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Pathohysiology > Acid-Base Balance > Flashcards

Acid-Base Balance Flashcards

1
Q

what is the normal systemic arterial blood pH?

A

7.4

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2
Q

what is considered a basic pH?

A

greater than 7.4

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3
Q

what is considered an acidic pH?

A

less than 7.4

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4
Q

Compensation

A

the attempt of renal and respiratory mechanisms to reestablish a normal pH

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5
Q

correction

A

the reestablishment of a normal systemic arterial blood pH, bicarbonate concentration, and carbonic acid concentration

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6
Q

what happens is pH is out of the normal range?

A

alterations in ion balance
alterations in membrane potentials
changes in the conformation of proteins (enzymes)

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7
Q

which pH range is not compatible with life?

A

less than 6.8 and greater than 7.8

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8
Q

Acidosis _______ the plasma concentration of calcium. Why?

A

increases

bc H+ displaces Ca from protein which increases blood Ca

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9
Q

what are the effects of acidosis?

A

depression of the CNS

coma and death

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10
Q

alkalosis _____ the plasma concentration of Ca.

A

decreases

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11
Q

what are the effects of alkalosis?

A

hyper-excitability of the CNS

convulsions and death

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12
Q

what are some extracellular buffers?

A

Bicarbonate

ammonia

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13
Q

what are some intracellular buffers?

A

protein

phosphate

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14
Q

What would happen with an increase in CO2?

A

the production of H+ would increase

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15
Q

what is the main driver of respiration?

A

the need to exhale carbon dioxide

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16
Q

what is a respiratory mechanism for adjusting body pH?

A

changing rate and depth of breathing

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17
Q

what are the 5 renal/metabolic mechanisms?

A

1-secretion of hydrogen into the urine and the recovery of bicarbonate from the urine
2-creation of new bicarbonate from the kidney by secretion of H+
3-buffering of secreted H+ by phosphate
4-creating bicarbonate by producing ammonium
5-buffering of H+ by ammonia

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18
Q

explain active secretion of H+ into the urine and recovery of bicarbonate from the urine

A

the net result of a hydrogen being secreted into the urine is a bicarbonate being recovered from the urine.

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19
Q

how much bicarbonate is usually recovered from the kidneys?

A

over 90%

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20
Q

explain the creation of new bicarbonate by primary active secretion of H+

A

hydrogen is secreted into the urine which increases the H+ concentration which then decreases pH. Because ATP is present, it allows H+ to go against its gradient (keep getting pumped out even though it’s concentration is high) new bicarbonate is synthesized rather than uptaken

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21
Q

what is the lowest urine pH?

A

4.5

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22
Q

describe the creation of new bicarbonate through buffering of secreted hydrogen by phosphate

A

hydrogen pumped into the urine combines with buffers in the urine. the NaHPO4- is converted into NaH2PO4. Bicarbonate can then be synthesized.

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23
Q

what does converting NaHPO4- to NaH2PO4 enable?

A

we are then able to trap more H+ in the urine and thus produce more bicarbonate

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24
Q

describe creation of new bicarbonate through direct production of ammonium

A

when arterial blood pH is low, glutamine is converted to ammonium and bicarbonate. the ammonium is transported into the urine which results in an ammonium increase in urine.

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25
Q

describe the production of new bicarbonate through the buffering of ammonia

A

this occurs in the collecting ducts. we have ATP mediated transport of H+ into the urine which allows it to combine with ammonia and then more can be pumped out. one new bicarbonate ion is synthesized as the result of pumping out one H+.

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26
Q

what is the source of intracellular H+?

A

anaerobic (non-mitochondrial) metabolism of glucose.
ATP hydrolysis (big source of H+)
excessive formation of ketones

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27
Q

what about the excessive formation of ketones?

A

it reduces pH
they are produces in the liver by converting acetyl-CoA to ketones which are acidic.
insulin inhibits ketogenesis

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28
Q

how do we correct changes in pH?

A

chemical buffering
respiratory compensation
renal compensation

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29
Q

chemical buffering

A

occurs almost instantly

30
Q

what is important considering buffers are rapidly exhausted?

A

this requires the elimination of hydrogen ions to remain effective

31
Q

respiratory compensation

A

the respiratory center in the brainstem responds rapidly t changes in CSF pH. So, a change in plasma pH or pCO2 results in change in ventilation within minutes.

32
Q

renal compensation

A

the kidneys respond to acid base balance changes by altering the amount of bicarbonate reabsorbed and hydrogen ions excreted. but, this takes a while. It can take up to 2 days for bicarbonate concentration to reach a new equilibrium.

33
Q

pCO2 of arterial blood is basic if

A

pCO2 is less than 35-45 mmHg

34
Q

pCO2 of arterial blood is acidic if

A

pCO2 is greater than 35-45 mmHg

35
Q

HCO3- of arterial blood is acidic if

A

HCO3- is lesst han 24-28 mM

36
Q

HCO3- of arterial blood is basic if

A

greater than 24-28mM

37
Q

the problem is respiratory if

A

pCO2 matches pH

38
Q

the problem is Metabolic (renal) if

A

HCO3- matches pH

39
Q

how do you know which system is compensating for a change?

A

you determine which if opposing pH

40
Q

what happens during respiratory acidosis?

A

there is a carbonic acid accumulation

hypercapnia (pCO2 > 40 mmHg)

41
Q

what conditions can induce respiratory acidosis?

A

depression of respiratory center-drugs of head trauma
paralysis or trauma of respiratory or chest muscles.
chronic pulmonary disease (emphysema)

42
Q

what are the symptoms of respiratory acidosis?

A

change in awareness and muscle control

respiration rate is initially high although ventilation is low (shallow breathing)

43
Q

what are some symptoms during early respiratory acidosis?

A

restlessness

apprehension

44
Q

what are some symptoms during middle respiratory acidosis?

A

lethargy

muscle twitching tremors

45
Q

what are some symptoms during severe respiratory acidosis?

A

coma

death

46
Q

what happens when metabolic compensation kicks in during respiratory acidosis?

A

conservation of HCO3-
an increase in HCO3- synthesis
elimination of H+ in the urine

47
Q

how do you treat respiratory acidosis?

A

ventilation and treat cause of condition

bicarbonate IV infusion if pH is less than 7

48
Q

what happens during respiratory alkalosis?

A

there is a deficit of carbonic acid

hypocapnia (pCO2<35 mmHg)

49
Q

what is the most common acid base imbalance?

A

respiratory alkalosis.

hypocapnia (pCO2<35 mmHg)

50
Q

what are some conditions that can induce respiratory alkalosis?

A 
O2 deficiency at high altitudes (low paO2)
fever
acute anxiety (hyperventilation)
51
Q

what are some symptoms of respiratory alkalosis?

A

dizziness
confusion
tinglng of extremities
coma (late)

52
Q

How do we compensate for respiratory alkalosis?

A

excrete HCO3-
reduce HCO3- synthesis
conserve H+

53
Q

how do we treat respiratory alkalosis?

A

treat cause of condition

have the patient re-breathe respiratory gases

54
Q

metabolic acidosis

A

bicarbonate deficit

HCO3- < 24mM

55
Q

what are some conditions that can induce metabolic acidosis?

A

diabetic ketoacidosis (kidneys likely suffering)
extreme prolonged exercise
renal failure
severe diarrhea

56
Q

what are some symptoms of metabolic acidosis?

A 
headache 
lethargy 
coma (late)
deep and rapid respiration 
nausea
vomiting 
diarrhea
57
Q

what is respiratory and metabolic compensation for metabolic acidosis?

A

increase ventilation (to reduce pCO2-kussmaul breathing)
increase HCO3- recovery (if kidneys are functional)
increase HCO3- synthesis
increase H+ excretion

58
Q

how do you treat metabolic acidosis?

A

treat cause of condition

if pH is less than 7, infuse with bicarbonate

59
Q

disorders that cause you to hyperventilate could cause a

A

change in pH

60
Q

Metabolic Alkalosis

A

bicarbonate excess

HCO3 >28 mM

61
Q

what are conditions that can induce metabolic alkalosis?

A

loss of gastric juices due to vomiting or suction of stomach
excess bicarbonate ingestion or infusion

62
Q

what are some symptoms of metabolic alkalosis?

A 
weakness
muscle cramps
hyperactive reflexes
respiratory slow and shallow 
confusion 
convulsions
63
Q

what is the respiratory and metabolic compensation for metabolic alkalosis?

A

reduce ventilation (increase pCO2)
decrease HCO3- recovery (if kidneys functional)
decrease HCO3- synthesis
decrease H+ excretion

64
Q

how do you treat metabolic alkalosis?

A

treat cause of condition

if severe, HCl infusion

65
Q

Respiratory failure that resulted in decrease delivery of oxygen to the tissues of the body and decreased removal of carbon dioxide from the body can result in

A

a combined metabolic and respiratory acidosis

66
Q

normal

A

pH-7.4
pCO2-40
HCO3- 24

67
Q

respiratory acidosis

A

ph-7.1 acidic
pco2- 80 acidic
bicab 24 normal

68
Q

respiratory alkalosis

A

ph 7.5 basic
pco2 30 basic
bicarb 42 normal

69
Q

metabolic acidosis

A

ph 7.2 acidic
pco2 40 normal
bicarb 20 acidic

70
Q

metabolic alkalosis

A

ph 7.8 basic
pco2 40 normal
bicarb 60 basic

71
Q

respiratory alkalosis with metabolic compensation

A

ph 7.5 basic
pco2 20 basic
bicarb 16 acidic

72
Q

combines respiratory and metabolic acidosis

A

ph 7.2 acidic
pco2 48 acidic
bicarb 18 acidic

Pathohysiology (16 decks)

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