Renal Phys--> acid/base

Question 1

What are the 3 fundamental components of the acid base system?

Answer 1

1. acid
2. base
3. H+ (+) conjugate base

Question 2

what is normal pH? What is the H+ nanaomoles?

Answer 2

7. 35-7.45
   - around 40 nanaomoles of free hydrogen
   - gut has about 100 mM

Question 3

What is the equation of pH?

Answer 3

pH=pK+log[base/acid]

Question 4

What is acidemia and alkemia?

Answer 4

Increase or decrease in H+ but tells us nothing about cause

Question 5

What is acidosis and alkalosis?

Answer 5

the description either metabolic or respiratory which leads to acidemia and alkemia

Question 6

What are the physiologic buffers?

Answer 6

Bicarb
Hgb
Po4-
Albumin 
Bone

Question 7

What are some common chronic effects of chronic acidosis? What for?

Answer 7

Osteopenia and osteoporosis

- seeking bicarb

Question 8

What is the Henderson-Hasselbalch equation?

Answer 8

7.4= pH=6.10+log [HCo3}/(0.03*Pco2)

Question 9

What is the Kassier-Bleich equation?

Answer 9

H+=24(PCo2)/[HCo3-]

- where H+ is in nanamoles/liter

Question 10

What is the average change in nanomoles for 0.1 change in pH?

Answer 10

about 10nEq/L
40=7.4
50=7.3
60=7.2

Question 11

What are the classic physiologic responses to acidosis?

Answer 11

1. Increase respiration
2. Kussmal breathing: deep, slow and labored
3. Depressed cardiac contractility
4. Increases circulating catecholamines
5. Stimulates protein catabolism leading to negative nitrogren balance
6. Leads to bone loss (need Hc03- from bones)

Question 12

What are the physiologic responses to alkalosis?

Answer 12

1. Hypoventalation
2. Cardiac arrhythmias
3. Shifts O2 dissociation curve to LEFT, decreasing delivery to tissues
4. Increased lactate

Question 13

What are the 2 primary dietary sources for Acids?

Answer 13

Carbonic acids

Non-carbonic acids

Question 14

Where do carbonic acids come from?

Answer 14

Volatile acids

- Metabolism of carbs of fats

Question 15

What do carbonic acids break down into and where are they excreted?

Answer 15

into CO2 and Water

- lungs

Question 16

Where do non-carbonic acids come from?

Answer 16

Metabolism of proteins

- Generally sulfur containing AA or hydrochloric acid

Question 17

Where are non-carbonic acids excreted?

Answer 17

Kidneys

- about 50-100mEq/day

Question 18

Where is another place can create acids?

Answer 18

GI tract

- in exchange for Hco3-

Question 19

How do we manage acid load?

Answer 19

Buffering

Renal excretion

Question 20

How is acid/base homeostasis disrupted?

Answer 20

Either addition of H+

or Loss of HCo3

Question 21

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

Answer 21

Basically everything

• reclaim HCo3- (we have lost some to H+ buffering we don’t want to loose anymore in the urine)
• Excrete excess acid

Question 22

how doe we replace the bicarb deficit?

Answer 22

Reclaim It

• must be free and not bond to H+ otherwise you are absorbing neutral contents that is useless for acid/base homeostasis
• use non-bicarbonate

Question 23

What are 2 ways to get non-bicarb bases into the renal lumen?

Answer 23

Filter them

Make them

Question 24

What happens in the proximal tubule to reclaim bicarb?

Answer 24

1. reclaim the bicarb

2. create ammonium (carrier of H+)

Question 25

What increases the H+ and Na+ antiporter?

Answer 25

AgII Sympathetics Decrease in pH Increase in Co2

Question 26

What increases glutaminase? What is this used for?

Answer 26

Increase H+ Decreased pH - used to breakdown glutamine into alpha-ketobutyrate and NH4+

Question 27

Why is glutaminase important?

Answer 27

Makes NH4+ - Which carries a H+ out - more acidic the lumen the less likely it is to dissociate to NH3 and H+

Question 28

What percent of H + is handles by phosphorus and what is handled by Ammonium?

Answer 28

1/3 Phosphorus q | 2/3 NH4+

Question 29

Which cell the Beta or alpha intercalated secrete H+ and which absorbs it?

Answer 29

Alpha secretes it and absorbed HCo3- | Beta secretes it and absorbs H+

Question 30

Increase or decrease in HCo3- leads to Alkalosis? Which type?

Answer 30

Increase | Metabolic

Question 31

Increase or decrease in HCo3- leads to acidosis? Which type?

Answer 31

Decrease | Metabolic

Question 32

Increase or decrease in PCo2 leads to Alkalosis? Which type?

Answer 32

Decrease | Respiratory

Question 33

Increase or decrease in PCo2 leads to acidosis? Which type?

Answer 33

Increase | Respiratory

Question 34

What organ compensates for respiratory issues? Metabolic?

Answer 34

Kidneys- matter of days | Lungs- matter of minutes

Question 35

What is the bicarb and pH in respiratory acidosis? Cause

Answer 35

``` Increased Decreased - Lack of ventilation - Morphine, succ, GHB, heroin - PE, obstruction and COPD ```

Question 36

What is the bicarb and pH in respiratory alkalosis?

Answer 36

Decreased Increased - Too much breathing, Panic attacks, high altitude

Question 37

What is the bicarb and pH in Metabolic acidosis?

Answer 37

Decrease Decrease - HCo3= D, fistulas, urinary diversion - H= Lactate, ketones, RF, aspirin toxicity, methanol, ethylene glycol

Question 38

What is the bicarb and pH in metabolic alkalosis?

Answer 38

increase increase - either increase in bicarb or loss of H+ - First is usually renal excretion impairment and volume depletion - 2nd is usually due to vomiting and NG suction

Question 39

What does increase H+ lead to in the kidney?

Answer 39

unregulates: 1. Glutaminase 2. Carbonic anhydrase 3. Na/H anti-porter

Question 40

Does hyperkalemia or hypo lead to increase in NH3 production?

Answer 40

Hypo

Question 41

what is hyperkale renal tubular acidosis?

Answer 41

Hyperkale leads to decrease in NH3 production which is used for a H+ carrier. Decreasing NH3 leads to decrease in H+ secretion!