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Renal and urology > Acid-Base balance > Flashcards

Acid-Base balance Flashcards

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1
Q

What is the normal range for [H+] in nmol/L?

A

35 – 45 nmol/L

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2
Q

What is the normal pH range for acid-base balance?

A

7.35 – 7.45

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3
Q

What is the formula for calculating pH from [H+]?

A

pH = -log10[H+]

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4
Q

What are the primary sources of acid production in the body?

A
  • Cellular respiration (producing CO2)
  • Metabolic processes (producing non-volatile acids like ketones and lactate)
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5
Q

What is the daily production of CO2 in mol?

A

~12 mol CO2 per day

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6
Q

What is the typical daily production of non-volatile acids in mmol?

A

~60 mmol non-volatile acids per day

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7
Q

What are the three main mechanisms of acid-base homeostasis in the body?

A
  • Buffers (rapid)
  • Lungs (fast)
  • Kidneys (slow)
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8
Q

What is the role of buffers in acid-base homeostasis?

A

They rapidly stabilize pH by neutralizing excess acids or bases.

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9
Q

How do the lungs contribute to acid-base balance?

A

They remove CO2, which helps to regulate pH.

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10
Q

What is the Henderson-Hasselbalch equation?

A

pH = 6.1 + log10([HCO3-] / (pCO2 x 0.23))

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11
Q

What is acidaemia?

A

[H+] > 45 nmol/L and pH < 7.35

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12
Q

What is alkalaemia?

A

[H+] < 35 nmol/L and pH > 7.45

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13
Q

What is respiratory acidosis?

A

A condition characterized by elevated pCO2 due to hypo-ventilation.

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14
Q

What is metabolic acidosis?

A

A condition characterized by overproduction of acids or impaired excretion.

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15
Q

What causes metabolic alkalosis?

A

Unusual losses of H+ or excessive ingestion of HCO3-.

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16
Q

What is the significance of base excess in blood gas analysis?

A

It indicates the amount of H+ needed to return to normal pH at a standard pCO2.

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17
Q

What is the standard reference range for HCO3-?

A

21 – 29 mmol/L

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18
Q

What does a negative base excess indicate?

A

It suggests metabolic acidosis.

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19
Q

What does a positive base excess indicate?

A

It suggests metabolic alkalosis.

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20
Q

What are the key components required for interpreting arterial blood gases (ABGs)?

A
  • pH or [H+]
  • pO2
  • pCO2
  • [HCO3-]
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21
Q

What is the role of the kidneys in acid-base homeostasis?

A

They excrete H+ and regenerate HCO3-.

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22
Q

True or False: Venous blood gas samples can sometimes be used instead of arterial samples.

A

True

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23
Q

What are some common causes of unusual losses that lead to metabolic alkalosis?

A
  • Vomiting
  • Diuretic therapy
  • Dehydration
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24
Q

What is the typical method for measuring HCO3- in blood gas analysis?

A

HCO3- is calculated based on the measured pCO2 and pH.

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25
Fill in the blank: The kidneys have a _______ response in acid-base homeostasis.
slow
26
What is respiratory alkalosis?
A condition characterized by decreased pCO2 due to hyper-ventilation.
27
What are the typical investigations for assessing acid-base disorders?
* Arterial blood gas (ABG) * Venous gas * Clinical history and examination
28
What is the significance of the anion gap in acid-base disorders?
It helps to differentiate between causes of metabolic acidosis.
29
What does the term 'mixed disorders' refer to in acid-base balance?
Simultaneous presence of multiple acid-base disturbances.
30
What are mixed acid-base disorders?
Disorders where one or more pathologies simultaneously drive acid-base disorders.
31
What do shaded areas in acid-base disorder charts define?
Usual behavior of acid-base disorders, such as degree of attempted respiratory compensation.
32
What is metabolic acidosis with partial respiratory compensation?
A condition where metabolic acidosis is present alongside respiratory compensation.
33
What is the primary disorder in Case 1?
Metabolic acidosis.
34
Fill in the blank: The primary acid-base disturbance in Case 1 is _______.
metabolic acidosis.
35
What is the anion gap?
The difference between the most abundant cations and anions in the blood.
36
What does an elevated anion gap indicate?
It indicates certain types of metabolic acidosis.
37
What are common causes of metabolic acidosis?
* Increased acid formation * Reduced excretion * Loss of HCO3-
38
What is the normal reference range for anion gap?
6 – 18 mmol/L.
39
What is the compensatory mechanism for respiratory acidosis?
Metabolic alkalosis.
40
What is the primary disorder in Case 2?
Respiratory acidosis.
41
What is the effect of acute metabolic acidosis on oxygen delivery?
Initially facilitates O2 delivery, but after several hours it impairs O2 delivery.
42
What is the consequence of chronic acidosis on bone?
Buffering by bone leads to decalcification.
43
What are the pH levels of H+ in Case 1?
78 nmol/l.
44
What would indicate a respiratory alkalosis condition?
Hyperventilation.
45
True or False: Metabolic alkalosis can occur with respiratory compensation.
True.
46
What condition is indicated by HCO3- levels of 38 mmol/L?
Metabolic alkalosis.
47
What is the typical compensation for metabolic acidosis?
Respiratory compensation through hyperventilation.
48
What might cause confusion and restlessness in patients?
Acidosis.
49
What does renal tubular acidosis lead to?
Reduced excretion of HCO3-.
50
What are the normal ranges for pCO2?
35 – 45 mmHg.
51
What is the effect of H+ on the oxyhemoglobin dissociation curve?
Causes a right shift, facilitating O2 delivery.
52
Fill in the blank: In metabolic acidosis, H+ levels can lead to impaired _____ delivery after several hours.
O2.
53
What happens to potassium homeostasis during metabolic acidosis?
Leakage from cells causes high plasma K+.
54
What is a potential cause of lactic acidosis?
Tissue hypoxia.
55
What are typical symptoms of respiratory acidosis?
* Cough * Wheeze * Breathlessness
56
What is the primary compensation for respiratory acidosis?
Metabolic alkalosis.
57
What does the term 'decompensation' refer to?
The failure of compensatory mechanisms in acid-base disorders.
58
What is the impact of renal failure on acid-base balance?
It can lead to reduced excretion of acids and metabolic acidosis.
59
What is respiratory acidosis?
A condition characterized by increased CO2 levels leading to decreased blood pH ## Footnote Causes include airway obstruction, respiratory arrest, and chronic lung diseases.
60
What are the causes of respiratory acidosis?
* Acute airway obstruction * Cardio-respiratory arrest * Infective exacerbation (e.g., COPD, pneumonia) * Neurological causes (e.g., opiate toxicity, Guillain-Barre syndrome, myasthenia gravis) * Chronic COPD * Obesity (obstructive) * Pulmonary fibrosis (restrictive) * Neuromuscular diseases (e.g., MND, myopathy) ## Footnote Differentiate between acute and chronic causes.
61
What are the effects of hypercapnia in respiratory acidosis?
* Shortness of breath (SOB) * Neurological effects (anxiety, coma, headache, myoclonus) * Cardiovascular effects (systemic vasodilatation) ## Footnote Symptoms may vary based on underlying pathology.
62
What is the primary disorder in case 3?
Acute respiratory alkalosis with no compensation ## Footnote This is indicated by low CO2 levels and normal HCO3.
63
What are the causes of respiratory alkalosis?
* Acute conditions (e.g., asthma, COPD exacerbation, pulmonary embolism) * Pain or panic attacks * Iatrogenic causes (over-ventilation) * Altitude sickness * Inappropriate stimulation of the respiratory center (e.g., head injury, raised ICP) * Metabolic causes (e.g., hepatic encephalopathy, salicylate poisoning) * Pregnancy (physiological) ## Footnote Distinguish between acute and chronic causes.
64
What are the effects of respiratory alkalosis?
* Acute hypocapnia * Cerebral vasoconstriction (lightheadedness, confusion, syncope) * Fall in ionized calcium (perioral and peripheral paraesthesia) * Increased heart rate and vasoconstriction ## Footnote Symptoms may include chest tightness in patients with coronary artery disease.
65
What is the primary disorder in case 4?
Metabolic alkalosis with partial respiratory compensation ## Footnote Indicated by high HCO3 levels and elevated pCO2.
66
What leads to metabolic alkalosis in case 4?
Severe vomiting ## Footnote Vomiting causes loss of acid and leads to alkalosis.
67
What are the potential causes of metabolic alkalosis?
* Vomiting * Diuretics * Hyperaldosteronism * Cushing's syndrome * Excessive intake of alkali * Hypokalemia ## Footnote Each of these factors can contribute to an increase in blood pH.
68
What is the significance of clinical context in diagnosing acid-base disorders?
Clinical context is crucial for interpreting lab results correctly ## Footnote Results may appear normal without considering the patient's symptoms and history.
69
Fill in the blank: Respiratory acidosis is characterized by increased _____ levels.
CO2
70
Fill in the blank: The primary compensatory mechanism for metabolic alkalosis is _____ respiration.
respiratory
71
What is the equilibrium reaction for bicarbonate?
HCO3- + CO2 + H2O ⇔ H2CO3 ⇔ H+ + HCO3-
72
What is respiratory acidosis caused by?
Hypoventilation, over-production of CO2, impaired excretion of H+
73
What are the causes of metabolic acidosis?
Unusual losses of H+, overproduction of H+, impaired renal excretion
74
What causes metabolic alkalosis?
Loss of H+ ions, gain of HCO3-, unusual ingestion of bicarbonate
75
What is a common effect of metabolic alkalosis?
May cause a shift of K+ into cells
76
What is the significance of IV sodium bicarbonate in CKD?
Can exacerbate metabolic acidosis
77
What should be considered when interpreting blood gas results?
Adequate oxygenation, pH or [H+], pCO2 disturbance, [HCO3-] disturbance
78
What is the primary disturbance in acid-base disorders usually matched with?
Underlying cause and direction of [H+] change
79
How does renal compensation for respiratory acidosis occur?
Slowly and usually only in chronic respiratory acidosis
80
What are the primary acid-base disturbances?
Respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis
81
In what condition is compensation for alkalosis usually limited?
Metabolic alkalosis
82
What should be checked if blood gas interpretation does not make sense?
Error in blood sampling, transport, or measurement
83
What categories do causes of acid-base disorders fall into?
Abnormal acid production, respiratory and renal pathologies, fluid loss
84
What is crucial for acid-base homeostasis?
Maintaining a balance against acidity
85
What is the H-H equation used for?
Describing extracellular fluid acidity
86
What is a key skill for managing patients with acid-base disorders?
Basic interpretation of blood gases
87
What percentage of blood gases are typically easy to interpret?
99%
88
What should be sought out for practice in blood gas interpretation?
Examples from online resources, textbooks, and clinical placements

Renal and urology (12 decks)

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