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IMF-019-01-0001-en	Name the three mechanisms the body uses to control hydrogen ion concentration.	Immediate chemical buffers, respiratory elimination of carbon dioxide, and renal handling of bicarbonate and non-volatile acid.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0002-en	Which reaction does carbonic anhydrase accelerate, and where does the manuscript locate the enzyme?	The combination of carbon dioxide with water to form carbonic acid, which dissociates into hydrogen and bicarbonate; it acts in red cells, kidney, and other tissues.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0003-en	The Henderson-Hasselbalch relationship expresses pH as a function of which two quantities?	Bicarbonate relative to dissolved carbon dioxide.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0004-en	How does the proximal tubule reclaim filtered bicarbonate, and why does that not add new buffer?	By hydrogen secretion and carbonic-anhydrase reactions, which only recover existing buffer; new bicarbonate appears when hydrogen is excreted with urinary buffers instead of being returned to blood with bicarbonate loss.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0005-en	Which urinary buffer becomes titratable acid, and which buffer can be adapted in quantity?	Phosphate accepts secreted hydrogen as titratable acid; ammonium is the quantitatively adaptable buffer, and acidosis increases ammoniagenesis.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0006-en	Trace how the kidney makes ammonium and traps it in the urine.	Proximal cells metabolise glutamine to ammonium and bicarbonate; ammonia diffuses into the collecting system, binds secreted hydrogen, and becomes trapped as ammonium.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0007-en	Give the six steps of the systematic interpretation in order.	Assess pH, identify whether carbon dioxide or bicarbonate explains it, test whether compensation is appropriate, calculate the anion gap in metabolic acidosis, compare delta changes, and integrate electrolytes, albumin, lactate, ketones, renal function, chloride, history, and treatment.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0008-en	Compensation limits pH change but never carries it past normal. What follows if measured compensation differs substantially from the expected value?	Another primary disorder is present.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0009-en	How is the anion gap calculated, which electrolyte is usually omitted, and what does it estimate?	Sodium minus chloride and bicarbonate, with potassium commonly omitted; it estimates unmeasured anions.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0010-en	Sodium is 138, chloride 98, and bicarbonate 10. Work out the anion gap and say what it points to.	Chloride and bicarbonate total 108, so the gap is 138 minus 108, that is 30; the gap is raised, so unmeasured anions such as lactate, ketones, retained renal acids, or toxic alcohol metabolites should be sought.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0011-en	Why can a low albumin conceal a high-gap acidosis?	Albumin is a major unmeasured anion, so a low albumin lowers the expected gap and a pathological rise can sit within an apparently normal value.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0012-en	What does a normal-gap metabolic acidosis usually reflect, and which causes are listed?	Bicarbonate loss or impaired renal acid excretion with chloride retention, from diarrhoea, pancreatic or intestinal loss, renal tubular acidosis, early kidney disease, or chloride-rich fluid administration.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0013-en	A patient with severe metabolic acidosis breathes deeply and rapidly. Why is that not evidence of primary lung disease?	Kussmaul breathing is the respiratory compensation, the lungs raising ventilation to lower carbon dioxide.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0014-en	When does lactic acidosis arise, and why is treating the lactate number inadequate?	It arises when production exceeds clearance, and the number does not identify the mechanism, which may be tissue hypoperfusion, severe hypoxaemia, seizures, adrenergic stimulation, liver dysfunction, mitochondrial toxins, drugs, malignancy, or thiamine deficiency.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0015-en	Metabolic alkalosis needs generation and maintenance. What is required for it to persist?	Impaired renal bicarbonate excretion, commonly from volume and chloride depletion, reduced filtration, potassium deficiency, or ongoing mineralocorticoid effect.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0016-en	What does urine chloride separate in metabolic alkalosis, and what confounds it?	Chloride-responsive states such as remote vomiting or diuretic effect from chloride-resistant states with ongoing mineralocorticoid activity; active diuretics and kidney disease complicate the interpretation.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0017-en	What harms follow when the blood pH becomes severely alkalotic?	Cerebral and coronary flow fall, ionised calcium is lowered, potassium shifts into cells, and arrhythmia is promoted.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0018-en	Why can a near-normal pH hide severe chronic hypercapnia?	Over days the kidneys retain bicarbonate and excrete acid, so chronic compensation returns pH toward normal while carbon dioxide stays high, and a further acute rise gives acute-on-chronic respiratory acidosis.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0019-en	In metabolic acidosis the carbon dioxide is low. When may that be called a separate respiratory alkalosis?	Only when it falls more than predicted; otherwise the low carbon dioxide is the expected compensation.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0020-en	Which two acid-base disorders does salicylate toxicity classically combine, and why can the pH mislead?	Respiratory alkalosis from central stimulation together with high-gap metabolic acidosis, so a near-normal pH can conceal severe poisoning.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0021-en	Why does a normal osmolar gap fail to exclude methanol or ethylene glycol poisoning?	The early osmolar gap can fall as the parent alcohol is metabolised to toxic organic acids and the anion gap rises, so neither gap excludes late poisoning.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0022-en	Which findings point to methanol rather than ethylene glycol?	Visual toxicity suggests methanol, whereas kidney injury and calcium oxalate accompany ethylene glycol.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0023-en	Acid-base state and potassium interact, but simple rules have exceptions. Which exceptions does the manuscript give?	Mineral acidosis tends to shift potassium out of cells while organic acids may behave differently, and insulin treatment of ketoacidosis shifts potassium into cells even when total body potassium is depleted.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending
IMF-019-01-0024-en	Bicarbonate therapy is not indicated in every acidosis. What harms can it cause?	It adds sodium, generates carbon dioxide, can lower ionised calcium, shift potassium, expand volume, and overshoot.	Integrated Medical Foundations; chapter 19, TTS module 1; https://theisegoria.github.io/medical-textbook/integrated-medical-foundations-expanded-english.md; module SHA256 at export: f40cd34c1174eeba883c639ec0de75d51d3c20361ab9d9fef621c6322f2dd1d2; editorial review pending	imf lang::en chapter::019 module::019-01 review::pending