Final Exam: Acid and Base Imbalances

Question 1

What are normal Arterial Blood gas levels?

Answer 1

pH: 7.35-7.45
PaO2: 80-100 mmHg
PaCO2: 35-45 mmHg
HCO3-: 22-26 mmol/L

Question 2

What are the two types of acid produced in the body?

Answer 2

1. Volatile Acid (CO2):
   - aerobic (O2 is present) metabolism
   - CO2 reacts with water to form Carbonic Acid
2. Nonvolatile Acids:
   - sulfuric acid and phosphoric acid

Question 3

What do kidneys (renal/urinary system) do to regulate acid-base imbalance

Answer 3

• Slow, can take days
• Can excrete any acid except for carbonic acid
• Excess metabolic acids = increase excretion of acid
• Deficit metabolic acids = decrease excretion of acid

kidney functioning must be normal for this to occur

Question 4

Describe the compensation mechanisms of Metabolic Acidosis/Alkalosis vs. Respiratory Acidosis/ Alkalosis

Answer 4

Respiratory acidosis/alkalosis: kidneys will compensate
Metabolic acidosis/ alkalosis: Respiratory system will compensate

Question 5

Describe regulation of H+ in tubules

Answer 5

• In proximal tubules, metabolic acids are excreted by secreting H+ ions
• H+ ions in tubule combine with bicarbonate, phosate (urine buffers) and ammonia
• Ammonium (NH4+) produced when H+ binds to NH3
• When kidneys need to increase secretion of H+ ions, renal tubule cells increase ammonia production, so ammonia will diffuse into renal tubule fluid and will form NH4+

Question 6

What is metabolic acidosis? What are key causes of it?

Answer 6

• Excess of any acid, EXCEPT carbonic acid

1. Diabetic Ketoacidosis (DKA):
   - blood sugar is high
   - lots of keytones (keytones is acid)
   - building up in body, causing bicarbonate to decrease
2. Decrease acid secretion
   - Renal failure: not filter enough waste products increasing acid and decreasing bicarbonate
3. Loss of bicarbonate
   - Diarrhea

Question 7

Describe the compensation mechanisms of Metabolic Acidosis/Alkalosis vs. Respiratory Acidosis/ Alkalosis

Answer 7

Respiratory acidosis/alkalosis: kidneys will compensate
Metabolic acidosis/ alkalosis: Respiratory system will compensate

Question 8

How does respiratory compensate for metabolic acidosis?

Answer 8

• Breathe more rapidly (hyperventilate) to expel CO2 and increase blood pH back to normal
• DEEP RAPID breath (Kussmal breathing)

Question 9

What are lab values for Metabolic Acidosis

Answer 9

pH: less than 7.35
HCO3: less than <22 decreased
PaCO2: less than <35 decreased

Question 10

Signs and symptoms of Metabolic Acidosis

Answer 10

Headache
Decreased BP
Hyperkalemia
Muscle twitching
Warm flushed skin (vasodilation)
Nausea, vomiting, diarrhea
Confusion and increased drowsiness
Kussmal respirations (fast and DEEP breathing)

Question 11

How does respiratory system compensate for Metabolic Alkalosis?

Answer 11

Primarily slows down respirations to maintain carbon dioxide as acid

Question 12

What are causes of Metabolic Alkalosis?

Answer 12

Severe vomiting
Excess GI sunctioning
Diuretics
NaHCO3 excess

Question 13

Signs and symptoms Metabolic Alkalosis

Answer 13

Restlessness and lethardy
Dysrhythmias
COMPENSATORY HYPOVENTILATION
Tremors, muscle cramps
Hypokalemia
N&V, diarrhea

Question 14

Arterial Blood Gas values with Metabolic Alkalosis

Answer 14

pH > 7.45
HCO3: > 26 increased
PaCO2: >45 increased

Question 15

What are causes of Respiratory Acidosis?

Answer 15

Decrease respiratory stimuli
- COPD
- Pneumonia
- Atelectasis
- Anaesthesia

Question 16

What are signs and sysmptoms of Respiratory Acidosis?

Answer 16

Rapid, shallow respirations
Dyspnea
Headache
Hyperkalemia
Dysrhythmias
Muscle weakness
Drowsiness, dizziness, disorientation

Question 17

What are the laboratory values of Respiratory Acidosis?

Answer 17

pH: Decrease below 7.35
PCO2: Increase above 45mmHg

Question 18

What are causes of Respiratory Alkalosis?

Answer 18

Any condition that causes hyperventilation