Resp - Lec 20: the kidneys and lungs in acid base balance.

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Across
  1. 4. if SBE is ____ - this means we have an excess of bases, and therefore (metabolic) alkalosis, if it is LOW – no base excess, (metabolic) acidosis.
  2. 5. up to 40 of an acute acid load can be buffered by _____. Efficient because 2 hydrogen ions swapped for one calcium (charges).
  3. 6. acid is a molecule that can donate a _______. Simplest is hydrogen.
  4. 8. because bicarbonate has a ___________ charge, it will be affected if the concn of other anions in the body change (Cl-, phosphates, sulphates, etc)
  5. 9. severe acidosis (less than 7.2) can cause: ______ arrhythmias, decreased _______ contractility, arterial vasodilation and low blood pressure, decreased flow to liver and kidney, insulin resistance, increased intracranial pressure, alterations in electrolyte balance (K+ and Ca++)
  6. 12. causes of metabolic alkalosis (rarer than acidosis): increased base intake, increased loss of acid, low chloride concentration (most common), and increased __________ of bases.
  7. 15. in chronic renal failure – kidney cannot retain _____________ (normally a buffer in blood). Loss of _____________ causes acidosis.
  8. 16. fluid therapy will help solve ______ % of metabolic acid base disorders. Except in eg diabetic ketoacidosis – need to give insulin.
  9. 18. acidosis and alkalosis can be ___________ by disorders, but can also cause problems if severe.
  10. 21. protein and phospholipid metabolism produces ____________ ions. CO2 is produced by carb met.
  11. 22. causes of alkalosis (opposite for acidosis) include: too much base produced, or too little base ___________. Or too little acid produced, or too much acid ___________.
  12. 27. (normal blood results: pH 7.4, pCO2 40, SBE 0) what condition do we have (what is the primary problem) if the results are: pH 7.1, pCO2 60, SBE +5?
  13. 28. can change CO2 in body by altering the ____ and depth of breathing.
  14. 29. the body must remain _____________, might sacrifice acid base balance to keep correct number of positive and negative charges around.
  15. 32. for the results pH 7.2, pCO2 31, SBE -11 what is the condition?
  16. 35. bone can act as an important buffer in cases of acute acidosis. However, acidosis causes ________ to be released from bone. ___________ then excreted in urine. Chronic acidosis can therefore lead to fragile bones, fractures, etc
  17. 36. because hydrogen has a ____________ charge, it can be significantly impacted on if the concentration of other cations in the body change (Na+, K+, Ca++ etc). Eg if lose potassium, might retain more hydrogen.
  18. 37. snake and tick _____ can paralyse resp muscles and cause hypoventilation – respiratory acidosis.
  19. 40. the __________ principle states that – no matter how many buffers are present, a solution can have only one pH, and therefore only one [H+], so the behaviour of any buffer can be predicted (in medicine use to carbonic acid-bicarbonate pair system to predict – we can measure bicarb, CO2, etc)
  20. 41. buffers in blood stream include – HCO3-, lactate and ____________ (a plasma protein).
  21. 42. ___________ excretion of acid (cause of met acidosis) occurs in: hypoadrenocorticism, renal tubular acidosis, uraemia.
  22. 44. with severe metabolic acidosis, we ______ give just bicarbonate – this just takes away the sign of the underlying problem. It doesn’t fix the underlying cause. Underlying cause is still happening.... cells die. (also side effects to bicarb administration)
  23. 45. causes of respiratory acidosis are any thing that causes ____________: traumatic brain injury, anaesthesia, end stage respiratory disease, upper airway obstruction, paralysis/weakness of resp muscles (snake/tick envenomation, myasthenia gravis, phrenic nerve injury).
  24. 49. SBE does not measure ____ (abb) as it is a volatile molecule.
  25. 50. in a mixed acid base disorder, resp acidosis (for eg) may _______balance met alkalosis to give a pH close to normal. Not compensation, both primary. These are tricky. Compensation will NEVER take pH back to normal, however, a mixed acid base balance may get close.
  26. 51. molecule with a negative charge.
  27. 53. when patients ______, they lose HCl. Loss of H+ will create a mild alkalotic env. Because water has been lost, we retain Na+ or K+ in kidneys to help water retention. Na+ or K+ is retained in place of lost H+. because body wants to remain electroneutral, need more negative ions. So HCO3- retained (Cl- lost in ______). This increase in HCO3- will cause the alkalosis to become more severe. (see slide)
  28. 54. metabolic __________ is much more rare than metabolic acidosis. Metabolic _________ can be caused by: vomiting of too much HCl, some drugs. Clinical effects at a pH of >7.5
  29. 55. clinical effects of metabolic alkalosis include: seizures and muscle __________, cardiac arrhythmias, hypoklemia, hypocalcaemia)
  30. 56. ______ therapy will resolve 90% of metabolic acid base disorders (improve tissue perfusion, renal perfusion (kidneys will help solve problem), normalise electrolytes, provide buffers).
  31. 57. most enzymes in the body function within a limited __ range. (7.35-7.45. optimal is 7.4)
  32. 59. most common cause of metabolic acidosis is cellular _______ - not enough oxygen going to cells, have to do anaerobic metabolism (2 x hydrogen ions produced in glycolysis).
  33. 60. to determine acid base status – take ______ blood and measure pH, pCO2, and SBE.
  34. 61. rule of _______ for looking at normal values on a blood gas analysis: pH should be 7.4, pCO2 should be 40 (35-45), SBE should be 0 (between -4 and +4).
Down
  1. 1. most common cause of metabolic alkalosis is low ___________ concentration. (vomiting, increased urinary excretion of __________)
  2. 2. if pCO2 is high – a (respiratory) acidosis. If it is ___ = (respiratory) alkalosis.
  3. 3. kidneys are _________ at excreting alkali than acid load.
  4. 7. there will be ________ in both respiratory and metabolic systems (measured by pCO2 and SBE) because one will compensate for the other, but we need to know which is CAUSING the problem in the first place (can occasionally have two primary disorders “mixed acid base disorders”!).
  5. 10. __________ animals cannot metabolise glucose (lack of insulin). Use fatty acids - __________ ketoacidosis –drop in pH.
  6. 11. ___________________ ______ ________ (SBE) = (helps measure acid base balance of METABOLIC system) does not measure CO2. Measures non volatile acids and bases (CO2 is volatile) including organic molecules and ions.
  7. 13. increased exrection of base (cause of met acidosis) occurs in: chronic _______ failure, severe small intestinal diarrhoea. (cant hold on to bicarb)
  8. 14. acid excreted via lungs and ________
  9. 17. acid is buffered by bicarbonate, __________ (in RBCs), and plasma proteins.
  10. 19. when there is a _____ acidosis or alkalosis, there will be an overall acidosis/alkalosis, and both pCO2 and SBE will be either acidotic or alkalotic (neither compensating, both primary causes). These are called ______ alkalosis or ______ acidosis.
  11. 20. severe ___________ can cause metabolic acidosis as the blood volume is reduced and so blood flow to tissues is impaired – hypoxia – anaerobic met (glycolysis) production of H+ etc.
  12. 23. panting dogs not necessarily hyperventilating, may just be moving _____ ________ air for themoregulation.
  13. 24. (normal blood results: pH 7.4, pCO2 40, SBE 0) for the results pH 7.1, pCO2 60, SBE +5 – we have a primary respiratory acidosis, with a compensatory ________ _________.
  14. 25. ___________________ for acidosis or alkalosis cannot bring the pH back to normal. (can be used to differentiate compensation vs mixed acid base disorder).
  15. 26. respiratory alkalosis is caused by anything that causes ________________: stress, pain, severe heat, catecholamine relase, pulmonary disease/injury, pleural space disease, intracranial disease.
  16. 30. respiratory acid base disorders are all about _________ ___________ concn.
  17. 31. if there is a problem with the metabolic acid base system, the respiratory system will try to ___________ (and vice versa).
  18. 32. causes of __________ acidosis: increased production of acid, or increased intake of acid, increased excretion of base, decreased excretion of acid.
  19. 33. many patients with resp acid base disorders (esp acidosis caused by hypoventilation) can be treated by __________ and placing on ventilation.
  20. 34. severe heat (not just regular panting of dead space air) and _______ can cause hyperventilation and therefore respiratory alkalosis (lots of CO2 lost)
  21. 38. increased acid intake (cause of met acidosis) occurs in: ethylene glycol ___________ (antifreeze), salicylate __________ (aspirin), metaldehyde _________.
  22. 39. increased ________ of acid (cause of met acidosis) occurs in: lactic acidosis ( vig exercise), ketoacidosis, or cellular hypoxia (anaerobic metabolism)
  23. 43. acidosis causes bone to release calcium and lay down ___________.
  24. 46. buffers inside cells include – Haemoglobin, proteins, and __________
  25. 47. in a mixed acid base disorder eg resp acidosis and metabolic alkalosis (neither compensating, both primary) – pH may be close to _______!
  26. 48. molecule with a positive charge.
  27. 52. severe acidosis is a ph of ____ _____ 7.2.
  28. 54. metabolic processes produce ______. Carbohydrate met produces CO2, protein and phospholipid met produces H+.
  29. 56. the _____ strategy to deal with acid base change is buffering. (allows changes in free H+ to because minimised).
  30. 57. measuring ____ (abb) in blood – look at respiratory component, while measuring SBE looks at metabolic component
  31. 58. in metabolic acidosis, the oxygen-Hb dissociation curve moves to the right, in met alkalosis, it moves to the _____ (Hb binds oxygen more tightly).