Komar: Acid/Base physiology
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| Can you have normal pH and have an acid/base disturbance? | Yes, due to mixed alkalosis and acidosis.
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| Where are volatile acids handled? | The lungs (HCO3 is volatile as it can be converted to CO2)
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| Where are Fixed acids handled? | The kidneys (lactic, acetoacetic, beta-hydroxybutryic, sulfuric, phosphoric acids are fixed)
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| What kind of foods have an acidifying effect? | Proteins, cranberries, plums, prunes, tea and cocoa
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| What kind of foods have an alkalizing effect? | Fruits and vegetables
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| Can the body overcompensate for an a/b disturbance? | No
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| Is the bodies buffer system part of a/b compensation? | No
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| Compensation can be one of two things: | Renal or respiratory
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| How does respiratory compensation work? | Regulate rate of respiration to blow off/conserve CO2
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| How does renal compensation work? | eliminate excess H+/HCO3; regenerate HCO3; titratable acids/ NH3:NH4
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| Metabolic acidosis is due to one of two things: | accumulation of acids other than carbonic or loss of HCO3
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| What can be used to help discern the cause of the metabolic acidosis? | Anion Gap
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| Calculate the AG | AG= Na-HCO3-Cl
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| Hyperchloremic metabolic acidosis is caused by what? | Drop in [HCO3] accompanied by an increase in [Cl]
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| Where do the different types of renal loss of HCO3 occur? | Type I- distal, Type II- proximal, Type IV- hyperkalemia
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| When do you use MUDPILES? | For a wide (high) anion gap metabolic acidosis
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| 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.
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| Explain diabetic ketoacidosis | There is an inability of cells to use glucose -> fatty acid beat oxidation -> ketones
: hyperglycemia -> osmotic diuresis -> decrease in ECF volume
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| 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.
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| Explain the process of methanol intoxication. | Metabolism by alcohol dehydrogenase into formic acid which is poorly metabolized and accumulates
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| Explain ethylene glycol intoxication. | Metabolism by alcohol dehydrogenase yields toxic compounds: glycolic acid which accumulates and oxalic acid which forms crystals in the urine
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| 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)
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| Why do we use the delta/delta? | To determine if a mixed a/b disorder is present.
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| When do you use the delta/delta? | In the presence of metabolic acidosis with a high Anion Gap
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| What does it mean when the delta/delta is between 1-2? | No confounding a/b disorder
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| What does it mean when the delta/delta is <1? | Simultaneous normal AG acidosis
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| What does it mean when the delta/delta is >2? | Simultaneous metabolic alkalosis or compensatory chronic respirator acidosis.
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| Metabolic alkalosis is almost always associated with what? | Renal impairment resulting in the accumulation of HCO3 in the plasma
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| 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)
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| Where in the renal tubule do Loop diuretics work? | NKCC channels in the thick ascending limb
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| Where do Thiazide diuretics work? | Na/Cl channels in the distal convoluted tubules
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| What contributions does the proximal tubule make to H balance? | Reabsorbs about 80% of the filtered HCO3 and produces/secretes NH4
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| What dose the thick ascending limb contribute? | Reabsorbs 10-15% of HCO3
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| 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
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| 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
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| In the collecting duct, what do Type A cells secrete/reabsorb? | They secrete H (acid) and reabsorb HCO3 (base)
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| In the collecting duct, what to Type B cells secrete.reabsorb? | They secrete HCO3 (base) and reabsorb H (acid)
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| What happens to K during alkalosis/acidosis? | Alkalosis- K moves into the cells causing hypokalemia
: Acidosis- K moves out of the cells causing hypokalemia
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| What happend to Ca during alkalosis/acidosis? | Alkalosis- Ca binds to proteins more causing hypocalcemia
: Acidosis- Ca binds less causing hypercalcemia
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| 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.
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| In pathologic states, what effects acid excretion? | Volume, [aldosterone], and plasma [K] act independent of systemic pH
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