week 11: Acid and base balance Flashcards
Define if these are true or false.
Review from gas exchange that connects to acid base balance :
In order to have appropriate gas exchange it is crucial to have appropriate blood flow
- appropriate oxygen intake and carbon dioxide removal
all the above are true
_____ is going to cause those impairment in acid base balance
carbon dioxide
Does a lot of C02 indicate being acidic or alkalotic?
acidic
true or false. Sodium potassium in our blood is a must
.
this is true
What are the concepts related to acid base balance?
fluid and electrolytes
perfusion
gas exchange
elimination
nutrition
cognition
What is vital to life and circulates in our bodies ?
this would be hydrogen ions
What is hydrogen ions expressed as ?
they are expressed as pH
Hydrogen overload or excess indicate which state ?
this indicates they are in an acidotic state
hydrogen deficit indicate which state ?
this indicates that they are in an alkalosis state
Select all that is true according to the pH values :
The normal range for arterial pH is 7.35 to 7.45
if the pH is below 7.35 the client is in an alkalotic state
if the pH is above 7.45 the client is in acidotic state
only the first one is correct
the other two is the opposite of each
True or false. The more hydrogen, the less pH will be , and the less hydrogen, the higher the pH will be ?
yes this is true
A low pH or a ton of hydrogen ( hydrogen excess ) will cause our body to be acidotic which is generally created from where/
cellular metabolism
Tru or false. Increased acid can be through exercising, tomatoes and citric. these can be many influencing increase hydrogen concentration in our plasma ?
true
Define what acids are
substances that release hydrogen ions when dissolved in water or body fluids, increasing the amount of free hydrogen ions in that solution; are produced as end products of metabolism
what is this describing ?
substances that release hydrogen ions when dissolved in water or body fluids, increasing the amount of free hydrogen ions in that solution; are produced as end products of metabolism
this is describing acids
define what bases are
Substances that bind free hydrogen ions in solution and lower the amount of free hydrogen ions in solution
what is this describing ?
Substances that bind free hydrogen ions in solution and lower the amount of free hydrogen ions in solution
bases
Having kidney issues can indicate that you are having an C02 problem or HC03?
HC03, in other words bicarbonate problem
How does our body maintain acid base balance ?
this occurs through different mechanisms ( now name these mechanisms )
- chemical ( protein buffers, chemical buffers )
2.respiratory
3.kidneys
potassium exchange
what takes the longest to balance acid base ?
this would be through our kidney mechanism
what is the first line of defense in which is quick to react to acidic
this is called chemical ( protein buffers, chemical buffers)
what are the different protein buffers
albumin, globulins, hemoglobin
what are the different chemical buffers
bicarbonate, phosphate
Chemical buffers :
bicarbonate
phosphate:
define what they do
bicarbonate is also discussed as carbonic acid bicarbonate system
phosphate is present in cells and body fluids; it is especially active in the kidneys. The system acts like bicarbonate and neutralized excess hydrogen ions.
Buffers : carbonic acid- bicarbonate system
let’s break it down: under what category would carbonic acid belong ? how about bicarbonate system ?
carbonic acid would be common acid
bicarbonate system would be common base
First define if this statement is true or false.
If it is true fill in the blank, if it false, disregard it.
bicarbonate is made up of ___ and water , in which the patient is not retaining c02.
this is a true statement
HC03
Frist define if this statement is true or false.
If it is true fill in the blank, if it false, disregard it.
Carbonic acid is made up of ___ and h20 creating carbonic acid, the pH will also decrease with this circumstance.
c02
Patients who are getting rid of C02 is also known as what term ?
hyperventilating
where is carbonic acid regulated in our body ? and how about bicarbonate ?
carbonic acid is very regulated in our respiratory system, and respiratory system has chemical mediator to detect in our brain , receptor will detect if it’s out of optimal function.
bicarbonate= kidneys
This is the primary buffer system in the body
carbonic acid bicarbonate system
Buffers : carbonic Acid- Bicarbonate system
The system maintains a pH of 7.4 with ratio of 20 parts bicarbonate to 1 part of carbonic acid ? Is this a true statement?
yes this is a true statement
Buffers: Carbonic Acid- bicarbonate system
what does this 20: 1 ratio determines ?
this determines the hydrogen ion concentration (pH) of body fluid.
Buffers: Carbonic Acid- bicarbonate system
How is carbonic acid concentration controlled?
it is controlled by the excretion of C02 in the lungs, the rate and depth of respiration change in response to the changes in C02.
Which organ controls the bicarbonate concentration in the buffer carbonic acid bicarbonate system ? and define what it’s role
the kidneys control the bicarbonate concentration and selectively retain or excrete bicarbonate in response to bodily needs.
When we think about carbonic acid excess, what type of issue are we initially thinking right from the start ?
we think of respiratory issue ( acidic )
When we think about base bicarbonate deficit, what type of issue are we initially thinking right from the start ?
metabolic issue ( this is outside of respiratory issue ) –> alkaline
What is the second defense of the body and interacts with the buffer system to maintain acid base balance?
respiratory
True or false. Respiratory system is under control of central nervous system that allows chemoreceptors we have in our brain to detect C02. If it detects that it’s too high, we are given signals to excrete those C02 ( e.g exercsing: we begin to hyperventilate)
true
Our drive to breathe is based on what ? name an example
it’s based on C02, ( e.g when we are exercising we are making more acid in our body, C02 is increasing which is causing our pH level to decrease –> usually this is why we hyperventilate when we exercise )
true or false. Respiratory defense mechanism to maintain acid base balance , activate only hydrogen ions carried by carbonic acid
false. it inactivates it.
When the body is in state of acidosis, what does the respiratory do in terms of balancing the acid base balance?
When the body is in state of acidosis the lungs increase the body’s respirations to excrete C02.
true or false. The second line of defense for acid base balance is respiratory and one of the mechanism it does is not change the rate nor the depth of our breathing.
bruh false duh obviously we are changing it.
define if this is a true statement under the category of respiratory in balancing acid and base.
- In alkalosis, the pH increases, and the respiratory rate and depth increases, C02 is retained, and carbonic acid increases to neutralize and decrease the strength of excess bicarbonate
false, respiratory and depth does not increase, it would decrease because you are trying to retain that carbonic acid NOT get rid off it.
How long does the process of correcting an acid base deficit or excess take when using the second line of defense ( respiratory)
only 10-30 seconds to complete!
determine how the lungs help in state of alkalosis when using respiratory in an acid base imbalance, what about acidosis what would the lungs contribute?
the lungs will either hold hydrogen ions in state of alkalosis
changing hydrogen ions to water molecules to be exhaled with C02 in states of acidosis
define if this is true or false.
The respiratory system, including the lungs, acts relatively quickly to make short-term adjustments, while the kidneys provide longer-term regulation by excreting or conserving bicarbonate ions.
true
These defense are strong when maintaining the acid base ( or balancing ) however they do the job slower ( takes about a day to get a respond)
kidenys
Define the characteristics that undergoes kidneys in balancing acid and base
- The renal correction of an acid- base imbalance is slower but is provides a more inclusive corrective response.
- Compensation (correcting) can take a few hours to several days
- The kidneys restore bicarbonate by excreting hydrogen ions and retaining bicarbonate ions.
- Excess hydrogen ions are excreted in the urine in the form of phosphoric acid.
Acidosis and alkalosis imbalances can indicate that there is an imbalance where ?
potassium imbalance
In situations we have patients who are acidotic meaning that there is extra hydrogen ions, ( refer to slide 14) for the diagram, there is less hydrogen ions inside of the cell, the hydrogen ions will try to move into the cell to neutralize their charge when this happens the cell will try to push the potassium to balance the change that is occurring. In this case what can we say our patient would become ?
our patient will become hyperkalemia ( acidosis stage )
Potassium exchange :
define the characteristics under normal conditions
the intracellular potassium content is much greater than that of the extracellular fluid. The concentration of hydrogen ions is low in both compartments.
Potassium exchange
define the characteristics of acidosis
the extracellular hydrogen ions content increases and the hydrogen ions move into the intracellular fluid. TO keep the intracellular fluid electrically neutral, an equal number of potassium ions leave the cell, creating a relative hyperkalemia
Potassium exchange :
Define the characteristics of alkalosis
more hydrogen ions are presenting intracellular fluid than in the extracellular fluid. Hydrogen ions move from the intracellular fluid into the extracellular fluid. To keep the intracellular electrically neutral, potassium ions move from the extracellular fluid not the intracellular fluid, creating a relative hypokalemia
Acid base imbalances name them and the sub categories that undergo the main imbalances.
acidosis –> respiratory acidosis and metabolic acidosis
alkalosis–> respiratory alkalosis and metabolic alkalosis
Define this statement:
tons of hydrogen and this is a condition due ot another disease or pathological process
acidosis
Define this statement :
pH is very high but very low of hydrogen ions ,result of a condition that is happening.
alkalosis
Respiratory and renal responses to disrupted acid base balance :
stimulus : too much carbonic acid ( respiratory acidosis)
respiratory response : what would be the cause of problem ? what would be the correction?
what would the renal response be ?
cause problem would be hypoventilation
correction would be hyperventilation
renal response :
compensation : increased secretion of H and more NH3 production ( ammonia)
Respiratory and renal responses to disrupted acid base balance :
stimulus : too little carbonic acid (respiratory alkalosis)
Respiratory response : what would be the cause of problem? what would be the correction?
what would the renal response be ?
cause of problem would be hyperventilation
correction wold be hypoventilation
renal response :
compensation : decreased secretion of H less NH3 production
Respiratory and renal responses to disrupted acid base balance :
stimulus : Too much metabolic acid (metabolic acidosis)
what would be the respiratory response ?
what is the renal response ?
respiratory response : compensation hypeventilation
renal response :
cause of problem : more metabolic acid than kidneys can excrete
correction : increased secretion of H and more NH3 production
Respiratory and renal responses to disrupted acid base balance :
stimulus : Too little metabolic acid (metabolic alkalosis)
what would be the respiratory response ?
what is the renal response ?
repsitaory response :
compensation hypoventilation
renal response :
cause of problem : more bicarbonate than kidneys an excrete ( too little metabolic acid )
correction c: decreased secretion of H and less NH3 production
what is respiratory acidosis?
this is retaining CO2 decreasing pH (increased Carbonic acid production)
what is the cause of respiratory acidosis?
pt is hypoventilating or is a CO2 retainer (COPD)
what is the treatment of respiratory acidosis?
Fix what is causing hypoventilation (antidotes, drugs, airway)
is there compensation within respiratory acidosis?
yes! kidneys reabsorb bicarbonate into blood stream, and will increase excretion of H+ (into urine) and produce more ammonia
what is metabolic acidosis?
Too much acid or too little bicarbonate
what is the cause of metabolic acidosis?
Acid excess (exercise/fever), Bicarbonate deficit (kidney failure)
what is the correction for metabolic acidosis?
Reabsorb bicarbonate into blood and increased excretion of H+ (into urine)
is tis true: you need to remove the excess CO2 - deep breaths
true
what is this inquiring: Respiratory compensation results in deep and rapid breaths (to get rid of carbonic acid through CO2 lowering pH)
metabolic acidosis
what are some clinical manifestations for acidosis? CV, CNS, NM, Resp, Integ
1 - cardiovascular signs and symptoms:
Ranges from bradycardia to heart
block
* ECG Changes
* Hypotension
* Thready peripheral pulses
central nervous system:
Depressed activity (lethargy, confusion, stupor, coma)
neuromuscular:
hyporeflexia
Skeletal muscle weakness
Flaccid paralysis
resp:
Kussmaul respirations (respiratory
compensation in metabolic acidosis)
* !!!!Variable respirations (cause respiratory acidosis)!!!! (hyperventilation but shallow in COPD, otherwise generally hypoventilation)
integ:
Warm, flushed, dry skin in metabolic acidosis
Pale-to-cyanotic and dry skin in respiratory acidosis
what is the cause of resp alkalosis?
often hyperventilation (breathing out too much CO2)
what is respiratory alkalosis?
too little carbonic acid (to little CO2)
what is the treatment for respiratory alkalosis?
Fix what is causing hyperventilation
where is corrections done and how is it done in respiratory alkalosis?
Correction by kidneys: Excreting bicarbonate in
urine
what is this describing: Too little acid or too much bicarbonate
metabolic alkalosis
what is the cause for metabolic alkalosis ?
intake of antacids, prolonged vomiting
what is the compensation for metabolic alkalosis?
done by resp system: hypoventilation (hold onto CO2)
where is the correction done for metabolic alkalosis?
in the kidneys: excrete bicarbonate through urine
what are the clinical manifestations for alkalosis? CV, CNS, NM, Resp
cardio:
increased hr
normal or low bp
cns:
increased activity
anxiety, irritability, seizures
parenthesis
NM:
hyperflexia
muscle cramping and twitching
skeletal muscle weakness
resp:
hyperventilation (cause) in respiratory alkalosis !!!!!
hypoventilation (resp compensation in metabolic alkalosis)
what is pH (components of an arterial blood gas)?
Refers to the balance of hydrogen ions in the arterial blood. A high pH indicates a solution is alkaline (low H+ concentration) and a low pH indicates a solution is acidic (high H+ concentration)
what is PaCO2 (components of an arterial blood gas)?
stands for partial pressure of Co2: measures the amount of carbon dioxide in the arterial blood. Indicates how well the lungs are excreting carbonic acid.
what is HCO3 (Components of an arterial blood gas)
bicarbonate: Measures the amount of bicarbonate in the arterial blood. Indicates how well the kidneys are excreting metabolic acid.
what is Pao2? Components of an arterial blood gas?
partial pressure of O2: Measures the amount of oxygen in the arterial blood. Let’s us know what is happening at the level of the tissue.
what is bass excess (Components of an arterial blood gas)?
An indicator of how well the buffers are managing metabolic acid (we will introduce but not test this concept of base excess)
what are the normal limits for pH, PaCO2 and HCO3? dont really need to memorize will be given on exam
pH - 7.35 - 7.45
PaC02- 35-45 mmhG lungs
HCO3 - 21-28 mmol/L kidneys
where would acidosis and alkalosis be closer to with pH, Paco2 and HCO3 level?
acidosis 7.35-7.45 alkalosis
paCO2- alkalosis 35 - 45 mmHg acidosis
HCO3 - acidosis 21 - 28 mmol/L alkalosis
select if all is true for ABG analysis:
pH acidosis or alkalotic
PaCO2 resp acidotic or alkalotic (makes carbonic acid)
HCO3- met acidosis or alkalosis
match pH to either 2 or 3
is there compensation? is other parameter going in opposite direction
assess PaO2 and O2 sat
all true
true or false: resp acidosis = too much carbonic acid in the lungs
true
what is compensation?
The body may attempt to compensate for the pH change
true or false: if the parameter that does NOT match the pH is moving in the OPPOSITE direction the body is trying to compensate
true
what is this an example of?
pH 7.20 (acidotic)
PaCO2 30 mmHg (alkalotic)
HCO3- 16 (acidotic)
compensation!!
select the partial and full compensation from the examples, also if its acidosis or alkalosis:
* pH 7.35
* PaCO2 30 mmHg (alkalotic)
* HCO3- 16 (acidotic)
- pH 7.20 (acidotic)
- PaCO2 30 mmHg (alkalotic)
- HCO3-16 (acidotic)
both metabolic acidosis
first one full compesation
second partial compensation
