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3 - Urinary > deck_1458802 > Flashcards

deck_1458802 Flashcards

1
Q

What is the normal range for plasma pH?

A

7.38 - 7.42

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2
Q

What pH is classed as alkalaemia?

A

pH > 7.42

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3
Q

What pH is classed as acidaemia?

A

pH

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4
Q

What are the clinical effects of acidaemia?

A
  • Reduced enzyme function- Reduced cardiac and skeletal muscle contractility- Reduced glycolysis - Reduced hepatic function- Increased plasma potassium
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5
Q

What are the clinical effect of alkalaemia?

A
  • It causes a reduction in the concentration of free calcium in the blood. - Increase the excitability of nerves- Causes paraesthesia and tetany
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6
Q

How is the pH of the blood plasma controlled?

A

By the buffering action of the carbon dioxide/hydrogen carbonate system.

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7
Q

Describe what happens in the carbon dioxide/hydrogen carbonate system

A

If there is a high [H+] then the H+ will bind to HCO3-, forming H2CO3 to lower the [H+] to try and increase the pH. In high pH, the kidneys will release HCO3- and therefore H+ in order to try and decrease the pH.

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8
Q

What happens following hyperventilation?

A

Causes hypocapnia, so there will be a decrease in pCO2 and a relative increase in HCO3-, which will cause the pH to increase.

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9
Q

What is respiratory alkalosis?

A

When the pH rises as a result of the effects of hyperventilation and hypocapnia– there is more HCO3- in the ratio than CO2 so there are more H+ ions

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10
Q

What is respiratory acidaemia?

A

When the pH drops as a result of hypoventilation, leading to hypercapnia. – there is more CO2 in the ratio than normal, so there are fewer H+ ions to buffer, causing a decrease in pH.

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11
Q

What are the blood gas analysis factors that indicate respiratory alkalosis?

A

High pHLow pCO2

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12
Q

What are the blood gas analysis factors that indicate respiratory acidosis?

A

Low pHHigh pCO2

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13
Q

What can be done to compensate for respiratory alkalosis and acidosis?

A

The kidneys control the [HCO3-] in the blood to restore the pH to normal values. Alkalosis – decrease [HCO3-] to decrease pHAcidosis – increase [HCO3-] to increase pH

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14
Q

What is a characteristic of a compensated blood gas analysis?

A

pH is normalOther values are raised and/or lowered

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15
Q

What indicates that there is hyperventilation on a blood gas analysis?

A

High pO2 Low pCO2

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16
Q

What indicates that there is hypoventilation a blood gas analysis?

A

Low pO2High pCO2

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17
Q

What is metabolic acidosis on a blood gas analysis?

A

When there is an increased concentration of H+ from metabolism which reacts with HCO3- to produce CO2. This CO2 is then breathed out, but the [HCO3-] is lowered, altering the ratio and giving a decrease in the pH as there are less H+ ions to buffer.

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18
Q

What is metabolic alkalosis on a blood gas analysis ?

A

There is a rise in the [HCO3-] in the blood (after persistent vomiting) which alter the HCO3-:CO2 ratio. There will be more H+ ions buffered, causing an increase in the pH.

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19
Q

How are metabolic acidosis and alkalosis compensated for?

A

By changing lung ventilation– increased for lowering the pCO2– decreased for increasing the pCO2

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20
Q

What are the blood gas analysis features for metabolic alkalosis?

A

High pHHigh [HCO3-]Low pO2

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21
Q

What are the blood gas analysis features for metabolic acidosis?

A

Low pHLow [HCO3-] Increased anion gap

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22
Q

What are the characteristic of partially compensated respiratory acidosis?

A

Low pHHigh pCO2High [HCO3-]Low pO2

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23
Q

What are the characteristics of partially compensated respiratory alkalosis?

A

High pHLow pCO2Low [HCO3-]High pO2

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24
Q

What are the characteristics of a partially compensated metabolic acidosis?

A

Low pHLow pCO2Low [HCO3-]High pO2

25
Q

What are the characteristics of a partially compensated metabolic alkalosis?

A

High pHHigh pCO2High [HCO3-]Low pO2

26
Q

What is the difference between correction and compensation?

A

Correction is changing the respiratory function to correct respiratory disturbances. Compensation is the kidneys changing [HCO3-] levels to alter pCO2 levels.

27
Q

What compensates for respiratory driven changes in the pH?

A

The kidneys

28
Q

What compensates for metabolically driven changes in the pH?

A

Changes in breathing

29
Q

How is the pCO2 normally controlled?

A

By central chemoreceptors

30
Q

What detects changes in the plasma pH?

A

Peripheral chemoreceptors which bring about change by causing changes with the pCO2

31
Q

How is HCO3- reabsorbed by the kidneys?

A

Na-K-ATPase creastes a Na gradient by pumping Na out of the tubular cell into the ECF. This allows Na to enter in from the lumen into the cell and the energy released allows for H+ to be pumped out into the lumen. The H+ reacts with HCO3- –> H20 and CO2 which can be brought into the tubular cell. The HCO3- is released inside the cell and H+ is recycled out to pick up more HCO3-. The HCO3- inside the cell can then move out into the ECF.

32
Q

Where is HCO3- reabsorbed mostly in the kidneys?

A

Proximal convoluted tubuleThick ascending limb of the loop of henle

33
Q

What else can occur in the PCT to give more HCO3-?

A

HCO3- can be created

34
Q

Describe the process of creating HCO3- in the PCT

A

GLutamine is broken down to produce:– aplha ketoglutarate (make HCO3-)– ammonium (NH4+)HCO3- leaves in the ECF and NH4+ moves into the lumen

35
Q

How is H+ secreted in the distal tubule?

A

Proton pumps pump H+ into the lumen using ATP. They are H+-ATPase pumps

36
Q

What occurs when you export H+ ions?

A

K+ ions are absorbed into the blood

37
Q

What is blood pH linked to?

A

[K+} in the blood

38
Q

What is the minimum pH of buffering H+ in the urine?

A

4.5

39
Q

How is H+ buffered in the urine?

A

Don’t have HCO3-, so it is buffered by phosphate. Can also attach to ammonia, forming ammonium

40
Q

What is a titratable acid?

A

It can freely gain H+ ions in an acid-base reaction

41
Q

What are the responses of cell to acidosis?

A
  • Enhances Na/H exchange- Enhanced ammonium production (helps get rid of excess H+)- Increased H+ATPase in the distal tubule (removes H+ which could be damaging)- Increases the capacity of the tubular cells to be able to export HCO3- from the tubular cells into the ECF
42
Q

What is the anion gap?

A

Gives an indication if any HCO3- has been replaced with something other than Cl-.

43
Q

How do you calculate the anion gap and what is the normal range of values?

A

([Na+] + [K+]) and ([Cl-] + [HCO3-])10-15 mmol/L

44
Q

What happens if the anion gap has increased?Why has this occurred?

A

HCO3- has been removed from the blood and replaced it with another ion. Usually it is due to metabolic processes which produce acid.

45
Q

What does a normal anion gap with low [HCO3-] indicate?

A

Kidney problems

46
Q

What does an increased anion gap and low [HCO3-] indicate?

A

Something wrong but not in the kidneys.

47
Q

What ion is linked to the acid-base balances?

A

Potassium

48
Q

What happens with potassium in metabolic acidosis?

A

K+ moves out of the cells, there is more reabsorption of K+ in the distal nephron and therefore an increased [K+] in the blood

49
Q

What happens with potassium in metabolic alkalosis?

A

K+ moves into the cells, there is less K+ reabsorption so there is a decrease [K+] in the blood

50
Q

What is hyperkalaemia linked to?

A

Metabolic acidosisHyperkalaemia makes the intracellular pH alkaline, so HCO3- is excreted into the blood, causing acidosis.

51
Q

What is hypokalaemia linked to?

A

Metabolic alkalosisHypokalaemia makes the intracellular pH acidic. So there is excretion of H+ and HCO3- reabsorption

52
Q

Why does the [HCO3-] increase when a patient has persistent vomiting?

A

Don’t have stomach acid, so there is a greater proportion of HCO3- to CO2.It also causes dehydration, so there is recovery of Na and HCO3- to increase the osmolarity of the plasma. Body stops actively secreting H+ ions as it would worsen the metabolic alkalosis.

53
Q

How can you treat the metabolic alkalosis causes by persistent vomiting?

A

Treat the dehydration. Once this is back to normal, then the HCO3- can be excreted by the kidneys very rapidly.

54
Q

What are the effects of metabolic alkalosis from persistent vomiting?

A

Body stops secreting H+ to avoid making metabolic alkalosis worse. K+ reabsorption also stops which can lead to hypokalaemia.

55
Q

What can hypokalaemia lead to?

A

ParaesthesiaTetanyCVS problems

56
Q

When can metabolic acidosis occur?

A

Excess metabolic production of acidsIngestion of acidsHCO3- is lostIssues with renal excretion of acid

57
Q

When does the anion gap increase?

A

When the HCO3- in the plasma that has been lost is replaced by another anion which is not included in the calculation.

58
Q

When is the anion gap measurement useful?

A

It can help distinguish between what is causing the acidosis (whether the lactate has replace the HCO3- in lactic acidosis for example)

3 - Urinary (39 decks)

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