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MULTIPLE CHOICE
ANS: A, C
The plasma concentration of bicarbonate is the key determinant of blood pH. It remains in
equilibrium with CO2, and therefore PCO2 also determines pH.
ANS: B
Because the plasma concentration of bicarbonate is determined by its renal reabsorption and
synthesis, it is, by convention, called the metabolic component of the acid-base balance. The
other component is the PCO2, which is called the respiratory component.
ANS: A, C
Diarrhea causes metabolic acidosis through the loss of bicarbonate. The acidosis in diabetes
mellitus is caused by an excess production of ketoacids, acetoacetate, and hydroxybutyrate.
ANS: A, C
Metabolic alkalosis is, by definition, characterized by a low hydrogen ion concentration (i.e.,
high pH). This is caused by the high bicarbonate concentration. The compensatory response is
slowing the ventilation rate (i.e., slow, deep breaths).
ANS: C
The respiratory compensation for metabolic acidosis is increasing the ventilation rate. The
typical pattern is fast, shallow breathing called Kussmaul breathing.
6. Bicarbonate is produced
A. By carbonic anhydrase in erythrocytes
B. In the liver
C. In the proximal kidney tubules
D. In the small intestine
E. In the duodenum
ANS: A, C
Bicarbonate is produced from the carbon dioxide and water by the enzyme carbonic anhydrase.
This reaction takes place in the erythrocytes and in the kidney.
ANS: B, D
The gas exchange in the lungs is determined by the rate of ventilation and the rate of blood
perfusion. Disorders of each and combined disorders exist.
ANS: A, B, D
Chest deformity may lead to inadequate ventilation and respiratory acidosis. Acute cardiac arrest
is usually accompanied by severe metabolic acidosis due to the accumulation of lactate. Asthma
in the early stages usually leads to respiratory alkalosis due to hyperventilation; however, severe
asthma may be accompanied by respiratory failure and respiratory acidosis.
ANS: B, C, E
Carbon dioxide is transported in the erythrocytes predominantly as bicarbonate. Transport
involves the so-called chloride shift, when bicarbonate is exchanged for chloride anion. A small
amount of carbon dioxide is dissolved in plasma.
ANS: B, D
In mixed respiratory and metabolic acidosis, the plasma potassium concentration is likely to be
high because acidosis releases hydrogen ions from cells. The low bicarbonate level (i.e.,
metabolic component) is low due to the existence of metabolic causes, such as diabetes. This is
accompanied by a high PCO2 value because of an independent respiratory cause, such as chronic
obstructive airways disease (COAD).