1 Practical Biochemistry

Practical module (102)

pH (Power of hydrogen)
pH: The Negative Value of Log [H+] so PH = - Log [H+]
pOH: The Negative Value of Log [OH-] so pOH = - Log [OH-]
in case of water: ▪
[H+] = 10-7 so pH = 7
[OH-] = 10-7 so pOH = 7
▪ So, for any substance dissolved in water pH + pOH = 14
▪ Low pH value = High concentration of H+ while and low concentration of OH-
▪ High pH value = Low concentration of H+ and high concentration of OH-
▪ The concentration of H+ in aqueous solution with known pH is calculated as:
[H+] = 10 –pH and similarly [OH-] = 10–pOH
Q1: Calculate the [H+] when: pH = 3
pOH = 5
Q2: Calculate the pH when [H+] = 10-8
[OH-] = 10-2
pH scale:
▪ The pH scale is used to determine the degree of acidity of a substance. It is divided into
levels from 0 to 14, 0 being the highest degree of acidity while 14 is the highest degree
of alkalinity.
▪ Solutions having a value of pH ranging from 0 to 7 on the pH scale are termed as acidic
and the value of pH ranging from 7 to 14 on pH scale are known as basic solutions.
▪ Solutions having the value of pH equal to 7 are known as neutral solutions.

▪ pH can be measured by: - pH strips

- pH indicators
- pH meter

PH strips

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pH meter:
▪ Laboratory equipment which is used to measure acidity or
alkalinity of solution
▪ Measures the concentration of H+ using ion sensitive electrode
▪ The most reliable and sensitive method for measuring the pH

Acids and Bases

1. Acids: Substances which increase [H+] i.e Proton Donors
▪ Strong acid: Completely dissociate in water with marked ↑ in [H+](irreversible)
HCl H+ + Cl-
▪ Weak acid: Partially dissociate in water with minimal ↑ in [H+](reversible)
CH3COOH CH3COO- + H+
2. Bases: Substances which increase [OH-] i.e proton acceptors
▪ Strong base: Completely dissociate in water with marked ↑ in [OH-] (irreversible)
NaOH Na + + OH-
▪ Weak base: Partially dissociate in water with minimal ↑ in [OH-] (reversible)
NH4OH NH 4+ + OH-
Solutions in water are classified into 3 types according to their pH
▪ Neutral solutions: Have [H+] = [OH-] and pH = 7
▪ Acidic solutions: Have [H+] more than [OH-] and pH < 7
▪ Basic solutions: Have [OH]more than[H+] and pH > 7
During metabolism body produces several acids which may be classified as:
1. Respiratory (Volatile) acids: As carbonic acid (H2CO3) → Excreted by the lungs
2. Metabolic (Fixed) acids: Not excreted by the lungs as:
▪ Phosphuric and sulfuric: from protein oxidation
▪ Uric acid: from nucleic acid (purine) catabolism
▪ Acetoacetic and β-hydroxybutyric acids: from partial oxidation of fats
▪ Lactic acid: from anaerobic oxidation of glucose.
- Continuously: In RBCs
- Occasionally: In muscles during severe exercise

NBs.:- All biological reactions in the body are pH dependent

- Minimal change in pH leads to alteration of these reactions so:
- Acid – base balance is required: amount of acid excreted must equal that
produced

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Mechanisms of regulation of pH:
1. Buffers:
- 1st line of defense
- Acts in a fraction of a second (immediate response)
2. Respiration (Ventilation):
- By ↑ or ↓ CO2 excretion so regulates the amount of H2CO3 in the body
3. Kidneys:
- 2nd line of defense
- Slow process (takes several days to reach maximum capacity)
- By excretion of excess acids (H+) or bases (HCO3-)
Buffers
Definition:
Solutions which resist changes in their pH when moderate amounts of acids or
bases are added.
Types of buffers: Acidic buffer – Alkaline buffer
Composition:
1. A weak acid and its salt with strong base
- The weak acid (HA) is the proton donor and its conjugate base (A-) is the proton
acceptor
- pH of the buffer is less than 7 (Acidic buffer)
- The most common in physiological systems
- Examples: Carbonic acid / Na bicarbonate (H2CO3 / NaHCO3)
Acetic acid / Na acetate (CH3COOH / CH3COONa)
2. A weak base and its salt with strong acid
- pH of the buffer is more than 7 (Basic buffer)
Example: Ammonium Hydroxide / Ammonium Chloride (NH4OH / NH4Cl ) -
Mechanism of action:
For example, carbonic bicarbonate system
1. Addition of a strong acid i.e HCL:
- Reacts with bicarbonate forming NaCl and H2CO3 which is a weak acid
HCl + NaHCO3 NaCl + H2CO3
- So the strong acid i.e HCL is converted to a weak acid i.e carbonic acid with
minimal change in pH
2. Addition of strong base i.e NaOH:
- Reacts with carbonic acid forming water and Na bicarbonate which is a weak basic
salt
NaOH + H2CO3 H2O + NaHCO3
- So the strong base i.e NaOH is converted into a weak base NaHCO3 with minimal
change in pH
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3. Addition of excess amounts of acids or bases:
- Causes depletion of the buffer followed by marked change of the pH

Physiological Buffers
Function: Keep the PH of the blood and tissues around 7. 4 which is suitable for the
function of most body enzymes
Types:
1. Bicarbonate buffer system: mainly in Extracellular fluid
2. Phosphate buffer system: in all types of cells
3. Protein buffer system: in cells and plasma
4. Hemoglobin buffer system: in RBCs and Specific for buffering CO2 Produced by
oxidation in tissues
1. Bicarbonate buffer system:
Structure: BHCO3/H2CO3
Ratio: 20:1
Characters: - The main buffer system in the blood and called alkali reserve
- Needs proper lung function
Mechanism of action:
▪ Addition of a strong acid i.e HCL:
- Reacts with bicarbonate forming NaCl and H2CO3 which is a weak acid
HCl + NaHCO3 NaCl + H2CO3
- H2CO3 is converted to H2O and CO2 which stimulates respiration
- So the metabolic acids like HCL are converted to respiratory (volatile) acids
▪ Addition of a strong base i.e NaOH
- Reacts with carbonic acid forming water and Na bicarbonate which is weak
basic salt
NaOH + H2CO3 H2O + NaHCO3
- NaHCO3 is formed and the level of H2CO3 decreases (as it buffers NaOH) so;
- More CO2 binds with H2O to replace H2CO3 with inhibition of respiration
Advantages of Bicarbonate buffer system:
Q: Bicarbonate buffer system is the most important buffer system.. Explain why?
1. Present in higher concentrations than other buffers
2. Easily formed at the tissues from CO2 by Carbonic Anhydrase enzyme
Carbonic Anhydrase
CO2 + H2O H 2CO3
3. Easily corrected by respiration; CO2 is excreted with expired air at Lungs
NB.: H2CO3 is determined by the lungs (respiratory component) while;
HCO3- is determined by the kidneys (metabolic component)
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2. Phosphate buffer system:

Structure: B2HPO4 / BH2PO4 (Alkaline phosphate / Acid phosphate)
Ratio: 4 : 1
Characters: Strictly related to the kidneys (healthy kidneys are needed for proper
function)

3. Protein buffer system:

Structure: H-proteinate / B-proteinate (Acid protein / proteinate salt)
Characters: include hemoglobin in RBCs and plasma proteins of the blood

Acid-Base Imbalance
- The body is present in a condition of acid – base balance
- PH of the blood should be around 7. 4 (7.35 – 7. 45)
- The ratio of BHCO3 / H2CO3 in blood is 20 / 1
- Disturbance of this ratio will lead to change in pH which may be either:
▪ Acidosis
▪ Alkalosis

NB.: All cases of acidosis and alkalosis are normalized when the cause is removed or
by cure of the disease.

Normal levels:
▪ Bicarbonate: 22- 26 mEq/L
▪ PCO2: 35 – 45 mmHg
▪ pH: 7.35 – 7.45
▪ PO2: 80 – 100%

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Interpretation of laboratory results

pH PCO2 [HCO3-]
Normal 7.35 – 7.45 35 – 45 mm Hg 22 – 26 mmol / L
Respiratory Acidosis
1. Uncompensated ↓ ↑ Normal
2. Partially compensated ↓ ↑ ↑
3. Fully compensated Normal ↑ ↑
Metabolic Acidosis
1. Uncompensated ↓ Normal ↓
2. Partially compensated ↓ ↓ ↓
3. Fully compensated Normal ↓ ↓
Respiratory Alkalosis
1. Uncompensated ↑ ↓ Normal
2. Partially compensated ↑ ↓ ↓
3. Fully compensated Normal ↓ ↓
Metabolic Alkalosis
1. Uncompensated ↑ Normal ↑
2. Partially compensated ↑ ↑ ↑
3. Fully compensated Normal ↑ ↑

Q: Comment on the following laboratory results:

1.
PH PCO2 [HCO3-]
↓ Normal ↓

2.
PH PCO2 [HCO3-]
↓ ↑ ↑

3.
PH PCO2 [HCO3-]
↑ ↓ ↓

4.
PH PCO2 [HCO3-]
Normal ↓ ↓
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Department Questions
1. In a man presented with pneumonia, measurement of arterial blood gas shows
pH 7.3, PaCO2 68 mm Hg, and HCO3- 28 mmol/L. How would you interpret this?
A) Partially compensated respiratory acidosis
B) Partially compensated metabolic acidosis
C) Uncompensated respiratory acidosis
D) Uncompensated metabolic Alkalosis
The answer is A: Partially compensated respiratory acidosis

2. A diabetic student was admitted to the hospital due to excess vomiting .

Measurement of arterial blood gas shows pH 7.2, PaCO2 23 mm Hg, and HCO3 12
mmol/L. What is your assessment?
A) Partially compensated respiratory acidosis
B) Partially compensated metabolic acidosis
C) Uncompensated respiratory acidosis
D) Uncompensated metabolic Alkalosis
The answer is B: Partially compensated metabolic acidosis

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3.

4. A 21 year old man is brought in by his father with a one week history of
vomiting. He has been diagnosed with Hashimoto’s thyroiditis by his local
doctor 4 months previously. These are his venous blood gas results:

pH 7.31 pCO2 39 HCO3- 19 pO2 25

Comment on the acid – base balance state
Metabolic acidosis- uncompensated
5. A patient has been receiving Morphine intravenously for complaining of severe
back pain. His respiratory rate is 7 per minute and measurement of arterial blood
gas shows pH 7.10, PaCO2 70 mm Hg and HCO3 24 mEq/L. What does this mean?
A) Partially compensated metabolic alkalosis
B) Partially compensated respiratory acidosis
C) Uncompensated metabolic acidosis
D) Uncompensated respiratory acidosis
The answer is D: Uncompensated respiratory acidosis

6. An athelete climbed mountain. He became drowsy. Measurement of arterial

blood gas reveals pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25
mmol/L. What does this mean?
A) Partially compensated respiratory acidosis
B) Partially compensated metabolic alkalosis
C) Uncompensated metabolic alkalosis
D) Uncompensated respiratory alkalosis
The answer is D) Uncompensated respiratory alkalosis

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7. patient was diagnosed as having gastroenteritis and dehydration. Measurement
of arterial blood gas shows pH 7.5, PaCO2 40 mm Hg, and HCO3 34 mmol/L.
What acid-base disorder is shown?
A) Uncompensated metabolic alkalosis
B) Uncompensated respiratory alkalosis
C) Partially compensated respiratory acidosis
D) Partially compensated metabolic alkalosis
The answer is A) Uncompensated metabolic alkalosis
8. Metabolic acidosis is caused by:
a. Uncontrolled diabetes with ketosis
b. Pneumonia
c. Fever
d. Morphine poisoning

9. Respiratory alkalosis occurs in:

a. Depression of respiratory center
b. Fever
c. Renal failure
d. Loss of intestinal fluids

10. A 3-year old child was brought to the hospital with a cough and difficulty in
respiration. Physical examination suggested pneumonia. Choose the most likely
acid- base imbalance state.
a. Metabolic Acidosis
b. Metabolic Alkalosis
c. Respiratory Alkalosis
d. Respiratory Acidosis

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Other Questions
A. What is the diagnosis of the following cases:
1. a 35-year-old mother reports to the ER in the early morning with shortness of
breath. She has cyanosis of the lips. She has had a productive cough for 2 weeks.
Her temperature is 102.2, blood pressure 110/76, heart rate 108, respirations 32,
rapid and shallow. Breath sounds are diminished in both bases, with coarse
rhonchi in the upper lobes. Chest X-ray indicates bilateral pneumonia.
ABG results are:
pH= 7.24, PaCO2= 58, HCO3= 24, PaO2= 54
2. A 64 year old gentleman with a history of COPD presents with worsening
shortness of breath and increased sputum production:
pH: 7.21
pO2: 59
pCO2: 70
HCO3: 29
3. A 21 year-old woman presents feeling acute shortness of breath. She has her
final university exams next week.
pH: 7.48 (7.35-7.45)
pO2: 90
pCO2: 25
HCO3: 22
4. A 67 year-old man with a history of peptic ulcer disease presents with persistent
vomiting.
pH: 7.56
pO2: 90
pCO2: 40
HCO3: 31
5. An 11 year-old boy presents with diarrhea and vomiting. He is complaining of
non-specific abdominal pain.
pH: 7.12
pO2: 90
pCO2: 29
HCO3: 9

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B. MCQs:
1. As regards water:
a. [H+] = 10-7.
b. It is a typical neutral solution.
c. pH = 7.
d. All the above.
2. pH is:
a. The negative value of [H+].
b. Log of [H+].
c. The negative value of Log [H+].
d. None of the above.
3. The pH of a solution with [OH-] = 10-6 is:
a. 6.
b. 9.
c. 8
d. 7.4
4. HCl is a:
a. Proton acceptor.
b. Proton donor.
c. Strong acid.
d. b and c.
5. Neutral solutions are characterized by:
a. Have [H+] = 10-7.
b. Have pH = 7.
c. [H+] = [OH-].
d. All of the above.
6. Buffers are:
a. Used to maintain the pH constant.
b. Mixture of weak base and its salt with strong base.
c. Mixture of weak acid and its salt with weak base.
d. a and c.
7. The most important physiologic buffer in extracellular fluid is:
a. Hb system.
b. Phosphate system.
c. Protein system.
d. Bicarbonate buffer system.

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8. The pH of blood is 7.4 when the ratio between H2CO3 and HCO3- is:
a. 1: 10 b. 1: 20
c. 1: 25 d. 20: 1
9. Acidosis is due to:
a. Addition of acids.
b. Failure of excretion of H2CO3.
c. Loss of bases.
d. All the above.
10. One of the following is NOT a cause of respiratory acidosis:
a. Pneumonia.
b. Bronchial asthma.
c. Morphia.
d. Hyperventilation.
11. Respiratory acidosis is compensated by:
a. Increase excretion of acids.
b. Increase reabsorption of bicarbonate by kidney.
c. Decrease reabsorption of bicarbonate by kidney.
d. a and b.
12. Ketosis leads to:
a. Respiratory alkalosis.
b. Respiratory acidosis.
c. Metabolic alkalosis.
d. Metabolic acidosis.
13. Severe Diarrhea leads to:
a. Metabolic alkalosis.
b. Respiratory acidosis.
c. Metabolic acidosis.
d. Respiratory alkalosis.
14. One of the following is NOT a characteristic of metabolic alkalosis:
a. There is increase in bicarbonate concentration.
b. There is decrease H2CO3 / HCO3- ratio.
c. Compensated by decrease bicarbonate excretion.
d. Compensated by increase bicarbonate excretion.

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15. A 3-year-old child was brought to the hospital with a cough, respiratory distress,
and cyanosis (bluish skin due to deoxyHb). Physical examination suggested a lower
respiratory tract infection. Other laboratory data available:
Patient Normal
pO2 (mm Hg) 29 80-100
pCO2 (mm Hg) 70 35-45
pH 7.1 7.35 – 7.45
HCO3 (mM) 24 22-26
Choose the condition most likely to result from the description given:-
a. Metabolic Acidosis
b. Metabolic Alkalosis
c. Respiratory Acidosis
d. Respiratory Alkalosis
16. John is a trauma patient with an altered mental status. His initial arterial blood gas
result is as follows:
pH 7.33
PaCO2 62
HCO3 35
What is your diagnosis?
a. Partially compensated metabolic Acidosis
b. Partially compensated metabolic Alkalosis
c. Partially compensated respiratory Acidosis
d. Partially compensated respiratory Alkalosis
Interpret the following ABG results.
17. pH 7.33 PaCO2 60 HCO3 34
a. Normal ABG values
b. Respiratory acidosis without compensation
c. Respiratory acidosis with partial compensation
d. Respiratory acidosis with full compensation
18. pH 7.48 PaCO2 42 HCO3 30
a. Metabolic acidosis without compensation
b. Respiratory alkalosis with partial compensation
c. Respiratory alkalosis with full compensation
d. Metabolic alkalosis without compensation
19. pH 7.38 PaCO2 38 HCO3 24
a. Metabolic alkalosis
b. Normal
c. Respiratory alkalosis
d. None of the above

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20. pH 7.21 PaCO2 60 HCO3 24
a. Normal
b. Respiratory acidosis without compensation
c. Metabolic acidosis with partial compensation
d. Respiratory acidosis with complete compensation
21. pH 7.48 PaCO2 28 HCO3 20
a. Respiratory alkalosis with partial compensation
b. Respiratory alkalosis with complete compensation
c. Metabolic alkalosis without compensation
d. Metabolic alkalosis with complete compensation
22. pH 7.50 PaCO2 29 HCO3 24
a. Normal
b. Respiratory acidosis with compensation
c. Respiratory alkalosis without compensation
d. Metabolic alkalosis with partial compensation
23. pH 7.28 PaCO2 40 HCO3 18
a. Metabolic acidosis without compensation
b. Respiratory alkalosis with partial compensation
c. Metabolic alkalosis with partial compensation
d. Respiratory alkalosis without compensation
24. A person was admitted in a coma. Analysis of the arterial blood gave the following
values: PCO2 16 mm Hg, HCO3 – 5 mmol/l and pH 7.1. What is the underlying
acid- base disorder?
a. Metabolic Acidosis
b. Metabolic Alkalosis
c. Respiratory Acidosis
d. Respiratory Alkalosis
25. In a man undergoing surgery, it was necessary to aspirate the contents of the
upper gastrointestinal tract. After surgery, the following values were obtained from
an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3 – 40 mmol/l. What is
the underlying disorder?
a. Metabolic Acidosis
b. Metabolic Alkalosis
c. Respiratory Acidosis
d. Respiratory Alkalosis

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26. A young woman is found comatosed, have taken an unknown number of sleeping
pills an unknown time before. An arterial blood sample yields the following values:
pH – 6.90, HCO3 – 13 meq/liter, PaCO2 68 mmHg. This patient’s acid-base status is
most accurately described as
a. Uncompensated metabolic acidosis
b. uncompensated respiratory acidosis
c. Simultaneous respiratory and metabolic acidosis
d. respiratory acidosis with partial renal compensation
27. A student is nervous for a big exam and is breathing rapidly, what do you expect
out of the followings
a. Metabolic Acidosis
b. Metabolic Alkalosis
c. Respiratory Acidosis
d. Respiratory Alkalosis
28. A 45- year-old female with renal failure, missed her dialysis and was feeling sick,
what could be the reason?
a. Metabolic Acidosis
b. Metabolic Alkalosis
c. Respiratory Acidosis
d. Respiratory Alkalosis
29. An 80-year-old man had a bad cold. After two weeks he said, “It went into my
chest, I am feeling tightness in my chest, I am coughing, suffocated and unable to
breathe!” What could be the possible result?
a. Metabolic Acidosis
b. Metabolic Alkalosis
c. Respiratory Acidosis
d. Respiratory Alkalosis
30. A post operative surgical patient had a naso gastric tube in for three days. The
nurse caring for the patient stated that there was much drainage from the tube
that is why she felt so sick. What could be the reason?
a. Metabolic Acidosis
b. Metabolic Alkalosis
c. Respiratory Acidosis
d. Respiratory Alkalosis
31. The pH of the body fluids is stabilized by buffer systems. Which of the following
compounds is the most effective buffer system at physiological pH?
a. Bicarbonate buffer
b. Phosphate buffer
c. Protein buffer
d. All the above
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32. Which of the following laboratory results below indicates compensated metabolic
alkalosis?
a. Low p CO2, normal bicarbonate and, high pH
b. Low p CO2, low bicarbonate, low pH
c. High p CO2, normal bicarbonate and, low p H
d. High pCO2, high bicarbonate and High pH
33. The greatest buffering capacity at physiological pH would be provided by a protein
rich in which of the following amino acids?
a. Lysine b. Histidine
c. Aspartic acid d. Leucine
34. Which of the following is most appropriate for a female suffering from Insulin
dependent diabetes mellitus with a pH of 7.2, HCO3-17 mmol/L and pCO2-20 mm
Hg
a. Metabolic Acidosis b. Metabolic Alkalosis
c. Respiratory Acidosis d. Respiratory Alkalosis
35. Which out of the following conditions will not cause respiratory alkalosis?
a. Fever b. Anxiety
c. Laryngeal obstruction d. Salicylate toxicity
36. All are true about metabolic alkalosis except one:
a. Associated with hyperkalemia
b. Associated with severe diarrhea
c. Can be caused due to increased intake of vegtables
d. Can be caused due to gastric wash
37. A patient has the following arterial blood gases: PaCO2 33, HCO3 15, pH 7.23. Which
of the following conditions are presenting?
a. Metabolic alkalosis partially compensated
b. Metabolic acidosis partially compensated
c. Respiratory alkalosis not compensated
d. Metabolic acidosis without compensation
38. A patient states he has been vomiting for the last 4 days. The patient is irritable,
weak, and reporting muscle cramping and weakness. On assessment, the patient is
experiencing low respiration with a respiratory rate of 10. The patient has the
following ABGs result: HCO3 36, pH 7.52, PaCO2 48. Which of the following
conditions are presenting?
a. Metabolic alkalosis partially compensated
b. Metabolic alkalosis fully compensated
c. Metabolic acidosis partially compensated
d. Metabolic acidosis not compensated

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39. One of the following is NOT true for renal handling of acids in metabolic acidosis:
a. Hydrogen ion secretion is increased
b. Bicarbonate reabsorption is decreased
c. Urinary acidity is increased
d. Urinary ammonia is increased.
40. In a man undergoing surgery, it was necessary to aspirate the contents of the
upper gastro-intestinal tract. After surgery, the following values were obtained
from an arterial blood sample: pH 7.55, PCO2 52 mm Hg and HCO3- 40 mmol/l. What
is the underlying disorder?
a. Metabolic acidosis b. Respiratory alkalosis
c. Metabolic alkalosis d. Respiratory acidosis
41. A person was admitted to hospital in a coma. Analysis of the arterial blood gave
the following values: PCO2 16 mm Hg, HCO3- 5 mmol/l and pH 7.1. What is the
underlying acid-base disorder?
a. Metabolic acidosis b. Respiratory alkalosis
c. Metabolic alkalosis d. Respiratory acidosis
42. A climber attempts an assault on a high mountain in the Andes and reaches an
altitude of 5000 meters (16,400 ft) above sea level. What will happen to his arterial
PCO2 and pH?
a. Both will be lower than normal.
b. The pH will rise and PCO2 will fall.
C. Both will be higher than normal due to the physical exertion.
d. The pH will fall and PCO2 will rise

C. State True or False & correct the false statement:

1. Biochemical characters in uncompensated respiratory acidosis
PH PCO2 [HCO3-]
↓ ↑ Normal
2. Biochemical characters in partially compensated respiratory acidosis
PH PCO2 [HCO3-]
↓ ↑ ↑
3. Biochemical characters in uncompensated metabolic acidosis
PH PCO2 [HCO3-]
↓ Normal ↓
4. Biochemical characters in partially compensated metabolic acidosis
PH PCO2 [HCO3-]
↓ ↓ ↓

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5. Biochemical characters in uncompensated respiratory alkalosis
PH PCO2 [HCO3-]
↑ ↓ Normal
6. Biochemical characters in partially compensated respiratory alkalosis
PH PCO2 [HCO3-]
↑ ↓ ↓
7. Biochemical characters in uncompensated metabolic alkalosis
PH PCO2 [HCO3-]
↑ Normal ↑
8. Biochemical characters in partially compensated metabolic alkalosis
PH PCO2 [HCO3-]
↑ ↑ ↑
9. 2 Causes of respiratory acidosis
- Lung disease: ABEP : Asphyxia – Bronchial asthma - Emphysema – Pneumonia
- Morphine poisoning
10. 2 Causes of metabolic acidosis
- ↑Acid production: sever exercise - ↑ Ptn in diet – ketosis in uncontrolled DM
- Loss of base: severe diarrhea
11. 2 Causes of respiratory alkalosis
HFHAM: Hysteria – Fever – High altitudrs – Aspirin poisoning – Meningitis
12. 2 Causes of metabolic alkalosis
Loss of acids: Vomiting and gastric wash - ↑ vegetables in diet – Intake of bases -
13. Metabolic acidosis is compensated by the kidney
14. Respiratory alkalosis is compensated by the kidney
E. Enumerate (Mention)
1. 3 mechanisms for regulation of pH
Buffers – respiration – kidney
2. 2 Methods for composition of buffers
A weak acid and its salt with strong base - A weak base and its salt with strong acid
3. Physiological buffers
Bicarbonate - Phosphate - Protein - Hemoglobin buffer system
4. Advantages of bicarbonate buffer system
- Present in higher concentrations than other buffers
- Easily formed at the tissues from CO2 by Carbonic Anhydrase enzyme
- Easily corrected by respiration; CO2 is excreted e` expired air at Lungs
5. 1 physiological buffer linked to the kidneys & another 1 linked to the lungs
Phosphate – Bicarbonate buffer system

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6. 2 Causes of respiratory acidosis
- Lung disease: ABEP: Asphyxia – Bronchial asthma - Emphysema – Pneumonia
- Morphine poisoning
7. 2 Causes of metabolic acidosis
- ↑Acid production: sever exercise - ↑ Ptn in diet – ketosis in uncontrolled DM
- Loss of base: severe diarrhea
8. 2 Causes of respiratory alkalosis
HFHAM: Hysteria – Fever – High altitudrs – Aspirin poisoning – Meningitis
9. 2 Causes of metabolic alkalosis
Loss of acids: Vomiting and gastric wash - ↑ vegetables in diet – Intake of bases –
hypokalemia
Answers
A. Cases:
1. Uncompensated respiratory acidosis with hypoxia
2. Partially compensated respiratory acidosis with hypoxia
3. Uncompensated respiratory alkalosis with NO hypoxia
4. Uncompensated metabolic alkalosis with NO hypoxia
5. Partially compensated metabolic acidosis with NO hypoxia
B. Answers of MCQs
1. D 2. C 3. C 4. D
5. D 6. A 7. D 8. B
9. D 10. D 11. D 12. D
13. C 14. C 15. C 16. C
17. C 18. D 19. B 20 B
21. A 22. C 23. A 24. A
25. B 26. C 27. D 28. A
29. C 30. B 31. A 32. D
33. B 34. A 35. C 36. B
37. B 38. A 39. B 40. C
41. A 42. B
C. Answers of True and False
1. True 2. True 3. True 4. True
5. True 6. True 7. True 8. True
9. True 10. True 11. True 12. True
13. False (lung) 14. True

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