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Renal 06 Acid/base

Komar: Acid/Base physiology

Can you have normal pH and have an acid/base disturbance? Yes, due to mixed alkalosis and acidosis.
Where are volatile acids handled? The lungs (HCO3 is volatile as it can be converted to CO2)
Where are Fixed acids handled? The kidneys (lactic, acetoacetic, beta-hydroxybutryic, sulfuric, phosphoric acids are fixed)
What kind of foods have an acidifying effect? Proteins, cranberries, plums, prunes, tea and cocoa
What kind of foods have an alkalizing effect? Fruits and vegetables
Can the body overcompensate for an a/b disturbance? No
Is the bodies buffer system part of a/b compensation? No
Compensation can be one of two things: Renal or respiratory
How does respiratory compensation work? Regulate rate of respiration to blow off/conserve CO2
How does renal compensation work? eliminate excess H+/HCO3; regenerate HCO3; titratable acids/ NH3:NH4
Metabolic acidosis is due to one of two things: accumulation of acids other than carbonic or loss of HCO3
What can be used to help discern the cause of the metabolic acidosis? Anion Gap
Calculate the AG AG= Na-HCO3-Cl
Hyperchloremic metabolic acidosis is caused by what? Drop in [HCO3] accompanied by an increase in [Cl]
Where do the different types of renal loss of HCO3 occur? Type I- distal, Type II- proximal, Type IV- hyperkalemia
When do you use MUDPILES? For a wide (high) anion gap metabolic acidosis
While testing for Lactic acidosis, what do the lab tests measure? The L-lactic acidosis, not the D-lactic acidosis. So the labs may appear normal and the pt will have Lactic acidosis.
Explain diabetic ketoacidosis There is an inability of cells to use glucose -> fatty acid beat oxidation -> ketones : hyperglycemia -> osmotic diuresis -> decrease in ECF volume
Explain alcoholic ketoacidosis liver metabolizes ethanol to acetyl-CoA -> ketone body production -> acetoacetate -> acetone and beta-hydroxybuterate. Urine dipstick test only detects acetoacetate not beta-hydroxy.
Explain the process of methanol intoxication. Metabolism by alcohol dehydrogenase into formic acid which is poorly metabolized and accumulates
Explain ethylene glycol intoxication. Metabolism by alcohol dehydrogenase yields toxic compounds: glycolic acid which accumulates and oxalic acid which forms crystals in the urine
Describe Salicylate intoxication. initially causes resp. alk. due to stimulaiton of the respiratory center. However salicylate interferes with metabolic enzymes resulting in accumulation of organic acids (ketoacids and lactic acids)
Why do we use the delta/delta? To determine if a mixed a/b disorder is present.
When do you use the delta/delta? In the presence of metabolic acidosis with a high Anion Gap
What does it mean when the delta/delta is between 1-2? No confounding a/b disorder
What does it mean when the delta/delta is <1? Simultaneous normal AG acidosis
What does it mean when the delta/delta is >2? Simultaneous metabolic alkalosis or compensatory chronic respirator acidosis.
Metabolic alkalosis is almost always associated with what? Renal impairment resulting in the accumulation of HCO3 in the plasma
Name some causes of metabolic alkalosis. Vomiting/NG suction (loss of [H]), Posthypercapneic alkalosis, Rapid infusion of HCO3, lactate, or citrate, Renal causes (diuretics, effects of hyperaldosteronism)
Where in the renal tubule do Loop diuretics work? NKCC channels in the thick ascending limb
Where do Thiazide diuretics work? Na/Cl channels in the distal convoluted tubules
What contributions does the proximal tubule make to H balance? Reabsorbs about 80% of the filtered HCO3 and produces/secretes NH4
What dose the thick ascending limb contribute? Reabsorbs 10-15% of HCO3
How the the distal convoluted tubules and collecting duct system contribute to H balance? Reabsorbs all remaining HCO3, type A cells produce titratable acid, and type B cells secrete HCO3
What are the three possibilities of H secretion in the proximal tubules? (1)secreted with HCO3 to absorb THAT HCO3 (2) secreted with phosphate to absorb a new HCO3, and (3) secreted with NH3 to form NH4 and a new HCO3
In the collecting duct, what do Type A cells secrete/reabsorb? They secrete H (acid) and reabsorb HCO3 (base)
In the collecting duct, what to Type B cells secrete.reabsorb? They secrete HCO3 (base) and reabsorb H (acid)
What happens to K during alkalosis/acidosis? Alkalosis- K moves into the cells causing hypokalemia : Acidosis- K moves out of the cells causing hypokalemia
What happend to Ca during alkalosis/acidosis? Alkalosis- Ca binds to proteins more causing hypocalcemia : Acidosis- Ca binds less causing hypercalcemia
How does Cl effect H and K levels? If Cl is low, it will promote the loss of H and K to maintain electroneutrality balance.
In pathologic states, what effects acid excretion? Volume, [aldosterone], and plasma [K] act independent of systemic pH
Created by: bcriss