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ESA3: Respiratory System > Session 5: Acid-Base Balance > Flashcards

Session 5: Acid-Base Balance Flashcards

1
Q

Give the range of normal plasma pH

A

7.35-7.45

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2
Q

Above what plasma pH is alkalaemia?

A

7.45

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3
Q

Below which plasma pH is acidaemia?

A

7.35

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4
Q

Which condition is more life threatening: alkalaemia or acidaemia?

A

Alkalaemia

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5
Q

If pH rises to 7.55 what is the mortality?

A

45%

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6
Q

If pH rises to 7.65 what is the mortality?

A

80%

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7
Q

How does alkalaemia increase neuronal excitability?

A

Lowers free calcium by making Ca2+ come out of solution

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8
Q

What are the two major symptoms of alkalaemia?

A

Parasthesia

Tetany

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9
Q

How does acidaemia cause arrhythmia?

A

Increased plasma potassium ion concentration

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10
Q

How does acidaemia affect enzymes?

A

Proteins damaged by increased [H+]

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11
Q

Below what pH is considered life threatening?

A

7.0

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12
Q

How do the kidneys control pH?

A

Vary the recovery of HCO3- and actively secrete H+ ions

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13
Q

How do the lungs control pO2 and pCO2?

A

Altering rate of ventilation

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14
Q

What organ controls the [HCO3-]?

A

The kidneys

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15
Q

What process produces acid in the body?

A

Metabolism

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16
Q

In which region of the kidney is HCO3- mostly recovered?

A

PCT

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17
Q

Which membrane is carbonic anhydrase located on in the tubular cells?

A

Apical membrane

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18
Q

What role does the Na+K+ ATPase have in renal recovery of HCO3-?

A

Sets up a Na+ concentration gradient across the basolateral membrane

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19
Q

What does the HCO3-Na+ transporter do?

A

Transports 3 HCO3- and an Na+ ion out into the ECF

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20
Q

How can HCO3- be created in the kidneys?

A

Breakdown of glutamine to α-ketoglutarate

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21
Q

What else apart from HCO3- is released from breakdown of amino acids?

A

Two NH4+ ions

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22
Q

Why does NH4+ get ‘trapped’ in the lumen?

A

It is charged so cant cross the membrane

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23
Q

What two compounds act to buffer H+ in the kidneys?

A

Ammonia and phosphate

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24
Q

Why is H+ produced in the kidneys?

A

Reaction between CO2 and water

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25
Q

How does a fall in pH affect ammonium production?

A

Increases it

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26
Q

What buffering system is mainly used in the proximal tubule?

A

Ammonium

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27
Q

What buffering system is used in the distal tubule of the kidney?

A

Phosphate

28
Q

Where is ammonium mostly created?

A

In the PCT

29
Q

What is the minimum safe pH of urine?

A

4.5

30
Q

What is the range of average total acid secretion a day?

A

50-100mmol

31
Q

How does acidosis cause hyperkalaemia?

A

Causes K+ to move out of the cells and so less is excreted at the distal nephron

32
Q

How does alkalosis cause hypokalaemia?

A

Cause enhanced excretion of K+ at the distal nephron as it moves into the cells

33
Q

How is metabolic alkalosis related to hypokalemia?

A

H+ moves into the tubular cells and lowers the pH

34
Q

How does hyperkalaemia cause metabolic acidosis?

A

H+ ions move out of the cells and into the blood

35
Q

What is respiratory acidosis characterised by?

A

Low pH
High pCO2
Normal HCO3-

36
Q

How will hyperventilation affect pH?

A

Causes a rise in pH due to hypocapnia

37
Q

What is respiratory alkalosis characterised by?

A

Raised pH
Low pCO2
Normal HCO3-

38
Q

How will the kidneys respond to compensate for respiratory acidosis?

A

Increase [HCO3-]

39
Q

How is compensated respiratory acidosis characterised?

A

High pCO2
Raised [HCO3-]
Relatively normal pH

40
Q

How is compensated respiratory alkalosis characterised?

A

Low pCO2
Lowered [HCO3-]
Relatively normal pH

41
Q

Why is metabolic acidosis different to respiratory acidosis?

A

There is no change in pCO2 but a fall in [HCO3-] as it reacts with the acid produced

42
Q

How do you calculate the anion gap?

A

([Na+]+[K+]) - ([Cl-]+[HCO3-])

43
Q

Give the normal range for the anion gap

A

10-18mmol/L

44
Q

When will the anion gap increase?

A

When HCO3- is replaced by other anions

45
Q

Why do renal causes of acidosis not change the anion gap?

A

Cl- replaces the fall in HCO3- production

46
Q

What are the characteristics of metabolic acidosis?

A

Low pH
Low HCO3-
Normal pCO2

47
Q

What is compensated metabolic acidosis characterised by?

A

Near normal pH
Low pCO2
Low HCO3-

48
Q

What are the characteristics of metabolic alkalosis?

A

Raised pH
Raised HCO3-
Normal pCO2

49
Q

Why can’t a reduction in breathing compensate for metabolic alkalosis?

A

Need to maintain pO2

50
Q

What conditions can lead to respiratory alkalosis?

A

Type 1 respiratory failure
Type 2 respiratory failure
Hyperventilation

51
Q

What is type 1 respiratory failure?

A

Hyperventilation in response to long term hypoxia

52
Q

What happens to the pCO2 in type 2 respiratory failure?

A

Increases

53
Q

How does pCO2 change in type 1 respiratory failure?

A

Falls

54
Q

How is chronic hyperventilation compensated for?

A

Drop in [HCO3-]

55
Q

What does an increase in the anion gap indicate?

A

Metabolic production of an acid

56
Q

Give three ways in which there may be metabolic production of an acid

A

Ketoacidosis
Lactic acidosis
Uraemic acidosis

57
Q

What is type 1 renal tubular acidosis?

A

Inability to pump out H+ (affects distal tubule)

58
Q

What does type 2 renal tubular acidosis cause?

A

Problems with HCO3- reabsorption

59
Q

How will the anion gap be changed in renal tubular acidosis?

A

Unaltered

60
Q

How can severe persistent diarrhoea lead to metabolic acidosis and why is there no change to the anion gap?

A

Loss of HCO3- but this is replaced by Cl-

61
Q

How do non renal causes of metabolic acidosis affect K+ at the kidneys?

A

Increases their reabsorption

62
Q

Why is there a total body depletion of K+ in diabetic ketoacidosis?

A

K+ moves out of cells and is lost in urine due to osmotic diuresis

63
Q

What effect does insulin have on movement of K+?

A

Causes it to move into the cells of the tubule

64
Q

What may severe prolonged vomiting lead to and why?

A

Metabolic acidosis because of loss of H+

65
Q

How is volume depletion avoided in metabolic acidosis?

A

Na+ H+ exchanger continues to operate (Na+ recovered and H+ excreted)

ESA3: Respiratory System (6 decks)

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