb
  3. Intracellular proteins
  4. Phosphate
  5. Ammonia
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6
Q

What is the pKa of HCO3?

A

6.1

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7
Q

Is bicarbonate buffer effective against metabolic or respiratory acid-base disturbances?

A

Metabolic

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8
Q

What is main reason bicarbonate acts as a good buffer?

A

Because it is present in high concentrations in the ECF

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9
Q

Where is HCO3 reabsorbed into the blood?

A

Proximal tubule

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10
Q

What molecule hyrdolyzes carbonic acid into water and CO2?

A

Carbonic anhydrase

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11
Q

In the proximal tubule, what is exchanged with H+ ions?

A

Na+

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12
Q

What percent of filtered bicarbonate is reabsorbed in the proximal tubule?

A

80-90%

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13
Q

What percent of filtered bicarbonate is reabsorbed in the distal tubule?

A

10-20%

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14
Q

Does reabsorption of HCO3 create acidic or alkalotic urine?

A

Acidic

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15
Q

What does H+ combine with to become trapped in renal tubule?

A

Hydrogen Phosphate to form H2PO4

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16
Q

Since Phosphate has a pKa of 6.8, does it work better as a buffer in acidic or alkalinic urine?

A

Acidic

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17
Q

What is H2CO3 called?

A

Carbonic acid

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18
Q

What is ammonium synthesized from?

A

Glutamine

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19
Q

Where does NH4 (Ammonium) act as a fluid buffer?

A

Proximal tubule, thick loop, and distal tubule

20
Q

Metabolic aklalosis is mainly possible in what two situations?

A
  1. Na+ Depletion

2. Increased aldosterone

21
Q

What is an example of contraction alkalosis?

A

When sodium is reabsorbed in the proximal tubule and this causes Chloride to move with it. As chloride decreases in tubule, HCO3 must be reabsorbed.

22
Q

What can cause a contraction alkalosis?

A

Long term diuretic use

23
Q

What is base excess?

A

Defined as the amount of acid or base that must be added to return the blood pH to 7.4 with PaCO2 to 40mmHg

24
Q

A positive base excess indicates what?

A

Metabolic alkalosis

25
Q

A Negative or base deficit indicates what?

A

Metabolic acidosis

26
Q

What 3 main concepts cause metabolic alkalosis?

A
  1. Loss of acid from extracellular space
  2. Excessive HCO3 loads
  3. Posthypercapnic states
27
Q

What are examples of things that cause a loss of acid from extracellular space?

A
  1. Loss of gastric fluid
  2. Acid loss in the urine\
  3. Acid shifts into the cells
  4. Loss of acid into stool
28
Q

What 6 factors maintain metabolic alkalosis?

A
  1. Decreased GFR
  2. Volume contraction
  3. Hypokalemia
  4. Hypochloremia
  5. Passive backflux of HCO3
  6. Aldosterone
29
Q

Severe combined resp/metabolic alkalosis will create what 3 major issues surrounding anesthesia time?

A
  1. Cardiac suppression
  2. Arrhythmias
  3. Further hypokalemia
30
Q

Treatment of metabolic alkalosis:

A
  1. Give Potassium

2. Give NS

31
Q

How much does Potassium increase for each 0.1 unit decrease in pH?

A

0.6mEq/L

32
Q

What are four physiologic effects of acidosis?

A
  1. K+ increase 0.6mEq/L for each 0.1 unit decrease in pH
  2. Rightward shift
  3. Cardiac contractility is decreased
  4. Decreased responsiveness to catecholamines
33
Q

Which patient population should NaHCO3 not be given for treatment of metabolic acidosis?

A

Patients with respiratory failure because CO2 will go up as compensatory mechanism

34
Q

Excessive infusions of NS and LR create what acid/base disturbances?

A

NS= creates acidosis

LR=creates alkalosis

35
Q

What is the main treatment concept for treating metabolic acidosis?

A

Treat underlying cause (ex: hypovolemia, anemia, cardiogenic shock

36
Q

What is treatment of alkalosis?

A
  1. IV HCl in rare cases
  2. Spironolactone
  3. Stop diuretics
  4. Correct gastric fluid loss
  5. Give NS instead of LR
37
Q

What is the most common cause of chloride sensitive metabolic alkalosis?

A

Diuretics

38
Q

By doubling alveolar ventilation, what happens to PaCO2 and cerebral blood flow?

A

Reduces PaCO2 to 20mmHg and halves cerebral blood flow.

39
Q

T/F: PaCO2 is proportionally related to cerebral blood flow?

A

False; they are inversely related

40
Q

How do you calculate anion gap?

A

(Na+)- [(Cl-)+(HCO3)]

41
Q

What is normal anion gap?

A

7-14mEq/L

42
Q

What is the most common reason we will see a normal anion gap metabolic acidosis?

A

Hyperchloremia (Cl- takes the place of the HCO3 anion)

43
Q

What are 9 causes of normal anion gap metabolic acidosis?

A
  1. Hyperchloremia
  2. Renal tubular acidosis
  3. Diarrhea
  4. Carbonic anhydrase inhibition
  5. Ureteral diversions
  6. Early renal failure
  7. Hydronephrosis
  8. HCl Administration
  9. Saline administration
44
Q

What are 7 causes of elevated anion gap metabolic acidosis?

A
  1. Uremia
  2. Ketoacidosis
  3. Lactic acidosis
  4. Methanol
  5. Ethylene glycol
  6. Salicylates
  7. Paraldehyde
45
Q

In chronic respiratory acidosis, how would HCO3 compensate?

A

Expect a 4mEq/L increase in HCO3 for every 10mmHg increase in CO2

46
Q

In acute respiratory acidosis, how would HCO3 compensate?

A

Expect a 1mEq/L increase in HCO3 for every 10mmHg increase in CO2

Renal (5 decks)

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