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Crrab2 > Renal Phys--> acid/base > Flashcards

Renal Phys--> acid/base Flashcards

1
Q

What are the 3 fundamental components of the acid base system?

A
  1. acid
  2. base
  3. H+ (+) conjugate base
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2
Q

what is normal pH? What is the H+ nanaomoles?

A
  1. 35-7.45
    - around 40 nanaomoles of free hydrogen
    - gut has about 100 mM
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3
Q

What is the equation of pH?

A

pH=pK+log[base/acid]

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4
Q

What is acidemia and alkemia?

A

Increase or decrease in H+ but tells us nothing about cause

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5
Q

What is acidosis and alkalosis?

A

the description either metabolic or respiratory which leads to acidemia and alkemia

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6
Q

What are the physiologic buffers?

A 
Bicarb
Hgb
Po4-
Albumin 
Bone
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7
Q

What are some common chronic effects of chronic acidosis? What for?

A

Osteopenia and osteoporosis

- seeking bicarb

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8
Q

What is the Henderson-Hasselbalch equation?

A

7.4= pH=6.10+log [HCo3}/(0.03*Pco2)

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9
Q

What is the Kassier-Bleich equation?

A

H+=24(PCo2)/[HCo3-]

- where H+ is in nanamoles/liter

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10
Q

What is the average change in nanomoles for 0.1 change in pH?

A

about 10nEq/L
40=7.4
50=7.3
60=7.2

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11
Q

What are the classic physiologic responses to acidosis?

A
  1. Increase respiration
  2. Kussmal breathing: deep, slow and labored
  3. Depressed cardiac contractility
  4. Increases circulating catecholamines
  5. Stimulates protein catabolism leading to negative nitrogren balance
  6. Leads to bone loss (need Hc03- from bones)
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12
Q

What are the physiologic responses to alkalosis?

A
  1. Hypoventalation
  2. Cardiac arrhythmias
  3. Shifts O2 dissociation curve to LEFT, decreasing delivery to tissues
  4. Increased lactate
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13
Q

What are the 2 primary dietary sources for Acids?

A

Carbonic acids

Non-carbonic acids

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14
Q

Where do carbonic acids come from?

A

Volatile acids

- Metabolism of carbs of fats

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15
Q

What do carbonic acids break down into and where are they excreted?

A

into CO2 and Water

- lungs

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16
Q

Where do non-carbonic acids come from?

A

Metabolism of proteins

- Generally sulfur containing AA or hydrochloric acid

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17
Q

Where are non-carbonic acids excreted?

A

Kidneys

- about 50-100mEq/day

18
Q

Where is another place can create acids?

A

GI tract

- in exchange for Hco3-

19
Q

How do we manage acid load?

A

Buffering

Renal excretion

20
Q

How is acid/base homeostasis disrupted?

A

Either addition of H+

or Loss of HCo3

21
Q

What is the role of the kidneys in the acid/base homeostasis?

A

Basically everything

  • reclaim HCo3- (we have lost some to H+ buffering we don’t want to loose anymore in the urine)
  • Excrete excess acid
22
Q

how doe we replace the bicarb deficit?

A

Reclaim It

  • must be free and not bond to H+ otherwise you are absorbing neutral contents that is useless for acid/base homeostasis
  • use non-bicarbonate
23
Q

What are 2 ways to get non-bicarb bases into the renal lumen?

A

Filter them

Make them

24
Q

What happens in the proximal tubule to reclaim bicarb?

A
  1. reclaim the bicarb

2. create ammonium (carrier of H+)

25
Q

What increases the H+ and Na+ antiporter?

A

AgII
Sympathetics
Decrease in pH
Increase in Co2

26
Q

What increases glutaminase? What is this used for?

A

Increase H+
Decreased pH

  • used to breakdown glutamine into alpha-ketobutyrate and NH4+
27
Q

Why is glutaminase important?

A

Makes NH4+

  • Which carries a H+ out
  • more acidic the lumen the less likely it is to dissociate to NH3 and H+
28
Q

What percent of H + is handles by phosphorus and what is handled by Ammonium?

A

1/3 Phosphorus q

2/3 NH4+

29
Q

Which cell the Beta or alpha intercalated secrete H+ and which absorbs it?

A

Alpha secretes it and absorbed HCo3-

Beta secretes it and absorbs H+

30
Q

Increase or decrease in HCo3- leads to Alkalosis? Which type?

A

Increase

Metabolic

31
Q

Increase or decrease in HCo3- leads to acidosis? Which type?

A

Decrease

Metabolic

32
Q

Increase or decrease in PCo2 leads to Alkalosis? Which type?

A

Decrease

Respiratory

33
Q

Increase or decrease in PCo2 leads to acidosis? Which type?

A

Increase

Respiratory

34
Q

What organ compensates for respiratory issues? Metabolic?

A

Kidneys- matter of days

Lungs- matter of minutes

35
Q

What is the bicarb and pH in respiratory acidosis? Cause

A 
Increased
Decreased
- Lack of ventilation 
- Morphine, succ, GHB, heroin
- PE, obstruction and COPD
36
Q

What is the bicarb and pH in respiratory alkalosis?

A

Decreased
Increased
- Too much breathing, Panic attacks, high altitude

37
Q

What is the bicarb and pH in Metabolic acidosis?

A

Decrease
Decrease

  • HCo3= D, fistulas, urinary diversion
  • H= Lactate, ketones, RF, aspirin toxicity, methanol, ethylene glycol
38
Q

What is the bicarb and pH in metabolic alkalosis?

A

increase
increase
- either increase in bicarb or loss of H+
- First is usually renal excretion impairment and volume depletion
- 2nd is usually due to vomiting and NG suction

39
Q

What does increase H+ lead to in the kidney?

A

unregulates:

  1. Glutaminase
  2. Carbonic anhydrase
  3. Na/H anti-porter
40
Q

Does hyperkalemia or hypo lead to increase in NH3 production?

A

Hypo

41
Q

what is hyperkale renal tubular acidosis?

A

Hyperkale leads to decrease in NH3 production which is used for a H+ carrier. Decreasing NH3 leads to decrease in H+ secretion!

Crrab2 (14 decks)

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