Lecture 4/24 - Acid/Base Flashcards by Shirica Shaw

________ ⇋ Strong bases + H+

Weak conjugate acid

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Strong bases want to ________ a proton and create _______.

Weak conjugate acids

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________ ⇋ Weak bases + H+

Strong conjugate acid

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Weak bases want to ________ a proton and create _______.

donate (less likely to combine with)

Strong conjugate base

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Equation: Buffer

Buffer + H+ ⇋ HBuffer

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What is the function of buffers?

To correct acidosis or alkalosis by stabilizing pH

Ionized buffers: binds with free protons to help correct acidosis (Buffer + H+)

Nonionized buffers: Can donate protons to help correct alkalosis (HBuffer)

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What are the main 3 buffers in the body?

Bicarb (predominant ECF)
Phosphate (predominant ICF; important plasma despite low concentration in ECF)
Proteins (2nd most important

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Kidneys use ________ to buffer urine to prevent a _______ pH during urination

Ammonia

Low –> painful

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T/F: A buffer is best at buffer a pH at its pKa value

This gives you 50% ionized & 50% nonionized –> Buffer can either donate or accept protons

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The pK of bicarb as a buffer is _____ and is the best buffer in the body for preventing ______

6.1

Acidosis

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The ______________ refers to the fact that all buffers work together at the same time with different pKa’s and work on the same pool of protons to maintain pH

Isohydric principle

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Blood buffer graph: what does the buffer line represent?

Combination of bicarb, proteins, phosphate

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Blood buffer graph: Why is albumin not included in the buffer line? What does it more so concern?

Amount of albumin in plasma is extremely small compared to large amount of Hb/protein inside RBC

Important w/ osmotic pressure & keeping fluid within the CVS

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T/F: Hb is found in the plasma

Component of ICF of RBC

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Hematocrit of the blood is ____. For every liter of blood _____ cc is RBC.

0.4

400cc
(within this is alot of Hb)

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Blood buffer graph: Add Hb = line ______. How does this affect the buffering system?

Line get steeper (more vertical)

Better buffering system

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Blood buffer graph: Subtract Hb = line ______. How does this affect the buffering system?

Line get flatter (more horizontal)

Less effective buffering system

Blood buffer graph: How does the isobars change with Hb?

Increase Hb: Isobars come closer to the 40mmHg isobar (compressed)
-Greater change in bicarb when +/- CO2 –> helps block some of the pH changes
-Better buffer

Decrease Hb: Isobars spread farther from the 40mmHg isobar (stretched)
-Less change in bicarb when +/- CO2 –> Not able to cope w/ pH changes –> Larger pH changes
-Less effective buffer

The lungs are the _____ buffers & the kidneys are _______ buffers.

Short term

Long term

How does the kidneys assist with acid/base balance?

Excrete protons (via urine)
Reabsorb protons

Excrete bicarb (urine)
Reabsorb bicarb
Create new bicarb

The graph with the flower that has all the acid/base conditions is called a ________. What is it used for?

nomograph

-cause of acid base problems
-determine appropriate treatment

Nomograph: Acute respiratory acidosis

-reduction in drive to breathe
-acute = kidneys not adjusting

PCO2: elevated
pH: decreased
Bicarb: increased
Protons: increased
———————
Rationales:

Increased PCO2 + H2O (in blood) = Increased bicarb + H+

Proton that is created is decreasing the pH
-Bicarb is increasing

-Bicarb is acting as a weak base –> does not want to accept proton

Nomograph: Acute respiratory alkalosis

Caused by breathing too much (overventilation):
-anxious
-head injury
-seizure
-asthma attack

PCO2: decreased
pH: increased
Bicarb: decreased
Protons: decreased
(Isobar to the R )
———————-
Rationales:

-decreased PCO2 –> decreased bicarb
-increased proton –> increased pH

Nomograph: Chronic respiratory acidosis

PCO2: small increase
pH: small decrease
Bicarb: large increase
Protons: increase
——————-
Rationale:
pH & CO2 compensated by kidneys
-kidneys help w/ large increase bicarb
-kidneys pump protons into urine to help pH

Nomograph: Chronic respiratory alkalosis

PCO2: small decrease pH: small increase Bicarb: large decrease Protons: decreased ----------------- Rationale: pH blunted by kidneys -less bicarb dt less CO2 & **kidney not reabsorbing bicarb** --> helps correct pH -kidney stops proton secretion (into tubule) & retains protons -- balances pH

Nomograph: Metabolic acidosis

PCO2: decreased pH: decreased Bicarb: decreased Protons: increased -------------- Isobar to the R Body hyperventilates

Nomograph: Metabolic alkalosis

PCO2: increased pH: increased Bicarb: increased Protons: decreased ---------------------- Isobar to the L Body hypoventilates

What is "gain" of a system? What is the normal gain of a system? Ex.

How much a problem in the system can be corrected **Formula: Correction / Error** Normal gain: 50% Ex) BP drops to 50 mmHg from 100 mmHg --> activate systems like ADH or catecholamines --> pressure goes up to 75 mmHg --> 25/50 --> 50%

Why is there no "acute/chronic" metabolic acidosis/alkalosis?

There isnt much difference between acute & chronic metabolic syndromes This is dt lungs & control centers in brain stem starting to buffer very quickly

The lungs start to buffer pH issues in ______ minutes.

3 minutes (Dr S says within seconds/immediately)

The response to metabolic acidosis is _______

Increased ventilation rate

The response to metabolic alkalosis is _______

Decrease ventilation rate

The lungs respond to acid/base issues _______ than the kidneys. I refuse to like

Faster

What are common causes of respiratory acidosis? (4/24 - Long card)

**hypoventilation** Depression of respiratory control centers: -Anesthetics -Sedatives -Opiates Brain injury/disease: -Head injury -Severe hypercapnia -Severe hypoxia Neuromuscular Disorders: -Spinal cord injury -Phrenic nerve injury: includes inadvertently saturating area with too much LA -Poliomyelitis, Guillain-Barre -Botulism, Tetanus -Myastenia Gravis -Curare-like drugs (NDNMB) -DIseases affect resp muscles Chest wall restriction: -Kyphoscoliosis: dt plates/screws holding ribs/vertebrae together --> thorax less flexible -Extreme obesity Lung restriction: -restrictive lung diseases -Pulmonary fibrosis -Sarcoidosis Pulmonary parenchymal disease -PNA -Pulmonary edema Airway obstruction: -Obstructive lung diseases -Upper airway obstruction: Collapse vocal cord; scar tissue from previous trach

What happens if you inadvertently block the phrenic nerve?

If healthy 20 yo: Ineffective breathing but still may be okat old & unhealthy: may need to swtich to GA --> RSI

Describe Botulism, Tetanus. What considerations should we have?

Prevents NS from talking to muscles that control botulinum tetanus --> **causes tetanic contracts** Respiratory muscles spasming --> air cannot move in/out of lungs properly

______ is associated with Lock Jaw

Botulism, Tetanus

Myasthenia Gravis is a problem occuring at the _______

NMJ

Why do obstructive & restrictive lung diseases cause acidosis?

Decreased ability to ventilate properly --> Mismatch V/Q --> dont bring O2 on or cant get rid of CO2 --> acidosis

Respiratory alkalosis is ______ common than acidosis

less

What are common causes of respiratory alkalosis? (4/24 - Long card)

**hyperventilation** --> blows off CO2 1. Extreme anxiety 2. Congenital hyperventilation syndromes 3. Inflammation of the brain: -Encephalitis -Meningitis 4. Tumors -on brainstem -in body that increase estrogen, estradiol, progesterone 5. Salicyclic sensitivity 6. Progesterone -Female hormone that interacts w brainstem -increases during pregnancy 7. High altitudes (hypoxia) -will hyperventilate to compensate for low O2 tension for first few days -Blowing CO2 off & there's no CO2 in air 8. Acute asthma dt anxiety 9. Overventilation w/ mechanical ventilation -dt accidentally inputting wrong targets ------------------ -Infection/fever -PE

Lecture 4/24 - Acid/Base Flashcards

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