Lecture 4/22 - Acid/Base Flashcards

Final (97 cards)

1
Q

______ (2) sensors in the peripheries look at ________ (2) to adjust ventilation. What is the control center for ventilation?

A

Nerve (neural) & gas

pH (acid/base) & CO₂ levels

Control center = Brain stem

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2
Q

Equation: Oxygen tension/PAO2

A

[(PB - 47mmHg) x FIO2] - PaCO2/R

‘alveolar gas equation”

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3
Q

What is R in the Oxygen tension formula?

A

R = respiratory exchange rate

CO₂ produced : O₂ consumed

It is required for the O₂ tension PAO₂ (alveolar) formula

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4
Q

Why do planes fly at higher altitudes?

A

Higher altitude → air thinner → more fuel efficient/better mileage

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5
Q

Planes usually fly at _______ ft high. The barometric pressure here is _____. What is the PO₂?

A

30,000 - 40,000 ft

141 mmHg (About 200 according to Schmidt)

29 mmHg

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6
Q

How does the plane combat low barometric pressures? Why is this needed?

A

Air is pumped in from the outside while maintaining the cabin pressurized to 8000 ft or 0.75 atm

Not pressurized to sea level because that is dangerous!!

Low PB → low PO₂ → even lower PAO₂ → humans cannot live like this

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7
Q

What conditions put you at risk of an adverse event at high altitudes? Why?

A

Pulmonary issues and a bad heart (Right heart especially)

Low PO₂ = hypoxia → blood vessels in lungs will constrict (HPV) → sufficient blood not going to lungs AND R heart has to push against higher pressure d/t constricted vessels → worsened oxygenation

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8
Q

Which side of the heart is stronger? Why?

A

L heart stronger

Operates at higher pressures normally

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9
Q

Why do the masks fall down on the plane? Describe what is happening

A

When plane depressurizes suddenly — trying to equilibrate with barometric pressure (not good)

Masks are hooked to containers that undergo a chemical reaction and are a source of concentrated oxygen

Helps to keep you conscious while pilot rapidly descends to safe altitude

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10
Q

What causes rapid loss of consciousness when a plane suddenly depressurize? What is recommended bc of this?

A

PAO2 <29 mmHg & PaO2 = 100 mmHg

This causes the gradient (delta P) to work in reverse pulling O2 off hb from pulm capillaries (out of the circulatory system) & back into the alveoli –> Brain sensitive to low oxygen –> within SECONDS unconscious

Recommended: PUT YA MASK ON FIRST!!!!!!!!!!!!! IDC ABOUT NO KIDS IDC IDC

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11
Q

Why aren’t pilots allowed to have beards?

A

For mask fitting for decompression

They have personalized masks that need to fit tightly on their face

They have different mask and separate oxygen reservoirs (duhh they are controlling the plane they need to stay conscious)

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12
Q

_______ is the chemical reaction that takes place when the masks fall on the plane during sudden decompression.

What does this reaction produce?

What consideration should I have?

A

Exothermic reaction

Byproducts: heat & oxygen

Considerations: if not maintained/serviced regularly → prematurely goes off

heat + O₂ + pressure = fires and explosions

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13
Q

The normal range for blood pH is ____ to _____.

Normal physiological/arterial pH is _____.

A

7.35 - 7.45

7.4

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14
Q

pH less than 7.35 = ______ and greater than 7.45 = _______. What can cause this?

A

acidosis

alkalosis

Respiratory (lungs) or metabolic (not lungs/probably kidney)

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15
Q

Acidity in the body depends on __________.

A

Hydrogen ions concentration = protons concentration

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16
Q

What does [H⁺] mean? Why?

A

Proton or Hydrogen ion CONCENTRATION in a solution (blood)

We measure proton concentration vs proton count because blood is relatively dilute with free protons → protons directly related to concentration

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17
Q

The main acid in the body is _____. It is considered a ______ acid and a ________ gas

A

CO2

weak

volatile

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18
Q

What does volatile mean?

A

It can go airborne (doesn’t necessarily have to always be airborne)

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19
Q

CO₂ + water =

A

H₂CO₃ (Carbonic Acid)

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20
Q

Equation: Acid Dissociation Formula

A

HA ⇄ H⁺ + A⁻

HA = Acid

H⁺ = proton

A⁻ = conjugate base

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21
Q

What are properties of strong acids?

Give an example.

A

Produce: Proton & weak conjugate base
- Easily dissociates (donates/produces proton)
- Extra protons can cause damage (more acidic environment due to conjugate not wanting proton back)

Example = HCl (hydrocloric acid)
HCL ⇄ H⁺ + Cl⁻

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22
Q

What are properties of weak acids? examples.

A

Produces: Proton & Strong conjugate base

Example: H₂CO₃ (Carbonic Acid)

H₂CO₃ ⇄ H⁺ + HCO₃⁻

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23
Q

A base formed from an acid falling apart is called a ______

A

Conjugate base

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24
Q

What are properties of weak conjugate bases? examples.

A

Made from strong acids

WCB don’t like to grab back on to protons (want to donate it as well…)

Example = Cl⁻
HCL ⇄ H⁺ + Cl⁻

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25
What are properties of strong conjugate bases? Give an example.
Made from weak acids Likes to accept protons Example = HCO₃⁻ H₂CO₃ ⇄ H⁺ + HCO₃⁻
26
The ratio of CO₂ : H₂CO₃ molecules in the body is _______. What does this mean & why?
1000:1 Carbonic acid is very dilute & in low concentrations in the body. That is because its being used to either create HCO₃⁻ (and H⁺) or going back into Water and CO₂
27
How is carbonic acid replenished? Why is this necessary?
Quickly replenished from (water + CO₂) or (H⁺ + HCO₃⁻) in the area. Low amounts in the body & difficult to measure.
28
What are non-volatile acids in the body? (6) What does this mean?
1. Sulfuric acid (H₂SO₄) 2. Phosphoric acid (H₃PO₄) 3. Hydrochloric acid (HCl) 4. Lactate/lactic acid (C₃H₆O₃) 5. Ascorbic acid (Vitamin C) (C6H8O6) 6. Salicylic acid (C7H₆O₃) These acids cannot go airbourne → cannot turn into CO₂ and be removed via the lungs Has to be removed by kidneys or liver has to metabolism into something different that can be excreted via kidneys or can be used in the body
29
What is the alternate name for sulfuric acid? (This pertains to all acids)
Sulfuric acid = sulfate -ate = acid
30
T/F: We produce alot of non-volatile acids
**False** A healthy person does NOT. An unhealthy person...maybe
31
What is the purpose of nonvolatile acids? What changes can you make to reduce to production of nonvolatile acids?
Breakdown of food → esp. proteins Avoid protein → go vegetarian This may only be needed if normal mechanisms to get of them aren’t working Kidney failure/liver failure → can be bad when accumulating
32
What are abnormal acids in the body? (2) Describe them.
**Acetoacetic acid**: Produced in ppl w poor glucose management DM & alcohol hangovers - can’t process sugar → use different metabolic pathway → this is a byproduct - similar to acetone (produces similar smell from DM) **Butyric acid**: Produced in poorly managed DM & poor health - production unexplained **These are both pathological because they are abnormal and should not be present** - These are acids → interact w/ CO₂ in body - Potential proton donors!!!! -These are nonvolatile → handled by kidney & liver
33
What are the byproducts of alcohol hangovers? (2) What causes the hangover effect?
**Acetoacetic acid and actelaldehyde** are the byproducts that cause hangover effects Alcohol dehydrogenase → the enzyme that breaks down ethanol
34
An example of a weak base that we use everyday is ______. What is its purpose?
**Sodium Fluoride (NaF)** Toothpaste → buffer pH in mouth to prevent acid from decaying teeth
35
Proteins are combinations of _________. What is their purpose? (4)
**Amino acids** Proteins Purposes: 1. Structural 2. Enzymatic 3. Buffering 4. Assisting w/ other processes
36
T/F: Amino acids can have different charges.
**True** Positive, negative, or neutral
37
T/F: Proteins can be in both water soluble and lipid soluble areas.
**True**
38
What does normal protein structure & function depend on?
**Normal amounts** of protons (positively charged) interacting with the proteins (negatively charged)
39
What happens to proteins when the enviroment (blood) is more acidic than normal? Examples. (3) Describe them.
**There’s a decrease in pH → causing an increase in free [H⁺] interacting with proteins → changes the structure of protein → decreases functionality of the protein** Example 1) Hb -changes structure → **O₂ falls off** -**O₂ dissociation curve shifts to RIGHT = BOHR EFFECT** Example 2) Na⁺/K⁺/ATPase pump -Needs ATP to function -changes structure → **pump slows down** d/t decreased functionality → K⁺ leaks back out of cell & pump can’t sequester K⁺ into cell → **hyperkalemia** Example 3) ATP synthase (creates ATP and is abundant in mitochondria) -changes structure → slows down pump d/t decreased functionality → **less ATP generated → less ATP for Na⁺/K⁺/ATPase pump** → Na⁺/K⁺/ATPase pump affected 2x → hyperkalemia worsens
40
Everything in the body is run off of the ______ pump
Na⁺/K⁺/ATPase pump
41
How is ATP created?
From ATP synthase Created in the mitochondria via **oxidative phosphorylation** in electron transport chain → ECT harness electrons to create a proton gradient → **uses proton gradient to SPIN pumps to make ATP** → oxygen accepts electrons to keep the chain moving Spinning the pumps is what creates ATP
42
What uses the most ATP in the body?
Na⁺/K⁺/ATPase pump
43
How does acidosis affect respiration?
Mild Acidosis → Increased respiratory rate Severe Acidosis → impairs neural tissue → Supress breathing/apnea
44
Dissociation of all compounds in the body is based on ______ in the system. What should you do if its abnormal?
pH Abnormal pH: make adjustments to type of drug, administration route, dosage
45
_____ helps with absorption or distribution with prescribed drugs. It’s a normal additive in prescriptions drugs because it provides stability.
HCl = hydrochloric salt (acid)
46
An example of an extremely basic drug is ________. What adverse effect does this have?
Sodium phenobarbital Fast IV infusion = Painful
47
What is the equation for pH?
For an Acid → pH = -log [H⁺] For a Base → pH = 14 - (-log [H⁺])
48
What is the equation to find [H⁺]? What is the equation to find [OH⁻]?
[H⁺] = 1 x 10[-(pH)] [OH⁻] = 1 x 10[-(14 - pH)]
49
pH range is from ________. Neutral is ____, acidic is _____ and basic is ______.
1 - 14 Neutral = 7 Acidic <7 Basic >7
50
What are the units for concentration of protons [H⁺]?
millimoles/Liter (mmol/L) Nanomoles/Liter (nmol/L)
51
pH is a _______ log
base 10 log log (10) = 1 x 10-[pH]
52
What is the most acidic acid in the body? How does the body handle this? What is its function?
Gastric secretions in stomach pH = 1 Tissues in stomach designed to be resistant to the secretions that it produces (thick & leathery) Function: Degrade food
53
What is the most basic acid in the body? What is its function?
Pancreatic secretions = Bicarbonate pH = 8 Function: Pancreas is behind the stomach & slightly early in digestive tract, **neutralizes gastric acid** to prevent destruction of intestines (soft tissue)
54
There is _____ volume of pancreatic secretions than gastric secretions. Why?
**larger** volume of pancreatic secreations --------------------- gastric pH = 1 & pancreatic pH = 8 If you're comparing them to neutral = 7, gastric secretions are way stronger than pancreatic secreations Need more pancreatic volume to balance out the pH differneces from gastric being much stronger
55
If you have diarrhea, you become ______. Why?
**Acidotic** Increased intestinal motility → Less pancreatic secreations to neutralize acidic gastric secretions → Higher loss of bicarb vs gastric secretions → Acidosis
56
If you are vomitting, you become ______. Why?
**Alkalotic** Vomitting up gastric acid from stomach → LESS acidic gastric secretions for pancreatic secretions to neutralize → excess bicarb continuing to flow in high volumes → alkalosis (This can happen with obstruction)
57
10-3 = how many in milli, micro, and nano?
**milli** 1 milli (m) = 1,000 micro (µ) = 1,000,000 nano (n) 10-3 = 0.001
58
10-6 = how many in milli, micro, and nano?
**micro** 0.001 milli (m) = 1 micro (µ) = 1,000 nano (n) 10-6 = 0.000001
59
60
The pH survival limits are _________
6.9 - 7.8
61
An increase in pH by 1 _____ proton concentration by _____. What is happening to the solution?
decreases ; 10x Solution becoming more basic
62
A decrease in pH by 1 _____ proton concentration by _____. What is happening to the solution?
increases ; 10x Solution becoming more acidic
63
Small changes in pH = _______ changes in proton concentration
large
64
What do buffers do? (3)
- Stabilize pH - Donate protons - Bind to protons
65
What is the purpose of a pKa of a buffer?
pKa tells you the pH at which the buffer is most effective — in other words, the point where it can best resist changes in pH when acids or bases are added.
66
Name the important body buffers (3). Describe them
**1. Bicarbonate (HCO₃⁻)** - **Main extracellular fluid buffer** in kidneys (kidneys help produce & regulate it) **2. Proteins (Hb, plasma proteins)** - **Most abundant buffer in the intracellular fluid (ICF) and blood** - Protons positively charged & proteins to negatively charged → protons become not reactive - Hemoglobin (Hb) is a major buffer in RBCs: **3. Phosphate** - **Main intracellular fluid buffer** - High concentrations in cell used for: • Energy storage • Phosphorylation & dephosphorylation (turning things on/off)
67
What is required to take phosphate off adenosine? What is this process called?
ATPase De-phosphorylation
68
The ability of the body to adjust pH quickly, depends on our bodies ability to do what?
Get rid of CO₂ = lungs need to be working properly **affects the ability of other buffers to work properly**
69
What happens if any portion of the buffering system becomes dysfunctional?
Other buffers have to do more work (especially if its the lungs that are dysfunctional) Buffers don't work as efficiently
70
Blood buffer graph: What are the normal values for Hb, HCO₃⁻, pH, [H⁺]?
Hb = 15 g/dL [HCO₃⁻] = 24 mmol/L or mEq/L pH = 7.4 [H⁺] = 40 nmol/L (please take note of the units that will be on the graphs)
71
Blood buffer graph: Which line is the normal Hb line?
Hb = 15 g/dL = 6 mEq/L The only black line (normally 2nd line from the top)
72
Blood buffer graph: Decreased Hb = ________ bicarbonate. What happens to the slope of the line? What does this mean?
Decreased Slope decrease (more horizontal) → **buffer system LESS effective** dt less proteins
73
Blood buffer graph: Increased Hb = ________ HCO₃⁻ What happens to the slope of the line? What does this mean?
**Increased** Steeper slope (more vertical) → **buffer system MORE effective** due to more proteins
74
Blood buffer graph: Decribe the Hb deviations
They are the blue lines -Hb 20 is line UP from normal -Hb 10 is line BELOW -Hb 5 is below that (These lines dont have an axis so need to know, he wont put the number)
75
Blood buffer graph: What is an isobar? What is the normal value? Abnormal? How are they identified?
Curved line that represents arterial PCO₂ Normal: PCO₂ = 40 mmHg — 3rd isobar PCO₂ = 20 mmHg — 4th isobar PCO₂ = 60 mmHg — 2nd isobar PCO₂ = 80 mmHg — 1st isobar
76
If the pH is 8 the concentration of protons is _______
10 nmol/L or .01 mmol/L (There are many deviations of this... Please review metrics... could be funny and ask for it in kilomoles...)
77
Blood buffer graph: What does shifting to the isobar to the R indicate?
**Uncompensated respiratory alkalosis** PCO₂ = 20 mmHg (decreased) Bicarb = 19 mmol/L (decreased) pH = 7.6 (increased) [H⁺] = 25 nmol/L (decreased) (Note: This is assuming Hb = 15 g/dL)
78
Blood buffer graph: What does shifting to the isobar to the L indicate?
**Uncompensated respiratory acidosis** PCO₂ = 60 mmHg (increased) HCO₃⁻ = 26 mmol/L (increased) pH = 7.25 (decreased) [H⁺] = 55 nmol/L (increased) (Note: This is assuming Hb = 15 g/dL)
79
Increased CO₂ = _______ HCO₃⁻
**Increased**
80
Decreased CO₂ = _______ HCO₃⁻
decreased
81
Acid/Base imbalances: Uncompensated Respiratory Acidosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↓↓ PCO₂: ↑↑ HCO₃⁻: ↑ (Nomograph shift: up, left)
82
Acid/Base imbalances: Uncompensated Respiratory Alkalosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↑↑ PCO₂: ↓↓ HCO₃⁻: ↓ (Nomograph shift: down, right)
83
Acid/Base imbalances: Uncompensated Metabolic Acidosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↓↓ (d/t more protons) PCO₂: — HCO₃⁻: ↓↓ (Nomograph shift: down, left) **uncommon → respiratory system usually compensate quickly**
84
Acid/Base imbalances: Uncompensated Metabolic Alkalosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↑↑ (due to less protons) PCO₂: — HCO₃⁻: ↑↑ (Nomograph shift: down, right) **uncommon → respiratory system usually compensate quickly**
85
Acid/Base imbalances: Partially Compensated Respiratory Acidosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↓ PCO₂: ↑↑ HCO₃⁻ : ↑↑ Graph shift: further up, right **compensated by kidneys** Kidneys add more bicarb to help even out acidosis
86
Acid/Base imbalances: Partially Compensated Respiratory Alkalosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↑ PCO₂: ↓↓ HCO₃⁻: ↓↓ Graph shift: further down, left **compensated by kidneys** Kidneys reduced bicarb to help compensate with pH
87
Acid/Base imbalances: Partially Compensated Metabolic Acidosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↓ PCO₂: ↓↓ HCO₃⁻: ↓↓ **Compensated by lungs** Hyperventilation → blow off CO₂ → pH less abnormal (1 arrow)
88
Acid/Base imbalances: Partially Compensated Metabolic Alkalosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↑ PCO₂: ↑↑ HCO₃⁻: ↑↑ **Compensated by lungs** Hypoventilation → increase CO₂ → pH less abnormal (1 arrow)
89
Acid/Base imbalances: Respiratory & Metabolic Acidosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↓↓ PCO₂: ↑↑ HCO₃⁻: ↓
90
Acid/Base imbalances: Respiratory & Metabolic Alkalosis (LOOKING FOR TRENDS NOT NUMBERS)
pH: ↑↑ PCO₂: ↓↓ HCO₃⁻: ↑
91
What causes respiratory alkalosis? What tries to compensate for this?
Hyperventilation or blowing off too much CO₂ (increased RR or minute ventilation for too long) Kidneys compensate by producing less HCO₃⁻
92
What are causes of respiratory acidosis? (Very long list & very long card - Ones mentioned 1st; listed ones last)
1. Decreased ventilation: decreased O₂ in lung → increased CO₂ in blood 2. **Brain stem injury: Head injury → knocks out CNS → All respiratory control centers are here** 3. Spinal cord injury: above C3 = stop breathing; C4/lower = abnormal; includes accessory muscles too 4. Stroke: ischemic or hemorrhagic can affect brainstem 5. Kyphoscoliosis: Abnormal curvature in sagital & coronal plane → Plates & rods from Sx not flexible → difficult to breath normal (restrictive lung diesease) 6. Extreme obesity: decreases chest wall compliance 7. Positioning: laying on back decreases total compliance 8. Opiates: Ex) Fentanyl → worse than sedatives/benzos 9. Anesthetics/Sedatives/Paralytics 10. Volatile gases 11. **Barbiturates: Pure GABA agonists - massive impact on resp control centers - dangerous** ----------------- -restrictive lung diseases -pneumothorax, pleural effusions -pneumonia, pulmonary edema -obstructive diseases, airway obstructions -diseases affecting respiratory muscles -Botulism, Tetanus
93
Respiratory acidosis is associated with buildup of _______ due to _______
CO₂ Poor lung function
94
The phrenic nerve rises from?
C3 C4 C5
95
T/F: A young healthy 20 yo will be affected with respiratory acidosis from a lower thorax spinal injury affecting the accessory muscles.
False They actually may not be affected by this. If old & unhealthy, then they need those muscles so this population will be affected
96
The higher up the spinal injury = _______ The lower down the spinal injury = _________
**More severe** the breathing problems **Less severe** the breathing problems
97
T/F: Benzodiazepines are GABA pure agonists.
**False** They are not pure GABA agonists → Bind at the lower parts of the GABA-R **Causes respiratory distress in combination with pure GABA agonists like alcohol**