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Flashcards in acid base 1 Deck (24):
1

What do the kidneys normally excrete and how much?

acid. 1 mEq/kilo

2

where is bicarb reabsorbed?

80% PT, 15% TAL, 5% CCD, none in urine

3

what are the apical H/bicarb transporters in PT

H/Na antiporter, H atpase (combines w/ bicarb)

4

what are the basolateral H/bicarb transporters in PT?

HCO3/Cl antiporter, HCO3/Na symporter

5

how does H/HCO3 happen in the CT.

alpha and beta intercalated cells. alpha- H/ATPase in apical so secretes acid. Beta- H/ATPase in basal so secretes bicarb via hco3/Cl antiporter

6

what is the most important transporter in CT?

H atpase

7

how does ECF volume contraction affect H secretion and where? Aldosterone? hypokalemia? PTH?

increases it in PT. increases in CT. increase in PT.

8

how does ECF expansion change bicarb reabsorption

inhibits

9

how does aldosterone affect the distal nephron

stimulates H ATPase in intercalated cells and Na reabsorption (na/H antiporter) (secretion).

10

what are the two main urine buffers?

ammonia and titratable acid (Hpo4)

11

how is ammonia formed?

1) NH4+ forms from glutamine in PT and enters tubular fluid 2)NH4+ reabsorbed in LOH 3) NH3 enters CT and gets trapped as NH4+

12

in non-gap acidosis, how much should Cl change? If it isn't?

increase 1:1 w/ decrease in bicarb. absence of 1:1 relationship means mixed disorder

13

Equation for urine AG? interpretation?

(Na+K)-Cl. Use in Acidosis setting. If UAG is very (-) there is NH4 secretion. If it is (+) or close to 0 then it indicates RTA

14

How is met alk compensated for by kidneys?

^ bicarb absorption from beta intercalated cells.

15

Tx for met alk w/ hypovolemia

Administer NaCl

16

DDx of met alk w/ hypokalemia

diuretics, vomiting (has low urine Cl), bartters

17

what is the henderson hasselbach eq

pH=6.1+log ([HCO3-]/(.03*pCO2))

18

Compensatory response: Met acid, met alk,

Decrease in pCO2=1.2(delta bicarb), Increase in pCO2=0.6(delta bicarb)

19

Compensatory response: Resp acid, resp alk

Acute: Increase in bicarb=.1(delta pCO2), chronic: .4(delta pCO2). Acute: decrease in bicarb=.2(delta pCO2), chronic=.5(delta pCO2)

20

causes of elevated AG acidosis

Methanol, uremia, DKA, Prop glycol, ischemia, Lactic acidosis, Ethanol, salicylates

21

causes of non elevated AG acidosis

Diarrhea, Ureteral diversion, RTA, Hypocapnia, Acetazolamide, Mineralcorticoid deficiency

22

Define Saline responsive met alk and causes

Urine Cl<15. Vomiting, NG suction. diuretics

23

define saline resistant met alk and causes

Urine Cl>20. Hyperaldosteronism, bartter and gitelmans, licorice

24

what does aspirin cause

AG acidosis w/ resp alkalosis