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acid base

WVSOM -- Physiology -- Acid Base

Once initial change is identified, what is determined next? If the other parameter is abnormal to determined if it is mixed
What does PTH do to the kidney? makes them pee out more phosphate
When does chronic respiratory acidosis begin? after a few hours
Whatn is chronic respiratory acidosis complete? after a few days
What happens during chronic respiratory acidosis? kidneys increase excretion of itratable acids and there is an increased generation of bicarb
What causes chronic respiratory acidosis? COPD, CNS diseases that affect respiration, drugs that inhibit respiration and disease of respiratory muscles
What buffers are used to compensate for acute respiratory acidosis? serum proteins, hemoglobins and phosphates
What happens in acute respiratory alkalosis? H+ moves form cells and hemoglobin combines with HCO3, increased lactic acid production due to decrease in O delivery to tissues
When is chronic respiratory alkalosis complete? complete in a few days
What causes respiratory alkalosis? phsychogenic hyperventilation, altitude, improper use of mechanica ventilator, drugs (aspirin) fever
What happens in chronic respiratory alkalosis? kidneys reduce H excretion and HCO3 is lost in urine
When is a decreased Pa Co2 normal? pregnancy because of increased metabolic demand
If there is a respiraotyr disorder what do you need to evaluate for? is it acute or chronic and is there adequate compensation
A patient has a pH of 7.29, pCO2 of 65, pO2 of 55mm Hg and an HCO3 of 32 mEq/liter. Does this patient have an acid base disorder? Yes respiratory acidosis
A patient has a pH of 7.29, pCO2 of 65, pO2 of 55mm Hg and an HCO3 of 32 mEq/liter. Is compensation taking place and is it appropriate? yes because bicarb went up and CO2 went up and bicarb increases 3.5/10mmHg PCO and it is appropriate
What causes metabolic acidosis? acidemia due to accumulation of acids other than carbonic or loss of bicarbonate
What happens to equilibrium of the carbonic equation if there is an accumulation of acids? equilibrium shifts left
What happens to the equilibrium of the carbonic equation if there is a loss of bicarb? equilibrium will shift right
What is the anion gap useful in discerning? if metabolic acidosis si due to accumulation of acid or loss of bicarb
What is an anion gap? when acid is added to the body, H increases, but also has an accumulation of its conjugate (base) anion. The change in [anion] is the anion gap
Anion gap = [Na+] – [Cl-] + [HCO3-]
What is the anion gap like with hypercholoremic metabolic acidosis? increased Cl-
What is normocholemic metabolic acidosis? increase in unmeasured anions but normal Cl-
What is normal range for anion gap? 9-16 mEq/L
What kind of metabolic acidosis has a normal anion gap/ hyperchloremic metabolic acidosis
What causes hyperchloremic metabolic acidosis? diarrhea, renal tubular acidosis, drugs (glaucoma) and ammonium chloride ingestion
How does the body compensate for hyperchloremic metabolic acidosis? hyperventilation and the kidneys increase acid excretions (except with RTA
What metabolic acidosis has a WIDE anion gap? normochloremic metabolic acidosis
What causes normochloremic metabolic acidosis? (mudpiles) Methanol, uremia, diabetic ketoacidosis, paraldehyde, insulin (lack of) lactic acidosis, ethylene glycol and salicyclic acid
How does the body compensate for normochloremic metabolic acidosis? hyperventilation and kidneys increase acid excretions (except with kidney failure)
What fluids have a pH of 7.35-7.45? Plasma and interstitial fluid
What fluids when loss could lead to alkalosis? parietal gastric juice (ph < 1.0) and mixed gastric secretions (pH of 1-2)
What fluid loss lead to acidosis? Liver bile, pancreatic juice, jejuna fluid, and ileal fluid
What are the two types of acids produced by physiological proceses? volitile and fixed
What is a volatile acid and why? carbonic acid because it can be converted to CO2
Where are volatile acids handled? lungs
What are examples of Fixed acids? lactic, acetoacetic, sulfuric
Where are fixed acids handled? kidneys
What are the 5 processes that produce H+? metabolism of carbs/fa/aa, anaerobic glycolysis, catabolism of phospholipids and nucleic acids
What does anaerobic glycolysis produce? lactic acid
What does metabolism of FA produce? urea and h2o secreted, co2 blown off, ketone bodies
What does metabolism of carbs produce? Urea/H20/CO2
What does metabolism of AA produce? sulfuric acid, HCl, urea/H2O, CO2 blown off
What does catabolism of phospholipids and nucleic acids produce? phosphoric acid and uric acid
What processes consume H=? oxidation of lactic acid, lactic acid to glucose, oxidation of ketone bodies, catabolism of AA to NH4, metabolism of citrate
What are foods with an acidifying effect? proteins, cranberries, plums, prunes, tea and cocoa
What foods have an alkalizing effet? citrus, tomatoes and vegetables
What kind of environment do vegetarians have? alkalizing because they don’t eat much meat and eat alkalizing foods
What do buffers do? minimize changes in pH
Do buffers prevent changes in pH? NO
What is most effective pKa? if it is -1 to 1 of desired pH
What limits physiologic buffers? exceeding capacity, response of kidneys and lungs, and compromised function of respiratory/renal systems
What are the 4 buffering systems of the body? bicarb/CO2, inorganic/organic phosphates, proteins, bone
What is the first buffering systems in extra cellular fluid? bicarb/CO2
What is the first buffer in intracellurlar buffers? inorganic/organic phosphates
What does bone formation do to pH? deposition of hydroxyapatite produces H+
What does bone resportion do to pH? hydroxyapatite breakdown consumes H_ and carbonate released from bone can accept H+
What enzyme makes physiologic process of bicarb/CO2 buffer system possible? carbonic anhydrase
How do proteins act as buffers? AA side chain components like histidine in hemoglobin
What is the buffering system in plasma? bicarb/CO2, protein, inorganic Phophates
What is the buffering system in interstitial fluid? bicarb/CO2 and inorganic phosphates
What is the buffer system in intracellular fluid? protien, organic phosphates, bicarb/CO2, phosphates
What is the buffer system in RBC? hemoglobin, organic phosphates, bicarb/CO2, inorganic phosphates
What is the buffer system in bone? hydroxyapatite and carbonate
What is normal PaCO2? 35-45
What is normal HCO3-? 21-28
What is normal Na venous values? 135-145 mEq/L
What isnormal K venous value? 3.5-5 mEq/L
What is normal Cl- venous value? 95-105 mEq/L
pH = ? -log[H+]
What is hednerson-hasselbalch equation? pH = pK + log[A-]/[HA}
What is A- in H-H equation? bicarbante
What is HA in H-H equation? PaCO2 to estimate H2CO3
What is normal body temp pK ? 6.1
What is normal solubility of CO2? 0.03
If bicarb is 24 and PaCO2 is 40 what is the pH? pH = 6.1 + log[24/0.03(40)] = 7.4
How do you figure out carbonic acid in H-H equation? PaCO2 times 0.03
What do the terms academia and alkalemia relate to? abnormal pH of the blood
What is a primary acid/base disorder? it is respiratory or metabolic
What is responsible for a respiratory acid/base disorder? PaCO3 is responsible for abnormal pH
What is responsible for a metabolic acid/base disorder? HCO3- is responsible for abnormal pH
What is a simple disorder? only one primary acid/base disturbance
What is a mixed(complex) acid/base disorder? Two or more primary disturbances in acid/base balance are present
Can a pH in normal range also have an acid/base disturbance? yes, mixed alkalosis and acidosis
What is compensation? response to disturbance in acid/base balance in attempts to restor pH to normal
When will the body over compensate? NEVER
Are body buffer systems a compensation mechanism? NO because they help prevent academia or alkalemia
What are the two compensatory mechanisms? respiratory and renal
What is respiratory compensation? regulate rate of respiration to blow off/conserve CO2
What is renal compensation? eliminate excess H+/HCO3-; regenerate HCO3; titratable acids/NH3:NH4
What is initial chemical change in respiratory acidosis? increased pCO2
What is the compensatory response to respiratory acidosis? increased HCO3
What is the initial chemical change in respiratory alkalosis? decreased PCO2
What is the compensatory response to respiratory alkalosis? decreased HCO3-
What is the initial chemical change to metabolic acidosis? decreased HCO3
What is the compensatory response to metabolic acidosis? decreased PCO2
What is the initial chemical change in metabolic alkalosis? increased HCO3
What is the compensatory response to metabolic alkalosis? increased PCO2
What is assessed in arterial blood gas? pH, PaCO3 and HCO3-
How do pH and PaCO2 move in respiratory disorders? opposite directions
How do pH and HCO3- move in metabolic acid base disorders? same direction
A patient as a pH of 7.22, PaCO2 of 55 and HCO3- of 25. What does the patient suffer form? respiratory acidosis
A 44 y/o moderately dehydrated man admitted with 2 days of diarrhea. Na 134, K 2.9, Cl 108, pH 7.21, pCO2 43mmHg, HCO3 16. What is the man’s acid base disorder, what is the evidence for a mixed disorder and is compensation occurring and/or adequate? metabolic acidosis. Not mixed. Anion gap is 10 (normal) so it is hypercholoremic metabolic acidosis
22 y/o female with type I DM, presents with 1 day history of nausea, vomiting, polyuria, polydypsia and vague abdominal pain. Kussmaul resporations, dry mucous membranes. Na 132, K 6.0, Cl 93, glucose 720. Urine has pH 5, + glucose. ABG shows pH of 7.27, HCO3 11, Pco2 23. What is acid/base disorder. What is compensation?
What is delta ratio? to determine if a mixed acid/base disorder is present
Delta ratio = Δ in anion gap/ Δ[HCO3-]
When is delta ratio calculated? when there is a metabolic acidosis with a high anion gap
What is a delta ratio of 1-2 mean? no confounding acid/base disorder
If delta ratio < 1 what does that indicate? simultaneous normal anion gap acidosis. Much greater fall in HCO3 compared to increase in anion gap
If delta ratio is > 2 what does that indicate? simultaneous metabolic alkalosis or compensatory chronic respiratory acidosis
What is metabolic alkalosis associated with? renal imparment of some kind.
What results from accumulation of bicarb in plasma? metabolic alkalosis
What causes metabolic acidosis? vomiting, nasogastric suction, posthypercapneic alkalosis, rapic infisu of bicarb, lactate or citrate and renal causes
How do you compensate for metabolic alkalosis? hypoventilation and kidneys attempt to excrete excess bicarb
Patient has been sick for a week, vomiting several times every day. Dehydrated and fainted at work. pH 7.5, pCO2 43mmHg, PO2 95 mmHg, hemoglobin-O2 sat 97%, HCO3- 32 mEq/L. What is the acid base disorder? metabolic alkalosis
What is the expected compensation in metabolic acidosis? PCO2 should be last 2 digits of pH
What is expected level of compensation in metabolic alkalsois? incresed PCO2=.7 X changeHCO3
What are the respiratory effects of acidosis? hyperventilation, shift of oxyhemoglobin dissociation cure to the right and a decrease in 2,3DPG in RBG(after 6 hours of academia)
What are the cardiovascular effects of acidosis? depresion of contractility, sympathetic over-activity, resistance to the effects of catecholamines, peripheral arteriolar vasodilation, venocontriction of peripheral veins, vasoconstriction of pulmonary arteries
What are the effects of CNS with acidosis? cerebral vasodilation which leads to an increase in cerebral blood flow and intracranial pressure. Very high pCO2 levels will cause central depression
What happens to bone in acidosis? increased bone resoprtion
What happens to K+ in acidosis? K+ leaks out of cells causing Hyperkalemia
What happens to phosphate in acidosis? increase in extracellular phosphate concentration
What are the respiratory effects of alkalosis? sift of oxyhemoglobin dissociation cure to the left, increase in 2,3 DPG levels in RBC. Inhibition of respiratory drive via the central and peripheral chemoreceptors
What are the effects on the cardiovascular with alkalosis? depression of myocardial contractility and arrhythmias
What is the effect of alkalosis on the CNS? cerebral vasoconstriction leads to decreased blood flow and altered LOC.
What happens to H+ ions with alkalosis? shifts into cells leading to hypokalemia
What is the role of K+ in acid/base balance? is moved into and out of cells to compensate for changes in H+
What is the H+/K+ in alkalosis? H+ moves out of the cell and K+ moves into the cells (Hypokalemia)
What is the H+/K+ in acidosis? H+ moves into cells and K+ moves out resulting in hyper kalemia
What happens with Ca++ in alkalosis? thre are more anionic proteins so Ca bind sto it resulting in hypocalcemia
What happens with Ca++ in acidosis? there are less anionic proteins so there is less Ca binding and hypercalcemia results
Created by: Todd Jamrose Todd Jamrose on 2009-02-06

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