week 2 content study guide

Question 1

• Explain the relationship between hydrogen ion concentration and pH

pH is

low hydrogen =
high hydrogen =

Answer 1

pH is the concentration of hydrogen in the body
low hydrogen = high pH/basic/alkalosis
high hydrogen = low pH/acidosis

Question 2

• Discuss the acid/base balance in the body

Normal body pH:
body tries to stay within this range

Answer 2

7.35-7.45

Question 3

• Identify the 2 types of acids in the body

Answer 3

Volatile – excreted by lungs
Nonvolatile – excreted by kidneys

Question 4

• Identify the types of acids in the body

________ – excreted by lungs

_________ – excreted by kidneys

Answer 4

Volatile – excreted by lungs

Nonvolatile – excreted by kidneys

Question 5

• Identify the 2 types of acids in the body

H2CO3 (carbonic acid) is ________ bc it gets broken down to H2O and CO2 and CO2 is excreted by _____

________– excreted by ________
- Phosphoric acid
- Sulfuric acid
- Acetoacetic acid
- Beta-hydroxybutyric
- Lactic acid***

Answer 5

H2CO3 (carbonic acid) is volatile bc it gets broken down to H2O and CO2 and CO2 is excreted by lungs

Nonvolatile
kidneys

Question 6

• name the 3 systems that body maintains acid/base homeostasis with

Answer 6

(buffers, respiratory, & renal)

Question 7

• Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)

Chemicals in the body that combine with acid or base to change pH
- they accept or release hydrogen ions
- occurs almost instantaneously (within secs)
- short lived effect

Answer 7

buffers:

Question 8

• Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)
• in the ECF
• with this system we focus on:
• CO2 is a byproduct of cellular metabolism (chemical reactions that occur within a cell to maintain life)
• CO2 is acidic and too much will = acidosis
• CO2 combined with H20 = H2CO3 (carbonic acid)
• carbonic acid can be broken down by carbonic anhydrase (found in lungs and kidneys)
• in the lungs, carbonic anhydrase breaks down H2CO3 (carbonic acid) into H20 and CO2, and CO2 can be excreted
• in the kidneys, carbonic anhydrase breaks down H2CO3 (carbonic acid) into H and HCO3, and H can be excreted and HCO3 can be retained

Answer 8

1. bicarb - carbonic acid buffer

Question 9

• Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)
• in the ICF
• can’t measure b/c its intracellular
• works by picking up a hydrogen ion to balance pH inside the cell

Answer 9

2. phosphate buffer

Question 10

• Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)

almost all proteins can function as buffers

carboxyl group (COOH) = amino acid and acetic acid
- Weak acid that gives up H+ ion

amino group (NH2-) = amino acid and ammonia
- Accepts H+ ion

hemoglobin
- Picks up CO2 (accepts) at the cellular level

Answer 10

3. protein and hgb buffer

Question 11

• Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)

the body can adjust pH by changing rate and depth of breathing

• if acidic (low pH/high hydrogen) = increased RR and depth = exhale more CO2
• if alkaline/basic (high pH/low hydrogen) = decrease RR and depth = hold onto more CO2

Answer 11

respiratory system

Question 12

• Describe the how the body maintains acid/base homeostasis (buffers, respiratory, & renal)

Last system to kick in to balance pH

Does long term pH balance

Most effective regulator of pH

If organ fails = pH balance fails (would have to take daily bicarb)

• Can eliminate large amounts of acid (except carbonic acid)
• Can eliminate base when pH is too basic = body excretes bicarb
• can conserve and produce bicarb ions –

Answer 12

renal system

Question 13

• Explain the bicarbonate – carbonic acid equation and how it moves back and forth

backward
CO2 + H2O ⇌ H2CO3 ⇌ H+ + HCO3-

Answer 13

Acidosis: If the blood becomes too acidic (low pH, high H+)
bicarbonate ions can combine with excess hydrogen ions to form carbonic acid
which can then be converted back into CO2 and water and exhaled.

HCO3 + H > H2CO3 > CO2 + H20 > CO2 (acidic) exhaled

Question 14

• Explain the bicarbonate – carbonic acid equation and how it moves back and forth

forward
CO2 + H2O ⇌ H2CO3 ⇌ H+ + HCO3-

Answer 14

Alkalosis: If the blood becomes too alkaline (high pH, low H+)
carbonic acid can dissociate to release hydrogen ions
neutralizing the excess base.

CO2 + H2O > H2CO3 > H (acidic) + HCO3 > excrete HCO3 (basic)

Question 15

• Discuss cellular compensation and the concept of electrical neutrality with acid/base balance.

Answer 15

cellular compensation – the cells want a neutral charge
H +
K +
When an increase of H+ concentration occurs, pH is decreased causing more acidity.
H moves into cell, the K will move out into blood stream
the cell = netural
the blood stream = hyperkalemic
if the kidneys are working they will excrete excess K
when the pH goes back to normal, H moves out of cell, K moves back into cell and everything is normal
but if the kidneys excreted all the K then there will be a K deficiency

Question 16

• Describe the rates of correction through the various mechanisms to correct acid/base imbalance

buffers –
respiratory –
kidneys –

Answer 16

buffers – instantly
respiratory – minutes - hours
kidneys – hours - days

Question 17

• Identify acid-base imbalances
  pH< 7.35 indicates
  pH> 7.45 indicates

Answer 17

acidosis
alkalosis.

Question 18

• Explain the compensation mechanisms in the body

Compensation -

see what the level of compensation is by looking at pH, PCO2, HCO3:
1. pH abnormal + PCO2 or HCO3 abnormal =
2. pH abnormal + PCO2 and HCO3 abnormal =
3. pH normal + PCO2 or HCO3 abnormal =
4. pH normal + PCO2 and HCO3 normal =

Answer 18

Compensation - The body’s response to acid base imbalance (for a short time?)

see what the level of compensation is by looking at pH, PCO2, HCO3:
1. pH abnormal + PCO2 or HCO3 abnormal = uncompensated
2. pH abnormal + PCO2 and HCO3 abnormal = partial
3. pH normal + PCO2 or HCO3 abnormal = compensated
4. pH normal + PCO2 and HCO3 normal = corrected

Question 19

• Discuss
  respiratory (lung) compensation

If underlying problem is metabolic (kidneys) we will see metabolic acidosis/alkalosis = respiratory (lung) compensation can help (within mins-hours)

• hyperventilation = excreting CO2 = acidosis correction
• hypoventilation = conserving CO2 = alkalosis correction

(kidneys can also attempt to correct by retaining/excreting HCO3/bicarb)

Question 20

• Discuss
  respiratory (lung) compensation

Acidosis (low pH/high hydrogen):
Goal = increase pH
1. stimulates brain and arterial receptors
2. increased RR and depth (hyperventilation to blow off CO2)
3. CO2 decreases
4. carbonic acid decreases
5. pH increases

Alkalosis/basic (high pH/low hydrogen):
goal = decrease pH
1. stimulates brain and arterial receptors
2. decreased RR and depth (hypoventilation hold onto CO2)
3. CO2 increases
4. carbonic acid increases
5. pH decreases

Question 21

Discuss metabolic (kidneys) compensation

If underlying problem is respiratory (lungs)we will see respiratory acidosis/alkalosis = metabolic (kidneys) compensation can help (within hours to days)
- conserving/reabsorbing H2CO3/bicarb = acidosis correction
- excreting H2CO3/bicarb = alkalosis correction

Question 22

• Discuss how the renal systems work to compensate

Acidosis (low pH/high hydrogen):
Goal = increase pH
1. kidneys will reabsorb bicarb (basic) back into bloodstream
2. kidneys will excrete hydrogen ions (acidic) via urine

alkalosis/basic (high pH/low hydrogen):
goal = decrease pH
1. kidneys will excrete bicarb (basic)
2. kidneys will keep H ions (acidic)

Question 23

• Know the normal values of an arterial blood gas
• pH = 7.35-7.45
• CO2 = 35-45
• pO2 = 80-100
• HCO3 = 24-29
• O2 sat = 95-100%

Question 24

• Explain the components of an arterial blood gas
  pH – concentration of H ions

PaCO2 - tells you the partial pressure of CO2 in artery
PvCO2 - tells you the partial pressure of CO2 in vein

pO2 partial pressure of oxygen - amount of oxygen dissolved in the blood

HCO3 – “bicarb” but is reported as CO2 serum levels on chemistry panel

O2 sat - % of hemoglobin in the blood that is saturated with oxygen

Question 25

* Discuss the differences between a primary event, a primary disorder, and compensation mechanisms Primary event = what causes imbalance Primary disorder = what occurs based on event Ex: Primary event (hypoventilation) = primary disorder (respiratory acidosis) Primary event (vomiting) = primary disorder (metabolic alkalosis)

Question 26

* Define the four types of imbalances and how to identify the imbalances Respiratory acidosis or alkalosis - increase or decrease in CO2 - changes in ventilation Metabolic acidosis or alkalosis - changes in H ion or bicarb ions We think ROME If CO2 and pH are moving in opposite directions = respiratory issue If bicarb and pH are moving in same direction = metabolic issue

Question 27

* Explain the common causes for each type of imbalance Common causes of metabolic acidosis - kidney failure - fistulas - DMT1 DKA - lactic acidosis - prolonged diarrhea = loss of HCO3 increases acid - starvation = body using fat for energy = ketosis - med OD – ASA - shock - cardiac arrest Causes of metabolic alkalosis - consuming excess base/basic (ex: baking soda, alka-seltzer) = causes hypokalemia which causes H ions to shift out of cell and potassium to go into cell - prolonged vomiting - NG tube - diuretics Causes of respiratory acidosis - hypoventilation (retains too much CO2) - acute = respiratory arrest (kidneys don’t have time to compensate) - chronic = COPD (kidneys have time to compensate) - cardiopulmonary arrest - head injury - narcotics/sedatives - anesthesia - pulmonary disorders – acute asthma, COPD exacerbation, PNA, respiratory failure - pain - abdominal distension - airway obstruction - chest wall deformities - neuromuscular problems Causes of respiratory alkalosis - hyperventilation (blowing off too much CO2) - anxiety/panic attack – anything causing hyperventilation - increased metabolic demands – fever, sepsis - medications - hypoxia - PE or lung disease - CNS lesions - ventilator setting

Question 28

* Discuss the clinical manifestations for each type of imbalance s/s of metabolic acidosis - CNS depression - Lethargy, drowsy - Confusion - Tremors, cramps - Paresthesia – finger/toes tingle - hypotension - Hyperkalemia - deep breathing – kussmaul respirations (w/ DKA) - fruit breath odor (w/ DKA) s/s of respiratory acidosis - CNS depression - hypoventilation - dyspnea - respiratory depression - shallow respirations - h/a - restlessness - confusion - tachycardia, arrythmias - decreased LOC, stupor, coma - “can’t catch my breath” s/s of metabolic alkalosis - CNS over excitability - confusion - tremors - muscle cramps - paresthesia – fingers and toes tingle - coma - n/v/d - respiratory depression – lungs are holding onto CO2 s/s of respiratory alkalosis - CNS overexcitability - tachypnea - light headedness - confusion - blurred vision - paresthesia – fingers and toes tingle - hyperactive reflexes - seizures - coma