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ANESTHESIA PRACTICE 2 > ACID-BASE REGULATION > Flashcards

ACID-BASE REGULATION Flashcards

(45 cards)

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1
Q

define acid

A

any substance that acts as a proton (H+) donor

AH A- + H+

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2
Q

name 3 strong acids

A

hydrogen chloride (HCl), sulfuric acid (H2SO4), phosphoric acid (H3PO4)

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3
Q

name 2 weak acids

A

carbonic acid (H2CO3), acetic acid (CH3COOH)

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4
Q

define base

A

any substance that acts as a proton recipient

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5
Q

name 3 strong bases

A 
sodium hydroxide (NaOH), potassium hydroxide (KOH)
B + H+  BH+
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6
Q

name 3 weak bases

A

sodium bicarbonate (NaHCO3), ammonia (NH3), sodium acetate (CH3COONa)

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7
Q

define pH

A

negative decimal logarithm of the hydrogen ion (H+) concentration
pH = -log [H+]

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8
Q

what is the normal pH range of blood?

A

7.35 – 7.45

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9
Q

what is the human basal metabolism rate of CO2 production?

A

13 moles/day (>20 moles with activity)

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10
Q

what values of pH will not sustain life?

A

pH 7.8

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11
Q

what are the mechanisms of equalizing pH?

A
  • buffering
  • respiratory (rapid response to pH disturbance to temporize the problem)
  • renal (ultimate excretion and/or reabsorption of acids (H+)/bases (HCO3-))
  • bone (fast and slow response systems built in to store/release needed elements)
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12
Q

describe buffering

A

weak acids and bases can dissociate, therefore donating/accepting an exogenous proton

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13
Q

define K (dissociation constant)

A

K = (H+ x A-) / (HA)

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14
Q

define the hendersen- hasselbach equation

A

pH = pK + log(A- / HA)

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15
Q

define the steps of the bicarbonate buffer system

A

CO2 + H2O H2CO3 H+ + HCO3-

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16
Q

how is the pH of the bicarbonate system determined?

A

pH = 6.1 + log ([HCO3] / (0.03*PaCO2))

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17
Q

why is bicarbonate such an efficient buffer?

A

2-sided elimination (CO2 and HCO3-)

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18
Q

what is the pK of bicarbonate?

A

6.1

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19
Q

which proteins in the protein buffer system have positively charged side groups?

Study These Flashcards
A

lysine (Lys, K), histidine (His, H), asparagine (Asn, N)

20
Q

which proteins in the protein buffer system have negatively charged side groups (negatively charged at physiologic pH)?

Study These Flashcards
A

glutamate (Glu, E), aspartate (Asp, D)

21
Q

why is the protein buffer system not very efficient?

Study These Flashcards
A

concentrations in plasma are too low for clinical significance

22
Q

define the steps in the phosphate buffer system

what is the pKa?

Study These Flashcards
A

H2OP4- H+ + HPO4(2-)

pKa = 7.21

23
Q

where is phosphate buffer system most/least efficient?

Study These Flashcards
A

most efficient in intracellular environment

least efficient in plasma (concentration too low for clinical significance)

24
Q

define the hemoglobin buffer system

Study These Flashcards
A

hemoglobin rich in histamine with a pKa of 6.8
* exists both as potassium salt or a weak acid
* H+ + KHb HHb + K+
(can serve as both proton acceptor (base) or donor (acid)

25
what is the second most important plasma buffer after bicarbonate?
hemoglobin buffer
26
describe the importance of bone as a buffering system
* most of bone is acellular hydorxyapatite crystal (can serve as a CO2 reservoir) * most important in chronic metabolic acidosis * generally a slower-responding buffer system
27
define acidemia
pH value lower than normal reference
28
define alkalemia
pH value higher than normal reference
29
define adicosis
excess of acid
30
define alkalosis
excess of alkali
31
define respiratory (in terms of pH balance)
disorder involves CO2
32
define metabolic (in terms of pH balance)
disorder involves all body acids except CO2
33
define anion gap
difference between sum of major cations and anions | * Na+ - (Cl- + HCO3-) = 8-12mmol/l (normally)
34
what is the expected compensation for metabolic acidosis?
decrease PaCO2 = 1.2 x [decrease in HCO3-]
35
what is the expected compensation for metabolic alkalosis?
increase PaCO2 = 0.7 x [increase in HCO3-]
36
what is the expected compensation for acute/chronic respiratory acidosis (increased PaCO2)?
acute: increase [HCO3-] 1mmol/L for every 10mmHg increase in PaCO2 chronic: increase [HCO3-] 4mmol/L for every 10mmHg increase in PaCO2
37
what is the expected compensation for acute/chronic respiratory alkalosis (decreased PaCO2)?
acute: decrease [HCO3-] 2mmol/L for every 10mmHg decrease in PaCO2 chronic: decrease [HCO3-] 4 mmol/L for every 10mmHg decrease in PaCO2
38
what are the renal causes of non-gap metabolic acidosis?
* renal tubular acidosis | * carbonic anhydrase inhibitor diuretics
39
what are the GI causes of non-gap metabolic acidosis?
* severe diarrhea * uretero-enterostomy or obstructed ileal conduit * drainage of pancreatic or biliary secretions * small bowel fistula
40
what are some other causes of non-gap metabolic acidosis?
addition of HCl or NH4Cl
41
name three causes of metabolic alkalosis
1. addition of base to ECF * milk-alkali syndrome * excessive NaHCO3 intake * massive blood transfusion (citrate) 2. chloride depletion * loss of acidic gastric juice (vomiting) * diuretics (furosemide/thiazide – impair Cl reabsorption) 3. potassium depletion * hyperaldosteronism (increased tubular Na+ reabsorption/K+ and H+ excretion) * cushing's syndrome * kaliuretic diuretics * excessive licorice intake (glycyrrhizic acid)
42
name three causes of respiratory acidosis caused by impaired CO2 elimination
1. CNS depression * drug depression of resp. center * CNS trauma or tumor * hypoventilation of obesity 2. nerve or muscle disorders * myasthenic syndromes * muscle relaxant drugs 3. mechanical * chest trauma * pneumothorax * restrictive lung disease * aspiration * upper airway obstruction * laryngospasms * bronchospasm/ asthma * inadequate mechanical ventilation
43
name two causes of respiratory acidosis caused by overproduction of CO2
1. hypermetabolic disorders * malignant hyperthermia * fever 2. increased intake * rebreathing exhaled gas * absorption from laparoscopy
44
name four causes of respiratory alkalosis
1. central causes (direct via respiratory center) * injury/stroke * hyperventilation (anxiety, pain, fear, stress) * various drugs/endogenous compounds 2. hypoxemia * respiratory stimulation via peripheral chemoreceptors 3. pulmonary causes (act via intrapulmonary receptors) * PE, pneumonia, asthma, pulmonary edema 4. latrogenic (act directly on ventilation) * excessive controlled ventilation
45
what is the albumin/malnourishment anion gap correction formula?
anion gap + (2.5 * (4-albumin))

ANESTHESIA PRACTICE 2 (5 decks)

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