26. Fluid and Electrolyte Balance, Acid Base Balance

Acid-Base Balance

Open Question
Explain how emphysema and congestive heart failure can lead to acid-base imbalance.
Open Question
During a routine medical checkup, Shelby, a 26-year-old physiotherapy student, is surprised to hear that her blood pressure is 180/110. She also has a rumbling systolic and diastolic abdominal bruit (murmur) that is loudest at the mid-epigastric area. Her physician suspects renal artery stenosis (narrowing). She orders an abdominal ultrasound and renal artery arteriography, which confirm that Shelby has a small right kidney and the distal part of her right renal artery is narrowed by more than 70%. Her physician prescribes diuretics and calcium channel blockers as temporary measures, and refers Shelby to a cardiovascular surgeon. Explain the connection between Shelby's renal artery stenosis and her hypertension. Why is her right kidney smaller than her left? What would you expect Shelby's blood levels of K⁺, Na⁺, aldosterone, angiotensin II, and renin to be?
Open Question
What happens to the pH of a solution when hydrogen ions are added?

a. The pH increases.
b. The pH decreases.
c. The pH does not change.
d. The pH does not measure hydrogen ion concentration.
Open Question
Mark the following statements as true or false. If a statement is false, correct it to make a true statement.

e. Chloride ions are generally reabsorbed from the kidneys, along with bicarbonate ions.
Open Question
The biggest source of metabolic acids in the body is:

a. lactic acid.
b. ketone bodies.
c. carbon dioxide.
d. uric acid.
Open Question
What is the main buffer system of the ECF?

a. Protein buffer system
b. Carbonic acid–bicarbonate ion buffer system
c. Phosphate buffer system
d. None of the above
Open Question
Explain what happens to the pH of a buffered solution when hydrogen ions are added. Why does this happen?
Open Question
Fill in the blanks: An increase in ventilation ________ the pH of the blood due to a/an ________ of carbon dioxide in the blood. A decrease in ventilation ________ the pH of the blood due to a/an ________ of carbon dioxide in the blood.
Open Question
Which of the following mechanisms is/are used by the kidneys to regulate the pH of the blood? Circle all that apply.

a. Hydrogen ions are secreted from the proximal and distal tubules and the collecting system.
b. Hydrogen ions are reabsorbed from the nephron loop.
c. New bicarbonate ions are formed from glutamine and carbon dioxide in the interstitial fluid that enters proximal tubule cells.
d. Bicarbonate ions can be secreted.
e. Bicarbonate ions are reabsorbed directly from the filtrate.
Open Question
Mark the following statements as true or false. If a statement is false, correct it to make a true statement.

a. Respiratory acidosis is caused by hypoventilation.
Open Question
Mark the following statements as true or false. If a statement is false, correct it to make a true statement.

b. Renal compensation for acid-base disturbances begins within minutes, whereas respiratory compensation begins within several hours.
Open Question
Mark the following statements as true or false. If a statement is false, correct it to make a true statement.

c. Respiratory compensation for metabolic acidosis consists of hypoventilation.
Open Question
Mark the following statements as true or false. If a statement is false, correct it to make a true statement.

d. Renal compensation for metabolic alkalosis consists of reabsorption of hydrogen ions and secretion of bicarbonate ions.
Open Question
Mark the following statements as true or false. If a statement is false, correct it to make a true statement.

e. You would expect to find an elevated Pco₂ in arterial blood gas analysis of a patient with respiratory acidosis.
Open Question
Diabetic ketoacidosis is characterized by an increased level of ketone bodies, which causes metabolic acidosis. A patient in diabetic ketoacidosis will have an altered rate of ventilation. Will the patient be hyperventilating or hypoventilating? How will a change in the rate and depth of ventilation compensate for an acidosis that is metabolic in nature?