Patho CH 9: Acid-base balance

Question 1

substances that donate hydrogen ions

Answer 1

acids

higher the acid lower the pH

Question 2

substances that accept hydrogen ions

Answer 2

bases

bases bind and neutralize acid = higher pH

Question 3

clinical measurement of acid:base ratio

Answer 3

pH

Question 4

primary extracellular buffer

Answer 4

bicarbonate buffer system

Question 5

buffer systems

Answer 5

mix acids and bases to resist pH change
trade stronger acids and bases for weaker

Question 6

three types of buffer systems

Answer 6

plasma
respiratory
renal

Question 7

plasma buffer system reaction

Answer 7

reacts in seconds to hydrogen ion level

Question 8

respiratory buffer system reaction time

Answer 8

reacts in minutes to excrete CO2

Question 9

renal buffer system reaction time

Answer 9

reacts in hours to days to produce, absorb, and excrete acids, bases, and ions

Question 10

Metabolic acidosis

Answer 10

base deficit of bicarbonate (HCO3-)
increased: production of nonvolatile acids, loss of bicarbonate, in Cl-)
decreased: secretion of acids by kidneys

Question 11

metabolic acidosis clinical manifestations

Answer 11

anorexia
nausea
vomiting
weakness
lethargy
confusion
coma
vasodilation
decrease HR
flushed skin

Question 12

metabolic acidosis lab findings

Answer 12

pH less than 7.35
HCO3- less than 24

Question 13

metabolic alkalosis

Answer 13

increased pH by plasma excess of HCO3-

Question 14

metabolic alkalosis contributing mechanisms

Answer 14

decreased hydrogen ions
increased bicarbonate ions
loss of chloride ions

Question 15

metabolic alkalosis clinical manifestations

Answer 15

asymptomatic
hypokalemia signs

Question 16

metabolic alkalosis lab findings

Answer 16

pH greater than 7.45
bicarbonate greater than 31

Question 17

metabolic

Answer 17

pH and HCO3-

Question 18

HAART

Answer 18

highly active antiretroviral therapy associated acidosis

Question 19

HAART patho

Answer 19

result of impaired oxidative phosphorylation

Question 20

HAART causes

Answer 20

NRTIs to treat HIV

Question 21

HAART adverse drug effects

Answer 21

mitochondrial dysfunction
hyperlactatemia/lactate acidemia
lactic acidosis (pH less than 7.3)

Question 22

HAARt clinical manifestations

Answer 22

MILD
-nausea
-vomiting
-abdominal discomfort
-weight loss
-hepatic steatosis
SEVERE
-hepatomegaly
-elevated liver enzymes
-hepatic failure
-coma
-multiple organ failure

Question 23

HAART diagnostic criteria

Answer 23

history of NRTI use
recognition of clinical manifestations
lab findings

Question 24

HAART labtests

Answer 24

blood lactate levels
electrolyte and blood pH
liver function tests

Question 25

HAART treatment

Answer 25

determined by symptoms alternate selection of NRTI combinations stopping NRTIs IV fluid

Question 26

renal tubulopathy patho

Answer 26

genetic mutations in renal membrane proteins

Question 27

renal genetic mutations in proteins

Answer 27

altered electrolyte balance (hypokalemia, hypochloremia, saltloss) altered acid-base balance (metabolic alkalosis) increased prostaglandins

Question 28

variants of renal tubulopathy

Answer 28

classic Bartter syndrome gitelman syndrome hyperprostaglandin E syndrome hyperprostaglandin E syndrome with sensorineural deafness

Question 29

renal tubulopathy clinical manifestations

Answer 29

fever vomiting diarrhea metabolic alkalosis

Question 30

renal tubulopathy CM related to pregnancy and infancy

Answer 30

pregnancy - maternal hydramnios, increased fetal urine output infant - increased urine output, hypercalciuria

Question 31

renal tubulopathy diagnostic criteria

Answer 31

lab studies renal US genetic testing

Question 32

renal tubulopathy lab studies

Answer 32

urine and serum electrolyte studies arterial blood gas, anion gap, base excess urine specific gravity

Question 33

renal tubulopathy corrective treatment

Answer 33

renal salt loss fluid loss electrolyte imbalances

Question 34

renal tubulopathy pharm treatment

Answer 34

sodium and potassium supplementation potassium sparing diuretics prostaglandin inhibitors

Question 35

metabolic acidosis in PN patho

Answer 35

metabolic acidosis from delivery of water, glucose, amino acids, lipids, vitamins, minerals, electrolytes, acetate, and trace elements

Question 36

additives to parenteral nutrition

Answer 36

hydrochloric and organic acids base to counter solution acidity

Question 37

metabolic acidosis in PN clinical manifestations

Answer 37

nausea vomiting anorexia weakness lethargy confusion coma vasodilation decrease HR flushed skin coma seizures cardiac dysrhythmias

Question 38

metabolic acidosis in PN labs

Answer 38

arterial blood gas pH less than 7.35 decreased HCO3- decreased CO2 electrolyte balance anion gap

Question 39

metabolic acidosis in PN treatment

Answer 39

adjustment of PN components and intake HCO3- hydration oxygen

Question 40

aerobic

Answer 40

uses oxygen produces 38 ATP

Question 41

anaerobic

Answer 41

no oxygen only 2 ATP - not enough for survival

Question 42

two main modulators for pH balance

Answer 42

renal and pulmonary systems

Question 43

pulmonary system in pH balance

Answer 43

adjusts pH using carbon dioxide

Question 44

renal system in pH balance

Answer 44

reabsorbing bicarbonate and excreting fixed acids

Question 45

ABG draw blood from ___

Answer 45

arteries (radial)

Question 46

respiratory acidosis primary disorder caused by ___

Answer 46

hypoventilation

Question 47

conditions leading to respiratory acidosis

Answer 47

COPD opiate abuse/overdose severe obesity brain injury

Question 48

largest buffering system - albumin

Answer 48

protein buffer system

Question 49

fast, second buffer system

Answer 49

respiratory buffer system

Question 50

primary regulators of acid base balance

Answer 50

kidneys

Question 51

metabolic alkalosis causes

Answer 51

Massive blood transfusion Cushing disease Respiratory insufficiency Prolonged mechanical ventilation Cystic fibrosis vomiting

Question 52

metabolic acidosis risk factors

Answer 52

septicemia low o2 levels

Question 53

build up of lactic acid in the bloodstream

Answer 53

lactic acidosis

Question 54

respiratory acidosis values

Answer 54

ph less than 7.35 CO2 greater than 45

Question 55

respiratory alkalosis values

Answer 55

ph greater than 7.45 CO2 less than 35