Muster - Acid Base

Question 1

The “friggen equation” to calculate the concentration of hydrogen ions in the blood

Answer 1

[H] = 24 (PCO2) / [HCO3-}

Question 2

Sx of acidosis

Answer 2

kussmaul breathing (deep, slow, labored breaths)

depresses cardiac contractility below 7.2

increases chatacholamines

stimulates protein catabolism, leading to negative nitrogen balance

bone loss

Question 3

Sx of alkalosis

Answer 3

hypoventilation

cardiac arrhythmias (above 7.5)

decreases O2 delivery to tissues

increased lactate production

Question 4

“two types of acids”

Answer 4

carbonic (volatile)

non carbonic ( non volatile)

Question 5

if you are acidotic, do you want you liver to be breaking down NH3, ammonia, into urea?

Answer 5

NO because it uses up bicarbonate.

you want to be excreting it in the kidney as NH4+, amonium, in the proximal tubule

Question 6

how does you proximal tubule in the kidney get bicarb into the blood stream

Answer 6

2 ways,

Glutamine way:

glutamine first gives off ammonium (NH4), which antiported with sodium into the ureter

then glutamine breaks off some bicarbonate groups

bicarbs all join up and are symported with sodium into blood

carbonic anhydrase way:

CA makes bicarb and H+

H+ antiported into the ureter for sodium

bicarbs all join up and are symported with sodium into blood

Question 7

Acid causes ionization of proteins. Which proteins does this actually help rather than hurt?

Answer 7

carbonic anhydrase
Na/H pump

and glutamate uptake (we don’t know how really)

Question 8

define ammonia recycling in the context of acidemia

Answer 8

your body puts a lot of NH3 into the lumen that floats down to the distal tubule, so that when acid is excreted by the alpha intercalated cells, it binds and makes NH4 and STAYS as NH4 (pKa is around 9, urine pH is around 5-6)

Question 9

what does the kidney do in an alkylosis

Answer 9

it stops converting NH3 to NH4, so the NH3 goes back to the liver, which uses bicarb to turn it into urea, lowering the pH