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38 Cards in this Set
- Front
- Back
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ventilation status changes pCO2 fast compensatory mechanism |
Respiratory (lung) |
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increase in acid production of loss of bicarbonate slow compensatory mechanism |
Metabolic (kidney) |
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Renal pH regulation mechanism |
increase activity of H/Na ATPase ~H out of cell, Na in cell excrete H as H2PO4 or NH4 increase HCO3 reabsoption |
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How is pCO2 regulated |
by the depth and frequency of respiration
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breathing slow= breathing fast = |
Hypoventilation Hyperventilation |
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increase in ventilation increase in pCO2 and increase [H+] decrease in pO2 |
Hypoventilation |
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decrease in ventilation decrease in pCO2 and [H+] increaes in pO2 |
Hyperventilation |
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Changes in [H+] are always associated with either: |
change in [anions] exchange with other cations (H increases is accompainined by either increase in anion , Cl or Lactate, or in exchange for a cation, K or Na) |
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A cells secrete |
acid |
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B cells secrete |
base |
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abnormal decreased plasma [HCO3] Due to: production of organic acids reduced excretion of acid excessive loss of bicarbonate |
Metabolic acidosis |
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Is the ratio of [HCO3/H2CO3] increased or decreased in metabolic acidosis what effect does this have on the [H] and pH |
The ratio is decreased increase in H decrease in pH |
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What does metabolic acidosis induce |
respiratory compensation by hyperventilation ~wanting to restore the ratio to 20:1 ~decrease pCO2 renal compensation through increased acid excretion and base reabsorption |
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Cause of Metabolic acidosis is based on the presence/absence of |
anion gap |
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Adding more acid Losing less acid Losing more base |
Acidosis |
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Adding more base Losing less base Losing more acid |
Alkalosis |
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H+ and HCO3- are coupled to transport of ____and _____-, so changes to levels of either of those electrolyes can inhibit the kidney from compensating properly for acidemia/alkalemia |
Cl and K |
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Kidney can’t reabsorb any HCO3- if _______, any excess excreted in urine |
>28mmol/L |
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produced by unmeasured anions (lactate and BHOB)
MUD PILES |
Anion gap |
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What is the normal range for anion gap |
7-16 mmol/L |
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M P L |
Methanol
Uremia of renal failure Dka Paraldehyde Iisoniazid, iron, ischemia Lactate Ethlylene glycol Salicylate |
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metabolism of fatty acids by beta-oxidation produces actoacetic acid and beta-hydroxybutyrate anion gap seen in diabetics, alcholics, malnourished |
Ketoacidosis |
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anaerobic metabolism of glucose by muscle and RBC produces lactate Anion gap seen in severe tissue hypoxia and some ingestions |
Lactic acidosis |
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What can cause metabolic acidosis |
Diarrhea Renal Failure (GFR <20) Renal tubular acidosis ~Type I and Type II Carbonic anhydrase inhibitors |
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primarily abnormality is increased plasma [HCO3] Due to: production of excess base reduced excretion of base excesive loss of acid-rich fluids |
Metabolic alkalosis |
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Is the ratio [HCO3/H2CO3] increased or decreased in metabolic alkalosis What about [H+] and pH |
increased H decreased increase in pH |
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What does metabolic acidosis induce |
hypoventilation (incr pCO2) decrease acid excretion and base reabsorption |
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The cause of alkalosis is identified based on what |
Chloride responce |
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occurs as a result of hypovolemia In responce to decr blood volume ~aldosternone causes kidney to retain Na, Cl, HCO3 and excrete K and H ~urine becomes acidic with low HCO3 and Cl ~urine Cl<10 mmol/L |
Chloride (saline) resonsive alkalosis |
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What can cause chloride responsive alkalosis |
vomiting, upper duodenal obstruction and some diluretics |
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occurs as a result of another underlying disease or due to addition of exogenous base Causes: Mineralocorticoid or glucocorticoid excess; exogenous base |
Chloride resistant alkalosis |
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___ competes with H+ for H+/Na+ ATPase in renal tubule |
K |
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if K is ____, it will be exchanged instead of H+, leading to acidosis |
Hight |
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if K is ____, it will be exchanged instead of H+, leading to alkalosis
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low |
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primarly abnormality is increased pCO2 Caused by direct depression or direct obstruction of respiratory Ratio of [HCO3-]/[H2CO3] decreased, leading to increased [H+] and decreased pH want to decrease the pCO2 |
Respiratory acidosis |
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Compensationoccurs first via what in respiratory acidosis |
plasma proteins |
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primarily abnormality is decreased pCO2 (acute or chronic) caused by increased rate or depth of breathing, aicd eliminatedas CO2 Ratio of [HCO3-]/[H2CO3] increased, leading to decreased [H+] and increased pH |
Respiratory Alkalosis |
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Compensation for resp alkalosis by plasma proteins by |
donate H+ to restore [HCO3-]/[H2CO3] ratio |
