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AP2 > Lecture 4/24 - Acid/Base > Flashcards

Lecture 4/24 - Acid/Base Flashcards

Final

1
Q

________ ⇋ Strong bases + H+

A

Weak conjugate acid

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2
Q

Strong bases want to ________ a proton and create _______.

A

Accept

Weak conjugate acids

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3
Q

________ ⇋ Weak bases + H+

A

Strong conjugate acid

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4
Q

Weak bases want to ________ a proton and create _______.

A

donate (less likely to combine with)

Strong conjugate base

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5
Q

Equation: Buffer

A

Buffer + H+ ⇋ HBuffer

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6
Q

What is the function of buffers?

A

To correct acidosis or alkalosis by stabilizing pH

Ionized buffers: binds with free protons to help correct acidosis (Buffer + H+)

Nonionized buffers: Can donate protons to help correct alkalosis (HBuffer)

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7
Q

What are the main 3 buffers in the body?

A
  1. Bicarb (predominant ECF)
  2. Phosphate (predominant ICF; important plasma despite low concentration in ECF)
  3. Proteins (2nd most important
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8
Q

Kidneys use ________ to buffer urine to prevent a _______ pH during urination

A

Ammonia

Low –> painful

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9
Q

T/F: A buffer is best at buffer a pH at its pKa value

A

T

This gives you 50% ionized & 50% nonionized –> Buffer can either donate or accept protons

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10
Q

The pK of bicarb as a buffer is _____ and is the best buffer in the body for preventing ______

A

6.1

Acidosis

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11
Q

The ______________ refers to the fact that all buffers work together at the same time with different pKa’s and work on the same pool of protons to maintain pH

A

Isohydric principle

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12
Q

Blood buffer graph: what does the buffer line represent?

A

Combination of bicarb, proteins, phosphate

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13
Q

Blood buffer graph: Why is albumin not included in the buffer line? What does it more so concern?

A

Amount of albumin in plasma is extremely small compared to large amount of Hb/protein inside RBC

Important w/ osmotic pressure & keeping fluid within the CVS

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14
Q

T/F: Hb is found in the plasma

A

F

Component of ICF of RBC

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15
Q

Hematocrit of the blood is ____. For every liter of blood _____ cc is RBC.

A

0.4

400cc
(within this is alot of Hb)

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16
Q

Blood buffer graph: Add Hb = line ______. How does this affect the buffering system?

A

Line get steeper (more vertical)

Better buffering system

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17
Q

Blood buffer graph: Subtract Hb = line ______. How does this affect the buffering system?

A

Line get flatter (more horizontal)

Less effective buffering system

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18
Q

Blood buffer graph: How does the isobars change with Hb?

A

Increase Hb: Isobars come closer to the 40mmHg isobar (compressed)
-Greater change in bicarb when +/- CO2 –> helps block some of the pH changes
-Better buffer

Decrease Hb: Isobars spread farther from the 40mmHg isobar (stretched)
-Less change in bicarb when +/- CO2 –> Not able to cope w/ pH changes –> Larger pH changes
-Less effective buffer

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19
Q

The lungs are the _____ buffers & the kidneys are _______ buffers.

A

Short term

Long term

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20
Q

How does the kidneys assist with acid/base balance?

A

Excrete protons (via urine)
Reabsorb protons

Excrete bicarb (urine)
Reabsorb bicarb
Create new bicarb

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21
Q

The graph with the flower that has all the acid/base conditions is called a ________. What is it used for?

A

nomograph

-cause of acid base problems
-determine appropriate treatment

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22
Q

Nomograph: Acute respiratory acidosis

A

-reduction in drive to breathe
-acute = kidneys not adjusting

PCO2: elevated
pH: decreased
Bicarb: increased
Protons: increased
———————
Rationales:

Increased PCO2 + H2O (in blood) = Increased bicarb + H+

Proton that is created is decreasing the pH
-Bicarb is increasing

-Bicarb is acting as a weak base –> does not want to accept proton

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23
Q

Nomograph: Acute respiratory alkalosis

A

Caused by breathing too much (overventilation):
-anxious
-head injury
-seizure
-asthma attack

PCO2: decreased
pH: increased
Bicarb: decreased
Protons: decreased
(Isobar to the R )
———————-
Rationales:

-decreased PCO2 –> decreased bicarb
-increased proton –> increased pH

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24
Q

Nomograph: Chronic respiratory acidosis

A

PCO2: small increase
pH: small decrease
Bicarb: large increase
Protons: increase
——————-
Rationale:
pH & CO2 compensated by kidneys
-kidneys help w/ large increase bicarb
-kidneys pump protons into urine to help pH

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25
Nomograph: Chronic respiratory alkalosis
PCO2: small decrease pH: small increase Bicarb: large decrease Protons: decreased ----------------- Rationale: pH blunted by kidneys -less bicarb dt less CO2 & **kidney not reabsorbing bicarb** --> helps correct pH -kidney stops proton secretion (into tubule) & retains protons -- balances pH
26
Nomograph: Metabolic acidosis
PCO2: decreased pH: decreased Bicarb: decreased Protons: increased -------------- Isobar to the R Body hyperventilates
27
Nomograph: Metabolic alkalosis
PCO2: increased pH: increased Bicarb: increased Protons: decreased ---------------------- Isobar to the L Body hypoventilates
28
What is "gain" of a system? What is the normal gain of a system? Ex.
How much a problem in the system can be corrected **Formula: Correction / Error** Normal gain: 50% Ex) BP drops to 50 mmHg from 100 mmHg --> activate systems like ADH or catecholamines --> pressure goes up to 75 mmHg --> 25/50 --> 50%
29
Why is there no "acute/chronic" metabolic acidosis/alkalosis?
There isnt much difference between acute & chronic metabolic syndromes This is dt lungs & control centers in brain stem starting to buffer very quickly
30
The lungs start to buffer pH issues in ______ minutes.
3 minutes (Dr S says within seconds/immediately)
31
The response to metabolic acidosis is _______
Increased ventilation rate
32
The response to metabolic alkalosis is _______
Decrease ventilation rate
33
The lungs respond to acid/base issues _______ than the kidneys. I refuse to like
Faster
34
What are common causes of respiratory acidosis? (4/24 - Long card)
**hypoventilation** Depression of respiratory control centers: -Anesthetics -Sedatives -Opiates Brain injury/disease: -Head injury -Severe hypercapnia -Severe hypoxia Neuromuscular Disorders: -Spinal cord injury -Phrenic nerve injury: includes inadvertently saturating area with too much LA -Poliomyelitis, Guillain-Barre -Botulism, Tetanus -Myastenia Gravis -Curare-like drugs (NDNMB) -DIseases affect resp muscles Chest wall restriction: -Kyphoscoliosis: dt plates/screws holding ribs/vertebrae together --> thorax less flexible -Extreme obesity Lung restriction: -restrictive lung diseases -Pulmonary fibrosis -Sarcoidosis Pulmonary parenchymal disease -PNA -Pulmonary edema Airway obstruction: -Obstructive lung diseases -Upper airway obstruction: Collapse vocal cord; scar tissue from previous trach
35
What happens if you inadvertently block the phrenic nerve?
If healthy 20 yo: Ineffective breathing but still may be okat old & unhealthy: may need to swtich to GA --> RSI
36
Describe Botulism, Tetanus. What considerations should we have?
Prevents NS from talking to muscles that control botulinum tetanus --> **causes tetanic contracts** Respiratory muscles spasming --> air cannot move in/out of lungs properly
37
______ is associated with Lock Jaw
Botulism, Tetanus
38
Myasthenia Gravis is a problem occuring at the _______
NMJ
39
Why do obstructive & restrictive lung diseases cause acidosis?
Decreased ability to ventilate properly --> Mismatch V/Q --> dont bring O2 on or cant get rid of CO2 --> acidosis
40
Respiratory alkalosis is ______ common than acidosis
less
41
What are common causes of respiratory alkalosis? (4/24 - Long card)
**hyperventilation** --> blows off CO2 1. Extreme anxiety 2. Congenital hyperventilation syndromes 3. Inflammation of the brain: -Encephalitis -Meningitis 4. Tumors -on brainstem -in body that increase estrogen, estradiol, progesterone 5. Salicyclic sensitivity 6. Progesterone -Female hormone that interacts w brainstem -increases during pregnancy 7. High altitudes (hypoxia) -will hyperventilate to compensate for low O2 tension for first few days -Blowing CO2 off & there's no CO2 in air 8. Acute asthma dt anxiety 9. Overventilation w/ mechanical ventilation -dt accidentally inputting wrong targets ------------------ -Infection/fever -PE
42
Respiratory alkalosis from hyperventilation is normally dt _________ (2) issues
Neurological Psychological
43
Metabolic acidosis is caused by decreased _______ or increased ________.
Bicarb Acid
44
What are causes of metabolic acidosis?
1. Ingesting drugs/toxic substances: -methanol -salicylates -ethylene glycol (antifreeze) -ammonium chloride 2. Loss of bicarb -diarrhea -pancreatic fistula: produce more bicarb --> lost in feces -renal dysfunction: CANNOT PRODUCE NEW BICARB 3. Lactic acid production -hypoxemia -anemia -carbon monoxide -shock -severe exercise -ARDS -ketoacidosis -alcoholism -starvation: dt no energy intake -renal dysfunction: dt proton buildup
45
Methanol is a byproduct of _______ and is an ______. What does ingestion of this cause?
fermentation acid (causes acidosis) -can make you go blind -stimulates pancreas --> produces more secretions (bicarb) --> **diarrhea & bicarb lost** --> acidosis
46
Salicylates are _______-like compounds that are found in _______.
aspirin ance/face cleansers
47
Ethylene glycol is a component of _______. What does it do? What considerations should we have with this?
antifreeze Prevents car from freezing over Considerations: -**Sweet smell** & extremely toxic --> Keep away from kids and pets VERY SMALL AMOUNT IS TOXIC
48
Ethylene glycol in a European car is _______ and for a Japanese/American car it is _______. Why?
Blue Green dt using different chemicals
49
Ammonium chloride is in _________.
Chemical plant fertilizer (not explosive)
50
The most efficient way to produce ATP is via an ________ process involving _________ metabolism. How many ATPs per glucose molecule are produced?
aerobic (requires oxygen) oxidative 38 ATP molecules
51
A less effective and backup way to produce ATP is via an ________ process involving _________ metabolism. How many ATPs per glucose molecule are produced?
anaerobic (not requiring oxygen) glycolytic 2 ATP molecules
52
What are the main difference between glycolytic and oxidative metabolism?
glycolytic: no O2 -2 ATP -Lactate byproduct -More glucose required to meet metbolic demands of the body (each cycle requires a glucose oxidative: needs O2 38 ATP -Less glucose required
53
What causes Lactic acid?
A byproduct of glycolytic metabolism (anaerobic process) **Caused by decreased oxygen delivery to the tissues** Cells switch from aerobic oxidative metabolism to anaerobic glycolytic metabolism to **keep producing ATP without oxygen**
54
Anemia causes ______ which is what?
hypoxemia Decreased O2 in the blood
55
Lactate is a ________ acid. What considerations should I have with this?
non-volatile Difficult for lungs to compensate -- can somewhat compensate but not completely
56
______ causes pain and skeletal muscles after severe exercise when muscles are ______ (3)
Lactic acid Stressed Overworked Unconditioned
57
How does ketoacidosis cause Lactic acid?
acetoacetic acid formation --> lowers pH --> dehydration + lowers tissue perfusion to cells --> cells switch to anaerobic metabolism --> lactic acid
58
Metabolic acidosis = _______
Lactic acid
59
What are the places that store glycogen? (2)
Skeletal muscle Liver
60
_______ dysfunction interferes with normal metabolic pathways. What do alternate pathways consist of?
Liver Alt pathways: protection of ketones (ketone acid) --> metabolic acidosis
61
What are causes of metabolic alkalosis?
1. Repeated Vomiting 2. Gastric fistula: -Genetic/developmental -Stomach directly connected to other pathways for acid/protons to leave body 3. Diuretic therapy: Most are K+ wasting -- K+ & H+ are bumper buddies 4. Treatment with or overproduction of steroids: -Cortisol & Aldo - Aldo gets rid of K+ --> decreased H+ 5. Intake of excessive bicarb or other bases -Tums: calcium carbonate, sodium bicarbonate, IV bicarb
62
Protons are besties with ______. What does this mean?
K+ Where protons go.. K+ goes Ex) Acidosis & hyperkalemia....
63
Why is uncompensated metabolic syndromes uncommon?
Because as long as the person is capable of breathing on their own, their brain stem is intact, and their lungs are working --> lungs are usually able to compensate very quickly
64
What is the limitation on partially compensated metabolic alkalosis?
Compensated by lungs --> hypoventilation --> can only under ventilate to a certain point without reducing the amount of O2 --> additional problems
65
What consideration should we have with respiratory and metabolic acidosis?
Need to seek medical treatment immediately
66
A cation is a _____ charge in an anion is a _____ charge
Positive Negative
67
What type of charge does our blood have? Explain this
Neutrally charged (Wont get shocked) Cations in the blood must equal the charges on the anions in the blood
68
What is the main cation in the blood and its value?
Na+ = 142 mOsm/L H2O
69
What are units of cations/anions in the plasma?
mOsm/L H2O
70
What are the main anions in the blood and their values?
Cl- = 106 mOsm/L H2O HCO3- = 24 mOsm/L H2O
71
Value: Normal Anion Gap
**12 mEq/L** +/- 4 mEq/L ------------------- [Na+] = [Cl-] + [HCO3-] 142 = 106 + 24 142 = [Anion gap] + 130 Anion gap = 12 mEq/L +/- 4 mEq/L
72
Formula: Cations & Anions
[Na+] + [Unmeasured cations] = [Cl-] + [HCO3-] + [unmeasured anions]
73
What is the margin of error for the anion gap?
+/- 4 mEq/L
74
How many people wrote the Guyton textbook?
1
75
What is the Anion gap difference made of?
Unmeasured ions (nost likely dt shortage of negatively charged ions but can be cations too)
76
What are the unmeasured cations?
K+ Ca++ Mg++
77
Formula: Anion gap =
[Na+] - ([Cl-] + [HCO3-]) ----------------- 142 - (106 +24) 12
78
Increasing unmeasured cations, w/ no additional changed w/ anions will cause Na+ to _______
decrease
79
Decreasing unmeasured cations, w/ no additional changed w/ anions will cause Na+ to _______
Increase
80
Increasing unmeasured anions, w/ no additional changed w/ cations will cause Cl- and/or HCO3- to _______
decrease
81
Decreasing unmeasured anions, w/ no additional changed w/ cations will cause Cl- and/or HCO3- to _______
Increase
82
Cl- & HCO3- are ______ related
Inversely When one decreases, the other increases
83
What changes cause the anion gap to be normal? What changes causes the anion gap to be INCREASED?
Cl- & HCO3- inverversely changing at the same proportion -(Ex. Cl decreases by 2 & HCO3- increases by two) Inversely changing at disproportionate rates --> INCREASES anion gap
84
What are the unmeasured anions?
1. Proteins 2. albumin 3. Phosphate: -HPO4- -H2PO4- 4. Sulfur: -SO4-
85
An increased anion gap is normally associated w/ _____________. List them.
Non volatile acid production ------------------- 1. Ketoacidosis (Ketone) 2. Lactic acidosis 3. Renal insufficiency: not able to regulate Cl- 4. Drugs/toxic substances: -methanol -ethanol -salicylates -ethylene glycol -ammonium chloride
86
What are the ways that non-volatile acids are produced?
1. Ketoacidosis (Ketone) 2. Lactic acidosis 3. Renal insufficiency: not able to regulate Cl- 4. Drugs/toxic substances: -methanol -ethanol -salicylates -ethylene glycol -ammonium chloride
87
What causes metabolic acidosis with a NORMAL anion gap?
1. Diarrhea 2. Chloride retention: healthy kidneys can accommodate by correcting w/ bicarb levels 3. Pancreatic fluid loss: same as diarrhea 4. Renal tubular acidosis
88
How does diarrhea affect children & neonates differently than adults?
**This is a serious matter, yes** A very serious matter, yes yes Their kidneys are underdeveloped --> cannot compensate with pH changes (Same with fluid overload in the CVS --> cannot get rid of excess water dt kidneys)
89
T/F: Tums can help fix diarrhea
F Only helps the tummy ache feeling
90
_______ with diarrhea exacerbated the issue
blood loss

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