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Kidneys > Acid Base > Flashcards

Acid Base Flashcards

1
Q

Below what pH are we in acidosis?

A

7.35

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2
Q

Above what pH are we in alkalosis?

A

7.45

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3
Q

What is the normal range for pH?

A

7.35 - 7.45 (ECF fluid pH)

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4
Q

How do acids enter our body?

A

Ingestion (we eat a LOT more ACIDS than bases), normal cellular metabolism

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5
Q

What’s the pathway of excess acids when they get into our body?

A

H+ first buffered by Bicarb & protein in ECF then H+ moves into ICF via H+/K+ exchanger where its buffered by phosphates (H2PO4) and protein, kidney secretes H+ ions in form of Titratable acids, ammonia (both of which each produce a new bicarb),
* Kidney also reabsorbs filtered bicarb

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6
Q

What is the major buffer in ECF?

A

Bicarb (HCO3-) (it binds w/ H+ acids)

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7
Q

What’s the major buffer in ICF?

A

Phosphates (H2PO4), proteins

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8
Q

How does kidney hand le excess acids?

A
  1. Reabsorption of filtered bicarb

2. Secretion of H+ ions via forming titratable acids and ammonium (which each produce a new bicarb)

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9
Q

How does kidney hand le excess acids?

A

FIRST: Reabsorption of filtered bicarb
THEN: Secretion of H+ ions via forming titratable acids and ammonium (which each produce a new bicarb)

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10
Q

Where does most of HCO3- reabsorption occur?

A

Proximal tubule

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11
Q

Where can HCO3- reabsorption occur?

A

Proximal tubule, distal tubule

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12
Q

Where can HCO3- reabsorption occur?

A

Proximal tubule (Na+/H+ and HCO3-Cl antiporter OR HCO3-Na symporter, distal tubule (K+/H+ and HCO3-Cl- antiporter OR HCO3-Na symporter)

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13
Q

The Kidney breaks down glutamine into what 2 products?

A

NH4+ and Bicarb

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14
Q

What’s the net acid excretion equation?

A

Bases - Acids
= Bicarb - (Titratable Acids + NH4+)
= HCO3- - (TA + NH4+)

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15
Q

Is most excess acid is excreted as NH4+ or TA?

A

NH4+

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16
Q

How do you determine what causes acidosis or alkalosis? i.e. how do you know if its respiratory vs. metabolic?

A
  1. pH: is it below 7.35 (acidosis) or above 7.45 (alkalosis)?
  2. pCO2: if above 40 = acidic, if below 40 = alkalosis
  3. HCO3-: if below 24 = acidosis, above 24 = alkalosis
  4. Which matches the pH? that determines respiratory or metabolic!
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17
Q

If a disease/condition is recurrent, is it chronic or acute?

A

Chronic!

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18
Q

What’s the normal range for anion gap?

A

8-12

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19
Q

What does an anion gap of 13 or more tell you?

A

likely an acidosis

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20
Q

If an individual has a normal anion gap, could it be causes by a base loss?

A

Yes! But, could NOT be caused by acid gain

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21
Q

What does anion gap tell you,

why do we calculate it?

A

whether acidosis is caused by acid gain or base loss

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22
Q

What’s the most prevalent titratable acids inside of tubules?

A

Phosphates (mainly H2PO4) so secreted into lumen of tubules!

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23
Q

What is the liver product (AA) that is broken down to form ammonia?

A

Glutamine

24
Q

What equation helps you decide whether acidosis is create from an acid gain or base loss?

A

Anion Gap

25
Q

What’s the typical plasma concentration of bicarb?

A

24 mm/L

Filtered Load = GFR x Px = 180 L/day * 24mm/L = 4320 mmol/day

26
Q

What hormone increases Na+ reabsorption by increasing the # of H+/Na+ transporters in the Proximal Tubule?

A

Angiotensin II

27
Q

What are 2 ways of reabsorbing the HCO3- across the basolateral membrane in the proximal tubule?

A

HCO3- Na+ SYMporter (Na+ & HCO3 go OUTSIDE cell)

HCO3- Cl- ANTIporter (Cl- goes INSIDE cell)

28
Q

What’s the major difference between Type A/alpha and Type B/beta intercalated cells in Distal Tubule?

A

They both have the same transporters but in Type A intercalated cells have K+ (in)/H+(out) exchanger/antiporter OR H+ pump on apical membrane and HCO3-/Cl- antiporter on basolateral membrane

In Type B = its vice versa where HCO3-/Cl antiporter is on apical membrane (so beta cells SECRETE HCO3-) and K+ (in)/H+ (out) antiporter OR H+ pump (ATP) is on basolateral membrane

29
Q

Under what acid-base conditions are Type A intercalated cells active?

A

acidosis

30
Q

Under what acid-base conditions are Type B intercalated cells active?

A

alkalosis

31
Q

Do we have Na+/HCO3- symporters in distal tubule?

A

No! Only have Na+/Cl-

32
Q

Where do we create and secrete ammonia?

A

Proximal tubule

To make ammonia from glutamine, takes a long time (delay) even though its UNLIMITED

33
Q

Where do we create and secrete titratable acids?

A

Distal tubule

34
Q

What are different causes of acid gain?

A
  1. Decreased respiration (due to airway obstruction e.g. COPD, emphysema)
  2. ketoacids (diabetes)
  3. renal failure (bec/ kidneys can’t secrete acids)
  4. Diarrhea = Base loss
35
Q

Diarrhea is a common cause of what condition?

A

Acidosis bec/ diarrhea is a base loss

36
Q

What is the anion gap equation?

A

AG = Na - (Cl- + HCO3-)

37
Q

Acid load acts as an unmeasured ______, unlike base loss bec/ when HCO3- lost, it’s replaced by _______ . This is why Anion Gap is normal when we have a base loss.

A

anion, Cl-

38
Q

Vomiting and/or hyperventilating cause what condition?

A

Alkalosis (it’s a loss of fixed acid)

Alternatively, alkalosis can also be caused by base gain due to overdosing on base

39
Q

What are the 2 processes by which the kidneys regulate plasma concentration of HCO3?

A
  1. Reabsorbing filtered bicarb (HCO3-)

2. Producing new HCO3 by either forming and secreting Titratable acids or forming and secreting ammonium/ammonia

40
Q

Do titratable acids change pH of the blood or urine?

A

NO! TAs are neutral molecules

41
Q

Does Ammonium change the pH of blood or urine?

A

Yes

42
Q

What is azotemia?

A

excess nitrogenous waste in urine

43
Q

What is azotemia?

A

excess nitrogenous waste in blood

44
Q

Is 16 breaths/min a normal respiratory rate?

A

Yes.

Range = 12-20

45
Q

The higher the creatinine the lower the _____?

A

higher creatinine, lower GFR

bec/ creatinine is only filtered = so glomerulus is not working

46
Q

The higher the creatinine the lower the _____?

A

higher creatinine, lower GFR

bec/ creatinine is only filtered = so glomerulus is not working if creatinine is high

47
Q

How do you figure out GFR from plasma creatinine levels?

A

GFR = 1/Plasma Creatinine

48
Q

How do you figure out GFR from plasma creatinine levels?

A

GFR = 1/[Plasma Creatinine]

49
Q

If you go from laying down to standing up, what happens to your BP?

A

goes down (this is orthostatic hypotension)

50
Q

Vomiting causes what conditions?

A

alkalosis due to acid loss (H+ and Cl-), so low Cl- levels (hypocholerima), dehydration due to volume loss (dehydration decreases GFR and increases creatinine levels)

51
Q

What is indicated by loss of skin turgor and flat jugular veins?

A

Low BP due to low blood volume

52
Q

During hypokalemia, what happens to K+ and H+ ions?

A

H+ ions pumped out, K+ ions pumped in

53
Q

What are normal plasma Cl- levels?

A

105 mEq/L

54
Q

What are normal plasma Na+ levels?

A

135-145 mEq/L

55
Q

What are normal plasma K+ levels?

A

4 mEq/L

Kidneys (5 decks)

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