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Renal Module > Lecture 7 - Acid Base Balance 2 > Flashcards

Lecture 7 - Acid Base Balance 2 Flashcards

1
Q

What is pH homeostasis?

A

Is a balance between acid production and acid excretion

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2
Q

What causes a low pH?

A

Metabolic acidosis (decrease in bicarbonate) and increase in respiratory acidosis (increase in PCO2)

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3
Q

What causes a high pH?

A

Metabolic alkalosis (increase in bicarbonate) and respiratory alkalosis (decrease in PCO2)

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4
Q

How do you compensate for metabolic acidosis?

A

Increased ventilation with a decrease pCO2 and H+

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5
Q

How do you compensate for respiratory acidosis?

A

Increased H+ secretion and excretion, all filtered bicarbonate reabsorbed, increased ammonia excretion

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6
Q

How do you compensate for metabolic alkalosis?

A

Decreased ventilation and increased PCO2

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7
Q

How do you compensate for respiratory alkalosis?

A

decreased HCO3- and decreased H+ secretion

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8
Q

What is compensation?

A

To try and correct the fault

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9
Q

What causes respiratory acidosis?

A

Obstructive airway disease and drugs which depress respiration

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10
Q

What is the primary defect for respiratory acidosis?

A

Increase in PCO2

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11
Q

What causes respiratory alkalosis?

A

Hyperventilation e.g. panic attacks, asthma and mechanical ventilation (salicylate overdose)

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12
Q

What is the primary defect for respiratory alkalosis?

A

Decrease in PCO2

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13
Q

What is a salicylate overdose?

A

Aspirin overdose

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14
Q

What is the primary defect for metabolic acidosis?

A

Decrease in bicarbonate

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15
Q

What are the causes for metabolic acidosis?

A

Gain of nonvolatile acid e.g. lactic acid, ketoacidosis and solvent abuse, lose of bicarbonate and decreased renal secretion

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16
Q

What is the primary defect for metabolic alkalosis?

A

Increase in bicarbonate

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17
Q

What are the causes of metabolic alkalosis?

A

Increased GI loss of protons - vomiting, increased renal loss of protons, administration of bicarbonate IV and liquorice

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18
Q

What can too much liquorice cause?

A

Pseudohyperaldosteronism

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19
Q

Why do people need bicarbonate IVs?

A

People who get acid reflux

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20
Q

What is the first line of defence of acid base disturbance?

A

To minimise the changes in pH - although it does not correct the underlying disorder

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21
Q

What is the multi step process for recovery from an acid-base disturbance process?

A

Acid base disturbance, buffering, respiratory compensation, renal compensation and correction of defect

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22
Q

What is the immediate response for acid base disturbance?

A

Immediate/minutes

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23
Q

What is the several hours response in acid base disturbance?

A

Respiratory compensation

24
Q

What is the longer (hours-day) response for acid base disturbance?

A

Renal compensation

25
Q

What is Pendrin?

A

It is a chloride bicarbonate antiporter

26
Q

What are beta intercalacted cells also know as?

A

Bicarbonate intercalating cells

27
Q

How do protons go back into the blood stream? - in the beta-intercalated cells of the distal tubule

A

By the V-ATPase

28
Q

When is the activity of the bicarbonate intercalated cells increased?

A

It is increased during metabolic alkalosis

29
Q

What helps with Cl- exchange?

A

The chloride transporter

30
Q

What diagram is used for acid-base disturbances?

A

The davenport diagram (it is not used clinically)

31
Q

What mmHg of CO2 is acidosis?

A

60mmHg

32
Q

What mmHg of CO2 is alkalosis?

A

20mmHg

33
Q

What is considered the buffer line in the davenport diagram?

A

40mmHg - this is where all the equivalences join together

34
Q

What does high bicarbonate acidosis = (in the davenport diagram)

A

Respiratory acidosis

35
Q

What condition is it where you have a low bicarbonate acidosis?

A

A metabolic acidosis

36
Q

What condition is it called if there is a high Bicarboante alkalosis?

A

Metabolic alkalosis

37
Q

What condition is it if you compensate with low bicarbonate alkalosis?

A

Respiratory alkalosis

38
Q

Acidosis with decrease pCO2 =

A

Metabolic acidosis

39
Q

Acidosis with increased bicarbonate =

A

Respiratory acidosis

40
Q

Alkalosis with increased PCO2 =

A

respiratory alkalosis

41
Q

Alkalosis with decreased bicarbonate =

A

Respiratory alkalosis

42
Q

Example Q - what is the condition, 7.28pH 26mmHg of PCO2, 14mEq of bicarbonate?

A

Bicarbonate = disorder and there is a decreased PCO2 therefore it is metabolic acidosis

43
Q

What is renal tubular acidosis?

A

To results from impaired H+ excretion by the kidneys

44
Q

What is type 1 renal tubular acidosis?

A

Distant renal tubular acidosis

45
Q

What is type 2 renal tubular acidosis?

A

Proximal renal tubular acidosis

46
Q

What are examples of Type 1 renal tubular acidosis?

A

Distal nephron dysfunction, increased H+ permeability and Sjogen syndrome

47
Q

How can type 2 - proximal tubular (RTA) be caused?

A

Usually due to a general dysfunction rather than specific transporter defect

48
Q

What does impaired H+ secretion in PT lead to?

A

Decreased in bicarbonate reabsorption

49
Q

What is the anion gap?

A

It is the difference in concentration of major ECF cations and anions

50
Q

What is the normal value for the anion gap?

A

8-16mEq

51
Q

What happens to the anion gap when there is acidosis from acid loading?

A

It increased to 17 and bicarbonate is reduced

52
Q

What happens to the anion gap when acidosis results from Bicarboante loss?

A

It decreased to 10 - it is within the normal range

53
Q

What is the equation for the anion gap with Na+, bicarbonate and Cl?

A

([Na+] - ([Cl-] + [HCO3-])

54
Q

Increased acid retention =

A

Decreased pH and increased RAAS production

55
Q

What causes decreased acid retention

A

Increased acid excretion and increased ammonia

56
Q

What does angiotensin II contribute to?

A

It contributes to tubular injury and fibrosis in chronic kidney disease

57
Q

What does ammonia genesis in chronic kidney disease result in?

A

It activates complement and exacerbates tissue damage - leads to an alternative compliment cascade

Renal Module (10 decks)

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