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Questions and Answers
What is the normal respiratory response to metabolic alkalosis?
What is the normal respiratory response to metabolic alkalosis?
- Decrease respiratory rate to retain CO2 (correct)
- No change in respiratory rate
- Increase respiratory rate to retain CO2
- Increase respiratory rate to eliminate excess CO2
What limits the efficiency of respiratory compensation for metabolic alkalosis?
What limits the efficiency of respiratory compensation for metabolic alkalosis?
- The necessity to increase oxygen uptake
- The threshold for tolerable decreases in respiration rate (correct)
- The speed of kidney response to pH changes
- The amount of bicarbonate produced by kidneys
How do kidneys respond to respiratory acidosis?
How do kidneys respond to respiratory acidosis?
- Increase reabsorption of bicarbonate and decrease H+ secretion
- Increase reabsorption of bicarbonate and increase H+ secretion (correct)
- Decrease reabsorption of bicarbonate and increase H+ secretion
- Decrease H+ secretion and reabsorb potassium
What mechanism do kidneys employ to regulate bicarbonate levels during respiratory alkalosis?
What mechanism do kidneys employ to regulate bicarbonate levels during respiratory alkalosis?
What role do kidneys play in the long-term adjustment of blood pH?
What role do kidneys play in the long-term adjustment of blood pH?
What serum sodium concentration defines hyponatremia?
What serum sodium concentration defines hyponatremia?
What is the serum sodium correction formula used to account for elevated glucose levels?
What is the serum sodium correction formula used to account for elevated glucose levels?
What factors can cause pseudo hyponatremia?
What factors can cause pseudo hyponatremia?
What is the condition called with serum potassium level greater than 5 mmol/L?
What is the condition called with serum potassium level greater than 5 mmol/L?
How does hyperglycemia lead to a decrease in serum sodium concentration?
How does hyperglycemia lead to a decrease in serum sodium concentration?
What does a high anion gap typically indicate?
What does a high anion gap typically indicate?
In the calculation of the anion gap, which formula is used?
In the calculation of the anion gap, which formula is used?
What happens during hyperventilation in the context of acid-base balance?
What happens during hyperventilation in the context of acid-base balance?
What is considered a normal anion gap range?
What is considered a normal anion gap range?
Which of the following is NOT a cause of a high anion gap?
Which of the following is NOT a cause of a high anion gap?
Which condition is characterized by an increase in bicarbonate?
Which condition is characterized by an increase in bicarbonate?
What physiological response occurs during metabolic acidosis?
What physiological response occurs during metabolic acidosis?
What defines acidosis in terms of pH levels?
What defines acidosis in terms of pH levels?
What is the primary difference between intracellular fluid (ICF) and extracellular fluid (ECF)?
What is the primary difference between intracellular fluid (ICF) and extracellular fluid (ECF)?
Which of the following best defines euvolemia?
Which of the following best defines euvolemia?
What effect does hypervolemia have on body weight?
What effect does hypervolemia have on body weight?
Which statement is true regarding osmotic pressure?
Which statement is true regarding osmotic pressure?
How does osmotic pressure relate to solubility?
How does osmotic pressure relate to solubility?
What is the relationship between osmolality and the concentration of particles in serum?
What is the relationship between osmolality and the concentration of particles in serum?
What best describes osmosis?
What best describes osmosis?
What is the main characteristic of a colligative property?
What is the main characteristic of a colligative property?
What pH level is indicative of metabolic acidosis?
What pH level is indicative of metabolic acidosis?
In respiratory alkalosis, what would you expect the pCO2 level to be?
In respiratory alkalosis, what would you expect the pCO2 level to be?
Which condition is characterized by high bicarbonate levels and high pCO2?
Which condition is characterized by high bicarbonate levels and high pCO2?
What indicates a mixed acid-base disorder?
What indicates a mixed acid-base disorder?
If a patient shows a pH of 7.7 and [HCO3-] > 24 mmol/L, what condition are they likely experiencing?
If a patient shows a pH of 7.7 and [HCO3-] > 24 mmol/L, what condition are they likely experiencing?
What is the expected change in bicarbonate levels in response to a respiratory acidosis condition?
What is the expected change in bicarbonate levels in response to a respiratory acidosis condition?
Which of the following pH levels is consistent with respiratory acidosis?
Which of the following pH levels is consistent with respiratory acidosis?
What is the threshold for HCO3- levels that indicates metabolic acidosis?
What is the threshold for HCO3- levels that indicates metabolic acidosis?
In metabolic alkalosis, how would the pCO2 levels typically present?
In metabolic alkalosis, how would the pCO2 levels typically present?
What response is expected in renal compensation during metabolic acidosis?
What response is expected in renal compensation during metabolic acidosis?
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Study Notes
Anion Gap (AG)
- AG is the difference between the sum of the main anions and the sum of the main cations.
- Formula: AG = (Na+ + K+) – (Cl- + HCO3-) or AG = (Na+) - (Cl- + HCO3-)
- Normal AG is 10-12 mmol/L
- High AG indicates metabolic acidosis.
- Causes of high AG include ketoacidosis, lactic acidosis, intoxications, and renal failure.
Assessing Fluid and Electrolyte Disturbances
- Factors to consider:
- Patient's weight
- Blood urea
- Blood glucose
- Electrolytes in serum and urine
- Osmolarity in blood and urine
- Osmolar gap
Acid-Base Balance and its Regulation
- Stable [H+] in the body fluid is crucial for acid-base balance.
Acid-Base Disorders
- Acidosis: High [H+] (pH < 7.35)
- Alkalosis: Low [H+] (pH > 7.45)
- Metabolic disorders are due to changes in bicarbonate (HCO3-):
- High HCO3-: metabolic alkalosis
- Low HCO3-: metabolic acidosis
- Respiratory disorders are due to changes in pCO2:
- High pCO2: respiratory acidosis
- Low pCO2: respiratory alkalosis
Regulation of Acid-Base Imbalance
- Compensation:
- Respiratory compensation: the lungs regulate blood levels of CO2.
- Hyperventilation: eliminates more CO2, increasing pH.
- Hypoventilation: accumulates CO2, decreasing pH.
- Compensates for metabolic disorders.
- Renal compensation: the kidneys make long-term adjustments to pH.
- Reabsorbs acids and bases or excretes them into urine.
- Produces HCO3 to replenish lost supply.
- Compensates for respiratory disorders.
- Respiratory compensation: the lungs regulate blood levels of CO2.
Simple Acid-Base Disorders
- Acidosis:
- Metabolic: Low HCO3-, low pCO2 (pH < 7.4)
- Respiratory: High CO2, high HCO3- (pH < 7.4)
- Alkalosis:
- Metabolic: High HCO3-, high pCO2 (pH > 7.4)
- Respiratory: Low CO2, low HCO3- (pH > 7.4)
- Respiratory compensation is less efficient for alkalosis than for acidosis, as there is a limit to the decrease in respiration.
Mixed Acid-Base Disorders
- Simultaneous occurrence of two or more primary acid-base disorders in the same patient.
Body Fluids
- Intracellular fluid (ICF): 2/3 of total body fluid in adults.
- Extracellular fluid (ECF): 1/3 of total body fluid.
- Composition of ICF differs from that of ECF due to the cell membrane.
Euvolemia, Hypervolemia, Hypovolemia
- Euvolemia: normal body fluid volume.
- Hypervolemia: increased body fluid volume (weight gain).
- Hypovolemia: decreased body fluid volume (weight loss).
Osmosis and Osmotic Pressure
- Osmosis: diffusion of water (solvent) through a semi-permeable membrane from a solution of lower concentration (high concentration in water) to a solution of higher concentration (low concentration of water).
- Osmotic pressure: pressure required to prevent osmosis. It depends on the molarity of the solution.
Osmolality and Osmolarity
- Osmolality: number of osmoles of particles/Kg of solvent - expressed in mosmol/kg.
- Higher osmolality means more particles in serum.
Pseudo Hyponatremia
- Normal osmolality but decreased sodium.
- Cause: hyperglycemia (glucose cannot enter cells, leading to water shifting from ICF to ECF).
- Corrected sodium formula: Corrected Na+ = Na+ + (excess glucose x 0.3)
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