Glossary of 12. Acid-Base balance and Blood gases
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- What are the 5 major buffer systems?
- 1. Carbonic acid/Bicarb (plasma and cells)
2. Protein (plasma)
3. Hemoglobin (RBCs)
4. Phosphate (plasma/cells/urine)
5. Ammonia (urine)
- What buffer is the major extracellular buffer?
- What buffer is the major intracellular?
- -What protein is the main protein buffer?
-How does it buffer?
- Albumin; via the imidazole group of histidine
- Which buffers do/can buffer base?
- Bicarbonate and Phosphate
- What is the normal Base:acid ratio in the hh eqn?
- Which component in the HH eqn reflects renal changes? Which reflects respiratory changes?
- Renal = top metabolic HCO3
Resp = lower respirty CO2
- In the bicarb buffer system:
-What shifts rxtn to left?
-What shifts rxtn to right?
- Left: increase in acid
Right: increase in base
(these are the body RESPONSES)
- What is INTERACTION REACTION?
- The term for when other conjugate bases act in concert with the bicarb sytem
- What detects changes in pCO2?
- -Chemoreceptors in medulla
- How does respiration change in
- Acidosis: increase respirations to blow off CO2
Alkalosis: depress respiratns to increase CO2
- What is the relationship between pO2 and pCO2?
- As PCO2 increases, pO2 decreases and vice versa
- What is the Bohr effect?
- Shifting of O2 diss. curve based on acid/base conditions.
- How does the Hb curve shift:
- Acid: shift to right
Base: shift to left
- What is the Haldane effect?
- the effect of pCO2 on the Hb-O2 dissociation curve.
- How does the O2 diss curve shift with
- Incr. CO2 = shift to right (acidosis)
Decr. CO2 = shift to left
- What happens to Hb's O2 affinity when curve shifts
-To the right?
-To the left?
- Right = decreased affinity - lose oxygen more easily
Left = increased affinity - harder to give oxygen to tissue
- How does CO2 enhance oxygen release from hemoglobin?
- By binding alpha amino groups of N-terminal valines on both Alpha and Beta chains
- How does 2,3-DPG enhance O2 release from hemoglobin?
- By binding alpha amino groups of N-terminal valines on ONLY Beta chains.
- On a Hb molecule:
-Where does O2 bind?
-Where does H+ bind?
- -O2 binds Iron group
-H+ binds imidazole group of histidine (similar to acid buffing by albumin)
- What is oxidized Hb bound to?
- Hydrogen; oxygenated hemoglobin is not denoted as oxidized.
- What enzyme keeps hemoglobin in its reduced state?
- Methemoglobin reductase, which requires NADH
- What is the function of the ISOHYDRIC shift?
- To remove excess CO2 from the tissues after Hb delivers O2.
- What is the function of the Chloride shift?
- To maintain the RBC's electronegativity while buffering.
- How does the Isohydric shift work?
- 1. O2 is delivered
2. CO2 diffuses into RBC
3. CO2 + H2O = H2CO3 = H+ and HCO3-
4. H+ binds naked Hgb
5. HCO3- diffuses out of RBC.
- How does the Chloride shift work?
- When HCO3 diffuses out of RBC, CL- diffuses in to balance the cell's ionic state.
- What pH state will produce
- Hyper K+ from Acidosis
Hypo K+ from Alkalosis
- Where does bicarb reabsorption occur in the kidney?
- Proximal tubule
- Where does conjugate acid secretion take place in the kidney?
- -Distal tubule
- what is the pH limit of acidotic urine?
- What 2 processes for H+ excretion occur in the distal tubule?
-Titratable acid - Phosphate
- What kidney response to Acid is:
-Immediate short term response
-Slow, long-term response?
- Immediate = Phosphate titratable acid.
Slow = Ammonium ion excretion
- What is the major indicator of a RESPIRATORY disturbance?
- What is the primary indicator of a METABOLIC disturbance?
- When is BE more off; in respiratory or metabolic disturbance?
Acidosis = --BE
Alkalosis = ++BE
- In what 3 conditions is resp alkalosis seen in?
- 1. Hyperventilation
2. Salicylate toxicity
- In what 3 conditions is metabolic alkalosis seen in?
- 1. Vomiting - K depletion
2. Diuretic long-term use
3. Cushing's disease
- In what 3 conditions is Resp acidosis seen?
- 1. Central/peripheral resp failure
3. Barbiturate toxicity
- In what 3 conditions is Metab acidosis seen?
- 1. Diabetic coma
2. Renal failure
3. Diarrhea w/ pyloric obstruction
- What is the treatment for Respiratory Acidosis?
- Increase respirations to blow off CO2
- What is treatment for Resp alkalosis?
- Breathe into bag to increase co2
- What is the treatment for Metabolic Acidosis?
- Give bicarb viat lactate/citrate ringers
- What is the treatment for Metabolic Alkalosis?
- Give salt - NaCl, KCl, or NH4Cl to acidify the kidney and induce loss of bicarb.
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