Acid base 3

Question 1

what is metabolic alk

Answer 1

alk due to high serum HCO3-

Question 2

what is met alk comp?

Answer 2

slight rise in CO2 - hypocapnea

Question 3

what usually accompanies met alk

Answer 3

hypokalemia

Question 4

4 sources of extra HCO3-

Answer 4

1. reduced ECF vol - increases [c]
2. vomiting - loss of HCl
3. hypokalemia and inclreased aldo - increased urine NH4
4. hypokalemia - shifts H into cells

Question 5

2 ways vomiting raises HCO3-

Answer 5

1. loss of HCl is compensated for and HCO3- is biproduct

2. lots of vomiting leads to volume depletion and increases [c]

Question 6

how does aldosterone increase HCO3- (2)

Answer 6

1. RAAS (A2 esp) activate NHE3 pump to pull in more Na and this ends up reabsorbing more HCO3-
2. aldosterone pushes our H into lumen which bind with NH3 and get more NH4+ flushed out

Question 7

how does hypokalemia affect HCO3- levels

Answer 7

1. K comes out of cell and H goes in
2. esp kidney cell thinks its acidemic
3. tell it to behave as if it’s acidemic and reabsorb and make more HCO3-

Question 8

2 reasons for absorbing more HCO3- in met alk

Answer 8

1. hypokalemia - body thinks acidemia

2. ECF volume depletion - RAAS acitvation

Question 9

how does vomiting create hypokalemia

Answer 9

1. vomiting creates high levels of HCO3-
2. body needs to excrete HCO3- as NaHCO3
3. high urine flow takes lots of K with it

Question 10

how to diff met alkalosis with hypokalemia

Answer 10

hypertension present or not

Question 11

2 causes if high BP

Answer 11

1. primary hyperadrenalism - Conns

2. renal art stenosis - kidney not getting blood so activates RAAS

Question 12

3 causes if normotensive

Answer 12

1. diuretics
2. vomiting
3. barter or gitelman syndrome