Eggena 18-1

Question 1

the patient’s current problem is not related heroin because

Answer 1

a narcotic overdose depresses breathing and causes constriction of pupils, signs not seen on physical examination.

Question 2

When a person with insulin dependent diabetes stops taking his usual dose of insulin or becomes resistant to insulin from an infection

Answer 2

glucose cannot enter muscle cells as usual so that glucose in blood rises well above its normal concentration.

Question 3

Without insulin fatty acids are released from adipose tissues and converted to

Answer 3

ketones in the liver

Question 4

the first line of defense against hydrogen ion insult is

Answer 4

buffering by bicarbonate in plasma.

Question 5

kussmaul breathing

Answer 5

PaCO2 has fallen by half, indicating that laveolar ventilation is twice what is needed to get rid of the carbon dioxide his tissues are making. It is a deep, labored inspiration with a grunting expiration.

Question 6

Shortly after hyperventilation started, the

Answer 6

PaCO2 in arterial blood fell, resulting in a decline in CO2 in CSF, decreasing CSF pH. This alkalosis inhibits central chemoreceptors, which masks the peripheral drive from chemoreceptors to hyperventilate.

Question 7

renal bicarbonate reabsorption during meatbolic acidosis

Answer 7

bicarbonate reabsorption is increased due to activation sodium/hydrogen ion antiporters by the low intracellular pH and stimulationby angiotensin II.

Question 8

to correct the bicarbonate defect

Answer 8

more ammonium and titratable acids must be excreted in urine.

Question 9

normally, _ is the most titratable acid in urine

Answer 9

phosphate buffer

Question 10

potassium sparing effect

Answer 10

Early in acidosis, when ammonium concentrations are low, much potassium is lost in urine. Later on, a greater proportionof the ketone load is excreted witha mmonium, so that the time dependent increase in synthesis and excretion of ammonium is said to have a potassium spaing effect.

Question 11

why did the patient have an elevated serum potassium level if more potassium than usual is being excreted in urine?

Answer 11

hydrogen ions are moveing into muscle cells in exchange for potassium ions.

without insulin, Na/K ATPases are not transorting potassium ions into cells as usual.

the rise plasma osmolarity causes cells to shrink, intracellular potassium to rise, and potassium ions leak out.