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Questions and Answers
What occurs when there is an acute increase of H2CO3 molecules in the body?
What occurs when there is an acute increase of H2CO3 molecules in the body?
How does acute ventilatory failure affect the HCO3- to H2CO3 ratio?
How does acute ventilatory failure affect the HCO3- to H2CO3 ratio?
In the situation of metabolic acidosis, what happens to both HCO3- and pH levels?
In the situation of metabolic acidosis, what happens to both HCO3- and pH levels?
What is the typical compensation response of the kidneys during chronic metabolic acidosis?
What is the typical compensation response of the kidneys during chronic metabolic acidosis?
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Which condition results in a low PaCO2 and a high pH due to hyperventilation lasting more than 24 hours?
Which condition results in a low PaCO2 and a high pH due to hyperventilation lasting more than 24 hours?
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What is a common cause of metabolic alkalosis related to potassium levels?
What is a common cause of metabolic alkalosis related to potassium levels?
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What indicates the body has undergone complete compensation during a respiratory acid-base imbalance?
What indicates the body has undergone complete compensation during a respiratory acid-base imbalance?
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In metabolic acidosis, what is an expected physiological change that occurs?
In metabolic acidosis, what is an expected physiological change that occurs?
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When renal compensation occurs in response to metabolic acidosis, what happens to HCO3- levels?
When renal compensation occurs in response to metabolic acidosis, what happens to HCO3- levels?
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What is the significance of the HCO3-/H2CO3 ratio in determining acid-base status?
What is the significance of the HCO3-/H2CO3 ratio in determining acid-base status?
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An increase in H2CO3 molecules leads to a decrease in HCO3- levels.
An increase in H2CO3 molecules leads to a decrease in HCO3- levels.
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Metabolic acidosis results in higher levels of both HCO3- and pH.
Metabolic acidosis results in higher levels of both HCO3- and pH.
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Hypoventilation leads to a decreased PCO2 level in the body.
Hypoventilation leads to a decreased PCO2 level in the body.
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The kidneys will retain HCO3- during a respiratory acid-base imbalance to correct low pH.
The kidneys will retain HCO3- during a respiratory acid-base imbalance to correct low pH.
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In chronic metabolic alkalosis, the body responds by decreasing the respiratory rate, which increases PaCO2.
In chronic metabolic alkalosis, the body responds by decreasing the respiratory rate, which increases PaCO2.
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Study Notes
Respiratory Acid-Base Imbalances
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Acute Ventilatory Failure
- Hypoventilation results in increased PaCO2, H2CO3, and HCO3-.
- Decreases the HCO3-/H2CO3 ratio
- After 24-48 hours, kidneys retain HCO3- to correct pH
- If PaCO2 is 80 mmHg, pH should be 7.2 and HCO3- 30 mEq/L according to the normal blood buffer line
- If pH and HCO3- levels are higher than expected, renal retention of HCO3- has occurred.
- A low pH indicates partial compensation, a normal pH indicates complete compensation.
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Acute Alveolar Hyperventilation
- Causes include pain and anxiety
- Results in low PaCO2, H2CO3, and HCO3-.
- Increases the HCO3-/H2CO3 ratio, leading to an increase in pH
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Chronic Alveolar Hyperventilation and Renal Compensation
- Hyperventilation for more than 24-48 hours results in low PaCO2, high pH.
- Kidneys excrete excess HCO3- in the urine to compensate.
Metabolic Acid-Base Imbalances
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Metabolic Acidosis
- Caused by the presence of acids not related to increased PaCO2 or renal compensation.
- Lowers both HCO3- and pH.
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Causes:
- Lactic acidosis (end product of anaerobic metabolism), often due to severe acute hypoxemia
- Ketoacidosis (low insulin levels in diabetics cause low intracellular glucose levels, leading to the production of ketone bodies as alternative metabolites)
- Renal failure
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Chronic Metabolic Acidosis and Respiratory Compensation
- The normal response to metabolic acidosis is an increase in respiratory rate to decrease PaCO2
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Metabolic Alkalosis
- Caused by an excess of bases in the blood.
- Increases pH
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Common Causes:
- Hypokalemia: low potassium levels lead to the kidneys retaining potassium by excreting hydrogen ions (H+), resulting in an increase in blood base.
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Chronic Metabolic Alkalosis and Respiratory Compensation
- Decreases in respiratory rate (RR) increase PaCO2, leading to a decrease in pH, compensating for the alkalosis.
Base Excess/Deficit
- Quantifies and manages non-respiratory acid-base imbalances.
Respiratory Acid-Base Imbalances
- Increased CO2: Increases PCO2, HCO3-, and H2CO3.
- Acute Ventilatory Changes: Immediately alter pH
- H2CO3 Changes: Powerful role in affecting pH compared to HCO3- changes.
- **Acute Ventilatory Failure:**Hypoventilation increases PCO2, H2CO3, and HCO3- which decreases the HCO3-/ H2CO3 ratio.
- Renal Compensation (24-48 Hours): Kidney retains HCO3- to correct pH.
- PaCO2 of 80 mmHg: pH should be 7.2 and HCO3- 30 mEq/L. Higher levels indicate renal retention of HCO3-.
- Partial Compensation: Low pH despite renal compensation.
- Complete Compensation: Normal pH.
- Acute Alveolar Hyperventilation: Pain and anxiety cause low PaCO2, H2CO3, and HCO3- leading to a larger HCO3-/H2CO3 ratio and higher pH.
Chronic Alveolar Hyperventilation and Renal Compensation
- Hyperventilation over 24-48 Hours: Low PaCO2, high pH, kidneys excrete excess HCO3- in urine.
Metabolic Acid-Base Imbalances
Metabolic Acidosis
- Low pH due to Acids: Acids unrelated to increased PaCO2 or renal compensation.
- Low HCO3- and pH: Both values are lower.
Causes of Metabolic Acidosis
- Lactic Acidosis: End-product of anaerobic metabolism; caused by severe acute hypoxemia.
- Ketoacidosis: Low insulin levels in diabetics cause low intracellular glucose levels. Increased ketones formed.
- Renal Failure:
Chronic Metabolic Acidosis and Respiratory Compensation
- Normal Response: Increased respiratory rate to decrease PaCO2.
Metabolic Alkalosis
- High pH due to Bases: Bases other than those related to CO2/HCO3- system.
- Hypokalemia: Low potassium levels cause kidneys to save potassium by excreting H+. This increases blood base levels.
Chronic Metabolic Alkalosis and Respiratory Compensation
- Decreased Respiratory Rate: Increases PaCO2, lowering pH.
Base Excess/Deficit
- Quantification and Management: Best method to quantify and manage non-respiratory acid-base imbalances.
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Description
This quiz covers the concepts of respiratory and metabolic acid-base imbalances, detailing mechanisms such as acute ventilatory failure, hyperventilation, and renal compensation. Understand how disturbances in these systems affect blood pH and bicarbonate levels. Test your knowledge on the physiological responses to these conditions.
