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MHD V: Renal > 11.4: Acid / Alka > Flashcards

11.4: Acid / Alka Flashcards

1
Q

What is metabolic acidosis?

A
  • Decrease in bicarb [] in plasma
  • Increases [H] plasma
  • Accompanied by decrease in PCO2 to maintain PH
  • Known as respiratory alkalosis
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2
Q

What is respiratory alkalosis?

A
  • Decrease in PCO2 to normalize PH increase in metabolic acidosis
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3
Q

What is total CO2 / CO2 content?

A

What the chemistry lab calls bicarb when they measure it

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4
Q

What is the henderson Equation?

A

H+ = 24 PCO2 / HCO3-

***Want to keep hydrogen ion constant

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5
Q

Various [H] and PHs

A
  1. 1 = 80
  2. 2 = 63
  3. 3 = 51
  4. 4 = 40
  5. 5 = 32
  6. 6 = 25
  7. 7 = 20
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6
Q

Equation of acid base homeostasis?

A

H + HCO3- -> H2CO3 -> H20 + PCO2 (excreted by lungs)

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7
Q

What are the abnormalities with respiratory alk/acidosis in?

A
  • PCO2

- Compensatory movement in bicarb

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8
Q

Predicted volume of compensation in alka / acid?

A

1.2 decrease bicarb = decrease in PCO2

.7 increase bicarb = increase in PCO2

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9
Q

What is electroneutrality?

A
  • Anions in body must match volume of cations
  • Na + UC = HCO3 + Cl + UA
  • UC/A: unmeasured cations and anions
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10
Q

What is the anion gap?

A
  • Na+, Cl-, and HCO3- are most prevalent ions
  • DIfference between Na+ and Cl- + HCO3- is “anion gap”
  • Anions must equal cations so no “real” gap
  • ***Usually is 10 - 12
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11
Q

What does increased anion gap acidosis point to?

A
  • Overproduction of an organic acid with retention of organic anion
  • Organic acids are anions
  • The acid is titrating the bicarb dropping its volume
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12
Q

2 causes and subclasses of increased anion gap acidosis?

A 
Increase organic acid production
1. Ketoacidosis 
2. Lactic acidosis
3. Toxin ingestion 
Failure to excrete organic ions:
1. Renal failure
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13
Q

What is hyperchloremic acidosis?

A
  • Bicarb is low, Cl- may increase to keep neutrality
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14
Q

Causes of Hyperchloremic acidosis?

A
  1. GI loss of bicarb: diarrhea
  2. Renal loss of bicarb: Renal tubular acidosis (RTA)
  3. Failure to excrete acid: renal failure
  4. Acid administration: TPN
  5. High doses of saline
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15
Q

What is type II RTA?

A

“Renal Tubular acidosis” proximal tubule

  • Impairment in HCO 3 reabsorption in proximal
  • Bicarb begins to be spilled in urine at earlier level
  • Causes acidosis in body with increased Cl- resorption with Na to neutralize HCO3 that was dumped
  • Patient will have low serum bicarb and high Cl
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16
Q

What is Type I RTA?

A
  • Inability to excrete H in distal tubule
  • H ATPase normally pumps H out to combine with bicard
  • This is impaired in RTA II
17
Q

2 most common causes of hyperchloremic acidosis?

A
  1. Diarrhea

2. Kidney disease

18
Q

How treat metabolic acidosis?

A

Normal anion gap: bicarb

  • Na or K / bicarb can be given as well
  • Bicarb formers can be given as well
19
Q

What is metabolic alkalosis?

A
  • Increase in plasma bicarb

- Accompanied by increased PCO2 to maintain PH

20
Q

Generation of metabolic alkalosis?

A
  1. Net loss of H from ECF
  2. Increased Bicarb to ECF
  3. Loss of chloride in excess of bicarb
21
Q

How can H be lost?

A
  1. GI tract: vomit
  2. Renal: in urine
  3. Shift into cells
22
Q

What happens to H in stomach?

A
  • Titrate by pancreatic bicarb

- If H is lost in vomiting, net increase in bicarb

23
Q

How is H lost in urine?

A
  1. Excess mineralocorticoids: ADH (tumor)
24
Q

What is mineralocorticoid in humans?

A

Aldosterone

25
Q

Why does H shift into cells?

A
  • K moves out of cells in sever HYPOkalemia

- H moves in to replace charge

26
Q

What can cause bicard gain?

A
  1. Exogenous: bicarb, lactate, citrate, acetate

2. Chloride rich fluid loss: more bicarb resorbed

27
Q

How is Cl lost in GI?

A
  1. Villous adenoma: Cl secreting tumor into school

2. Failure of gut to resorb

28
Q

Causes of renal chloride loss?

A
  1. Diuretics: impair resorption
  2. Bartter’s syndrome: defect of K2Cl in loop
  3. Gitelman’s syndrome: defect in NACL cotransporter in distal
29
Q

How is Cl lost in skin?

A

CF loss of Cl in excess of bicarb in sweat

30
Q

How does kidney handle bicard?

A
  • Freely filtered
  • Reabsorbed in proximal nephron
  • That consumed by acid is regenerated in distal
31
Q

Reason for maintenance of metabolic alkalosis?

A
  • Chloride depletion
  • If you give solely Cl- back it corrects
  • Usually given as NaCl
32
Q

Why does chloride correct metabolic alkalosis?

A
  • In type B intercalated cell, Cl moves into cell allowing bicarb to be dumped in urine to correct alkalosis
33
Q

Signs of metabolic alkalosis?

A
  1. Hypoventilation
  2. Vomiting
  3. Diuretics
  4. Cramps
  5. Htn.
34
Q

What is low Cl in urine indicative of?

A
  • Cl depletion
35
Q

DD for metabolic alkalosis?

A
  1. Chloride responsive: low Cl in urine
  2. Chloride resistant: high Cl seen in urine: ADH excess state
    - Extra Cl- will just be dumped in urine
36
Q

How is metabolic alkalosis treated?

A
  • Potassium administration
  • Acetazolamide
  • Volume repletion
  • Intravenous HCl or NH4Cl
37
Q

What is normal PCO2?

A

40

38
Q

What is normal anion gap?

A
  • 10 - 12
  • If less than this when you calculate its normal anion gap
  • If higher, high anion gap

MHD V: Renal (28 decks)

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