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Disturbed acid-base balance Flashcards

1
Q

What is hyperventilation?

A

Increase in alveolar ventilation

without change in metabolism

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2
Q

How does hyperventilation affect alveolar pO2 and pCO2?

A

Alveolar pO2 increases because are inspiring more oxygen

Alveolar pCO2 decreases because are expiring more carbon dioxide

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3
Q

How does hyperventilation affect plasma pO2 and pCO2?

A

Plasma pO2 increases because more oxygen diffuses from alveoli into pulmonary capillaries

Plasma pCO2 decreases because more carbon dioxide diffuses from pulmonary capillaries to alveoli

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4
Q

What is hypoventilation?

A

Decrease in alveolar ventilation

without change in metabolism

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5
Q

How does hypoventilation affect alveolar pO2 and pCO2?

A

Low alveolar pO2 because are inspiring less oxygen

High alveolar pCO2 because are expiring less carbon dioxide

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6
Q

How does hypoventilation affect plasma pO2 and pCO2?

A

Low plasma pO2 because less oxygen diffusing into pulmonary capillaries from alveoli, hypoxia

High plasma pCO2 because less carbon dioxide diffusing from pulmonary capillaries into alveoli

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7
Q

What is hypercapnia?

A

Increase in plasma pCO2 above normal range

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8
Q

How does hypercapnia affect plasma pH?

A

Higher concentration of carbon dioxide dissolved in the blood
favours forwards bicarbonate buffer reaction
increases concentration of hydrogen ions
decrease in plasma pH

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9
Q

What is hypocapnia?

A

Decrease in plasma pCO2 below normal range

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10
Q

How does hypocapnia affect plasma pH?

A

Lower concentration of carbon dioxide dissolved in the blood
favours backwards bicarbonate buffer reaction
reduces concentration of hydrogen ions
increase in plasma pH

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11
Q

What is respiratory acidosis?

A

Hypoventilation
gives hypercapnia
gives decrease in plasma pH

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12
Q

What are the relative levels of the following in respiratory acidosis

  • plasma pCO2
  • plasma bicarbonate ion concentration
  • plasma pH
A

plasma pCO2 - high

plasma bicarbonate ion concentration - normal

plasma pH - low

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13
Q

What is meant by compensating for respiratory acidosis?

A

Kidneys increase their reabsorption and production of bicarbonate ions
to increase the plasma bicarbonate ion concentration

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14
Q

How does increasing plasma bicarbonate ion concentration compensate for respiratory acidosis?

A

Stops the forwards bicarbonate buffer reaction from being favoured
plasma pH returns to normal

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15
Q

How long does it take for the kidneys to increase plasma bicarbonate ion concentration to compensate for respiratory acidosis?

A

2-3 days

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16
Q

What is the similarity between fully compensated and partially compensated respiratory acidosis?

A

plasma pCO2 - high

plasma bicarbionate ion concentration - higher

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17
Q

What is the difference between fully compensated and partially compensated respiratory acidosis?

A

Fully compensated respiratory acidosis
plasma pH - normal

Partially compensated respiratory acidosis
plasma pH - low

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18
Q

What is respiratory alkalosis?

A

Hyperventilation
gives hypocapnia
gives increase in plasma pH

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19
Q

What are the relative levels of the following in respiratory alkalosis

  • plasma pCO2
  • plasma bicarbonate ion concentration
  • plasma pH
A

plasma pCO2 - low

plasma bicarbonate ion concentration - normal

plasma pH - high

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20
Q

What is meant by compensating for respiratory alkalosis?

A

Kidneys decrease their reabsorption and production of bicarbonate ions
to decrease the plasma bicarbonate ion concentration

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21
Q

How does decreasing plasma bicarbonate ion concentration compensate for respiratory alkalosis?

A

Stops backwards bicarbonate buffer reaction being favoured

pH returns to normal

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22
Q

How long does it take for the kidneys to decrease plasma bicarbonate ion concentration to compensate for respiratory alkalosis?

A

2-3 days

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23
Q

What is the similarity between partially compensated and fully compensated respiratory alkalosis?

A

plasma pCO2 - low

plasma bicarbonate ion concentration - lower

24
Q

What is the difference between partially compensated and fully compensated respiratory alkalosis?

A

Fully compensated respiratory alkalosis
plasma pH - normal

Partially compensated respiratory alkalosis
plasma pH - high

25
What is meant by the anion gap?
Difference between measured cations and anions
26
Which cations are measured?
Sodium ions Potassium ions
27
Which anions are measured?
Chloride ions Bicarbonate ions
28
What is the equation for the anion gap?
Anion gap = (sodium ion concentration + potassium ion concentration) - (chloride ion concentration + bicarbonate concentration)
29
Why is there an anion gap in the first place?
Because there are other anions | which are not measured
30
What are the causes of metabolic acidosis?
Tissue metabolism produces more acid Kidneys don't excrete enough hydrogen ions Kidneys don't reabsorb or produce enough bicarbonate ions Severe diarrhoea gives loss of bicarbonate ions from the GI tract
31
What can cause tissue metabolism to produce more acid?
Lactic acidosis - intense exercise, decreased perfusion of tissues Ketoacidosis - diabetes
32
How does the kidneys not excreting enough hydrogen ions cause metabolic acidosis?
Higher concentration of hydrogen ions in plasma | decrease in plasma pH
33
How does the kidneys not reabsorbing or producing bicarbonate ions and severe diarrhoea causing loss of bicarbonate ions from the GI tract give metabolic acidosis?
Decrease in plasma bicarbonate ion concentration favours forwards bicarbonate buffer reaction increased concentration of hydrogen ions decreases plasma pH
34
What are the relative levels of the following in metabolic acidosis - plasma pCO2 - plasma bicarbonate ion concentration - plasma pH
plasma pCO2 - normal plasma bicarbonate ion concentration - low plasma pH - low
35
How does metabolic acidosis caused by tissue metabolism producing more acid and kidneys not secreting hydrogen ions cause a decrease in the plasma bicarbonate ion concentration?
Because increased concentration of hydrogen ions favours backwards bicarbonate buffer reaction bicarbonate ions react with hydrogen ions decrease in bicarbonate ion concentration
36
How does metabolic acidosis caused by tissue metabolism producing more acid affect the anion gap? Why?
Anion gap is bigger because bicarbonate ion concentration decreases replaced with anion of acid which is not measured
37
How does metabolic acidosis caused by the kidneys not secreting enough hydrogen ions affect the anion gap? Why?
Anion gap is bigger because bicarbonate ion concentration decreases replaced with anion of acid which is not measured
38
How does metabolic acidosis caused by the kidneys not reabsorbing enough bicarbonate ions affect the anion gap? Why?
Anion gap remains the same | because the bicarbonate ions are replaced with chloride ions, which is a measured anion
39
How does metabolic acidosis caused by severe diarrhoea giving loss of bicarbonate ions through the GI tract affect the anion gap? Why?
Anion gap remains the same | because the bicarbonate ions are replaced with chloride ions, which is a measured anion
40
What is meant by compensating for metabolic acidosis?
Peripheral chemoreceptors detect decrease in plasma pH stimulate increased alveolar ventilation to decrease plasma pCO2
41
How does decreasing plasma pCO2 compensate for metabolic acidosis caused by tissue metabolism producing more acid or kidneys not excreting enough hydrogen ions?
Removes extra carbon dioxide in the plasma produced from backwards bicarbonate buffer reaction being favoured
42
How does decreasing plasma pCO2 compensate for metabolic acidosis caused by kidneys not reabsorbing or producing enough bicarbonate ions and severe diarrhoea causing loss of bicarbonate ions from GI tract?
Carbon dioxide concentration in plasma decreases prevents forwards bicarbonate buffer reaction being favoured plasma pH returns to normal
43
What is the similarity between partially compensated and fully compensated metabolic acidosis?
plasma bicarbonate ion concentration - low plasma pCO2 - low
44
What is the difference between partially compensated and fully compensated metabolic acidosis?
Fully compensated metabolic acidosis plasma pH - normal Partially compensated metabolic acidosis plasma pH - low
45
What are the causes of metabolic alkalosis?
Tissue metabolism produces less acid Severe vomiting causes loss of hydrogen ions from stomach
46
What are the relative levels of the following in metabolic alkalosis - plasma pCO2 - plasma bicarbonate ion concentration - plasma pH
plasma pCO2 - normal plasma bicarbonate ion concentration - high plasma pH - high
47
Why is the plasma bicarbonate ion concentration high with metabolic alkalosis?
Fewer bicarbonate ions react | increased bicarbonate ion concentration
48
What is meant by compensating for metabolic alkalosis?
Peripheral chemoreceptors detect increase in plasma pH stimulate decreased alveolar ventilation to increase plasma pCO2 Kidneys secrete fewer hydrogen ions and reabsorb fewer bicarbonate ions
49
How does increasing plasma pCO2 compensate for metabolic alkalosis?
Increase plasma carbon dioxide concentration stops backwards bicarbonate buffer reaction being favoured pH returns to normal
50
How does the kidneys secreting fewer hydrogen ions and reabsorbing fewer bicarbonate ions compensate for metabolic alkalosis?
Decreased concentration of bicarbonate ions in plasma | pH returns to normal
51
How effective are the kidneys in compensating for metabolic alkalosis caused by severe vomiting losing hydrogen ions from the stomach?
Usually effective but in cases of hypotension, hypovolaemia kidneys increase reabsorption of sodium ions, water this increases secretion of hydrogen ions by NHE, and reabsorption of bicarbonate ions
52
How effective is decreased alveolar ventilation in compensating for metabolic alkalosis Why?
Not very effective because cannot decrease alveolar ventilation very much because plasma pO2 would decrease below normal range giving hypoxia
53
What are the consequences of acidaemia?
Proteins denature Hyperkalaemia
54
What are the consequences of alkalaemia?
Tetany Hypokalaemia
55
How does alkalaemia cause tetany?
Calcium ions leave solution, bind to proteins lower concentration of calcium ions in plasma increases neuronal excitability at neuromuscular junctions, this gives tetany
56
What is the relationship between disturbances in acid-base balance and disturbances in plasma potassium ion concentration?
Acidosis causes hyperkalaemia Hyperkalaemia causes acidosis Alkalosis causes hypokalaemia Hypokalaemia causes alkalosis
57
What is the exception to acidosis causing hyperkalaemia?
Type 1 diabetes ketoacidosis acidosis and lack of insulin causes more potassium ions to move out of cells into blood but then diuresis by kidneys causes loss of potassium ions giving hypokalaemia

Respiratory system (32 decks)

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