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Acid Base - Coggle Diagram

- - - - Look for bicarb concentration
    - - Measured in venous plasma
  - - - Metabolic: Low bicarbonate <24 mmol/L
        
        Anion Gap: Increase in acid intake/generation
        
        Na - (Cl+HCO3)
        
        Any increases or addition of acid increases the annion gap and demonstrates what happens to the biocarboinate
        
        Leads to
        
        Lactic Acidosis
        Ketoacids
        Toxic Alcohols
        Renal Failure
        
        Non-Anion gap: Loss of bicarbonate or lack of renal acid excretion
        
        Loss of bicarbonate in stool or urine
        
        Failure to excrete acid in urine (ammoniagenesis)
        
        Loss of bicarb is accompanied by cation loss which leads to no change in the anion gap
        
        Normal GFR
        
        Failure to reabsorb bicarb proximally or fail to excrete acid
        
        Renal tubular acidosis
        
        Low GFR
        
        Fail to excrete acid due to too few nephrons and retain organic ions
      - Respiratory: High CO2 >40 mmHg
- - - - Addition/loss of acid or base
    - - Buffering
        
        Bicarbonate/Carbon Dioxide Buffer
        
        H+ + HCO3 <--> H2CO3 <--> H2O + CO2 (aqueous) -> CO2 (gas)
        
        Buffering by proteins, phosphates and in erythrocytes, hemoglobin
        
        Phosphate is not enoguh for entire daily acid load, and kidney need to make a new base to accept H+ ions that are excreted (ammoniagenesis)
        
        3 Steps
        
        Proximal tubular cells produce NH4+ from glutamine and produce bicarb
        
        Reabsorption of NH4+ wiht creation of interstitial NH3 gradient
        
        1 more item...
        
        Low potassium -> Increased ammoniagenesis, intracellular acidosis, systemic alkalosis
        
        High Potassium, intracellular alkalosis, decreased ammoniagenesis, systemic acidosis
        
        Adverse consequence of intracellular buffering
        
        altered enzyme activity
        
        Altered cell structure
        
        Altered oxygen delivery
      - Control of pCO2
        
        H+ + HCO3- <--> H2O + CO2
        
        Depends on
        
        Ample supply of HCO3 (Kidneys)
        
        Able to get rid of CO2 (lungs)
        
        Controlled by
        
        Oxygen tension (brainstem)
        
        pCO2 (inducs changes in cerebral interstitial pH)
        
        Systemic pH (peripheral chemoreceptors)
      - Control of serum bicarbonate
        
        Body needs to generate new bicard to prevent acidosis
        
        Kidneys contribute by:
        
        Reabsorption of filtered bicarbonate
        
        occurs in proximal tubule
        
        Regulated by:
        
        3 more items...
        
        Excretion of ammonium which is equivalant to producing one bicarbonate
- - - - CO2 generated by cellular respiration: CO2+ H2O -> H2CO3
    - - Metabolism of sulphur containing amino acids generate acids
- - - - If it is metabolic acidosis is there an anion gap?
        
        Is it appropriately compensated