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L16 Acid-base homeostasis


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total CO2
acid production: 25 mol/day
unmetabolised acids
acid production: 50mmol/day
plasma [H+]
acid production: 40nmol/L
Buffering systems
CO2 _________ _________: haemoglobin, bicarbonate, phosphate, proteins, ammonia & misc. inorganic acids
Henderson-Hasselbalch
___________-___________ Equation: balance between H+ production and regeneration of HCO3-
7.35-7.45
normal range of blood pH (normal H+ range = 35-45mol/L)
lungs
primary site of acid-base metabolism: _______gs
kidneys
site of acid-base metabolism: K______
GI tract
site of acid-base metabolism: G__ ______
Liver
site of acid-base metabolism: _____r
RIGHT
O2-Hb dissociation curve shifts ____ with *I*ncreased 2,3-BP*G*, acidosis (*H*+) & *T*emperature - aka promotes dissociation
reclamation
renal _________ of bicarbonate: CO2 + H2O uptake → H2CO3 → Na+ exchanged for H+ → Na+ HCO3-
generation
renal __________ of bicarbonate: kidney increases metabolism → ↑CO2 → H2CO3 → HCO3- absorbed & H+ exchanged for Na+
stomach
site of H+ secretion in GI tract
pancreas
site of HCO3- secretion in GI tract
lactate
the liver is the dominant site of ______ metabolism
urea
the liver is the only site of _____ synthesis
inhibited
urea cycle is ________ by acidosis (long term) → prevents H+ generation
stimulated
urea cycle is _______ by alkalosis (long term) → NH3 excretion in urine & H+ generation
liver failure
In severe _____ _____, oxo-glutamate deficiency means NH4+ cannot be broken down → METABOLIC ALKALOSIS & NH4+ toxicity
metabolic acidosis
↑H+, ↓pCO2, ↑pO2
metabolic alkalosis
↓H+, ↑pCO2, ↓pO2 - consequence is respiratory suppression
respiratory acidosis
↑H+, ↑pCO2, ↓pO2
respiratory alkalosis
↓H+, ↓pCO2, ↑pO2
Causes of Metabolic Acidosis
increased H+ formation, acid ingestion, reduced renal H+ excretion or loss of bicarbonate
H+ formation
all increase __ _________: ketoacidosis (diabetic or alcoholic); lactic acidosis; poisoning; inherited organic acidoses
diabetic ketoacidosis
hyperglycaemia; osmotic diuresis (to pre-renal uraemia); hyperketonaemia; increased FFA → acidosis
lactic acidosis
Either Type A (shock) or Type B (metabolic and toxic causes)
Causes of Metabolic Alkalosis
bicarbonate generation by gastric mucosa, renal generation of HCO3- in hypokalaemia or administration of bicarbonate
Causes of Respiratory Acidosis
Increased CO2 retention due to inadequate ventilation, parenchymal lung disease or inadequate perfusion
Causes of Respiratory Alkalosis
Increased CO2 excretion due to excessive ventilation
anion gap
(Na+ K) - (Cl+ HCO3) >15
alcoholics
acidosis in _____: NAD+ depletion (thiamine); thiamine deficiency (PDH co-factor); enhanced glycolysis for ATP formation; ketoacids secondary to counter-regulatory hormones; profuse vomiting!