Exam3Lec7AcidBase2

Question 1

Total acid production=____ + ____

Answer 1

Volatile Acid (99.8 %)+Fixed Acid (0.02 %)

Question 2

What does the davenport diagram show?

Answer 2

• It is a graphical visualization of the HH equation.
• pH-Bicarbonate Diagram with PCO2 Isobars
• By changing PP of CO2 and measuring pH and bicarb you can get different points and put them together to get the normal buffer line.

Question 3

Is the red solid line or the black solid line a more powerful buffer? Why?

Answer 3

red line is a more powerful line because for example when the pp changed from 40 to 80, pp change when from 7.4 to 7.2. The black line change more, pH went from 7.4 to 7,15

Question 4

What makes blood a better buffer and how?

Answer 4

Hemoglobin makes blood a better buffer and increases bicarbonate concentration

more hemoglobin in the blood, makes the slope steeper

Question 5

Which buffer system is more powerful (left vs right graph) and why?

Answer 5

The right graph is more powerful because it represents HCO3-/H2CO3 biffer system with hemoglobin.
As seen on the graph and using the HH equation, then change in the pH is less as pp CO2 incr. It keeps the overall ratio of [HCO3-]/[CO2] relatively the same bc as CO2 incr so does HCO3-. Same for decr.

Question 6

Explain transport of CO2 and buffering by hemoglobin

why when blood has hemoglobin our plasma buffering system is more powerful?

Answer 6

Because Most CO2 is transported in the blood as HCO3-

CO2 comes into cell and is converted to H2CO3 when then dissociates into HCO3- and H+. HCO3- can leave and be reabsorb, Hemoglobin can buffer proton.

incr CO2 concentration, incr bicarb concentraiton in plasma,

Question 7

Regulation of Body pH is achieved by what 3 mechanisms?

Answer 7

1. Chemical Buffering
2. Respiratory Compensation (lungs)
3. Renal Compensation (kidney)

Question 8

ADDITION OF A STRONG ACID

Lets say that there is an addition of HCL to the plasma (final: 12 mM HCl). Explain the First Line of Defense (fast chemical buffering) with the HH equation. How does the pH change?

Answer 8

pH went from 7.4-6.06 with the fast chemical buffering

Question 9

ADDITION OF A STRONG ACID

Explain acidosis and our second line of defense** (fast respiratory component)** with the HH equation. How does the pH change?

Answer 9

1. With regular ventilation: . The increased [CO2] by buffering is removed by alveolar ventilation, so PCO2 is maintained at 40 mmHg (1.2 mM CO2) and pH goes up to 7.1
2. Acidosis causes incr in ventilation, so PCO2 decr from 40 to 25 (0.75). pH incr to 7.3 which is closer to 7.4

decr in [HCO3-] and [CO2]. decr in [CO2] b/c neural reflex to increase ventilation.

Question 10

Explain acidosis and our third line of defense (Slow Renal Compensation) with the HH equation. How does the pH change?

Answer 10

Here H+ secretion and HCO3- reabsorption is occuring and Over a period of days plasma HCO3- returns to normal. pH comes back to 7.40

Restoration of [HCO3-], Restoration of [CO2]

Question 11

How can the kidney bring bicarb concentration from 12mmol back to 24 mmol?

Answer 11

By H+ secretion and HCO3- reabsorption through renal transporters of HCO3- and H+

Question 12

What are 3 main mechanisms of H+ secretion and note their location on the nephron.

Answer 12

1. H+ exchanged for Na+ ( HCO3- reabroption)- at the PT
2. H+ ATPase and H+K+ATPase in DT and CT

Question 12

Bicarbonate reabsoprtion primary in ____ and does ____ % of acid excretion

Answer 12

PT, 0%

Question 13

How does bicarbonate reabsoprtion occur in the PT and how is there is no acid excretion?

Answer 13

Question 14

Bicarbonate Reabsorption
(Proximal Tubule)
Summary
____ of Na+ and HCO3-
____ secretion of H+
____ tubular pH

Answer 14

Net reabsorption of Na+ and HCO3-
No net secretion of H+
No change in tubular pH

Question 15

What enhances Na+/H+ exchange in the PT and what are the limits of Net reabsorption of Na+ and HCO3- in the PT?

Answer 15

• ATII enhances Na+/H+ exchange
• Limits: If filtered load of HCO3- exceeds ~40 mM, the reabsorption mechanism becomes saturated.

Question 16

Review: what are the non-volatile acids (fixed acids) produced by the human body?

Answer 16

H+ + HPO42-
H+ + SO42-

Question 17

Explain Titratable acid excretion
Lxn?
Acid excretion %?

Answer 17

• Proton is being actively pumpped into lumen using ATP and binds to fixed acids and the proton is excreted and bicarb is regenerated
• Primarily in Distal Tubule & CD
• Accounts for 33 % of Acid Excretion

every time you secrete a prton you generate a new bicarb

Question 18

Explain Ammonium excretion
Lxn?
Acid excretion %?
[H+]?

Answer 18

• H+ is pumped into the lumen and it binds to NH3 (ammonia). This now becomes NH4+ whihc is membrane impermeable so it becomes excreted. Bicarb is regenerated
• Primarily in Distal Tubule & CD
• Accounts for 66 % of Acid Excretion
• [H+] is 1000 X greater in the lumen than the cell

[H+] is 1000 X becuase H+ is accumulating in the lumen and tubular fluid becomes very acidic

Question 19

Name what each slope represents

Answer 19

Question 20

respiratory acidosis/alkalosis is due to ____
metabolic cidosis/alkalosis is due to ____

Answer 20

respiratory acidosis/alkalosis is due to CO2
metabolic cidosis/alkalosis is due to HCO3-

Question 21

What causes respiratory acidosis?

Answer 21

Any impairment of alveolar ventilation.
1) COPD, CHF and other lung diseases.
2) Anesthetics and Drugs

Question 22

What occurs to pH and CO2 in respiratory acidosis?

Answer 22

pH decr due to incr CO2

Question 23

Chronic respiratory acidosis has some metabolic compensation. How does this work?

Answer 23

Kindey would help by incr concentration os bicarb to incr bicarb reabsorb so pH can incr.

Question 24

What causes respiratory *alkalosis*?

Answer 24

Anything leading to hyperventilation, in excess of that needed to keep pace with body CO2 production, such that arterial PCO2 drops below 35 mmHg. 1) Pain 2) Anxiety or Hysteria. 3) Hypoxia, **High Altitude** (mentioned skiing many times)

Question 25

What occurs to pH and CO2 in respiratory *alkalosis*?

Answer 25

pH incr bc CO2 decr

Question 26

Chronic respiratory *alkalosis* has some metabolic compensation. How does this work?

Answer 26

It will decr bicarb so you can decr pH more. (ex: after skiing you pee alot to get rid of bicarb)

Question 27

What are 5 causes of metabolic *acidosis*?

Answer 27

1. Loss of Bicarbonate Ions (e.g. diarrhea, renal dysfunction) 2. Inability to secrete H+ ions (renal dysfunction) 3. Ketoacidosis (diabetes, starvation, alcoholism) 4. Lactic Acidosis (strenuous exercise, shock, CO, ARDS, etc.) Ingested Drugs or Toxicants (methanol, ethanol, salicylates, ethylene glycol, ammonium chloride)

Question 28

What occurs to pH and HCO3 in metabolic *acidosis*?

Answer 28

pH decr because HCO3 decr

Question 29

What are the causes of metabolic *alkalosis*?

Answer 29

1) Too much Intake of Base (antacids, i.v. or ingested bicarbonate) 2) Loss of Acid (vomiting, gastric suction tube, diuretic therapy, steroid therapies).

Question 30

What occurs to pH and HCO3 in metabolic *alkalosis*?

Answer 30

pH incr because HCO3- incr

Question 31

Fill in the blank for Renal and Respiratory Compensatory Responses to Disturbances in Acid-Base Balance

Answer 31

Overall concept: compensation is always going in same direction as response bc you want to minimize change in HCO-3/ CO2 ratio

Question 32

What are 3 renal responses to metabolic acidosis

Answer 32

1. Decreased filtered bicarbonate 2. Increased H+ secretion: coupled to bicarb reabsoprtion and generation of new bicarb 3. Increased NH3 production (b/c linked to incr H+ secretion)

Question 33

What mediates long-term Renal Compensation for Acidosis?

Answer 33

Ammonia (we incr ammonia production to excrete more acid; ammonia is turned into ammonium and then excreted)

Question 34

What are 3 factors that stimulate H+ secretion

Answer 34

1. Acidosis (Metabolic or Respiratory) 2. Aldosterone 3. Hypokalemia

Question 35

How does aldosterone and hypokalemia incr H+ secretion?

Answer 35

High Aldosterone: Stimulates H+ secretion And K+ secretion. Thus Aldosterone lowers plasma K+. (hypokalemia). The end result is that NH3 Is also increased. ## Footnote Hypokalemaia leads to more acid secretion b/c NH3 production is normally inhibited by K+. So there is less inhibition and more NH3 production and more H+ secretion

Question 36

Anion Gap= ____- ____

Answer 36

Plasma [Na+] - ( [Cl-] + [HCO3-] )

Question 37

For metabolic acidosis there are 2 types of anion gap acidosis. What are they and what can they represent clinically?

Answer 37

1. *Normal anion gap acidosis*: HCO3- decreases and replaced by Cl- shift * EX: Diarrhea or simple gain of H+ + Cl- 2. *Increased anion gap acidosis* : HCO3- decreases and replaced by other organic anions so no Cl- shift * EX: actic acidosis, diabetic ketoacidosis, salicylate poisoning, methanol poisoning ## Footnote look at annion gaps for diagnosing

Question 38

Acid-base Balance Part II Summary 1. ____ improves buffering capacity of blood 2. Changes in PCO2 cause____ 3. Changes in HCO3- cause ____ 4. The respiratory compensation for acid-base imbalance is a change in ____ 5. The renal compensation for acid-base imbalance is to due to change in ____ 6. The anion gap is useful for____

Answer 38

1. **Hemoglobin** improves buffering capacity of blood. 2. Changes in PCO2 **cause respiratory acidosis/alkalosis.** 3. Changes in HCO3- cause **metabolic acidosis/alkalosis.** 4. The respiratory compensation for acid-base imbalance is a change in **respiration/ventilation, and is relatively fast (minutes)**. 5. The renal compensation for acid-base imbalance is due to change in **HCO3- reabsorption and H+ secretion.** 6. The anion gap is useful for **differentiating the cause of metabolic acidosis.**

Question 39

True or False: Bicarbonate is readily absorbed by the tubule because of its high permeability.

Answer 39

False ## Footnote reabsorbed by CO2 diffusion on lumen side and on capillary side its by Na+ bicarb transporter or HCO3-/Cl- exchanger

Question 40

True or False: A carbonic anhydrase inhibitor decreases renal bicarbonate reabsorption and H+ secretion.

Answer 40

True

Question 41

True or False: Hypokalemia leads to reduced renal H+ secretion and acidosis.

Answer 41

False ## Footnote incr renal secretion