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AP2 > Lecture 4/22 - Acid/Base > Flashcards

Lecture 4/22 - Acid/Base Flashcards

Final

1
Q

______ (2) sensors in the peripheries look at ________ (2) to adjust ventilation. What is the control center for ventilation?

A

Nerve (neural) & gas

pH (acid/base) & CO2 levels

Control center = Brain stem

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2
Q

Equation: Oxygen tension/PAO2

A

[(PB - 47mmHg) x FIO2] - PaCO2/R

‘alveolar gas equation”

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3
Q

What is R in the Oxygen tension formula?

A

R = respiratory exchange rate

CO2 produced : O2 consumed

It is required for the O2 tension PAO2 formula

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4
Q

Why do planes fly at higher altitudes?

A

Higher altitude –> air thinner –> more fuel efficient/ better mileage

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5
Q

Planes usually fly at _______ ft high. The barometric pressure here is _____. What is the PO2?

A

30,000 - 40,000 ft

141 mmHg (About 200 according to S)

29 mmHg

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6
Q

How does the plane combat low barometric pressures? Why is this needed?

A

Air is pumped in from the outside while maintaining the cabin pressurized to 8000 ft
-Not pressurized to sea level bc dangerous

Low PB –> low PO2 –> even lower PAO2 –> humans cannot live like this

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7
Q

What conditions put you at risk of an adverse event at high altitudes? Why?

A

pulmonary issues
-bad heart (R heart especially)

Low PO2 –> hypoxia –> blood vessels in lungs will constrict (HPV) –> sufficient blood not going to lungs AND R heart has to push against higher pressure dt constricted vessels –> worsens oxygenation

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8
Q

Which side of the heart is stronger? Why?

A

L heart stronger

Operates at higher pressures normally

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9
Q

Why do the masks fall down on the plane? Describe what is happening

A

When plane depressurizes suddenly – trying to equilibrate with barometric pressure (not good)

Masks are hooked to containers that undergo a chemical reaction and are a source of concentrated oxygen

Helps to keep you consious while pilot rapidly descends to safe altitude

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10
Q

What causes rapid loss of consciousness when a plane suddenly depressurize? What is recommended bc of this?

A

PAO2 <29 mmHg & PaO2 = 100 mmHg

This causes the gradient (delta P) to work in reverse pulling O2 off hb from pulm capillaries (out of the circulatory system) & back into the alveoli –> Brain sensitive to low oxygen –> within SECONDS unconscious

Recommended: PUT YA MASK ON FIRST!!!!!!!!!!!!! IDC ABOUT NO KIDS IDC IDC

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11
Q

Why aren’t pilots allowed to have beards?

A

For mask fitting for decompression

They have personalized masks that need to fit tightly on their face

They have different mask and separate oxygen reservoirs (duhh they are controlling the plane they need to stay conscious)

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12
Q

_______ is the chemical reaction that takes place when the masks fall on the plane during sudden decompression. What does this reaction produce? What consideration should I have?

A

Exothermic reaction

Byproducts: heat & oxygen

Considerations: if not maintained/serviced regularly –> prematurely goes off

heat + 02 + pressure = fires and explosions

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13
Q

The normal range for pH is ____ to _____ with _____ being normal physiological/arterial pH

A

7.35 - 7.45

7.4

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14
Q

pH less than 7.35 = ______ and greater than 7.45 = _______. What can cause this?

A

acidosis

alkalosis

Respiratory (lungs) or metabolic (not lungs/probably kidney)

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15
Q

Acidity in the body depends on __________.

A

Hydrogen ions concentration = protons concentration

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16
Q

What does [H+] mean? Why?

A

proton or hydrogen ion CONCENTRATION in a solution (blood)

We measure concentration vs count bc blood is relatively dilute with free protons –> protons directly related to concentration

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17
Q

The main acid in the body is _____. It is considered a ______ acid and a ________ gas

A

CO2

weak

volatile

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18
Q

What does volatile mean?

A

It can go airborne (doesn’t necessarily have to always be airborne)

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19
Q

CO2 + water =

A

H2CO3
Carbonic Acid

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20
Q

Equation: Acid Dissociation Formula

A

HA ⇄ H+ + A-

HA = Acid (+proton)

H+ = proton

A- = conjugate base

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21
Q

What are properties of strong acids? examples.

A

Produce: Proton & weak conjugate base
-Easily dissociates (donates/produces proton)
-Extra protons can cause damage (more acidic environment dt conjugate not wanting proton back)

Ex) HCl (hydrocloric acid)
HCL ⇄ H+ + Cl-

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22
Q

What are properties of weak acids? examples.

A

Produce: Proton & Strong conjugate base

Ex) H2CO3 (Carbonic Acid)
H2CO3 ⇄ H+ + HCO3-

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23
Q

A base formed from an acid falling apart is called a ______

A

Conjugate base

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24
Q

What are properties of weak conjugate bases? examples.

A

Made from strong acids
-Dont like to grab back on to protons (wants to donate it as well…)

Ex) Cl-
HCL ⇄ H+ + Cl-

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25
What are properties of strong conjugate bases? examples.
Made from weak acids -Likes to accept protons Ex) HCO3- (bicarb) H2CO3 ⇄ H+ + HCO3-
26
The ratio for CO2:carbonic acid moles in the body is _______. What does this mean & why?
1000:1 Carbonic acid is very dilute & in low concentrations in the body That is bc its being used to either create bicarb (and proton) or going back into Water and CO2
27
How is carbonic acid replenished? Why is this necessary?
Everytime carbonic acid is turned into bicard --> more is created quickly from water + CO2 in the area Low amounts in the body & difficult to measure.
28
What are non-volatile acids in the body?(6) What does this mean?
Sulfuric acid -phosphoric acid -hydrochloric acid -lactate/lactic acid -ascorbic acid (vitamin C) -salicylic acid These acids cannot go airbourne --> cannot turn into CO2 and removed via lungs Has to be removed by kidneys - or liver has to metabolism into something different that can be excreted via kidneys or can be used in the body
29
What is the alternate name for sulfuric acid? (This pertains to all acids)
Sulfuric acid = sulfate -ate = acid
30
T/F: We produce alot of non volatile acids
F a healthy person does NOT. -An unhealthy person... maybe
31
What is the purpose of nonvolatile acids? What changes can you make to reduce to production of nonvolatile acids?
Breakdown of food --> esp. proteins Avoid protein --> go vegetarian This may only be needed if your mechanisms to get of them arent working - Kidney failure/liver failure --> can be bad when accumulating
32
What are abnormal acids in the body? (2) Describe them.
Acetoacetic acid: Produced in ppl w poor glucose management DM & alcohol hangovers -cant process sugar --> use different metaboic pathway --> this ia a byproduct -similar to acetone (produces similar smell from DM) Butyric acid: Produced in poorly managed DM & poor health -production unexplained **These are both pathological bc they are abnormal and should be here** -These are acids --> interact w/ CO2 in body -Potential proton donors!!!! -These are nonvolatile --> handled by kidney & liver
33
What are the byproducts of alcohol hangovers? (2). Why causes the hangover effects?
**Acetoacetic acid** <-- hangover effects -Alcohol dehydrogenase
34
A weak acid is ______. What is its purpose?
Fluoride Specifically Sodium Fluoride (NaF) Toothpaste --> buffer pH in mouth to prevent acid from decaying teeth
35
Proteins are combinations of _________. What is their purpose?(4)
Amino acids Proteins purposes: -structural -enzymatic -buffering -assisting w/ other processes
36
T/F: amino acids can have different charges
T Positive, negative, or neutral
37
T/F: proteins can be in both water soluble and lipid soluble areas
T
38
What does normal protein structure & function depend on?
**Normal amounts** of protons (positively charged) interacting with the proteins (negatively charged)
39
What happens to proteins when the enviroment (blood) is more acidic than normal? Examples. (3) Describe them.
Decrease pH --> increase free protons interacting w proteins --> changes structure of protein --> decreases functionality Ex1) Hb -changes structure --> **O2 falls off** -**O2 dissociation curve shifts to R = BOHR EFFECT** Ex2) Na/K/ATPase pump -Needs ATP to function -changes structure --> **slows down** dt decreases functionality --> K+ leaks back out of cell & pump cant sequester K+ into cell --> **hyperkalemia** Ex3) ATP synthase -- which creates ATP -abundant in mitochondria -changes structure --> slows down pump dt decreased functionality --> **less ATP generated --> less ATP for Na/K/ATPase pump** -Na/K/ATPase pump affected 2x --> hyperkalemia worsened
40
Everything in the body is run off of the ______ pump
Na/K/ATPase
41
How is ATP created?
From ATP synthase in mitochondria --> oxidative phosphorylation in electron transport chain --> harness electrons to create a proton gradient --> **use proton gradient to SPIN pumps to make ATP** --> oxygen accepts electrons to keep the chain moving Spinning thr pumps is what creates ATP
42
What uses the most ATP in the body?
Na/K/ATPase pump
43
How does acidosis affect respiration?
Mild increase CO2 or protons (decreased pH) = Increased RR Severe acidosis --> impairs neural tissue --> can supress breathing
44
Dissociation of all compounds in the body is based on ______ in the system. What should you do if its abnormal?
pH Abnormal pH: make adjustments to type of drug, administration route, dosage
45
_____ helps with absorption or distribution with prescribed drug
HCl = hydrochloric salt (acid)
46
An example of an extremely basic drug is ________. What adverse effect does this have?
Sodium phenobarbital Fast IV infusion = Painful
47
Equation: pH
-log[H+]
48
Equation: [H+]
1 x 10-[pH]
49
pH range is from ________. Neutral is ____, acidic is _____ and basic is ______.
1 - 14 Neutral = 7 Acidic <7 Basic >7
50
What are the units for concentration of protons [H+]?
millimoles/Liter (mmol/L) Nanomoles/Liter (nmol/L)
51
pH is a _______ log
base 10 log log(10) --> 1 x 10-[pH]
52
What is the most acidic acid in the body? How does the body handle this? What is its function?
Gastric secretions in stomach pH = 1 Tissues in stomach designed to be resistant to the secretions that it produces (thick & leathery) Function: Degrade food
53
What is the most basic acid in the body? What is its function?
Pancreatic secretions = bicarb pH = 8 Function: pancreas behind stomach & slightly early in digestive tract -**neutralizes gastric acid** to prevent destruction of intestines (soft tissue) -
54
There is _____ volume of pancreatic secretion than gastric secretions. Why?
More --------------------- gastric pH = 1 & pancreatic pH = 8 If you're comparing them to neutral = 7. gastric secretions is way stronger Need more pancreatic volume to balance out the pH differneces from gastric being much stronger
55
If you have diarrhea, you become ______. Why?
acidotic Increased pancreatic secretions vs gastric + increased motility --> higher loss of bicarb vs gastric --> acidotic
56
If you are vomitting, you become ______. Why?
alkalotic vomitting up gastric acid from stomach --> bicarb continuing to flow in high volumes + losing acid from stomach --> alkalosis (This can happen with obstruction)
57
10-3 =
milli
58
10-6
micro
59
10-9
nano
60
The pH survival limits are _________
6.9 - 7.8
61
An increase in pH by 1 _____ proton concentration by _____. What is happening to the solution?
decreases 10x Solution becoming more basic
62
An decrease in pH by 1 _____ proton concentration by _____. What is happening to the solution?
increases 10x Solution becoming more acidic
63
Small changes in pH = _______ changes in proton concentration
large
64
What do buffers do? (3)
-stabilize pH -donates protons -binds to protons
65
What is the purpose of a pKa of a buffer?
The chemical composition that dictates what pH its going to try to get to
66
Name the important body buffers (3). Describe them
1. Bicarbonate (HCO3-) -Main extracellular fluid buffer in kidneys (kidneys help produce & regulate it) 2. Proteins (including Hb) -Protons positively charged & protein to negatively charged --> protons become not reactive 3. Phosphate - main intracellular fluid buffer -high concentrations in cell used for: energy storage; phosphorylation/phosphorylation (turning things on/off)
67
What is required to take phosphate off adenosine? Whst is this process called?
ATPase dephosphorylation
68
The ability of the body to adjust pH quickly, depends on our bodies ability to do what?
Get rid of CO2 = lungs need to be working properly **affects the ability of other buffers to work properly**
69
What happens if any portion of the buffering system becomes dysfunctional?
Other buffers have to do more work (especially if its the lungs that are dysfunctional) Buffers don't work as efficiently
70
Blood buffer graph: What are the normal vales for Hb, bicarb, pH, [H+]?
Hb = 15 g/dL bicarb = 24 mmol/L pH = 7.4 [H+] = 40 nmol/L (please take note of the units that will be on the graphs)
71
Blood buffer graph: Which line is the normal Hb line?
Hb = 15 g/dL The only black line -Normally 2nd line from the top
72
Blood buffer graph: Decreased Hb = ________ bicarb. What happens to the slope of the line? What does this mean
Decreased Slope decrease (more horizontal) --> **buffer system LESS effective** dt less proteins
73
Blood buffer graph: Increased Hb = ________ bicarb. What happens to the slope of the line? What does this mean
Increased Steeper slope (more vertical) --> **buffer system MORE effective** dt more proteins
74
Blood buffer graph: Decribe the Hb deviations
They are the blue lines -Hb 20 is line UP from normal -Hb 10 is line BELOW -Hb 5 is below that (These lines dont have an axis so need to know, he wont put the number)
75
Blood buffer graph: What is an isobar? What is the normal value? Abnormal? How are they identified?
Curved line that represents arterial PCO2 Normal: PCO2 = 40 mmHg -- 3rd isobar PCO2 = 20 mmHg -- 4th isobar PCO2 = 60 mmHg -- 2nd isobar PCO2 = 80 mmHg -- 1st isobar
76
If the pH is 8 the concentration of protons is _______
10 nmol/L or .01 mmol/L (There are many deviations of this... Please review metrics... could be funny and ask for it in kilomoles...)
77
Blood buffer graph: What does shifting to the isobar to the R indicate?
**Uncompensated respiratory alkalosis** PCO2 = 20 mmHg (decreased) bicarb = 19 mmol/L (decreased) pH = 7.6 (increased) [H+] = 25 nmol/L (decreased) (Note: This is assuming Hb = 15 g/dL)
78
Blood buffer graph: What does shifting to the isobar to the L indicate?
**Uncompensated respiratory acidosis** PCO2 = 60 mmHg (increased) bicarb = 26 mmol/L (increased) pH = 7.25 (decreased) [H+] = 55 nmol/L (increased) (Note: This is assuming Hb = 15 g/dL)
79
Increase CO2 = _______ bicarb
increase
80
Decrease CO2 = _______ bicarb
decrease
81
Acid/Base imbalances: uncompensated respiratory acidosis
pH: ↓↓ PCO2: ↑↑ HCO3-: ↑ Graph shift: up, left
82
Acid/Base imbalances: uncompensated respiratory alkalosis
pH: ↑↑ PCO2: ↓↓ HCO3-: ↓ Graph shift: down, right
83
Acid/Base imbalances: uncompensated metabolic acidosis
pH: ↓↓ PCO2: HCO3-: ↓↓ Graph shift: down, left
84
Acid/Base imbalances: uncompensated metabolic alkalosis
pH: ↑↑ PCO2: HCO3-: ↑↑ Graph shift: down, right
85
Acid/Base imbalances: partially compensated respiratory acidosis
pH: ↓ PCO2: ↑↑ HCO3-: ↑↑ Graph shift: further up, right
86
Acid/Base imbalances: partially compensated respiratory alkalosis
pH: ↑ PCO2: ↓↓ HCO3-: ↓↓ Graph shift: further down, left
87
Acid/Base imbalances: partially compensated metabolic acidosis
pH: ↓ PCO2: ↓↓ HCO3-: ↓↓
88
Acid/Base imbalances: partially compensated metabolic alkalosis
pH: ↑ PCO2: ↑↑ HCO3-: ↑↑
89
Acid/Base imbalances: respiratory and metabolic acidosis
pH: ↓↓ PCO2: ↑↑ HCO3-: ↓
90
Acid/Base imbalances: respiratory and metabolic alkalosis
pH: ↑↑ PCO2: ↓↓ HCO3-: ↑
91
What causes respiratory alkalosis? What tries to compensate for this?
Blowing off too much CO2 (increased RR or minute ventilation for too long) Kidneys
92
What are causes of respiratory acidosis? (Very long list & very long card - Ones mentioned 1st; listed ones last)
1. Decreased ventilation: decreased O2 in lung --> increased CO2 in blood 2. **Brain stem injury: Head injury --> knocks out CNS --> All respiratory control centers are here** 3. Spinal cord injury: above C3 = stop breathing; C4/lower = abnormal; includes accessory muscles too 4. Stroke: ischemic or hemorrhagic can affect brainstem 5. Kyphoscoliosis: Abnormal curvature in sagital & coronal plane --> Plates & rods from Sx not flexible --> difficult to breath normal (restrictive lung diesease) 6. Extreme obesity: decreases chest wall compliance 7. Positioning: laying on back decreases total compliance 8. Opiates: Ex) Fentanyl -- worse than sedatives/benzos 9. Anesthetics/Sedatives/Paralytics 10. Volatile gases 11. **Barbiturates: Pure GABA agonists - massive impact on resp control centers - dangerous** ----------------- -restrictive lung diseases -pneumothorax, pleural effusions -pneumonia, pulmonary edema -obstructive diseases, airway obstructions -diseases affecting respiratory muscles -Botulism, Tetanus
93
Respiratory acidosis is associated with buildup of _______ dt _______
CO2 Poor lung function
94
The phrenic nerve rises from
C3 C4 C5
95
T/F: A young healthy 20 yo will be affected with respiratory acidosis from a lower thorax spinal injury affecting accessory muscles
F They actually may not be affected by this. If old & unhealthy, then they need them muscles and will be affected
96
The higher up the injury = _______ & lower down the spine = _________
worse breathing problem Less severe
97
T/F: Benzos are GABA pure agonist
F They are not pure agonist --> Bind at the lower parts of the GABA-R **Causes respiratory distress in combo with pure agonists like alcohol**

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