acid base balance Flashcards

1
Q

where is bicarbonate reabsorbed

A

90% in the pct, the rest in the dct

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2
Q

what other buffers are there apart from bicarbonate

A
urate
phosphate 
creatinine
beta hydroxybutyrate
proteins 
haemoglobin
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3
Q

what is fraction of inspired oxygen

A

the proportion of air that is breathed in which is oxygen

eg room air is 20% which is 0.2

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4
Q

what is a healthy p/f ratio

A

12/ 0.2 = 60

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5
Q

what type of blood is the anion gap calculated from

A

venous

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6
Q

what are the features of a normal anion gap acidosis

A

loss of bicarb

therefore chlorine is retained by the kidneys in order to maintain neutrality of the serum

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7
Q

what is renal tubular acidosis

A

failure of kidneys to excrete acid causes blood acidosis
will not cause an increased anion gap
hypercholaemic

either failure to reabsorb bicarb or failure to secrete acid

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8
Q

what type of acidosis would anion gaps be used for

A

metabolic only

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9
Q

what is normal anion gap

A

16

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10
Q

what two substances will cause an increase anion gap when ingested

A

methanol

ethylene glycol

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11
Q

what gap does renal failure cause

A

increased gap

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12
Q

what does the kidney do to bicarbonate

A

reabsorbs filtered bicarb

regenerates bicarb consumed by buffering

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13
Q

why does diarrhoea cause acidosis

A

for every bicarb ion released into the gut one H+ is released into the ECF
This process is increased in diarrhoea

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14
Q

how can the kidneys correct for metabolic acidosis

A

only if non renal origin and the kidneys are working

secrete more acid into the urine and make new bicarb

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15
Q

what is pf ratio

A

the arterial oxygen partial pressure / fraction of air that is oxygen

normal arterial oxygen is approx. 12
room air is approx. 20% O2

so PF = 12/0.2= 0.6 or 60%

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16
Q

where is bicarbonate reabsorbed

A

PCT (90%) , DCT and collecting duct(10%)

17
Q

what is titratable acid

A

any acid except for ammonium

18
Q

what is distal renal tubular acidosis

A

failure to concentrate H+ in the distal tubule

19
Q

what is proximal renal tubular acidosis

A

impairs PCT reabsorption of bicarbonate

most common in children

20
Q

what is hyperkalaemic renal tubular acidosis

A

reduction in aldosterone inhibits NH3 production

most common in adults

21
Q

what factors regulat renal bicarb handling

A

PCO2, H+, volume of ECF, angiotensin 2, aldosterone, potassium

22
Q

what amino acid is involved in ammonium excretion

A

glutamine

23
Q

what acid excretion increases greatly during acidosis

A

ammonium

titratable acid excretion is relatively constant

24
Q

what is glutamine turned into in ammonium secretion

A

alpha keto glutarate

25
Q

what buffers are found in urine

A

urate
creatinine
beta hydroxybutarate

26
Q

what part of the kidney is resposible for acid base balance

A

collecting duct

27
Q

what is the feature of increased anion gap acidoses

A

the body is producing an acid e.g. lactic acid

28
Q

what could cause maintainance of the alkalosis

A

potassium/ chloride depletion group which impairs the kidneys ability to secrete bicarb

chloride and bicarb are the only anions present in the ecf therefore must be maintained in order to maintain electrical neutrality