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Physiology Part 2 > Lec 48-49 Acid Base > Flashcards

Lec 48-49 Acid Base Flashcards

1
Q

What is equation for pH?

A

pH = -log[H]

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2
Q

What is pH of stomach acid?

A

2

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3
Q

What is pH of urine?

A

6

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4
Q

what is pH of saliva?

A

6

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5
Q

What is normal blood pH?

A

7.4

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6
Q

What are the two types of acid you make?

A
  • non-carbonic/non-volatile/fixed [from protein digestion]

- carbonic/volatile [from cell respiration]

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7
Q

What are some non-volatice acids from protein metabolism?

A
  • cycstein
  • H2S
  • SO4
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8
Q

How are carbonic acids excreted?

A

via lungs

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9
Q

How are non-carbonic acids eliminated?

A

via kidney

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10
Q

What is plasma conc HCO3?

A

24 mEq/L = 24 mmol/L

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11
Q

What is plasma pCO2?

A

40 mmHg

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12
Q

What happens if we eat excess H?

A
  • more glutamine comes into PT cell –> more NH4 into lumen and more HCO3 into blood
  • in alpha intercalated: can excrete more H since it can bind NH3 and won’t affect urine pH , create more HCO3 that goes into blood
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13
Q

Will you get alkaline blood if you eat too much HCO3?

A

No - because there is a threshold in PT for how much HCO3 the transporter can reabsorb
- if you eat too much HCO3 it will get excreted and not reabsorbed

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14
Q

What happens if you exercise heavily and generate lactic acid?

A
  • lactic acid –> lactate + H
  • the H then: H + HCO3 -> H2CO3
  • H2CO3 –> H2O + CO2 and breathed off
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15
Q

What is function of kidney in high H handling?

A
  • reabsorption and generation of HCO3

- excretion of H

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16
Q

What is function of lungs in high H handling?

A

regulation pCO2

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17
Q

What is relationship [H] to pCO2 and [HCO3]

A

[H] is proportional to pCO2/[HCO3]

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18
Q

What is definition acidemia?

A

blood pH < 7.4

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19
Q

what is definition alkalemia?

A

blood pH > 7.4

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20
Q

what is definition acidosis?

A

a process that increases the [H]

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21
Q

what is definition alkalosis?

A

a process that decreases the [H]

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22
Q

Can you have acidemia and alkalemia at the same time?

A

No

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23
Q

Can you have alkalosis and acidosis at the same time?

A

yes

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24
Q

What does it mean if an acidosis/alkalosis is respiratory? [ie what value is changing]

A
  • primary change in pCO2 –> problem caused by lungs
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25
Q

What does it mean if an acidosis/alkalosis is metabolic? [ie what value is changing]

A
  • primary change in HCO3
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26
Q

What is a compensation?

A

predictable response by body to change in pCO2 or HCO3

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27
Q

in the equation H ~ pCO2/[HCO3] which part do lungs compensate with? which part does kidney compensate with?

A
  • lungs compensate by altering pCO2

- kidney compensates by altering HCO3

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28
Q

What is cause of respiratory acidosis?

A

not breathing too much – accumulate pCO2

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29
Q

what is cause of respiratory alkalosis?

A

breathing too much - loss of pCO2

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30
Q

What is path of respiratory disorder [initial change, acute, chronic]?

A

initial: change in pCO2
acute: compensate by intracellular buffering
chronic: compensation by kidney HCO3 handling

31
Q

What is path of changes [initial and compensation] from hypoventilation?

A

initial: respiratory acidosis
- low pH/ high H
- high pCO2
- normal HCO3

compensation by kidneys

  • slightly less low pH
  • still high pCO2
  • high HCO3
32
Q

What are lab pH, CO2, and HCO3 values from respiratory acidosis?

A
  • low pH
  • high pCO2
  • high HCO3
    two in same direction = respiratory
33
Q

What are some acute causes of respiratory acidosis?

A
  • upper airway obstrcution
  • respiratory center inhibition
  • exacerbation of chronic lung disease
  • mechanical ventilation
34
Q

What are some chronic causes of respiratory acidosis?

A
  • mechanical ventilation
  • COPD
  • extreme obesity
35
Q

What is path of changes [initial and compensation] from hyerventilation?

A

initial: respiratory alkalosis
- high pH/ low H
- low pCO2
- normal HCO3

compensation by kidneys

  • slightly less high pH
  • still low pCO2
  • low HCO3
36
Q

What is kidney compensation for respiratory acidosis?

A
  • increased regeneration of HCO3 in alpha intercalated cells
37
Q

What is kidney compensation for respiratory alkalosis?

A
  • decreased HCO3 reabsorption in PT

- decreased regenration HCO3 in alpha intercalated

38
Q

What are some causes of respiratory alkalosis

A

hypoxemia - from anemia, high altitutide, fibrosis/edema, CHF

  • direct stimulation of medullary respiratory center
  • mechanical ventilation
39
Q

What are lab pH, CO2, and HCO3 values from respiratory alkalosis?

A
  • high pH
  • low pCO2
  • low HCO3

2 in same direction = respiratory

40
Q

Case: 54 M, COPD, hip fracture
Na = 138, K = 3.9, CL = 103, HCO3 = 29, pH = 7.35, pCO2 = 55

acidemia or alkalemia?
metabolic or respiratory?
is compensation appropriate?

A

respiratory acidemia

41
Q

What rise in HCO3 do you expect from 15 mmHg rise pCO2 in respiratory acidosis if acute? if chronic?

A

acute: 1.5 mEq/L rise
chronic: 5.25 mEq/L rise

42
Q

What is initial change in metabolic disorder? compensation?

A
  • initial change [HCO3]

- compensate by change in ventilation of pCO2

43
Q

What are the four ways you can get metabolic acidosis?

A
  1. increased acid production
  2. decreased acid excretion
  3. decreased HCO3 production
  4. increased HCO3 excretion
44
Q

What is path of changes in metabolic acidosis? Initial and compensation?

A

initial:

  • low pH/ high H
  • normal pCO2
  • low HCO3

compensation by lungs:

  • slightly less low pH
  • low pCO2
  • still low HCO3
45
Q

What are lab pH, CO2, and HCO3 values from metabolic acidosis?

A
  • low pH
  • low pCO2
  • low HCO3

all in same direction = metabolic

46
Q

What could cause metabolic acidosis from under excretion of acid?

A

acute or chronic renal failure

47
Q

What could cause metabolic acidosis from over-secretion of HCO3?

A

GI loss

renal loss

48
Q

What could cause metabolic acidosis from under-production of HCO3?

A

renal defect

49
Q

What could cause metabolic acidosis from over-production of acid? Exogenous? endogenous?

A

endogenous
- lactic, ketone, amino, phosphoric
exogenous
- salicylate, methanol, HCl, ethylene glycol, toluene

50
Q

What is the equation for anion gap?

A

AG = Na - (HCO3 + Cl)

51
Q

What is normal anion gap? range?

A

11 ‘unmeasured anions’

8-12 mEq/L

52
Q

What is explanation of anion gap idea?

A
  • blood must be electrically neutral
  • [Na] = 140 is main cation so there must be equivalent anion conc in blood
  • main anions are:
  • – [HCO3] = 24
  • – [Cl] = 105

the anion gap = whatever leftover anions unmeasured

53
Q

Why is it normal to have an anion gap?

A

because there are anions present that aren’t measured like albumin, phosphaste etc

54
Q

When do you have low Cl?

A

hyponatremia –> Na and Cl travel together

55
Q

Why might you have low bicarb in metabolic acidosis?

A

bicarb is buffering the H+ from whatever extra acid acumulated

56
Q

What are the causes of high anion gap acidosis? [mnemonic]

A

MUDPILES

  • Methanol
  • Uremia = kidny failure
  • Diabetic, alcoholic, or starvation ketoacidosis
  • Propylene glycol, pyroglutamic acid
  • INH or Iron
  • Lactic Acidosis
  • Ethylene glycol
  • Salicylates
57
Q

Methanol is associated with what metabolic state?

A

high anion gap acidosis

[due to exogenous acid acumulation]

58
Q

Uremia [kidney disease] is associated with what metabolic state?

A

high anion gap acidosis

[due to failure to excrete acid]

59
Q

ketoacidosis [from diabetes, alcohol, or starvation] is associated with what metabolic state?

A

high anion gap acidosis

[due to endogenous acid build up]

60
Q

propylene glycol is associated with what metabolic state?

A

high anion gap acidosis

[due to exogenous acid]

61
Q

Iron is associated with what metabolic state?

A

high anion gap acidosis

[due to exogenous acid]

62
Q

Lacid Acidosis is associated with what metabolic state?

A

high anion gap acidosis

[due to endogenous acid]

63
Q

Ethylene glycol is associated with what metabolic state?

A

high anion gap acidosis

[due to exogenous acid]

64
Q

Salicylates are associated with what metabolic state?

A

high anion gap acidosis

[due to exogenous acid]

65
Q

What causes non-anion gap acidosis?

A
  • due to loss of bicarbonate in diarrhea or renal
66
Q

What happens to Na/HCO3/Cl/unmeasured levels in non anion-gap acidosis?

A
  • normal Na
  • low HCo3
  • high Cl
67
Q

Why do you get high Cl in non anion-gap acidosis?

A

You don’t have as much HCO3 around to use to reabsorb Na

you start increasing Cl reabsorption to help with Na reabsorption

68
Q

Case:
- 25F 3 days diarrhea
Bp 100/60 HR 110 RR 20
Na = 143, K = 3.3, Cl = 117, HCO3 = 16, Alb = 3.7 pH = 7.25, pCO2 = 34

acidemia or alkalemia?
met or resp?
anion gap or none?
appropriate compensation?

A
  • metabolic acidemia

- no anion gap and high Cl

69
Q

What is winter’s formula? what do you use it for

A

expected pCO2 = 1.5 (HCO3) + 8 +/- 2

determining expected respiratory compensation in metabolic acidosis

70
Q

What is path of changes in metabolic alkalosis? Initial and compensation?

A

initial

  • high pH/low H
  • normal pCO2
  • high HCO3

compensation:

  • less high pH/ less low H
  • high pCO2
  • still high HCO3
71
Q

What are two causes of metabolic alkalosis?

A
  1. loss of H via GI [vomit] or kidney [diuretics]
  2. loss of ECF [contraction alkalosis]
    - less volume with same HCO3 so HCO3 conc rises
72
Q

What are 3 reasons you might get HCO3 reabsorption increases even when you have high HCO3?

A
  1. decreased GFR: get decreased filtered load
  2. decreased effective circulation volume: promotes Na/HCO3 reabsorption in PT
  3. hypokalemia: promotes H secretion / K reabsorption in a-intercalated cell
73
Q

What are lab pH, CO2, and HCO3 values from metabolic alkalosis?

A
  • high pH
  • high HCO3
  • high pCO2

Physiology Part 2 (19 decks)

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