chapter 48 quiz 1 Importance of Acid-Base Balance

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Questions and Answers

What is the negative logarithmic value of hydrogen ion concentration typically measured as?

  • pH (correct)
  • Acid power
  • Alkaline concentration
  • Hydrogen power

What is the resting value of extracellular pH?

  • 6.8
  • 7.4 (correct)
  • 5.6
  • 8.2

In the context of acid-base balance, what process impact the water to auto-ionize into hydrogen and hydroxyl ions?

  • Deviations in extracellular pH
  • Tight control of electrolyte composition
  • Alterations in the relative concentrations of electrolytes and carbon dioxide (correct)
  • Changes in the local concentration of O2

changes in the local concentration of strong ions, weak acids, and CO2 lead to ?

<p>Acid-base abnormalities (B)</p> Signup and view all the answers

Which equation represents the Henderson-Hasselbalch equation for acid-base balance?

<p>pH=6.1 + log [HCO3]/PCO2 ×0.03 (C)</p> Signup and view all the answers

What is the structural formula of water?

<p>H-O-H (C)</p> Signup and view all the answers

Why is water considered neutral?

<p>Equal concentration of hydrogen ions and hydroxyl ions (D)</p> Signup and view all the answers

In the context of acid-base chemistry, what does Brønsted-Lowry define an acid as?

<p>A proton donor (B)</p> Signup and view all the answers

In the context of acid-base chemistry, what does Brønsted-Lowry define an base as?

<p>A proton acceptor (C)</p> Signup and view all the answers

What is the consequence when the concentration of hydrogen ions increase?

<p>Decrease in hydroxyl ion concentration (B)</p> Signup and view all the answers

Lactic acid is a

<p>strong acid (C)</p> Signup and view all the answers

carbonic acid is a

<p>Its pKa value of 6.4 (B)</p> Signup and view all the answers

Which of the following ions are considered strong ions?

<p>Sodium (Na+), potassium (K+), and chloride (Cl−) (A)</p> Signup and view all the answers

In the context of the text, what function do all cations serve?

<p>Function as bases (A)</p> Signup and view all the answers

Why is the delivery of hydrogen moiety into extracellular fluid by Cl− significant?

<p>It acts as an acid (B)</p> Signup and view all the answers

What role does water play in the reaction NaOH + H2O→H2O + OH− + Na+

<p>Water acts as acid (D)</p> Signup and view all the answers

What role does water play in the reaction HCL + H2O→H3O+ + Cl−?

<p>Water acts as a base (C)</p> Signup and view all the answers

How do the hydrogen and hydroxyl ions delivered by Cl− and Na+ ultimately form?

<p>They form water molecules (B)</p> Signup and view all the answers

What principle must be followed in acid-base reactions to ensure that the sum of all positive ions equals the sum of all negative ions in a compartment?

<p>Electrical neutrality (B)</p> Signup and view all the answers

What is the term used to describe substances that dissociate completely ?

<p>Strong ions (A)</p> Signup and view all the answers

Which ion is mentioned as one of the most abundant strong ions in the extracellular space?

<p>Na+ and Cl−. (A)</p> Signup and view all the answers

why strong ions are occasionally referred to as “mineral” acids or bases ?

<p>cannot be metabolized (D)</p> Signup and view all the answers

Which rule states that the total concentration of an incompletely dissociated substance is the sum of concentrations of its dissociated and undissociated forms?

<p>Mass conservation (A)</p> Signup and view all the answers

In acid-base chemistry, what significance do strong cations and strong anions carry?

<p>They contribute to charge balance (C)</p> Signup and view all the answers

What independently influences the hydrogen ion concentration in a solution ?

<p>SID (B)</p> Signup and view all the answers

In human ECF, SID is always?

<p>positive (A)</p> Signup and view all the answers

Any change in SID will change ?

<p>[H+] and [OH−] concentrations. (C)</p> Signup and view all the answers

what is the relationship betweeb [H+]and [OH−]

<p>inverse (A)</p> Signup and view all the answers

Which variable is considered independent in the equations involving SID and ATOT?

<p>SID and ATOT (C)</p> Signup and view all the answers

Which compound exists in multiple forms in extracellular fluid along with CO2(d)?

<p>[HCO3−] (A)</p> Signup and view all the answers

In the context of weak acid 'buffer' solutions, which molecule influences acid-base balance?

<p>Albumin and phosphate. (A)</p> Signup and view all the answers

What does Stewart's term ATOT represent in the context of acid-base balance?

<p>Total concentration of weak acids (D)</p> Signup and view all the answers

What determines the concentration of CO2(d) in the extracellular fluid?

<p>solubility coefficient of CO2 (C)</p> Signup and view all the answers

What is a simple rule of thumb for acute respiratory alkalosis?

<p>ΔHCO3- = 0.2 ΔPaCO2 (D)</p> Signup and view all the answers

Which symptom is associated with hyperventilation in a patient with acute respiratory alkalosis?

<p>Hypocalcemia (A)</p> Signup and view all the answers

In respiratory alkalosis, how does the pH compare to normal?

<p>pH &gt; 7.45 (A)</p> Signup and view all the answers

What characterizes acute respiratory alkalosis in terms of PaCO2 and HCO3−?

<p>Low PaCO2, low HCO3− (C)</p> Signup and view all the answers

What is the normal value of PaCO2 in arterial blood?

<p>40 mm Hg (B)</p> Signup and view all the answers

What is the main cause of hypocalcemia in a patient with acute respiratory alkalosis?

<p>Increase in albumin binding to calcium (A)</p> Signup and view all the answers

What is the main compensatory mechanism for metabolic alkalosis mentioned in the text?

<p>Hypoventilation (C)</p> Signup and view all the answers

What is the result of a decrease in the SID as per the text?

<p>Acidemia (C)</p> Signup and view all the answers

Which scenario may lead to a reduction in the SID and dilutional acidosis according to the text?

<p>Expansion of the extracellular compartment with free water (D)</p> Signup and view all the answers

What clinical significance does metabolic acidosis have according to the text?

<p>vasodilation and decreased muscular performance (A)</p> Signup and view all the answers

In metabolic alkalosis, what symptoms and signs are mentioned in the text?

<p>Tetany and paresthesia (A)</p> Signup and view all the answers

What happens to blood pH in metabolic acidosis compared to respiratory acidosis as per the text?

<p>Blood pH falls less in metabolic acidosis (D)</p> Signup and view all the answers

What is The most significant form of metabolic acidosis ?

<p>net gain of unmeasured anions (A)</p> Signup and view all the answers

In hospital medicine, what solution containing 154 mEq of sodium and 154 mEq of chloride is commonly used?

<p>Normal saline (NaCl 0.9%—NS) (A)</p> Signup and view all the answers

What causes metabolic alkalosis due to an increase in SID?

<p>Vomiting (C)</p> Signup and view all the answers

Which of the following is NOT a cause of acidosis according to the text?

<p>Excessive sodium intake (C)</p> Signup and view all the answers

What is also important determinant of acid-base status ?

<p>Serum albumin and phosphate (D)</p> Signup and view all the answers

What impact does hyperphosphatemia have on the acidosis of renal failure?

<p>It worsens the acidosis (A)</p> Signup and view all the answers

What happens when hypoalbuminemia decreases ATOT?

<p>It causes metabolic alkalosis (B)</p> Signup and view all the answers

'Contraction alkalosis' is commonly seen in clinical practice following the administration of which type of diuretics?

<p>'Loop diuretics' (D)</p> Signup and view all the answers

'Metabolic alkalosis' is caused by chloride loss obeying which principle mentioned in the text?

<p>'Law of conservation of mass' (D)</p> Signup and view all the answers

'Hypoalbuminemia' is associated with a strong relationship with which aspect mentioned in the text?

<p>Severity of critical illness (A)</p> Signup and view all the answers

What is the main reason why therapeutic hyperventilation is no longer used to treat intracranial hypertension?

<p>Risk of cerebral hypoperfusion and ischemia (B)</p> Signup and view all the answers

Which condition is associated with problems in central ventilator control according to the text?

<p>Stroke (D)</p> Signup and view all the answers

What clinical signs are indicative of respiratory acidosis?

<p>Cyanosis and vasodilatation (D)</p> Signup and view all the answers

What does an increase in PaCO2 by 10 mm Hg result in during acute Respiratory Acidosis ?

<p>Increase in HCO3− by 1 mmol/L (A)</p> Signup and view all the answers

Respiratory Acidosis occurs when there is an acute rise in PaCO2 usually associated with respiratory failure. This may result from problems with?

<p>Central ventilator control duo to stroke, spinal cord injury (D)</p> Signup and view all the answers

Why might a patient fail to liberate from mechanical ventilation due to acute metabolic alkalosis?

<p>hypoventilation (D)</p> Signup and view all the answers

Which intravenous fluid could impact postoperative CO2-HCO3− homeostasis based on the information provided?

<p>Isotonic saline solution (A)</p> Signup and view all the answers

In the context of acute respiratory distress syndrome (ARDS), what is preferred?

<p>'Permissive' hypercapnia is preferred (B)</p> Signup and view all the answers

In anesthesia practice, patients may hyperventilate preoperatively and develop Respiratory Alkalosis as a consequence of ?

<p>anxiety (A)</p> Signup and view all the answers

In anesthesia practice, patients may hyperventilate postoperatively and develop Respiratory Alkalosis as a consequence of ?

<p>full bladder (B)</p> Signup and view all the answers

Respiratory Alkalosis due to hyperventilation More commonly results from

<p>poor mechanical ventilation strategy (C)</p> Signup and view all the answers

Compensation for hypercarbia due to Respiratory Acidosis is

<p>slow, requiring increased urinary excretion of Cl− (A)</p> Signup and view all the answers

Compensation for hypercarbia due to Respiratory Acidosis result in

<p>increase in the plasma HCO3− occurs and reflects a higher total CO2 load. (A)</p> Signup and view all the answers

“rules of thumb In acute hypercarbia (acute Respiratory Acidosis ) is:

<p>An increase in PaCO2 by 10 mm Hg (1.3 kPa) results in an increase in HCO3− by 1 mmol/L (1 mEq/L) (B)</p> Signup and view all the answers

what is the expected HCO3 for A patient returning to the ICU from the operating room, with a PaCO2 of 80 mm Hg ?

<p>28 mmol/L (C)</p> Signup and view all the answers

In chronic respiratory failure, the total CO2 load in the body increases substantially, reflected by

<p>high levels of plasma HCO3−. (A)</p> Signup and view all the answers

In chronic respiratory failure There is a concomitant fall in plasma ?

<p>plasma chloride, reflecting compensation for elevated levels of carbonic acid. (D)</p> Signup and view all the answers

rules of thumb In chronic Respiratory Acidosis

<p>An increase in PaCO2 by 10 mm Hg (1.3 kPa) will increase plasma [HCO3−] by 3 mmol/L (3 mEq/L) (B)</p> Signup and view all the answers

A patient returning to the intensive care unit from the operating room, ventilated to a PaCO2 of 40 mm Hg but with high total CO2, secondary to chronic respiratory failure ( COPD). the preoperative baseline of total CO2 is 33 mEq/L. what is the PaCO2 baseline

<p>PaCO2 of 70 mm Hg (C)</p> Signup and view all the answers

A useful rule of thumb used to characterize metabolic acidosis?

<p>for every 1 mEq/L fall in the SID, there is a 1 mEq/L fall in the [HCO3−] from baseline (A)</p> Signup and view all the answers

The body is hyperresponsive to acidosis. Increasing hydrogen ion content in cerebrospinal fluid lead to

<p>reducing Bicarbonate concentration (B)</p> Signup and view all the answers

In normal ECF, the SID is 40 to 44 mEq/L, this positive charge being balanced principally by weak acids which without it the PH will be

<p>11.9 (D)</p> Signup and view all the answers

Albumin deficits can result from ?

<p>capillary leak with loss of albumin into the interstitium; (D)</p> Signup and view all the answers

the presence of hypoalbuminemia may mask the detection of acidosis caused by?

<p>unmeasured anions (A)</p> Signup and view all the answers

What is the role of a buffer in maintaining pH balance?

<p>Minimization of changes in pH (C)</p> Signup and view all the answers

How does deoxygenated hemoglobin contribute to acid-base balance?

<p>It buffers volatile acids (C)</p> Signup and view all the answers

Which of the following is the primary source of acid in the body?

<p>Volatile acid CO2 (D)</p> Signup and view all the answers

What happens when carbon dioxide combines with water within erythrocytes?

<p>Formation of bicarbonate ions (D)</p> Signup and view all the answers

How is the regulation of hydrogen ion concentration primarily achieved ?

<p>Binding by hemoglobin (A)</p> Signup and view all the answers

Why is it important for a buffer to have a pKa close to the physiological pH range?

<p>To prevent rapid changes in pH (D)</p> Signup and view all the answers

What effect does respiratory failure have on the principal CO2 buffering system?

<p>It overwhelms the buffering capacity of Hb (B)</p> Signup and view all the answers

Which process is conventionally referred to as 'metabolic compensation'?

<p>The maintenance of ECF osmolality through NH4+ usage (D)</p> Signup and view all the answers

What is the result of compensation for chronic hypercarbia due to respiratory acidosis?

<p>A rightward shift in the PCO2 response curve (B)</p> Signup and view all the answers

What is the role of carbonic anhydrase?

<p>conversion of CO2 to HCO3 (A)</p> Signup and view all the answers

How is metabolic acid buffered in the body?

<p>By retaining weak acids in plasma (A)</p> Signup and view all the answers

What characterizes renal tubular acidosis in terms of Cl− excretion?

<p>Inability to excrete Cl− in proportion to Na+ (C)</p> Signup and view all the answers

How does pseudohypoaldosteronism primarily impact chloride reabsorption?

<p>By promoting high reabsorption of Cl− over Na+ (A)</p> Signup and view all the answers

What is the significance of the bicarbonate buffering system in extracellular buffering?

<p>It accounts for 13% of overall extracellular buffering (A)</p> Signup and view all the answers

'Hypoalbuminemia' is strongly associated with which aspect mentioned in the text?

<p>'Metabolic alkalosis' (B)</p> Signup and view all the answers

what is The major effect of the kidney on acid-base balance

<p>handling of sodium and chloride ions. (A)</p> Signup and view all the answers

Bartter syndrome is caused by a mutation in the gene encoding the

<p>Na-K-2Cl cotransporter (A)</p> Signup and view all the answers

other causes of hyperchloremic metabolic acidosis ?

<p>DIARRHEA (C)</p> Signup and view all the answers

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