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CVS > L6 - Acid Base Balance II > Flashcards

L6 - Acid Base Balance II Flashcards

1
Q

What is the long term way to regulate acid-base balance?

A

Renal mechanisms

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2
Q

What are the 3 renal mechanisms to controlling acid-base balance?

A 
HCO3 handling 
- 90% proximal tubule 
- 10% distal tubule 
Urine acidification 
Ammonia synthesis
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3
Q

Proximal cell model - HCO3 handling

A

Na influx and recycling of halogen ion across apical membrane
This allows the cell to absorb 90% of the filtered bicarbonate

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4
Q

How is base conserved?

A

Acidification of urine – 25%

Ammonia synthesis - 75%

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5
Q

How is urine acidified?

A

In tubular fluid…which is then excreted in urine

  • Alkaline salt –> acid salt
  • Alkaline phosphate –> acid phosphate
  • Na2HPO4 –> NaH2PO4
  • Other examples - uric acid and creatinine
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6
Q

How is ammonia synthesised?

A

NH3 + H+ –> NH+4
- Ammonia is permeable
- Ammonium is impermeable
NH3 formed by glutamine –> alpha keto-glutarate

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7
Q

How do the kidneys respond to acidosis?

A

Increase in H+ excretion
Normal HCO3- excretion (nearly 0)
Decrease in urine pH
Increase in change in plasma pH

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8
Q

How do the kidneys respond to alkalosis?

A

Decrease in H+ excretion
Increase in HCO3- excretion
Increase in urine pH
Decrease in change in plasma pH

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9
Q

What are respiratory disorders caused by?

A

Changes in CO2 levels

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10
Q

What are metabolic disoders caused by?

A

Changes in acid and base levels

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11
Q

What are the two different types of respiratory disorders?

A

Respiratory acidosis – low pH and high [HCO3]

Respiratory alkalosis – high pH and low [HCO3]

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12
Q

What are the two different types of metabolic disorders?

A

Metabolic acidosis – low pH and low [HCO3]

Metabolic alkalosis – high pH and high [HCO3]

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13
Q

What is respiratory acidosis?

A

CO2 elimination decreases

Caused by lung diseases – emphysema, chronic bronchitis

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14
Q

What is the renal compensation for respiratory acidosis?

A

Increase in H+ secretion
Increase in reabsorption of HCO-3
Rise in pH but further rise in HCO-3

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15
Q

What is respiratory alkalosis?

A

CO2 elimination increases

Caused by hyperventilation, fear, stress, pain

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16
Q

What is the renal compensation for respiratory alkalosis?

A

Decrease in H+ secretion
Decrease in reabsorption of HCO-3
Fall in pH but further fall in HCO-3

17
Q

What is metabolic acidosis caused by?

A

Ingestion acid or loss of alkaline fluid

Diarrhoea, cholera, diabetic ketoacidosis

18
Q

What is the respiratory compensation for metabolic acidosis?

A

Increase in respiratory rate
Decrease in arterial PCO2
Increase in pH and drop in PCO2

19
Q

What is the renal compensation for metabolic acidosis?

A

Increase in H+ secretion

Increase in reabsorption of HCO3-

20
Q

What is metabolic alkalosis caused by?

A

Ingestion of alkaline fluid or loss of acid

Vomiting

21
Q

What is the respiratory compensation for metabolic alkalosis?

A

Decrease in respiratory rate
Increase in arterial PCO2
Decrease in pH and rise in PCO2

22
Q

What happened if you have a mix or respiratory and metabolic disorders?

A

Both same type – pH additive – life threatening

Opposite types – pH subtractive – mild

23
Q

What are the 4 examples of mixed disorders?

A

Alcoholics
Asthma
COPD patients treated with diuretics
Salicylate poisoning

24
Q

How do alcoholics have a mixed disorder?

A 
Met acidosis (breakdown)
Met alkalosis (vomiting)
25
Q

How do asthma patients have a mixed disorder?

A 
Respiratory acidosis
Lactic acidosis (due to lack O2 for aerobic respiration)
26
Q

How do COPD patients treated with diuretics have a mixed disorder?

A 
Respiratory acidosis
Metabolic alkalosis (caused by the diuretics)
27
Q

How is salicylate poisoning a mixed disorder?

A 
Respiratory alkalosis (stimulated respiratory centre)
Metabolic acidosis

CVS (15 decks)

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