Respiratory (Both)
In acute respiratory acidosis, bicarbonate compensatory increase takes several hours to days to compensate.
True! Kidney compensation takes a while. There are lots of variables at play :<
Why does excessive vomitting cause metabolic alkalosis?
Depleted H+ in the body. Also, increased HCO3- (many methods)
In metabolic acidosis, a decrease in HCO3- would lead to an expected (increase/decrease?) in pCO2 from compensation. This is done via [action]
Decrease in CO2 (from hyperventilation). Arrows typically follow each other in compensation in acid-base disorders (sorta)
Name the steps to determining acid-base disorder (do not worry about delta delta, anion gap, or all that stuff. Just basic steps)
Step 1: Look at pH lol (acidosis vs alkalosis)
Step 2: Look at which value of CO2 or HCO3- explains the acidosis/alkalosis. CO2 is acidic. HCO3- is basic.
Step 3: If CO2 is responsible, it is respiratory. If HCO3- is responsible, it is metabolic.
So a high HCO3- and a high CO2 with a low pH means it is respiratory acidosis.
If needed to treat alkalosis, this drug can specifically help eliminate excess HCO3-
Carbonic anhydrase inhibitor (acetazolamide)
This blood thinning drug can cause respiratory alkalosis. Why? (name the drug too)
Aspirin (salicylic acid) causes alkalosis via direct stimulation of the respiratory drive in the medulla oblongata. Huff and puff amirite
Write out the FULL equilibrium of water and carbon dioxide
Hint: carbonic anhydrase
H2O + CO2 <-> H2CO3 <-> HCO3- + H+ -
Explain the delta-delta gap and why it's used
Change in anion gap / Change in bicarbonate. It tells you if there is any underlying additional acid-base disorder going on!
Write out Winter's Formula, and explain what it's used for
Expected PaCO2 = 1.5 x [HCO3-] + 8 ± 2
If the measured PaCO2 deviates significantly from the expected range, it may indicate the presence of a coexisting primary metabolic disorder or inadequate compensatory response.
Name 2 lung diseases that can cause kidney stones
Sarcoidosis and Squamous Cell Lung Cancer!!! Causes hypervitamin D osis lol
How could pneumonia lead to respiratory acidosis? (this is from amboss don't get mad at me)
Pneumonia causes alveolar dead space, leading to poor ventilation, which manifests as respiratory acidosis. However, if dyspnea is present, this can cause hyperventilation, which may lead to respiratory alkalosis.
How does hyperaldosteronism cause metabolic alkalosis?
Excess aldosterone increases renal reabsorption of sodium and excretion of hydrogen and potassium ions, leading to elevated bicarbonate levels. Thus, higher PH
Diarrhea can cause metabolic acidosis. How/Why?
Diarrhea can cause metabolic acidosis through the excessive loss of bicarbonate-rich fluids from the body. Bicarbonate is an important buffer that helps maintain the body's acid-base balance.
Methanol
Ethylene Glycol
Salicylates
Lithium
Cyanide
Lactic Acid
Propylene Glycol
Iron
Chronic Kidney disease typically leads to metabolic acidosis. Ok cool. Explain why CKD leads to hyperparathyroidism
Decreased 1a hydroxylase, decreased Vitamin D, decreased Calcium in blood, drives for increased hyperparathyroidism
Explain why sepsis leads to respiratory alkalosis
Hyperventilation in sepsis leads to respiratory alkalosis due to the body's compensatory response to increased metabolic acid production and tissue hypoxia.
Name 2 diuretics (in amboss) that cause metabolic alkalosis and explain why
Loop and thiazide diuretics lead to increased Cl- wasting.
The kidneys respond by increasing the reabsorption of bicarbonate ions (HCO3-) in the proximal tubules. to help to balance the chloride (anion) loss. Thus, alkalosis :>
Explain how each of these renal tubular acidoses causes metabolic acidosis overall.
Type 1
Type 2
Type 4
Type 1 - Impaired H+ secretion in DCT
Type 2 - Impaired HCO3- reabsorption in PCT
Type 4 - Reduced aldosterone, hyperkalemia, acidosis (impaired potassium secretion and hydrogen ion retention, resulting in increased acid levels in the body.)
Metabolic alkalosis and metabolic acidosis both have compensatory mechanisms. Why is the compensatory mechanism behind metabolic alkalosis not as efficient as metabolic acidosis'?
The compensatory process in metabolic alkalosis is not as efficient as the process in metabolic acidosis, as hypoxia, which is induced by hypoventilation (compensation), blunts the decrease in the ventilatory drive.
Basically, you will want to depress your breathing, then want to breath really fast again.
How do NSAIDs cause Acute Kidney Injury?
Decreased renal blood flow (vasoconstriction from loss of prostaglandins)
Also, some autoimmune reactions can occur (Interstitial Nephritis)
How might liver failure cause respiratory alkalosis???
Liver cirrhosis contributes to respiratory alkalosis due to impaired hepatic clearance of circulating metabolites, leading to increased production of ammonia, which stimulates the respiratory center and causes hyperventilation
Explain how each of the following causes metabolic alkalosis:
Bartter Syndrome
Liddel Syndrome
Gitelman Syndrome
Bartter - Defective Na Cl K reabsorption results in hypokalemia. Hypokalemia will cause alkalosis. Also, bicarb will be reabsorbed more to make up for electrolyte loss. Also also, subsequent RAAS activation results in further K+ loss and Na+ reabsorption.
Liddel - Gain of function ENaC increases Na+ reabsorption. Elevated intravascular volume, and subsequent stimulation of bicarbonate reabsorption
Gitelman Syndrome - Impaired Cl- reabsorption drives increased HCO3- retention to makeup for loss. Increase
Increased Na+ reabsorption creates a greater concentration gradient for bicarbonate, which drives its passive reabsorption.
A high anion gap in metabolic acidosis is considered more deadly and urgent than a normal anion gap. Why?
In a normal anion gap metabolic acidosis, the increase in acid is primarily due to the loss of bicarbonate or the addition of non-carbonic acids, such as chloride. The body can compensate for this type of acidosis through respiratory mechanisms and renal adjustments.
However, a high anion gap metabolic acidosis indicates the presence of additional unmeasured organic acids, such as lactic acid, ketoacids, or toxic substances like ethylene glycol or methanol. These acids are typically produced as a result of underlying medical conditions or toxic exposures that can lead to severe metabolic disturbances and potentially life-threatening conditions.
This specific cell and receptor in the kidney is what is able to detect/monitor/and correct respiratory alkalosis.
a-intercalated cell of the kidney, chemoreceptor.
Extracellular pH-sensitive G-protein coupled receptor known as the "intercalated cell receptor."
Respiratory Acidosis can be caused by Lambert Eaton syndrome. What lung pathology did we learn causes this, and what's the mechanism?
Small Cell Lung Cancer creates antibodies against presynaptic Ca2+ channels, which could cause Lambert Eaton myasthenia gravis. Respiratory depression causes the academia (CO2 buildup)