Keef: Acid Base Select Topics

Question 1

Does diarrhea cause acidosis or alkalosis? Hypo or hyperkalemia?

Answer 1

Acidosis; hypokalemia

Question 2

Does renal failure cause acidosis or alkalosis? Hypo or hyperkalemia?

Answer 2

Acidosis; hyperkalemia

Question 3

Does renal tubular acidosis cause hypo or hyperkalemia?

Answer 3

Hypokalemia

Question 4

Does diabetic ketoacidosis cause hypo or hyperkalemia?

Answer 4

Hyperkalemia

Question 5

Does lactic acidosis cause hypo or hyperkalemia?

Answer 5

Neither; normal K+ levels

Question 6

In RTA type 1, NH4Cl can be administered. It will dissociate into HCl and H+ will be available to enter the distal nephron. If RTA type 1, urine pH will not decrease below (blank)

Answer 6

5.5

Question 7

Impaired apical H+ATPase or H+/K+ ATPase or basolateral HCO3/Cl- exchanger; increased apical membrane leakiness to H+

Answer 7

Type 1 Renal tubular acidosis

Question 8

In type 1 RTA, you cannot adequately secrete H+. So what happens to urine HCO3-, pH, K+, and Cl- with Type 1 RTA.

Answer 8

Increased HCO3-
Increased urine pH
Urine K+ will increase
Urine Cl- will decrease

Question 9

What is the cause of hyperkalemia in diabetic ketoacidosis?

Answer 9

No insulin around to stimulate Na+/K+ pump, so extracellular K+ builds up.

Question 10

What is the cause of hyperkalemia in metabolic acidosis?

Answer 10

Add an acid to the body, such as HCl. Cl will dissociate and H+ will flow into the cell, where it will build up and not allow the exchange of Na+ for K+. So, high extracellular K+.

Question 11

Secretion of H+ is the way to get (blank) back into the body.

Answer 11

HCO3-

Question 12

Secretion of H+ is fundamental to getting (blank) back into the body.

Answer 12

HCO3-

Question 13

Type 1 and 2 renal tubular acidosis cause hyper or hypokalemia?

Answer 13

Hypokalemia

Question 14

Does the anion gap change in renal tubular acidosis?

Answer 14

No

Question 15

Things that may occur with renal tubular acidosis?

Answer 15

Bone demineralisation
Urinary stone formation
Nephrocalcinosis
Failure to thrive

Question 16

How to distinguish type 2 from type 1 RTA?

Answer 16

Give NH4Cl; in this case, urine pH will go down below 5.5

Question 17

How to treat renal tubular acidosis?

Answer 17

Give base! NaCO3 or sodium citrate

Question 18

After a single episode of vomiting, what three things increase?

Answer 18

K+
HCO3-
pH

Question 19

Vomiting leads to loss of (blank) and an increase in (blank).

Answer 19

H+; HCO3-

Question 20

Loss of H+ causes less H+ to be secreted, so less (blank) can be reabsorbed.

Answer 20

HCO3-. This can return pH to a normal level.

Question 21

With persistent vomiting, what happens to plasma [Na+], [K+], [Cl-], [HCO3-] and pH.

Answer 21

Dehydration, so want to save Na+! So plasma Na+ will stay the same.
High levels of aldosterone will excrete lots of K+, so plasma K+ will go down!
When you vomit, you lose Cl-, so it will go down.
Bicarb will be higher!
pH will go up!

Question 22

What happens to BUN and plasma creatinine with prolonged vomiting?

Answer 22

Dehydration causes a huge concentration of urea in urine. Creatinine will also increase, because low GFR due to low urine flow.

Question 23

What happens to pCO2 with prolonged vomiting?

Answer 23

High pCO2, trying to compensate for alkalotic condition.

Question 24

What will happen to urine [Cl-], [Na+], and [K+] with prolonged vomiting?

Answer 24

All will be low.
Body is reabsorbing Na+.
K+ body stores are depleted.
Cl- is following Na+ back into body, so it will be low.

Question 25

Why is urine pH within the normal range after days of prolonged vomiting?

Answer 25

If you vomit once, expect alkalotic urine. BUT, with prolonged vom, acidic urine. Aldosterone will increase K+ excretion, causing hypokalemia. Low K+ stimulates H+ATPase, so greater H+ secretion, leading to acidic urine!

Question 26

3 things that occur with hyperaldosteronemia?

Answer 26

1. Increased Na+ reabsorption
2. Increased K+ secretion
3. Increased H+ secretion

Question 27

In respiratory acidosis, what is the primary disturbance? What is the compensation mechanism?

Answer 27

1. increase in pCO2

2. increase HCO3-

Question 28

In respiratory alkalosis, what is the primary disturbance? What is the compensation mechanism?

Answer 28

1. decreased pCO2

2. decrease HCO3-

Question 29

In metabolic acidosis, what is the primary disturbance? What is the compensation mechanism?

Answer 29

1. decreased HCO3-

2. decreased CO2

Question 30

What is the primary disturbance in metabolic alkalosis? What is the compensation mechanism?

Answer 30

1. increased HCO3-

2. increased CO2