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MSS Renal Exam 2 > Renal Regulation of Acid/Base Balance > Flashcards

Renal Regulation of Acid/Base Balance Flashcards

1
Q

normal pH of body?

A
  1. 4

7. 35-7.45

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2
Q

henderson hasselbalch equation

A

pH = pKa + log (H A / HA)

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3
Q

buffer system depends on?

A

concentration of buffer system components

nearness of pKa to pH of solution

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4
Q

phosphate buffer system

A

pKa = 6.8

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5
Q

volatile acid

A

carbon dioxide acid

-can be expired via respiration

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6
Q

fixed acids

A

generated metabolically
-excreted in urine

glycolysis, fatty acid oxidation

cannot be removed via respiration**

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7
Q

3 lines of defense?

A

chemical buffer systems
respiration
kidneys

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8
Q

extracellular buffers

A

bicarb
inorganic phosphate (H2PO4 > HPO4)
plasma proteins

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9
Q

intracellular buffers

A

hemoglobin
organic phosphate (HPO4 > PO4)
bicarbonate

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10
Q

bicarbonate buffer system

A

3.8 - 6.1

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11
Q

pH = ?

A

6.1 + HCO3- / log (0.03 x P-CO2)

uses bicarbonate and PCO2

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12
Q

why is bicarbonate buffer so powerful

A

its an open system

  • too much CO2 - we can breath it out
  • too much HCO3- we can excrete in kidney
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13
Q

secretion of H+

A

mainly as NH4+

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14
Q

renal response to excess acid?

A

HCO3- reabsorbed

H+ secreted as NH4+

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15
Q

renal response to excess base?

A

incomplete reabsorption of HCO3-
decreased H+ secretion
secretion of HCO3- in collecting duct

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16
Q

urinary buffers?

A

need to buffer H+ because urine can only have so many free H+ irons

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17
Q

titratable acid

A

conj base of metabolic acid

-phosphate, creatinine, urate accept H+

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18
Q

ammonia

A

generated by tubular epithelium

-can accept H+

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19
Q

total renal H+ excretion?

A

titratable acid + ammonium - HCO3-

20
Q

HCO3- excretion?

A

equivalent to adding H+ to body fluids

21
Q

acidification of urine?

A

collecting duct, can be acidified to pH as low as 4.5

22
Q

alpha-intercalated cells?

A

actively secretes H+

H+ ATPase

HCO3-/Cl exchanger basolateral membrane
-for every H+ secreted, a HCO3- is reabsorbed

23
Q

beta-intercalated cells?

A

secretes HCO3-

-HCO3-/Cl exchanger apical membrane

24
Q

proximal tubule

A

secrete H+ to reabsorb HCO3-
-only slight fall in pH

Na/H exchanger secretes H to combine with HCO3-

H2CO3 converted to CO2 and H2O via carbonic anhydrase
-CO2 moves into cell and combines with H2O to then form bicarbonate and H+

bicarbonate then reabsorbed

**no net secretion of H+ due to this mechanism

saturable process**

25
Q

excretion of H+ as titratable acid

A

HPO2- is most important buffer

26
Q

glutamine

A

intracellularly broken down to 2x NH4+

-produces 2x HCO3- **

27
Q

chronic acidemia

A

upregulation of NH4+ production

bc they need to get rid of excess H+

28
Q

beta-intercalated cell

A

secrete bicarbonate in exchange for Cl

in alkalemia**

29
Q

factors controlling renal H+ secretion

A 
intracellular pH
plasma PCO2
carbonic anhydrase activity
Na reabsorption
extracellular [K]
aldosterone
30
Q

diuretic abuse

A

can cause alkalemia

lower ECF volume

  • activates RAAS, increases aldosterone
  • increases sodium and secretes H+

leads to metabolic alkalosis

31
Q

acidemia

A

pH below 7.35

32
Q

acidosis

A

condition resulting in acidemia

33
Q

alkalosis

A

condition resulting in alkalemia

34
Q

alkalemia

A

arterial pH above 7.45

35
Q

respiratory acidosis

A

increased PCO2

renal response
-increased H+ secretion

36
Q

respiratory alkalosis

A

decreased PCO2

renal response
-less H+ secretion

37
Q

chronic

A

24-48 hours

38
Q

respiratory acidosis/alkalosis

A

can be compensated completely by kidneys

39
Q

metabolic acidosis

A 
gain fixed acid
also diarrhea (lose HCO3-)

respiratory compensation - increased ventilation
renal compensation - increased H+ secretion as ammonium mainly and HCO3- production

40
Q

metabolic alkalosis

A

excessive gain of strong base or HCO3-
vomiting - lose fixed acid (gastric acid)

respiratory compensation - decreased ventilation
renal compensation - incomplete reabsorption of HCO3- and beta-intercalated secrete HCO3-

41
Q

diarrhea

A

metabolic acidosis

42
Q

vomiting

A

metabolic alkalosis

43
Q

anion gap

A

Na - (Cl + HCO3-)

used in DDx of metabolic acidosis
-gap is unmeasured anion

greater than around 18 is abnormal

44
Q

hyperchloremic acidosis

A

anion gap is unchanged

-loss of HCO3- matched by gain in Cl-

45
Q

high anion gap acidosis

A

anion gap increase

  • HCO3- replaced by unmeasured anion
  • lactate, ketoacidosis, poisoning
  • ethanol, antifreeze, aspirin, etc.

MSS Renal Exam 2 (7 decks)

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