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Vuck Path/Pharm Test 2
Acid Base Regulation
111
Pharmacology
Professional
01/19/2012

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Term
Normal pH range
Definition
7.35 - 7.45
Term
High mortality pH range
Definition
pH < 6.9 or > 7.8
Term
Decreases in pH denote . . .
Definition
higher concentrations of H+ ions, or higher levels of acidity.
Term
_____ is continuously produced during cellular metabolism
Definition
Acid
Term
Total body _____ is a combination of volatile acids (those that contain CO2 and its variants) and nonvolatile acids (i.e. amino acids, lactic acid)
Definition
acid load
Term
______ can build up in the blood during intense exercise, but only becomes pathologic when increased production can not be corrected by the kidneys.
Definition
Lactic acid
Term
Causes of build up of acid
Definition
Ingestion, hypoventilation, diarrhea
Term
Products of fat metabolism during periods of inadequate glucose availablility; i.e., starvation ketosis and metabolic acidosis.
Definition
Ketone bodies, or ketoacids
Term
Carbonic Acid (H2CO3)
Definition
Volatile acid
Dissociates into H2O and CO2
Excreted by lungs
Term
5 Non-volatile (fixed) acids, excreted by kidneys
Definition
Sulfuric Acid
Phosphoric Acid
Lactic Acid
Ammonium ions
Ketone Bodies:
Acetoacetic Acid
b-Hydroxybutyric Acid
Term
pH homeostasis constantly regulated by
Definition
Buffers
Bicarbonate buffer system (ECF)
Phosphate, hemoglobin, & protein
Respiratory System
Renal System
Term
Buffering systems consist of a weak acid + base. Prevent large changes in pH by taking up/releasing H+ to maintain normal pH.
Definition
work to maintain pH within normal levels.
Term
Bicarbonate buffering system ratio
Definition
Maintained at constant ratio of
20 HCO3 : 1 H2CO3
Term
Bicarbonate ions (HCO-3) regulated by
Definition
kidneys
Term
Carbonic Acid (H2CO3) regulated by
Definition
lungs
Term
Excess acid build up
Definition

During periods of excess acid accumulation in the blood, bicarbonate is released into extracellular fluid where it can take up the extra H+ ions released by the acid and becomes carbonic acid. Carbonic acid is a weak acid and easily gives up H+.  Thus, through enzymatic conversion by carbonic anhydrase, H2CO3 cans be dissociated into CO2 and H2O, which can be excreted by the lungs during respiration.

Term
Bicarb amount in blood
Definition
24 milliequivalents/L
Term
Respiratory regulation of acid base balance
Definition
During exhalation, lungs continually excreting carbonic acid-effectively maintaining pH @ 7.4.
High levels of CO2 result from hypoventilation (slow, shallow respirations).
Low levels of CO2 result from hyperventilation (rapid, deep respirations)
Correction of alterations in CO2 is accomplished by changes in respiratory rate and depth.
Term
Typical level of CO2 in blood
Definition
PaCO2: level of CO2 in blood
35 – 45 mm Hg
Term
Increased CO2 result of
Definition
hypoventilation
Term
Decreased CO2 result of
Definition
hyperventilation
Term
Poor respiratory function means acid base balance
Definition
Cannot be properly regulated by respiration
Term
CO2 + H2O =
Definition
H2CO3
Term
Renal regulation of acid base balance
Definition
Metabolic acid excretion
1. Filtered HCO3 reabsorbed-@ 80%
2. H+ or HCO3 secreted to maintain balance,
Term
Renal compensation to excess or decrease in carbonic acid takes _____ to be effective
Definition
days
Term
______ is the only acid not excreted by kidneys. Can only be excreted from lungs. Decreased HCO3 reflects an excess of metabolic acids in the blood.
Definition
Carbonic acid
Term
Bicarbonate is freely filtered at _________.
Definition
renal corpuscles

Usual plasma concentration is 24 mmol/L. The average daily glomerular filtration rate is 180 L/day, so huge amounts of bicarb (@4320 mmol/day would be excreted! That would be like adding huge amounts of acids to the body. Most-if not all-the filtered bicarbonate must be reabsorbed to balance acid!
Term
______ occurs when the absolute values of HCO3- and PaCO2 return to normal.
Definition
Correction
Term
Compensation
Definition
regulation of acid base balance through adaptive mechanisms, NOT correction of the primary imbalance
Term
Main source of bicarb
Definition
kidneys
Term
4 Key acid-base disturbances
Definition
Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis
Term
Respiratory Alkalosis
Definition
: Decreased CO2. Carbonic acid deficit. Caused by hyperventilation due to anxiety.
Term
Respiratory Acidosis:
Definition
Hypoventilation and accumulation of CO2 in body. Caused by airway obstruction, chronic obstructive lung diseases (emphysema), neuromuscular disorders.
Term
Metaboloic Alkalosis
Definition
: Increase of blood pH by ingestion of excess alkali (sodium bicarbonate) or abnormal loss of acid (prolonged vomiting).
Term
Metabolic Acidosis
Definition
: Decreased blood pH caused by disorders that increase lactic acid, ketone bodies (acetoacetic acid and b-hydroxybutyrate) or by ingestion of salicylates, ethylene glycol, methyl alcohol. Example: Diabetic ketoacidosis.
Term
Respiratory alkalosis causes
Definition
hyperventilation
Anxiety, excessive sobbing
Brainstem stimulation-head trauma, meningitis
Term
Respiratory alkalosis compensatory response
Definition
decreased renal excretion of metabolic acids
Term
Treatment of respiratory alkalosis
Definition
Rebreathe CO2-laden breath, sedative
Term
Respiratory acidosis causes
Definition
Retention of CO2
Pulmonary diseases: COPD, pneumonia, pulmonary edema, OSA
Impaired neuromuscular function
Term
Respiratory acidosis compensation
Definition
increased renal excretion of metabolic acids
Term
Respiratory acidosis treatment
Definition
Correct respiratory impairment
Infusion of sodium bicarbonate if severe
Term
4 causes of metabolic acidosis
Definition
1. Chronic renal failure
2. Loss of bicarbonate during severe diarrhea
3. Ketoacidosis (ex: type 1 diabetes, starvation)
4. Methanol and certain medication poisoning
Term
Metabolic acidosis s/s
Definition
headache, abdominal pain (unique--cause unknown), CNS depression
Term
Metabolic Alkalosis causes
Definition
Excessive loss of gastric acid (vomiting, suctioning)
Overuse of bicarbonate products
Term
Metabolic alkalosis compensatory response
Definition
hypoventilation: losing acid--hang on to carbonic acid by decreasing exhalation of CO2
Term
Metabolic alkalosis treatment
Definition
Solution of sodium chloride plus potassium chloride
Facilitates renal excretion of bicarbonate
Term
Metabolic Acidosis compensatory response
Definition
Respiratory: hyperventilation
Decreases H2CO3 in attempt to normalize pH when HCO3 is low
Term
Metabolic acidosis treatment
Definition
Correct the underlying cause of acidosis
Occasionally Alkalinizing salt (sodium bicarbonate) if severe
Given oral or IV
Term
Arterial Blood Gas (ABG)
Definition
pH: 7.35-7.45
PaCO2: 35 – 45 mm Hg
HCO3-: 22 – 26 mEq/L
Term
Normal Values: PaO2 and SaO2
Definition
Partial pressure of arterial oxygen (PaO2): 80-100 mm HG (varies with age)
Oxygen saturation (SaO2): % of Hgb carrying O2: 95%-100%
Term
CS3: 78 year old male, lifetime smoker, history of emphysema x 4 years
pH: 7.35
PaCO2: 60 mm Hg
HCO3: 38 mEq/L
Definition
Impaired lung function, can't get rid of excess acid. High bicarb is compensatory. Fully compensated respiratory acidosis.
Term
CS1: Man brought to ED for OD of tricyclic antidepressant. Unconscious, with resp. rate of 5-8 BPM.
pH: 7.25
PaCO2: 61 mm Hg
PaO2: 76 mm Hg
HCO3: 26 mm Hg
SaO2: 89%
Definition
Ph is low, so Uncompensated resp acidosis
Term
CS2: 13 year old female brought to ED with stomach pain, nausea and vomiting. She is lethargic and slightly confused. Resp. rate: 34.
pH: 7.2
PaCO2: 28 mm Hg
HCO3: 10 mm Hg
SaO2: 90%
Definition
Metabolic acidosis, somewhat compensated thanks to hyperventilation. Acid and base are both low. Losing metabolic acids quickly. Prebicarb is binding to excessive acid load, so we're losing all this to urine. In ketoacidosis. Kidneys have been releasing more bicarb. Can't keep up--trying to breathe it out. Low bicarb-->metabolic
Term
serum osmolality
Definition
a measure of the number of dissolved particles per unit of water in serum. concentration of the number of particles
Term
TBW as a percentage of BW varies
Definition
males (60%); females (50%);infants (70%)
Term
Half of _____ is in the ICF & ECF of muscle
Definition
TBW (total body weight)
Term
Hydrostatic pressure
Definition
Push

Created by fluid
Capillaries: the pumping of the heart
Tissue: interstitial fluid
Term
Osmotic = oncotic = colloidal pressure
Definition
Pull
Created by proteins
Capillaries: plasma proteins
Tissue: interstitial proteins
Term
1. The ____consists of fluid contained within all the billions of cells in the body.
Definition
intracelluar fluid compartment
Term
2. The ____ contains all the fluids outside the cell, including those in the interstitial or tissue spaces and blood vessels.
Definition
extracellular_fluid compartment
Term
3. ___ is the movement of charged or uncharged particles along a concentration gradient.
Definition
Diffusion
Term
4. _is the movement of water across a semi-permeable membrane.
Definition
Osmosis
Term
5. __refers to the osmolar concentration 1 L of solution and ___ to the osmolar concentration in 1 kg of water.
Definition
Osmolarity; osmolality
Term
6. _ and other organic compounds cannot pass through the membrane.
Definition
Proteins
Term
7. The ___ membrane pump continuously removes three Na+ ions from the cell for every two K+ ions that are back into the cell.
Definition
Na-K-ATPase
Term
8. __refers to the movement of water through the capillary pores because of a mechanical, rather than osmotic force.
Definition
Capillary filtration
Term
1. The ___represents an accessory route whereby fluid from interstitial spaces can return to the circulation.
Definition
lymphatic system
Term
10. ___is a palpable swelling produced by expansion of the interstitial fluid volume.
Definition
Edema
Term
11. Edema due to decreased capillary colloidal osmotic pressure is the result of inadequate production of abnormal loss of _____.
Definition
plasma proteins
Term
12. __edema occurs at times when the accumulation of interstitial fluid exceeds the absorptive capacity of tissue gel.
Definition
Pitting
Term
13. __ represent an accumulation or trapping of body fluids that contribute to body weight but not to fluid reserve or function.
Definition
Third-space fluids or third spacing
Term
14. Most sodium losses occur through the __or _.
Definition
urine; kidney
Term
15. The major regulator of sodium and water balance is the maintenance of the ___.
Definition
effective circulating volume
Term
16. When the effective circulating blood volume is compromised, the condition is often referred to as ___.
Definition
hypovolemia
Term
17. __ cause sequestering of ECF in the serous cavities, extracellular space in injured tissues, or lumen of the gut.
Definition
Third spacing
Term
18. Fluid volume excess represents an ____expansion of the ECF compartment with increases in both interstitial and vascular volumes.
Definition
isotonic
Term
19. A plasma sodium concentration below 135 mEg/L is called _.
Definition
hyponatremia
Term
20. Hypernatremia represents a deficit of ____in relation to the body’s sodium stores.
Definition
water
Term
21. Chronic hyperkalemia is usually associated with _____________
Definition
renal failure
Term
22. ___acts to sustain normal plasma levels of calcium and phosphate by increasing their absorption from the intestine. It is also is necessary for normal bone formation.
Definition
Vitamin D
Term
23. One liter of water weighs __ kg or __ lb.
Definition
1;2.2
Term
24. ____ pressure pushes water out of the capillary and into the interstitial space.
Definition
Capillary filtration
Term
positively charged ions
Definition
cations
Term
pressure by which water is dawn into a solution through a semi-permeable membrane
Definition
Osmotic pressure
Term
osmotic pressure generated by the plasma proteins impermeable to the capillary wall
Definition
Capillary colloidal
osmotic pressure
Term
effect that the effective osmotic pressure of a solution on cell size because of water movement across the cell membrane
Definition
Tonicity
Term
result of increased vascular volume
Definition
Generalized edema
Term
increased permeability of glomerular to proteins
Definition
glomerulonephritis
Term
effective osmolality same as the ICF
Definition
Isotonic solution
Term
urine output that is required to eliminate waste
Definition
obligatory urine output
Term
negatively charged ions
Definition
Anions
Term
edema due to impaired lymph drainage
Definition
lymphedema
Term
60 40 20 Rule
Definition
Total Body Water = 60% of body weight
Intracellular fluid = 40% of body weight
Extracellular fluid = 20% of body weight
Term
ICF
Definition
2/3
Term
ECF
Definition
1/3
Plasma: 1/4-influenced by kidney
Interstitial: 3/4-pathological states
Term
– occurs at the glomerulus; non selective process
Definition
Filtration
Term
- 99% of water, electrolytes, and nutrients undergo reabsorption by active transport; occurs all along the nephron
Definition
Reabsorption
Term
- proximal convoluted tubule
Definition
Active tubular secretion (not excretion!)
Term
Most diuretics share the same MOA-
Definition
block Na and Cl reabsorption
(stays in the nephron)
Term
Three basic functions of diuretics:
Definition
1. Cleansing and maintenance of extracellular fluid (ECF) (volume and composition)
2. Maintenance of acid-base balance
3. Excretion of metabolic wastes and foreign substances
Term
Classification of Diuretics
Definition

 

üHigh-ceiling (loop) diuretics
Thiazides and related diuretics
Potassium-sparing diuretics
Aldosterone antagonists
Nonaldosterone antagonists
Osmotic diuretics
Carbonic anhydrase inhibitors (not covered)
Term
___ produces greatest diuresis
Definition
Proximal tubule
Term
Adverse effects of diuretics
Definition
Hypovolemia
Acid-base imbalance
Electrolyte imbalances (K)
Term
Osmotic
Definition
Mannitol
proximal convoluted tubule
65% Na reabsorbed
Term
Loop
Definition
Furosemide
thick segment ascending limb of Henle's loop
20% Na reabsorbed
Term
Thiazides
Definition
Thiazides
early distal convoluted tubule
10% Na reabsorbed
Term
Potassium (K)-sparing
Definition
Spironolactone, Triamterene
late distal convoluted tuble, collecting duct
1 - 5% Na reabsorbed
Term
Potassium-sparing: two subdivisions
Definition
Aldosterone antagonists (spironolactone)
Nonaldosterone antagonists (triamterene)
Term
Factors Influencing Edema Formation
Definition
↑ Hydrostatic pressure (e.g. Heart failure)
 Oncotic pressure (low protein states)
↑ capillary permeability (inflammation)
Lymphatic obstruction
Na and H2O retention by the kidneys
Term
A major side effect of ___ and ___ diuretics is hypokalemia.
Definition
loop; thiazide
Term
Amount of Na + Cl reabsorption inhibited
Definition
diuresis
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