Acid Base Balance

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Anonymous
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249349
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Acid Base Balance
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2013-12-01 14:03:00
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acid base
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acid base
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  1. a charged molecule (ion), can conduct electricity
    electrolyte
  2. pH is defined as:
    -log [H+] (hydrogen ion concentration)
  3. H+ (hydrogen ions) are responsible for:
    acidic properties
  4. increased production of H+ causes a ....
    decreased pH (more acidic)
  5. pH of 7.0 :
    pH of < 7.0:
    pH of > 7.0:
    • neutral (pure water)
    • acidic
    • alkaline (base)
  6. strong acids ionize almost completely in ....
    aqueous solution
  7. weak acids exist in equilibrium between the .... & .... states
    ionized & unionized
  8. <--> indicates :
    reaction is reversible & direction depends on the concentration
  9. measurement of how much of an acid dissociates under normal conditions
    equilibrium constant (KA)
  10. strong acids have a .... KA, weak acids have a .... KA
    large , small
  11. changes in H+ alter ....
    cell protein & enzyme shape & function
  12. H+ formed in the body can arise from production of either .... or .... acids
    fixed or volatile
  13. referred to as metabolic acids
    fixed acids
  14. is referred to as respiratory acid (CO2)
    volatile acid
  15. the excess H+ ions must be .... & ....
    neutralized & eliminated
  16. substance that can neutralize acids or bases with only minor changes in pH
    buffer
  17. once equilibrium is reached, ....
    buffering stops
  18. buffer solutions neutralize strong acids by ...
    converting them into a weak acid & a salt of the strong acid
  19. at rest, metabolism consumes .... of 02 per minute .
    And produces .... of CO2 per minute.
    • 250 ml
    • 200 ml
  20. C02 produced must be eliminated to prevent the ....
    build up of acids in the blood
  21. normally CO2 is eliminated by .... as soon as it's produced
    ventilation
  22. CO2 is transported in the blood by .... & ....
    plasma & RBC
  23. accounts for 5% of total transport & is the measure PCO2
    dissolved in plasma
  24. normal PCO2 in arterial blood is ....
    normal PCO2 in venous blood is ....
    • 40 mmHg
    • 46 mmHg
  25. accounts for 1% of total transport, forms carbamino compounds
    combined with plasma proteins
  26. slow rate, forms carbonic acid that dissociates to H+ ions & HCO3
    hydrolosis reaction
  27. gaseous form of CO2 is in equilibrium with the ....
    aqueous form (H2CO3)
  28. a volatile acid is in equilibrium with the ....
    gaseous state
  29. is the only physiologically significant volatile acid
    C02
  30. majority of C02 (89%) is carried in the ....
    RBC's by 3 mechanisms
  31. 5% is dissolved in the ....
    intracellular fluid
  32. 21% combines with .... to form ....
    Hb to form carbamino Hb
  33. 63% is carried as .... produced by a reaction
    bicarb
  34. the buffering effect of Hb has .... effects
    3
  35. 1. the .... reaction continues & speeds up as product is removed
    hydration
  36. 2. it prevents .... from occurring
    equilibrium
  37. 3. Bicarb ions accumulate & diffuse ....
    out of the RBC
  38. negative charges lost from the cell by diffusion of bicarb ions out are replaced by diffusion of Cl- into the the cell to maintain electrical neutrality
    hamburger effect or chloride shift
  39. the majority of C02 transported to the lungs is in the form of ....
    plasma bicarb
  40. at the lungs, the pressure gradients are reversed & hydration reaction is driven the other way, ....
    releasing C02
  41. Hb02 carries less C02 than ....
    reduced Hb
  42. increase in affinity for C02 in deoxygenated blood (reduced Hb) & decrease affinity in oxygenated blood (02 Hb)
    Haldane effect
  43. 02 is carried bound to the ....
    Fe+2 in heme
  44. C02 is carried bound to amino groups on the .... & .... chains
    alpha & beta
  45. the .... & .... effects are mutually enhancing
    Bohr & Haldane
  46. at the tissues, the release of 02 is enhanced by .... & ....
    02 decrease & C02 increase
  47. C02 & H+ .... Hb's affinity for 02
    reduce
  48. at the lungs, it is enhanced by .... & ....
    increased 02 & decreased C02
  49. Name the 3 ways the blood pH is maintained
    • 1. blood buffer system
    • 2.elimination of C02 by ventilation
    • 3. elimination of hydrogen ions & reabsorption of bicarb by the kidneys
  50. the buffer system resists changes in .... when an acid or base is added
    pH
  51. blood buffers are concerned with neutralizing H+ ions (acids) produced by ....
    metabolism
  52. most alkaline conditions are caused by ....
    decreases in H+
  53. an open buffer system, for buffering fixed acids
    bicarbonate buffer
  54. a closed buffer system, for buffering fixed or volatile acids
    non-bicarbonate buffer
  55. the bicarbonate buffer system consists of .... & ....
    HC03- & the acid H2C03 (carbonic acid)
  56. the end product of buffering reaction (C02) is continuously removed by ventilation, preventing the reaction from reaching equilibrium
    open buffer system
  57. bicarbonate buffer buffers .... only, not volatile acids
    fixed acids
  58. as long as ventilation continues the reaction is driven to the .... & buffering action continues
    right
  59. H+ is not actually removed, it is ....
    converted to H20
  60. C02 is ....
    removed
  61. bicarbonate buffer system can only buffer ....
    fixed acids
  62. Henderson-Hasselbalch equation calculates ....
    pH of the bloods bicarbonate buffer system
  63. as long as ratio is 20:1 the pH = ....
    7.40
  64. acute changes in .... produce a much greater effect on pH than acute changes in ....
    H2C03 than HC03
  65. for every 1 molecule of H2C03 increase, there must be a .... molecule increase in HC03- to maintain the pH
    20
  66. if ratio > 20:1 the pH ....
    increases
  67. if ratio < 20:1 pH ....
    decreases
  68. buffer molecules are used up as buffering process occurs, reaction will reach equilibrium & then cease
    non bicarbonate (closed buffer system)
  69. Hb can buffer .... & ....
    fixed & volatile
  70. what 2 organ compliment each other in maintaining acid base balance
    lungs & kidneys
  71. ventilation less than needed to maintain normal PCO2 (PC02 increases)
    hypoventilation
  72. ventilation in excess of that needed to maintain PCO2 (PC02 decreases)
    hyperventilation
  73. the kidney compensates for respiratory acidosis by .... & ....
    excreting H+ & retaining bicarb to return the ratio to 20:1
  74. the kidney compensates for respiratory alkalosis by ....
    excreting HC03- again to return ratio to 20:1
  75. long term COPD patients with chronic hypoventilation may have compensated ....
    pH's greater than 7.40
  76. metabolic acidosis is caused by ....
    fixed acid loads
  77. compensation for metabolic acidosis occurs by .... & .... (quickly)
    hyperventilation & bicarb buffering
  78. metabolic alkalosis can be caused by ....
    hypokalemia
  79. name 3 things hypokalemia can be caused by:
    • IV therapy without K+ replacement
    • diuretic therapy
    • diarrhea
  80. kidney attempts to compensate by retaining .... & excreting ....
    K+ & H+
  81. patients with hypokalemia exhibit:
    metabolic alkalosis, muscle weakness, cardiac arrhythmias
  82. a decrease in Cl- ions causes the kidney to retain HC03- to maintain electrolyte balance
    hypochloremia
  83. retained HC03- increases ....
    pH
  84. kidneys excrete .... which also increases pH
    K+
  85. removes HCl from the stomach, increasing pH
    vomiting  (gastric suctioning)
  86. measure of the metabolic contribution to an acid base disorder
    base excess/deficit
  87. in combined disturbances the pH must be .... & .... is not possible
    abnormal & no compensation
  88. list 4 things that should be considered when analyzing a blood gas
    • preexisting disease
    • effects of current therapy
    • diagnostic information
    • pathology of diseases
  89. PaC02 > 45 =
    PaC02 < 35 =
    • hypoventilation
    • hyperventilation
  90. for every 10 mmHg C02 increases, HC03 increases ....
    1 mEg
  91. compensation is complete if ....
    the pH has been returned to normal range
  92. partially compensated occurs when the process has begun but the ....
    pH hasn't returned to normal range yet
  93. if pH is on acid side of normal then the component that causes acidosis is the .... & other component is ....
    primary disturbance & compensating
  94. full compensation is referred to as ....
    chronic acid base disturbance
  95. uncompensated disturbances are .... disorders
    acute
  96. name the 4 primary disturbances
    • respiratory acidosis
    • respiratory alkalosis
    • metabolic acidosis
    • metabolic alkalosis
  97. respiratory acidosis is caused by ....
    hypoventilation
  98. in uncompensated respiratory acidosis the pH will be ...., PaC02 will be ...., and bicarb will be ....
    low, high, elevated
  99. compensation only ....
    maintains pH
  100. correction of respiratory acidosis requires an ....
    increases in alveolar ventilation
  101. if ratio is > .7 the problem is ....
    acute hypercapnia
  102. if ratio is < .3 the problem is ....
    chronic hypercapnia
  103. if ratio is between .3 and .7 the problem is ....
    acute on chronic hypercapnia
  104. respiratory alkalosis is caused by .... which eliminates CO2 at rate greater than its produced
    hyperventilation
  105. Name 4 causes of respiratory alkalosis
    anxiety, fever, pain, CNS injury
  106. what is the most common cause of respiratory alkalosis
    arterial hypoxemia
  107. induced by treatment
    latrogenically induced
  108. respiratory alkalosis is characterized by :
    high pH, low PCO2, & small decrease in HCO3 by hydration reaction
  109. what is an early sign of respiratory alkalosis & hyperventilation?
    numb/tingling feeling in extremities, & dizziness
  110. during respiratory alkalosis the kidney compensates by ....
    excreting HCO3 in the urine
  111. how do you correct respiratory alkalosis
    removing stimulus causing hyperventilation
  112. metabolic acidosis is characterized by :
    reduced HCO3
  113. metabolic alkalosis is characterized by:
    increased HCO3
  114. Name the 2 ways metabolic acidosis can occur
    • 1. accumulation of fixed acids
    • 2. decrease in HCO3
  115. What is a normal range for anion gap?
    8 - 16
  116. the anion gap exists because ....
    not all ions are measured
  117. elevates anion gap (>20) indicates ....
    metabolic acidosis related to increase in fixed acids
  118. when fixed acids accumulate in the blood they ....
    increase the H+
  119. metabolic acidosis caused by bicarb loss does not cause ....
    an increase in anion gap because Cl- ions are retained
  120. how do you determine the coexistence of 2 metabolic disorders?
    bicarbonate gap
  121. compensation for metabolic acidosis is ....
    hyperventilation
  122. metabolic alkalosis is characterized by a ....
    high bicarb concentration & high pH
  123. name the 2 ways metabolic alkalosis can occur
    • 1. loss of fixed acids
    • 2. gain of blood buffer base
  124. metabolic alkalosis is most commonly caused by ....
    loss of acid or hypokalemia
  125. compensation for metabolic alkalosis is ....
    hypoventilation
  126. related to the metabolic component of blood
    base excess (deficit)
  127. .... should be looked at separately from acid base status
    oxygenation
  128. Pa02 decreases with ....
    age
  129. .... leads to metabolic acidosis
    anaerobic metabolism
  130. hyperventilation stimulated by hypoxemia leads to ....
    respiratory alkalosis
  131. .... must be noted
    Fi02
  132. voluntary control is ....
    limited
  133. the .... is believed to originate in the medulla oblongata by 2 groups of respiratory neurons
    rhythmic spontaneous ventilator pattern
  134. name the 2 groups of rhythmic spontaneous ventilatory pattern
    • 1. ventral respiratory group
    • 2. dorsal respiratory group
  135. the dorsal respiratory group consists of .... and is responsible for regular rhythmicity of ventilation
    inspiratory neurons
  136. the DRG inputs modify the .... and ....
    rate and depth of inspiration
  137. ventral respiratory group contains .... and ....
    inspiratory and expiratory neurons
  138. during normal quiet breath the VRG neurons are ....
    totally inactive
  139. name the 2 respiratory centers in the Pons
    • 1. apneustic center
    • 2. pneumotaxic center
  140. apneuistic breathing indicates ....
    damage to the pons
  141. pneumotaxic center controls the ....
    off switch point for inspiration
  142. pneumotaxic center enhances the ....
    rhythmicity of the breathing pattern
  143. generated by stretch receptors located in the smooth muscle of large and small airways
    hering-breuer inflation reflex
  144. hering-breuer reflex is only active at ....
    large tidal volumes
  145. compression or deflation of the lungs, stimulates increased rate of breathing
    deflation reflex
  146. hyperinflating the lungs, causing an increase in inspiratory effort (opposite of hering-breuer)
    head's paradoxic reflex
  147. located in epithelium of large airways, reflexes has sensory & motor paths by the Vagus nerve
    irritant receptors
  148. located in lung parenchyma near pulmonary capillaries
    juxtapulmonary-capillary receptors (J receptors)
  149. name 4 things the J receptors are stimulated by
    • 1. pulmonary vascular congestion
    • 2. pulmonary hypertension
    • 3. edema
    • 4. pulmonary embolism
  150. found in muscles, joints, tendons, send stimulatory signals to the medulla increasing  inspiration, pain receptors
    peripheral proprioceptors
  151. .... & .... baroreceptors can increase or decrease ventilation in response to blood pressure changes
    aortic & carotid
  152. ...., ...., .... stimulate ventilation by activation of various chemoreceptors which send signals to medullary centers, increasing ventilation
    hypercapnia, acidemia, hypoxemia
  153. central chemoreceptors located in medulla, respond directly to .... , but are indirectly controlled by ....
    H+ , PC02
  154. these chemoreceptors are not in direct contact with arterial blood but with the ....
    CSF
  155. blood brain barrier is impermeable to .... & .... ions, but permeable to ....
    H+ & bicarbonate  ,  C02
  156. in cases of chronic hypercapnia the kidney compensates by ....
    retaining HC03-
  157. no oxygen = no ....
    effect on chemoreceptors
  158. .... has no direct effect on central chemoreceptors
    02
  159. located in carotid bodies & aortic arch near baroreceptors
    peripheral chemoreceptors
  160. the carotid bodies are more sensitive to .... levels than aortic bodies
    Pa02
  161. carotid bodies respond to .... & not to .... content
    Pa02 & 02
  162. peripheral chemoreceptors are not stimulated until the Pa02 ....
    drops below 60 mmHg
  163. .... plays no role in ventilatory rate of healthy individuals at sea level
    02
  164. peripheral chemoreceptors also respond to .... & .... levels in the blood to increase ventilation
    H+ & C02
  165. peripheral chemoreceptors response occurs .... to changes than central chemoreceptors
    much quicker
  166. Name 5 things responses to peripheral receptors
    • 1.peripheral vasoconstriction
    • 2.increased PVR
    • 3.systemic hypertension
    • 4.tachycardia
  167. increased PaC02 dilates ....
    cerebral vessels
  168. C02 levels in head trauma are usually maintained at ....
    <35 mmHg
  169. Name 4 effects of renal failure
    • 1. hypertension
    • 2. CHF
    • 3. anemia
    • 4. pulmonary edema
  170. the renal artery, vein, nerves, & ureters enter & exit the kidney at the ....
    hilum
  171. outer section of the kidney
    cortex
  172. inner section of the kidney
    medulla
  173. the renal pyramids contain the .... of the kidneys nephrons
    functional units
  174. each kidney contains .... nephrons
    1 million
  175. the nephron consists of ...., .... ,.... ,....
    glomerulus, proximal convoluted tubule, loop of henle, & distal convoluted tubule
  176. the distal convoluted tubules empty into the ....
    collecting ducts
  177. hollow pouch which surrounds the glomerulus
    bowmans capsule
  178. capillary bed formed by afferent arterioles
    glomerulus
  179. the glomerulus & bowmans capsule form the ....
    renal corpuscle
  180. determined by glomerular pressure, plasma oncotic pressure, and bowmans capsular pressure (10 mmHg)
    glomerular filtration rate (GFR)
  181. a constant GFR is important to adequately ....
    eliminate waste products & reabsorb solutes
  182. what is GFR arterial pressure
    70 - 160 mmHg
  183. average urine output is ....
    60 ml/hour
  184. H20 moves out into the ....
    peritubular capillaries
  185. the volume of urine is affected by the ....
    perfusion pressure
  186. aldosterone causes .... retention and .... excretion
    Na+ and K+
  187. the renal tubules are capable of secreting ....
    H+ ions
  188. when H+ concentrations decrease the kidneys excrete HC03 to ....
    reduce alkalinity
  189. For every H+ excreted an .... is gained by the blood
    HC03-
  190. name the 2 buffers that H+ ions excreted in filtrate
    • 1. phosphate buffer
    • 2. ammonia buffer
  191. name 5 common causes of renal failure
    • 1. infections
    • 2. toxicity
    • 3. obstructive disorders
    • 4. congenital disorders
    • 5. immune responses
  192. infections are most common in ....
    urinary tract infection
  193. renal disorders can be classified by ....
    where in the renal system they occur
  194. name 4 renal conditions that obstruct blood flow through the kidney
    • 1. renal ischemia
    • 2. intratubular obstructions
    • 3. acute inflammatory conditions
    • 4. glomerular injury
  195. post-renal disorders are usually ....
    obstructions in urinary tract
  196. .... can also cause decreased urinary output & renal failure
    mechanical ventilation
  197. name the 2 tests for kidney function
    • 1. BUN
    • 2. Creatinine

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