Patho Class 8 - Part 2

Slight changes in amounts of hydrogen and changes in pH can significantly ___ biological processes in cells and tissues

alter

Hydrogen ion is needed to maintain ___ and the speed of metabolic enzyme reactions

membrane integrity

The ___ the [H+], the more alkaline or basic the solution and the higher the pH

lower

Body acids exist in two forms: ___ (can be eliminated as carbon dioxide [CO2 ] gas) and nonvolatile (can be eliminated by the kidney).

volatile

___ acids are sulphuric, phosphoric, and other organic acids. They are strong acids (readily release their hydrogens)

Nonvolatile

Nonvolatile acids are secreted into the ___ by the renal tubules

urine

gastric juices are affected by HCI and what is their pH?

1.0–3.0

Hydrogen ion excretion from waste products affects urine acidity, what is normal pH range?

5-6

pH of arterial blood is slightly ___ because there is less carbonic acid

higher

what is normal pH of arterial blood?

7.35-7.45

pH of venous blood is slightly lower because there is ___ carbonic acid

more

what is normal pH for venous blood?

7.37

in cerebrospinal fluid, decreased ___ and higher carbon dioxide content decrease pH, making the normal 7.32

bicarbonate

pancreatic fluid contains bicarbonate produced by exocrine cells, making it more basic at which pH

7.8-8.0

bile contains bicarbonate so normal pH is…

7.0-8.0

small intestine fluid contains alkaline fluid from ___ so it is normally 6.5-7.0

pancreas, liver, and gallbladder

___ occurs in response to changes in acid-base status.

buffering

Buffers can ___ excessive hydrogen ion (H+) (acid) or hydroxyl ion (OH−) (base) and prevent a significant change in pH

absorb

The ___ buffer pair operates in both the lung and the kidney and is a major extracellular buffer

carbonic acid–bicarbonate

The ___ are a second line of defence and can relatively quickly (within seconds to minutes) decrease the amount of carbonic acid by blowing off carbon dioxide and leaving water

lungs

The ___ are a third line of defence (hours to days) and can reabsorb bicarbonate (a type of base) or regenerate new bicarbonate from carbon dioxide and water

kidneys

___ is an excellent intracellular blood buffer because it can bind with hydrogen ion (H+) (forming HHb) and carbon dioxide (forming HHbCO2).

Hemoglobin (Hb

Dibasic phosphate ( ) and ammonia (NH3 ) are two important ___ because they can attach hydrogen ions and be secreted into the urine.

renal buffers

In ___ the pH of arterial blood is less than 7.4.

acidemia

A systemic increase in hydrogen ion concentration or a loss of base is termed ___

acidosis

In ___ the pH of arterial blood is greater than 7.4

alkalemia

A systemic decrease in hydrogen ion concentration or an excess of base is termed ___

alkalosis

In ___ the concentrations of non–carbonic acids increase or bicarbonate is lost from ECF or cannot be regenerated by the kidney

metabolic acidosis

When acidosis is severe, buffers become depleted and cannot compensate, and the ratio of the concentrations of bicarbonate to carbonic acid decreases to less than ___

20 : 1

Early symptoms of metabolic acidosis include ___, which progress to confusion and coma in severe acidosis

headache and lethargy

The respiratory system's efforts to compensate for the increase in metabolic acids result in what are termed ___ (a form of hyperventilation), which are deep and rapid

Kussmaul respirations

Other symptoms of metabolic acidosis include ___, nausea, vomiting, diarrhea, and abdominal discomfort

anorexia

When excessive loss of metabolic acids occurs, bicarbonate concentration increases, causing ___

metabolic alkalosis

When acid loss is caused by ___, renal compensation is not very effective because loss of chloride (an anion) in hydrochloric acid (HCl) stimulates renal retention of bicarbonate (an anion)

vomiting

___ may produce a mild alkalosis because they promote greater excretion of sodium, potassium, and chloride than of bicarbonate

diuretics

Some common signs and symptoms of ___ are weakness, muscle cramps, hyperactive reflexes, tetany, confusion, convulsions, and atrial tachycardia

metabolic alkalosis

Respirations may be shallow, and slow ventilation may manifest as the lungs attempt to compensate by ___ carbon dioxide retention (metabolic alkalosis)

increasing

The symptoms of ___ occur because alkalosis increases binding of Ca++ to plasma proteins, thus decreasing ionized calcium concentration (metabolic alkalosis)

hyperactive reflexes and tetany

Respiratory acidosis occurs when there is alveolar ___, resulting in an excess of carbon dioxide in the blood (hypercapnia)

hypoventilation

Common causes of respiratory acidosis include ___ (e.g., from medications or head injury), paralysis of the respiratory muscles, disorders of the chest wall (e.g., kyphoscoliosis or broken ribs), and disorders of the lung parenchyma (e.g., pneumonia, pulmonary edema, emphysema, asthma, bronchitis)

depression of the respiratory centre

The signs and symptoms of respiratory acidosis seen often include headache, blurred vision, breathlessness, restlessness, and apprehension followed by lethargy, disorientation, muscle twitching, tremors, convulsions, and ___

coma

The skin may be ___ because the elevated carbon dioxide concentration causes vasodilation (respiratory acidosis)

warm and flushed

Respiratory alkalosis occurs when there is alveolar ___ (deep, rapid respirations).

Excessive reduction in plasma carbon dioxide levels (hypocapnia) decreases carbonic acid concentration

hyperventilation

Respiratory alkalosis can be ___

chronic or acute

Hypoxemia (caused by pulmonary disease, heart failure, or high altitudes), hypermetabolic states (e.g., fever, anemia, thyrotoxicosis), early salicylate intoxication, hysteria, cirrhosis, and Gram-negative sepsis ___ hyperventilation

stimulate

The central and peripheral nervous systems are stimulated by respiratory alkalosis, causing ___, confusion, tingling of extremities (paresthesias), convulsions, and coma

dizziness

Carpopedal spasm (spasm of muscles in the fingers and toes), tetany, and other symptoms of ___ occur in respiratory alkalosis

hypocalcemia

When the blood becomes too acidic, the __ help to neutralize the excess acid by releasing alkaline salts, such as calcium carbonate and calcium phosphate, into the bloodstream

bones

What is the normal range for pH?

7.35–7.45

There are ___ forms of respiratory acidosis: Acute and Chronic, just like respiratory alkalosis

two

___ of an opiate or opioid, such as morphine, tramadol, heroin, fentanyl, or magnesium sulfate (MgSO4) can cause respiratory acidosis.

overdose

When the lungs can’t remove all of the carbon dioxide produced by the body through normal metabolism, the blood becomes acidified, leading to increasingly serious symptoms, from ___ to coma.

sleepiness