Mod 2: Acid Base

Question 1

Drop in 1pH=

Answer 1

NaKpump function 50% dysfunction

Question 2

Acid enters blood from 5 sources

Answer 2

Carbonic acid
Lactic acid
Sulfuric acid
Phosphoric acid
Ketone bodiesmk

Question 3

Lactic acid byproduct of

Answer 3

Anaerobic metabolism of glucose

Caused by poor perfusion /AIDS medication

Question 4

Sulfuric acid results from

Answer 4

Oxidation of sulfur containing amino acids

Question 5

Phosphoric acid results from

Answer 5

Metabolism of phosphoproteins and ribonucleotides

Question 6

Chemical buffer systems (4)

Answer 6

Bicarbonate
Phosphates
Proteins
HGB

Question 7

Kidneys role in balance (3)

Answer 7

Reabsorb bicarbonate
Excrete H
Excrete H as ammonium

Question 8

Phosphates (buffer)
Inorganic
Organic

Answer 8

Inorganic-ECF buffer
HPO4/H2PO4
Organic-ICF Buffers: ATP,ADP, AMP, Glucose1phosphate, 2,3DPG

Question 9

Proteins as buffers

Answer 9

ECF buffers bc negative and bind to hydrogen =hypercalcemia

Question 10

Hgb as buffer

Answer 10

IMPORTANT ICF buffer
H20, co2 on RBC=Carbonic acid=H,HCO3 H is buffered by Hgb
CO2 carried to lungs and expired

Question 11

Acetazolamide site of action

Answer 11

Carbonic anhydrase inhibitor in lumen, blocks reabsorption of hco3, stays carbonic acid cannot go back to cell

Question 12

When is bicarbonate excreted

Answer 12

Plasma bicarbonate reaches 40mEq/L-saturated

Question 13

Expanded ECF volume affect on HCO3 reabsorption

Answer 13

Inhibited=acidic

Question 14

Depleted ECF affect on bicarbonate absorption

vECF Stimulates what

Answer 14

Increased=alkalotic

RAAS stimulated
Angiotensin2 stimulates NAH exchanger in proximal tubule=^reabsorbtion=alkalosis (contraction alkalosis) 2` volume depletion like w loop/thiazide diuretics

Question 15

Excretion of H as titrateable acid

Answer 15

In distal and collecting ducts are H-ATPase and H-K-ATPase
H->Lumen->binds w HPO4(monohphos)= dihydrogenphosphate->
Excreted
1Hgone=1bicarb abosrbed

Question 16

Excretion of H as ammonium

Answer 16

Proximal tubule, ascending loop, collecting ducts
Glutamine+glutaminase= NH4+glutamate
Glutamate->a-Ketoglutarate->CO2+H2O
Eventually into HCO3=reabsorbed

Question 17

Excretion of H as ammonium

NH3 NH4

Answer 17

NH3 diffuses, NH4->lumen by NaH exchanger
NH3+H =NH4(excreted or reabsorbed by asc loop->interstitial kidney fluid by substituting for K on NaK2CL transporter
(Inhibited by hyperK)

Question 18

Metabolic acidosis effect on on reabsorption of NH4

Answer 18

Enhance

Question 19

NH3 concentration gradient

Answer 19

Greater in Kidney interstium than collecting duct lumen, flows into tubule and binds with NH4=excreted

Question 20

Excretion of NH4 Increases as urine pH ____

Helpful when

Answer 20

Decreases

When in acidic state

Question 21

CO2 (indirect HCO3)

Answer 21

Acid 23-30 alk

Question 22

Hco3

Answer 22

21-28

Question 23

Base excess/Deficit

Answer 23

Negative =metabolic acidosis

Positive= metabolic alk or resp acidosis compensation

Question 24

Bicarbonate loss from

Answer 24

Diarrhea, renal tubular necrosis 2(cant reabsorb)

Question 25

Diminished acid excretion from

Answer 25

CKD, Tubular necrosis 1

Question 26

Academia effects

Answer 26

vCardiac contractility/output,vBP, ^K

Question 27

High anion gap acidosis=

Answer 27

Lactic,keto,acidosis, renal failure

Question 28

Normal anion gap acidosis

Answer 28

Hyperchloremic acidosis

GI loss, ^saline, NSAIDS, ACEi, tremthoprim

Question 29

Metabolic alk

Answer 29

Hypocal, hypoK,hypoventilation ^pCO2