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Renal > SM_201a: Acid Base Integration II > Flashcards

SM_201a: Acid Base Integration II Flashcards

1
Q

Acidemia is _____

A

Acidemia is an increase in [H+] in blood manifested by decreased pH

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2
Q

Alkalemia is a _____ in [H+] in blood manifested by _____ pH

A

Alkalemia is a decrease in [H+] in blood manifested by increased pH

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3
Q

Acidosis refers to a disorder that _____

A

Acidosis refers to a disorder that tends to lower pH and cause acidemia

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4
Q

Aklalosis refers to a disorder that ______

A

Aklalosis refers to a disorder that tends to increase pH and cause alkalemia

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5
Q

What is the Henderson-Hasselbach equation?

A
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6
Q

Simple acid base disorders affect _____

A

Simple acid base disorders affect either HCO3- (metabolic) or PCO2 (respiratory) and any assoicated changes in the other are compensatory and predictable based on expected physiological compensation

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7
Q

Mixed acid base disorders affect ______

A

Mixed acid base disorders affect both the HCO3- (metabolic) and the PCO2 (respiratory) as a result of at least two different disease processes and not physiological compensation

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8
Q

Describe the compensatory responses

A
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9
Q

In metabolic acidosis, the compensatory response is: _____

A

In metabolic acidosis, the compensatory response is: decrease in PCO2 = 1.2 * ∆HCO3-

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10
Q

In metabolic alkalosis, the compensatory response is: _____

A

In metabolic alkalosis, the compensatory response is: increase in PCO2 = 0.6 * ∆HCO3-

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11
Q

In chronic respiratory acidosis, the compensatory response is: _______

A

In chronic respiratory acidosis, the compensatory response is: increase in HCO3- = 0.4 * ∆PCO2

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12
Q

In chronic respiratory alkalosis, the compensatory response is: ______

A

In chronic respiratory alkalosis, the compensatory response is: decrease in HCO3- = 0.5 * ∆PCO2

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13
Q

In metabolic acidosis, pH _____ and blood [HCO3-] _____

A

In metabolic acidosis, pH decreases and blood [HCO3-] decreases

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14
Q

Defense mechanisms against metabolic acidosis include _______ and _______

A

Defense mechanisms against metabolic acidosis include hyperventilation (decreases PCO2) and increased renal acid excretion (leading to increase in blood HCO3-)

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15
Q

In metabolic alkalosis, pH _____ and blood [HCO3-] _____

A

In metabolic alkalosis, pH increases and blood [HCO3-] increases

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16
Q

Defense mechanisms against metabolic alkalosis include _______ and _______

A

Defense mechanisms against metabolic alkalosis include hypoventilation (increases PCO2) and decreased net acid excretion which leads to a decrease in blood HCO3-

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17
Q

In respiratory acidosis, blood pH _____ and PCO2 _____

A

In respiratory acidosis, blood pH decreases and PCO2 increases

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18
Q

Defense mechanism against respiratory acidosis is ______

A

Defense mechanism against respiratory acidosis is increased renal net acid excretion which leads to an increase in blood HCO3-

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19
Q

In respiratory alkalosis, blood pH _____ and PCO2 _____

A

In respiratory alkalosis, blood pH increases and PCO2 decreases

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20
Q

Defense mechanism against respiratory alkalosis is ______

A

Defense mechanism against respiratory alkalosis is decreased renal net acid excretion which leads to decreased blood HCO3-

(excrete less acid -> bicarb decreases)

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21
Q

Describe different types / causes of metabolic acidosis

A
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22
Q

Metabolic acidosis is characterized by decreased ____, which ____ pH

A

Metabolic acidosis is characterized by decreased blood bicarbonate, which decreases pH

(physiological compensation attenuates the fall in pH)

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23
Q

Describe general mechanisms of metabolic acidosis

A

General mechanisms of metabolic acidosis: low HCO3- state

  • Loss of HCO3- externally - by GI tract (diarrhea) or kidney (proximal RTA)
  • Failure of the kidneys to excrete acid (distal RTA) and CKD
  • Addition of H+ which titrates HCO3-
  • H+ buildup in the circulation (blood) can occur as an organic acid (e.g. lactic acidosis / ketoacidosis)
24
Q

Hallmark of RTA is ______

A

Hallmark of RTA is bicarbonate wasting (lot of bicarbonate in urine)

25
Q

Metabolic acidosis from loss of HCO3- can result from _____

A

Metabolic acidosis from loss of HCO3-​ can result from proximal renal tubular acidosis (PRTA)

  • clinical features: Fanconi syndrome (bicarbonate wastage, glycosuria, phosphaturia, hyperuricosuria, aminoaciduria), hypokalemia, no nephrocalcinosis or kidney stones, rickets
26
Q

Metabolic acidosis from failure of the kidneys to excrete acid can result from _____

A

Metabolic acidosis from failure of the kidneys to excrete acid can result from distal renal tubular acidosis (DRTA)

  • hyperchloremic metabolic acidosis, hypokalemia, nephrocalcinosis, kidney stones, and inability to lower urinary pH below 5.5 despite acidemia

(can occur if AE1 or CA2 do not work)

27
Q

H+ buildup in the blood can occur as an organic acid such as _____

A

H+ buildup in the blood can occur as an organic acid such as lactic acidosis

  • Lactic acidosis is the most frequent and severe cause of this type of metabolic acidosis
  • Increased lactic acid generation (Type A): tissue hypoxia as in severe hypotension, cardiac arrest, and sepsis
  • Decreased utilization of lactic acid (Type B): liver failure, drugs, and malignancies
28
Q

Diabetic ketoacidosis results from ____ and ____

A

Diabetic ketoacidosis results from insulin deficiency and relative glucagon excess

29
Q

Anion gap = _____

A

Anion gap = [Na+] - ([Cl-] + [HCO3-])

anion gap: normal is 12 ± 2 mEq/L

30
Q

_______ are the causes of anion gap metabolic acidosis

A

MUD PILES are the causes of anion gap metabolic acidosis

31
Q

_____ are the causes of non-anion gap metabolic acidosis

A

USED CARS are the causes of non-anion gap metabolic acidosis

32
Q

When bicarbonate decreases, anion gap _____

A

When bicarbonate decreases, anion gap increases

33
Q

In non-anion gap metabolic acidosis, Cl- is ______

A

In non-anion gap metabolic acidosis, Cl- is elevated

34
Q

Net acid excretion = _____

A

Net acid excretion = (NH4+ + titratable acid) - HCO3-

35
Q

____ net acid excretion leads to metabolic acidosis

A

Low net acid excretion leads to metabolic acidosis

36
Q

Distal RTA and CKS are mainly due to _____ and _____

A

Distal RTA and CKS are mainly due to low NH4+ and titratable acid excretion

37
Q

Proximal RTA is due to ______

A

Proximal RTA is due to bicarbonate wastage

38
Q

Urine anion gap = ______

A

Urine anion gap = (Na+ + K+) - (Cl-)

39
Q

If NH4+ increases, urine anion gap _____

A

If NH4+ increases, urine anion gap decreases

(occurs in metabolic acidosis caused by diarrhea)

40
Q

If NH4+ does not increases, urine anion gap ______

A

If NH4+ does not increases, urine anion gap does not decrease

(occurs in distal RTA, which is a disease with metabolic acidosis because NH4+ is excreted in the urine in low amounts)

41
Q

A large negative urine anion gap occurs in ______

A

A large negative urine anion gap occurs in metabolic acidosis caused by diarrhea

(NH4+ high in urine)

42
Q

A positive urine anion gap occurs in _____

A

A positive urine anion gap occurs in distal RTA

(Low NH4+ in urine)

43
Q

Metabolic alkalosis is characterized by _____, leading to _____ pH

A

Metabolic alkalosis is characterized by increase in blood [HCO3-], leading to increase in blood pH

44
Q

Metabolic alkalemia is sensed by _____, which result in _____

A

Metabolic alkalemia is sensed by peripheral chemoreceptors, which results in a decrease in respiratory ventilation and thus CO2 retention

(for every 1.0 mEq/L increase in HCO3-, expect an increase in PCO2 of 0.6 mmHg)

45
Q

Respiratory compensation for metabolic alkalosis is _______

A

Respiratory compensation for metabolic alkalosis is not effective

(if it was very effective, ventilation would decrease too much and cause hypoxemia)

46
Q

Describe the steps to calculate expected compensation in metabolic alkalosis

A

Calculating expected compensation in metabolic alkalosis

  1. Calculate ∆HCO3-: plasma HCO3- – normal
  2. Verify expected PCO2: 0.6 * ∆HCO3-
  3. Add expected PCO2 + plasma PCO2
47
Q

Compensatory response to metabolic alklalosis is ______

A

Compensatory response to metabolic alklalosis is increasing excretion of HCO3-

(reduce HCO3- reabsorption along the nephron and increase its secretion by beta-intercalated cells)

48
Q

Causes of metabolic alkalosis include _____ and _____

A

Causes of metabolic alkalosis include loss of hydrogen ions (gains of HCO3-) and retention of administed bicarbonate

49
Q

The pathophysiologic approach to metabolic alkalosis includes a _____, _____, and _____

A

The pathophysiologic approach to metabolic alkalosis includes a generation phase and maintenance phase

50
Q

In the generation phase of metabolic alklaosis, ______ is the initiating event

A

In the generation phase of metabolic alklaosis, loss of acid from the stomach is the initiating event (vomiting or nasogastric suction)

51
Q

In the maintenance phase of metabolic alkalosis, there is _____, _____, and _____

A

In the maintenance phase of metabolic alkalosis, there is decreased GFR, increased proximal bicarbonate reabsorption, and increased distal tubular bicarbonate reabsorption

  • Increased proximal bicarbonate reabsorption: volume depletion, potassium depletion
  • Increased distal tubular bicarbonate reabsorption: mineralocorticoid excess, hypokalemia
52
Q

In the recovery phase of metabolic alkalosis, use _____ or _____

A

In the recovery phase of metabolic alkalosis, use Cl- administration (usually normal saline) to reexpand volume and correct the Cl- deficit or KCl administration if hypokalemia is present

53
Q

Kidney responds to metabolic alkalosis resulting from vomiting by retaining _____ and secreting ______

A

Kidney responds to metabolic alkalosis resulting from vomiting by retaining Cl- and secreting K+

54
Q

Differential diagnosis of metabolic alkalosis with hypokalemia is _____, _____, and _____

A

Differential diagnosis of metabolic alkalosis with hypokalemia is diuretics, vomiting, and Bartter’s and Gitelman syndrome

55
Q

In metabolic alkalosis with hypokalemia due to vomiting, urine Cl- is ____

A

In metabolic alkalosis with hypokalemia due to vomiting, urine Cl-​ is low

Renal (31 decks)

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