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SF3Renal > Man - ACID BALANCE and Shapiro hypertension > Flashcards

Man - ACID BALANCE and Shapiro hypertension Flashcards

1
Q

Blood pH range compatible with life

A

6.8 - 7.8

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2
Q

The normal physiological pH

A

7.35 - 7.45

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3
Q

Primary change in metabolic acidosis/alkalosis

A

[HCO3-]

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4
Q

Major change in respiratory acidosis/alkalosis _____

A

PCO2

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5
Q

Normal [HCO3-]

A

23-25 mEQ/L

24

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6
Q

Normal Pco2

A

35-45mmHg

40

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7
Q

3 defense mechanism for pH maintenance

A

Extracellular and intracellular buffering

Adjustments in Pco2 by alterations in ventilatory rate

Adjustments in renal acid excretion

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8
Q

Metabolic disorders are buffered primarily in the

A

Extracellular fluids

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9
Q

What are other extracellullar buffers besides bicarb?

A

HPO4

Protein

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10
Q

Inside the cells, H+ is titrated by ?

A

Phosphate and proteins

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11
Q

Renal response to metabolic acidoses takes _____ to complete

A

Several days.

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12
Q

The renal response to acidosis is ?

A

Increase secretion of hydrogen ions

Reabsorb the entire filtered load of bicarb

Increase production and excretion of NH4

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13
Q

The renal response to alkalosis?

A

Decrease secretion of H ions

Decrease HCO3 reabsorption

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14
Q

What kind of defense mechanisms are used in respiratory disorders?

A

ICF buffers

Renal NAE changes

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15
Q

What kind of defense mechanisms are there in metabolic disorders?

A

ICF and ECF buffers

Ventilatory changes

NAE changes

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16
Q

A graph that helps predict the different disorders in acid base balance and their compensation. Based on the blood pH and the amount of bicarb in solution

A

Davenport diagram

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17
Q

Low plasma bicarbonate and pH

Due to addition of nonvolatile acid

The removal of a nonvolatile alkali

Or the failure of the kidneys to excrete sufficient net acid

A

Metabolic acidosis

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18
Q

Unmeasured anions are

A

Proteins, phosphates, sulfates, etc.

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19
Q

Unmeasured cations are

A

Calcium, magnesium, minerals, etc.

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20
Q

A way of approximating the total concentration of anions other than Cl- and HCO3- in the plasma.

The sum of the “routinely measured” cations minus the sum of the ‘routinely measured’ anions in the blood

A

Anion gap

21
Q

Normal value for anion gap??

If K is not used to calculate?

A

16mEq/L

Less than or equal to 12 if K is not used

22
Q

Causes of metabolic acidosis with high anion gap ?

A

Diabetic ketoacidosis

Saolicylate poisoning

Lactic acidosis

23
Q

Metabolic acidosis with normal anion gap

A

Decreased bicarbonate is replaced by Cl-

24
Q

Metabolic acidosis with ____ anion gap has decreased bicarbonate replaced by ‘unmeasured anions’

A

High

25
Q

A high anion gap tells you that ?

A

An acid has been added!

26
Q

Characterized by increased plasma pH and [HCO3-]

Can develop by the addition of nonvolatile alkali to the body (ingestion of antacids)
Or
The loss of nonvolatile acid (vomit)

A

Metabolic alkalosis

27
Q

Characterized by elevated pCO2 and reduced plasma pH

Can develop by inadequate ventilation (brain centers suppressed)

Or

Impaired gas diffusion (pulmonary edema)

A

Respiratory acidosis

28
Q

What are the responses for respiratory acidosis?

A

Increased renal excretion of NH4 and acids, and increased reabsorption of bicarbonate

Intracellular compartment buffering

29
Q

Characterized by reduced pCO2 and increased pH

Can be caused by stimulation of the respiratory centers

A

Respiratory alkalosis

30
Q

Compensation for respiratory alkalosis?

A

Buffering ICF

Renal compensation; decrease NH4 excretion, increase Bicarb excretion

31
Q

A second acid-base disturbance compounding the first acid-base disturbance

A

Combined simple

32
Q

Respiratory failure followed by renal failure is an example of ?

A

A combined simple

Respiratory acidosis and renal failure

33
Q

People with hypertension are ___- times more likely to get CAD

A

3

34
Q

People w/ hypertension are ___ times more likely to develop CHF

A

6

35
Q

People with hypertension are ____ times more likely to develop stroke`

A

7

36
Q

The closest link between hypertension and another disease is with _____

A

Stroke

37
Q

Usual clue is hypokalemia

Hypokalemia in face of ACE inhibitor is red flag

Goal is to demostrate suppressed renin and non-suppressible aldosterone

Try to stimulate renin with diuretic and suppress aldosterone with volume expansion

A

Evaluation for hyperaldosteronism

38
Q

Type of renovascular hypertension.

Seen in :
Young
Female > male
Familial history

Responds well to correction

UNCOMMON in people of african descent

A

Fibromuscular dysplasia

39
Q

Who should be evaluated for Secondary Hypertension?

A

Hypertension presenting “early”

Hypertension w/o family history

Severe or difficult to control hypertension

40
Q

Medical injury

Evidence for acute vascular injury in context of hypertension

Generally evidence for acute vascular injury is found on the retinal examination

Actual number may not be all that high.

A

Malignant hypertension

41
Q

The vast majority of hypertension is ________

A

Essential (primary)

42
Q

The most common cause of secondary hypertension?

A

Sleep apnea (as high as 50% of secondary)

43
Q

___________ is necessary to produce sustained hypertension

A

Renal involvement

44
Q

Altered renal _______ necessary to maintain hypertension

A

Set point

45
Q

Risk factors for atherosclerosis:

A

Smoking

Dyslipidemia (high LDL or low HDL)

Age > 60

Male or postmenopausal female

Family history

46
Q

JNC 7 recommendation for uncomplicated hypertension

A

Diuretics

47
Q

JNC 7 agent recommendations for hypertension w/ diabetes

A

ACE inhibitors or ARB if proteinuria present

48
Q

JNC 7 agent recommendations for hypertension w/ Myocardial infarction

A

Beta blocker

49
Q

JNC 7 agent recommendations for systolic heart failure

A

ACE inhibitors or ARB

SF3Renal (13 decks)

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