Test 3: Wk13: 2 Acid Base Imbalance 1 - Puri

Question 1

henderson hasselbach equation

Answer 1

pH = pH + log (HCO3- / 0.03PCO2)

Question 2

hyperventilation or hypoventilation during acidosis

Answer 2

hyperventilation to remove excess CO2

Question 3

hyperventilation or hypoventilation during alkalosis

Answer 3

hypoventilation to retain CO2

Question 4

— is the main way to achieve net acid excretion

Answer 4

Ammonia

Question 5

Ammonia requires

Answer 5

Glutamate

Question 6

acidosis in the kidney does what to glutamine

Answer 6

increases it

Question 7

Acidosis Respiratory or Metabolic stimulates Renal

Answer 7

resorption of HCO3 and excretion of protons

Question 8

renal HCO3 is increased due to

Answer 8

increased activity of NHE in the PT

Question 9

Extracellular Buffer System

Answer 9

CO2 ⇆ H2CO3 ⇆ H+ ⇆ HCO3-

Question 10

Intracellular Buffer System

Answer 10

Uses non-bicarbonate buffers

Phosphate, Proteins, Bone

Question 11

Metabolic Acidosis is characterized by — Arterial pH and — Serum HCO3

Answer 11

Low pH

Low Serum HCO3

Question 12

Normal Arterial pH and range

Answer 12

7. 4

7. 35 - 7.45

Question 13

Normal Serum HCO3- concentration and range

Answer 13

24 meq/L

22-28 meq/L

Question 14

4 causes of increased acid generation

Answer 14

Lactic Acidosis

Ketoacidosis

Ingestions

Question 15

2 causes for loss of HCO3-

Answer 15

Diarrhea

PT Acidosis - inability to reabsorbed filters HCO3

Question 16

2 causes of diminished renal acid secretion

Answer 16

Renal Failure

Distal renal tubular acidosis - inability to excrete daily acid load

Question 17

Type 1 RTA Pathology

Answer 17

↓ H excretion in the

collecting ducts

Question 18

Type 1 RTA Cause

Answer 18

Defect in the H-ATPase

Question 19

Type 1 RTA Urine pH

Answer 19

> 5.3

Question 20

Type 1 RTA Plasma K

Answer 20

↓

Question 21

Type 2 RTA Pathology

Answer 21

↓ HCO3 reabsorption in

the proximal tubule

Question 22

Type 2 RTA Cause

Answer 22

Reduced NHE activity,
possibly due to ↓
carbonic anhydrase

Question 23

Type 2 RTA Urine pH

Answer 23

<5.3

Question 24

Type 2 RTA Plasma K

Answer 24

↓

Question 25

Type 4 RTA Pathology

Answer 25

↓ H excretion in the

collecting ducts

Question 26

Type 4 RTA Cause

Answer 26

Hypoaldosteronism

Question 27

Type 4 RTA Urine pH

Answer 27

<5.3

Question 28

Type 4 RTA Plasma K

Answer 28

↑

Question 29

Winters rule for Compensation in metabolic acidosis

Answer 29

Expected pCO2 = 1.5 x [HCO3] + 8 +/- 2

Question 30

PCO2 appropriately low

Answer 30

well compensated primary metabolic acidosis

Question 31

PCO2 higher than predicted

Answer 31

superimposed respiratory acidosis

Question 32

PCO2 lower than predicted

Answer 32

superimposed primary respiratory alkalosis

Question 33

HCO3 <25

Answer 33

Primary Metabolic Acidosis

Question 34

HCO3 > 40

Answer 34

Primary Respiratory Acidosis

Question 35

Metabolic acidosis depletes

Answer 35

body stores of K

Question 36

Normal anion gap

Answer 36

12

Question 37

Normochloremic Acidosis

Answer 37

Wide anion gap Mudpiles

Question 38

2 most important causes of wide anion gap

Answer 38

Ethylene Glycol

Salicylate Poisoning

Question 39

Anion Gap =

Answer 39

measured Cation - Measured anion

Question 40

6 Causes of Hyperchloremic Acidosis

Answer 40

1. Fistula
2. Type 2 RTA
3. Type 1 RTA
4. Type 4 RTA
5. Diarrhea
6. NaCl or NH4Cl infusion

Question 41

why does Cl increase in hyperchloremic acidosis

Answer 41

volume loss causes the kidneys to try and retain NaCl. Kidneys absorb more Cl to maintain electronegativity

Question 42

Respiratory Acidosis is also called

Answer 42

hypercapnia

Question 43

how long does renal compensation take

Answer 43

48 hours

Question 44

4 for 10 rule

Answer 44

expected HCO3 in chronic respiratory acidosis will increase by 4mmol/L for every 10mmhg above pCO2 about 40mmHg

Question 45

if HCO3 rises more suspect

Answer 45

metabolic alkalosis with respiratory acidosis

Question 46

if HCO3 does not increase suspect

Answer 46

renal insufficiency or metabolic acidosis with respiratory acidosis

Question 47

PaCO2 < 40

Answer 47

Metabolic Acidosis

Question 48

PaCO2 > 40

Answer 48

Respiratory Acidosis

Question 49

Metabolic Alkalosis of renal origin is associated with Volume depletion caused by

Answer 49

Diuretics - Loops and HCTZ

Barters Syndrome - defective NKCC2

Question 50

Metabolic Alkalosis of Non-renal origin with extracellular volume depletion causes

Answer 50

GI fluid Loss

Question 51

metabolic Alkalosis of renal origin with volume expansion and hypertension causes

Answer 51

Hyperaldosteronism or Liddle Syndrome

Renal Artery Stenosis

Question 52

metabolic alkalosis is almost always

Answer 52

hypochloremic

Question 53

Buffering in metabolic alkalosis causes

Answer 53

hypokalemia

Question 54

Respiratory Compensation in metabolic alkalosis

Answer 54

Expected pCO2 = 40 + (.6 x deltaHCO3)

Question 55

Respiratory Alkalosis main cause

Answer 55

hyperventilation

Question 56

5 for 10 rule

Answer 56

at completion of compensation serum HCO3 decreased

5 mEq/L per 10mmHg decrease in PCO2 due to increased HCO3 reabsorption

Question 57

if HCO3 drops more suspect

Answer 57

metabolic acidosis with respiratory alkalosis

Question 58

if HCO3 does not decrease suspect

Answer 58

renal insufficiency or metabolic alkalosis with respiratory alkalosis