Chapter 9: Regulation of Hydrogen Ion Balance Flashcards

1
Q

What value of protons in ECF is essential for proteins exposed to ECF to function properly?

A

It is essential for body to regulate the concentration of free protons in the ECF to a value close to 40nM (pH 7.4) in order for proteins exposed to the ECF to function properly

this regulation is acid-base balance
(matching excretion of acid/base equivalents to input and regulating ratio of weak acids to their conjugate bases in buffer systems)

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2
Q

Describe some routes for entry of acids or bases.

A

(1) processing of ingested food, (2) secretions of the gastrointestinal (GI) tract, and (3) de novo generation of acids
and bases from metabolism of stored fat and glycogen.

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3
Q

Acids and bases that enter the body must be excreted at the same rate to maintain
balance. There is often a lag between input and output, allowing a transient
accumulation of acid or base. What prevents large changes in pH when these transient accumulations occur?

A

buffer system

=weak acid, its conjugate base, and free protons

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4
Q

In a buffer system how is free aqueous concentration of protons determined?
Give equation.

A

by ratio of concentrations of conjugate base to weak acid

Henderson-Hasselbach
[H]= K [acid]/[base]
pH=pK + log [base/acid]

p 165

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5
Q

Describe how a system is different with/without buffers.

A

If we added strong
acid (eg, hydrochloric acid) to water that contained no buffers, the concentration of free protons would equal the concentration of the acid. If we had 10 mmol/L acid, we would have 10 mmol/L protons (ie, pH 2 blood). However, if the same
amount of acid is added to a buffer system, most of the protons combine with the conjugate base, resulting in only a small rise in concentration of free protons.

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6
Q

What are the important buffers in the ECF?

A

phosphate and albumin

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7
Q

What is the important buffer in RBC? Why?

A

Hemoglobin

important bc changes in plasma pH lead to uptake or release of protons from RBC

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8
Q

What is the most important buffer system in the body?

A

CO2-bicarbonate buffer system

their ratio is regulated
ratio of weak acid to conj base sets pH so this system regulates pH.

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9
Q

Describe CO2 as an acid.

A

CO2 is not a weak acid but it acts like a weak acid in the buffer system bc when it combines w water it releases protons.

CO2 is called a volatile acid bc it can evaporate
(all other acids; sulfuric, lactic…are fixed acids)

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10
Q

Would a change in PCO2 reflect a response to addition or loss of hydrogen ions? Why/why not?

A

no… change in PCO2 would reflect activity of respiratory system

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11
Q

If there is excess input of fixed acid, the body cannot convert this acid to CO2 and excrete
it through the lungs. Why?

A

every proton derived from a fixed acid that combines with bicarbonate to form CO2 removes that bicarbonate and lowers its concentration. Although the CO2 is simply exhaled, the deficit in bicarbonate
remains. A continuous input of fixed acid would soon reduce the bicarbonate concentration
to zero. Thus, an input of fixed acid must be balanced by renal output

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12
Q

What is the end result of sulfur-or phosphorus- containing amino acids and those with cationic side chains metabolized to CO2, water and urea?

A

end result is fixed acid

metabolism of dietary protein

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13
Q

Describe the fruit juice paradox.

A

metabolism of citrus fruit can alkalinize the blood

complete oxidation of the protonated form of an organic acid (citrus acid) to CO2 and water is acid-base neutral

but the complete oxidation of the base form adds bicarbonate to the body

One can think of this as taking a
hydrogen ion from the body fluids to protonate the base, converting it to the acid,
and then oxidizing the acid.
Before oxidation, the mixture is
acidic, but on complete oxidation to CO2 and water, the result is addition of base

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14
Q

When we generate bicarbonate and protons from CO2 and water in a given medium, say in blood or cell, is the result always acidification or alkalization?

Why? Where do bicarb and protons go from GI tract?

A

acidication bc concentration of protons rises

cells of the GI tract separate the protons from the bicarbonate. They transport protons out of the cell into one medium
(eg, the lumen of the GI tract), and bicarbonate into another (the interstitium bathing the basolateral surface). Therefore, the lumen becomes acidified and the surroundings (and therefore the blood leaving the tissue) becomes alkalinized (see
Figure 9–1 p 170

In other regions of the GI tract the cells reverse the direction of these processes, ie, they transport bicarbonate into the lumen (alkalinizing it) and protons
into the surroundings. Thus, different regions of the GI acidify and alkalinize the blood. Normally, the sum of GI tract secretions is nearly acid-base neutral

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15
Q

What does the anaerobic metabolism of carbohydrate produce?

When will the effects of this be greatest?

A

a fixed acid (lactic acid)

In conditions of poor tissue perfusion, this can be a
major acidifying factor

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16
Q

Describe renal processing of acids and bases in the proximal tubule and distal nephron.

A

early part (mostly PT) kidneys reabsorb enormous filtered load of bicarb from plasma

distal nephron (mostly collecting tubules) kidneys secrete either protons or bicarb to balance the net input into the body

proximal tubule: reabsorb most filtered bicarb (about 80%), produce and secrete ammoninum

TAL: reabsorb second largest fraction of filtered bicarb (normally about 10-15%)

distal convoluted tubule and collecting duct:

reabsorb virtually all remaining filtered bicarb as well as any secreted bicarb (type A intercalated cells)
produce titrable acid (type A intercalated cells)
secrete bicarb (type B intercalated cells)
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17
Q

What do type A and type B intercalated cells do?

A

reabsorb virtually all remaining filtered bicarb as well as any secreted bicarb (type A intercalated cells)

produce titrable acid (type A intercalated cells)

secrete bicarb (type B intercalated cells)

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18
Q

Describe how bicarb is reabsorbed.

A

enormous amount of H ion secretion occurs in PT with additional secretion in the TAL and collecting duct system

(collecting duct cells that secrete hydrogen ions are type A intercalated cells, not principal cells)

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19
Q

How does the process of H ion secretion achieve bicarbonate reabsorption?

A

once in the tubular lumen, the secreted H ion combines w a filtered bicarb to form water and carbon dioxide which diffuse into the cell

the CO2 and water that is now within the cell combines to form bicarbonate and hydrogen ion

Thus, no net change
in plasma bicarbonate concentration has occurred as all bicarbonate filtered has
combined with secreted hydrogen ion and subsequently ended up first inside the
cell and then in plasma.

p172

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20
Q

What happens to the H ion secreted into the lumen (participating in bicarb reabsorption)? Is it excreted?

A

not excreted in the urine. It has been incorporated into water. Any secreted hydrogen ion that combines with bicarbonate in the lumen to cause bicarbonate
reabsorption does not contribute to the urinary excretion of hydrogen ions but
only to the conservation of bicarbonate.

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21
Q

How is H secreted into the lumen?

A

actively secreted by a N-H antiporter in the PT lumen

also a primary active H-ATPase exists in all the hydorgen-ion secreting distal tubular segments

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22
Q

What receptors are present in type A intercalated cells? What do they do?

A

type A intercalated cells of collecting-duct system…

in addition to their primary active H-ATPase, possess a primary active H-K-ATPase, which moves H ions into the lumen and K into the cell both actively

(the luminal
membrane H-K-ATPase also mediates active potassium reabsorption by these cells
and contributes to potassium homeostasis)

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23
Q

Describe the basolateral transporters for bicarb.

A

Cl-HCO3 antiporters or Na-HCO3 symporters -PT
(dep on tubular segment)

(both cases transport is passive bc HCO3 is moving down its conc. gradient.

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24
Q

Summarize the tubular segments in which bicarb is reabsorbed.

A

Through its secretion of hydrogen ions, the proximal tubule reabsorbs 80–90%
of the filtered bicarbonate. The thick ascending limb of Henle’s loop reabsorbs
another 10%, and almost all the remaining bicarbonate is normally reabsorbed by the distal convoluted tubule and collecting-duct system (except for alkalotic
individuals, who will excrete some of the bicarbonate;

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25
Q

How does the kidney balance input and output of bicarb.

A

excrete enough bicarb in urine to match input

1) allow some filtered bicarb to pass through urine
2) secrete bicarb via type B intercalated cells

type B intercalated cells (found only in cortical collecting duct) do secrete bicarb

26
Q

Explain the disappearance of excess plasma bicarbonate and the appearance of bicarbonate in the urine, with resulting acidification of the plasma and
alkalinization of the urine and maintenance of bicarbonate balance.

A

H-ATPase pump is located in
the basolateral membrane, and the Cl-HCO3 antiporter is in the luminal membrane.
Accordingly, bicarbonate moves into the tubular lumen, whereas hydrogen ion is actively transported out of the cell across the basolateral membrane and enters the blood, where it can combine with a bicarbonate ion.

27
Q

Summarize the process by which kidney replaces lost bicarb.

Start in the cells with CO2 and water.

A

Hydrogen ions and bicarbonate are produced from carbon dioxide and water within cells. Hydrogen ions are secreted and combine with the conjugate
base of buffers in the tubular lumen other than bicarbonate, thereby generating the
acid form of the buffer. The acid form of that buffer is excreted in the urine. The process of producing and secreting hydrogen ions generated new bicarbonate that goes into the blood and replaces the bicarbonate lost when the acid load entered the body. The key is generation of new bicarbonate to replace the bicarbonate that
was lost. If we just reabsorb filtered bicarbonate, nothing is changed. We must
generate new bicarbonate.

28
Q

Identical transport process of hydrogen ion secretion
can also achieve acid excretion and addition of new bicarbonate to the blood. How can the same process produce these two different end results?

A

The answers lies in the fate of the hydrogen ion once it is in
the lumen. If the secreted hydrogen ion combines with bicarbonate, then we are
simply replacing bicarbonate that would have left the body. In contrast, if the secreted
hydrogen ion combines with a non-bicarbonate buffer in the lumen (or, to an extremely small degree, remains free in solution), the hydrogen ion is excreted.
The bicarbonate produced in the cell and transported across the basolateral membrane
is new bicarbonate, not a replacement for existing bicarbonate.

so renal contribution of a new bicarbonate to the blood is accompanied by the excretion of an equivalent amount of buffered H ion in the urine

29
Q

What is the most important filtered buffer?

Most important synthesized buffer?

A

most important filtered buffer- phosphate

most important synthesized buffer- ammonia

30
Q

Write the equation for monovalent dihydrogen phosphate.

A

H2PO4- H+ +HPO42-
(monovalent dihydrogen phosphate is a weak acid and divalent monohydrogen phosphate is its conjugate base)

at normal pH of plasma 7.4, of the glomerular filtrate, we find that about 80% of the phosphate is the base (divalent) form and 20% is the acid (monovalent) form

31
Q

What happens to HPO42- as the tubular fluid is acidified in the collecting ducts?

A

As tubular fluid is acidified in the collecting ducts, most of the base form combines with secreted H ions

by the time the minimum intratubular pH of 4.4 is reached, virtually all the base (HPO42-) has been converted to acid (H2PO4-)

32
Q

Ordinarily, hydrogen ion excretion associated with phosphate and other
filtered buffers is no greater than about 40 mmol/day. This amount is not sufficient to balance the normal hydrogen ion production of 50–100
mmol/day or take care of any unusually high (usually pathological) production of
acid loads. How is balance achieved and the rest of hydrogen ions excreted?

A

involves ammoniagenesis and excretion of H ions as ammonium

far more H ions can be excreted as ammonium than via organic buffers.

33
Q

What is the regulatory signal that determines the magnitude

of hydrogen ion excretion (= the production of new bicarbonate)?

A

the conc. of free hydrogen ion in the fluids to which the various transport elements are exposed (the pH of ECF and cytosol within renal cells)

34
Q

What happens during alkalosis?

A

During alkalosis, tubular secretion of hydrogen ion should be too low to completely reabsorb the filtered bicarbonate

Then bicarbonate can be lost in the urine; no titratable acid is formed because no extra secreted hydrogen ions are available to combine with non-bicarbonate buffers, and so no new bicarbonate is contributed to the blood

35
Q

What happens during acidosis?

A

During acidosis,
tubular hydrogen ion secretion should increase to reabsorb all filtered bicarbonate
and have enough hydrogen ions left to convert most of the base form of titratable
buffers to the acid form

Furthermore, glutamine production by the liver and its
subsequent metabolism by the proximal nephron to produce ammonium should
increase in order to excrete as ammonium the hydrogen ion that is not excreted
as titratable acid. As should be clear by now, both titration of filtered buffer and
production of ammonium contribute new bicarbonate to the blood.

36
Q

Describe what happens in respiratory acidosis and alkalosis. Is H ion secretion increased or decreased? Why?

A

An increase in PaCO2, as occurs during respiratory acidosis (eg, caused by shallow
breathing after chest trauma), will produce a decrease in plasma pH and,
thereby, signal an increased tubular hydrogen ion secretion.

A decrease in PaCO2,
as occurs during respiratory alkalosis (eg, high altitude hyperventilation), causes
a decrease in secretion.

The effects are not due to the CO2 molecule itself but to
the effects of an altered PaCO2 on renal intracellular pH. Thus, because the tubular
membranes are quite permeable to CO2, an increased arterial PCO2 causes an equivalent increase in PCO2 within the tubular cells.

This, in turn, causes elevated
intracellular hydrogen ion concentration by driving the reactions shown in
Equation 9–4 to the right.

37
Q

How is generation of glutamine by the liver affected in low or high pH?

A

glutamine prod. is increased by low extracellular pH (liver shifts some of the disposal of ammonium ion from urea to glutamine)

A decrease in extracellular pH stimulates renal glutamine oxidation by the proximal tubule, whereas an increase does just the opposite

38
Q

How do the kidneys respond to acidosis (in regards to glutamine oxidation and the effect of that)?

A

acidosis, by stimulating renal glutamine oxidation, causes the kidneys to contribute more new bicarbonate to the blood, thereby counteracting the acidosis

Conversely, an alkalosis inhibits
glutamine metabolism, resulting in little or no renal contribution of new
bicarbonate via this route

acidosis increases renal NH4
+ synthesis and excretion, whereas alkalosis does the opposite.

table 9-3 p 185

39
Q

What two things increase tubular hydrogen ion secretion?

A

increased by the increased blood PCO2 of respiratory acidosis and decreased by the decreased PCO2 of respiratory alkalosis

increased independently of changes in PCO2, by the local effects of decreased extracellular pH on the tubules; the opposite is true for increased extracellular pH

40
Q

Does GI tract secretion of acid alkalinze the blood or make it more acidic?

A

alkalinizes the blood (puts bicarb in blood)

41
Q

Do fruits and meat make the blood more acidic or alkalotic?

A

fruits- alkalinize blood

meat- acidify blood

42
Q

What effect does infusion of lactated Ringer’s solution have on the blood?

A

alkalinizes the blood

43
Q

What are the renal mechanisms of acidifying the blood?

A

allow some filtered bicarb to pass into the urine

secrete bicarb (type B intercalated cells)

44
Q

What are renal means of alkalinizing the blood?

A

secrete protons that form urine titratable acidity (type A intercalated cells)

excrete NH4+ synthesized from glutamine

45
Q

Describe lactated Ringer’s solution.

A

its a mixture of salts that contain lactate at a conc. of 28mEq/L.

pH is about 6.5

but is an alkalinizing solution (for same reason as juice paradox...) Lactate is the conjugate base of lactic
acid. When lactate is oxidized to CO2 and water, it takes a hydrogen ion from the
body fluids (and leaves a bicarbonate)
46
Q

What chemical is high in respiratory disorders? metabolic disorders?

A

If there are respiratory

disorders, the PaCO2 is high or low; if there are metabolic disorders, the bicarbonate is high or low.

47
Q

How does the kidney compensate in respiratory acidosis?

A

(Henderson-Hasselbalch eq.) …pH can be restored to normal if the bicarb could be elevated to the same degree as elevation is PaCO2.

kidneys can cause this bicarb increase by contributing new bicarb to the blood… compensation

1) NH4+ production and excretion are increased
2) rise in PaCO2 and drop in extracellular pH both stimulate renal tubular hydrogen ion secretion so that all filtered bicarb is reabsorbed and increased amounts of secreted hydrogen are left over for the formation of titratable acid

48
Q

How does respiratory alkalosis occur and how does the kidney compensate?

A

result of hyperventilation, as occurs in high altitude, in which person transiently eliminates CO2 faster than it is produced, thereby lowering PaCO2 and raising pH.

The decreased PaCO2
and increase in extracellular pH reduce tubular hydrogen ion secretion, so that
bicarbonate reabsorption is not complete. In addition, bicarbonate secretion is
stimulated. Bicarbonate is, therefore, lost from the body, and the loss results in
decreased plasma bicarbonate and a return of plasma pH toward normal

There is no titratable acid in the urine (the urine is alkaline in these conditions), and there
is little or no NH4+ in the urine because the alkalosis inhibits NH4+ production and excretion.

49
Q

If bicarb conc. is too low how will the kidneys respond?

A

try to raise plasam bicarb conc. back toward normal, thereby returning pH toward normal

reabsorb all filtered bicarb and contribute new bicarb through increased formation and excretion of NH4+

50
Q

How does total body volume contraction bc of salt loss interfere with the body’s ability to handle bicarb appropriately?

What would happen normally/How does this go wrong with total body volume contraction?

A

Because the bicarbonate
concentration is high in any metabolic alkalosis, the normal renal response should be to turn down hydrogen ion secretion to a level that falls short of complete bicarbonate reabsorption, thereby allowing the excess bicarbonate to be
excreted.

the presence of the extracellular volume contraction stimulates
not only sodium reabsorption but also hydrogen ion secretion because the transport of these ions is linked via the Na/H antiporters in the proximal tubule. In
addition, the renin-angiotensin system is usually activated, resulting in the stimulation
of aldosterone secretion. Besides stimulating sodium reabsorption, aldosterone
stimulates hydrogen ion secretion by Type A intercalated cells. The net result is that all the filtered bicarbonate is reabsorbed so that the already elevated plasma bicarbonate associated with the preexisting metabolic alkalosis is locked in, and the plasma pH remains high

urine will be somewhat acidic rather than alkaline (as usually is when responding to metabolic acidosis)

51
Q

How does chloride depletion occur and

A

chloride depletion, (independent of, and in addition to extracellular volume contraction) helps maintain metabolic alkalosis by stimulating hydrogen secretion

(chloride depletion can be caused by chronic vomiting and heavy use of diuretics)

52
Q

How does aldosterone and K depletion affect the body?

A

aldosterone stimulates ion secretion

K depletion by itself also weakly stimulates tubular hydrogen ion secretion and NH4+ production.

However, the combination of potassium depletion of even moderate degree and high levels of aldosterone stimulates tubular hydrogen ion secretion markedly

As a result, the renal tubules
not only reabsorb all filtered bicarbonate but also contribute inappropriately large
amounts of new bicarbonate to the body, thereby causing metabolic alkalosis

53
Q

Even if the urine pH is neutral (7.4), the kidneys can still excrete acid in the form of
ammonium. True or false?

A

The answer is true.

54
Q

A patient is observed to excrete 2 L of alkaline (pH, 7.6) urine having a bicarbonate
concentration of 28 mmol/L. What is the rate of titratable acid excretion?
A. 56 mmol
B. Negative
C. Cannot determine without data for ammonium

A

The answer is B. If the urine has a pH greater than 7.4, clearly there is
no titratable acid excreted. Indeed, there is negative titratable acid excretion.
Ammonium does not contribute to titratable acid and may be
ignored in the calculation of titratable acid.

55
Q

Which of the following is an acid load per se or generates an acid load that must be
excreted by the kidneys?
A. Prolonged vomiting of stomach secretions
B. Eating unsweetened grapefruit juice
C. Eating sweetened grapefruit juice
D. Intravenous infusion of sodium lactate

A

None of them are acid loads. Vomiting of stomach acid adds bicarbonate to the blood. Fruit juice, when oxidized to CO2 and water, adds
bicarbonate. Sweetening it makes no difference because the metabolism
of saccharides is acid-base neutral. Lactate, when metabolized, adds
bicarbonate.

56
Q

Proximal tubular reabsorption of filtered bicarbonate involves a pair of transporters:
one that imports bicarbonate across the apical membrane and another that
exports bicarbonate across the basolateral membrane. True or false?

A

The answer is false. Filtered bicarbonate is not transported into the epithelial
cells; rather, it is converted in the lumen to CO2 and water when it combines with secreted protons. Bicarbonate is generated within the epithelium on a one-for-one basis as the secreted protons, and this bicarbonate is transported across the basolateral membrane.

57
Q

During a metabolic acidosis, such as a diabetic ketoacidosis, the renal excretion of
acid decreases well below normal levels. True or false?

A

The answer is false. Renal acid excretion rises. The acidosis is caused by increased generation of metabolic acids, not failure of the kidneys to
excrete acid. The kidneys respond by increasing their excretion of acid. A steady state is reached when input and output are both elevated and plasma bicarbonate is low.

58
Q

Two patients have plasma pH values of 7.39 and 7.41, respectively. What is their
acid-base status?
A. One is acidotic; the other is alkalotic.
B. They are both normal.
C. There is not enough information.

A

The answer is C. The pH values are both within the normal range, so both patients could be perfectly normal. However, pH is set by
the ratio of bicarbonate to Pco2. Both values could be elevated or depressed,
yielding a normal ratio but an acidosis or alkalosis that is well
compensated.

59
Q

An emphysema patient has had serious difficulty breathing for a long time. Which
of the situations below are likely?
A. His Pco2 is elevated.
B. His bicarbonate is low.
C. His urine has an elevated amount of titratable acidity.

A

Answer A is certainly true. This a respiratory acidosis. Answer B is false. In response to the prolonged acidosis, the patient’s bicarbonate would
be elevated as compensation, not depressed. Answer C is false. Although the development of compensation would require increased acid excretion, the maintenance would only require a urinary excretion to match the input of fixed acid. CO2, no matter how much it is elevated, cannot
be excreted as urinary acid.

60
Q

From an acid-base perspective, 1 mEq of titratable acid in the urine is the same as
1 mmol of ammonium. True or false?

A

The answer is true. The excretion of titratable acid and ammonium both involve secreting a hydrogen ion and generating a bicarbonate that goes into the blood.