Acid Base/fluid

Question 1

Carbonic acid

Answer 1

Aerobic metabolism CO2 + carbonic anhydrase

Question 2

Lactic acid

Answer 2

Anaerobic metabolism

Question 3

Sulfuric acid

Answer 3

Sulphur containing amino acids (methionine, cysteine, noneocystine, tourine)

Question 4

Phosphoric acid

Answer 4

Phospho proteins, ribonucleic acids

Question 5

Ketone bodies

Answer 5

Acetoacetic acid, beta hydroxybutyric acid
Synthesized form of acetylcoa by product of mitochondrial beta oxidation of fatty acids

Question 6

Intravascular fluid

Answer 6

ECF, 8 % of total body water, blood plasma
BP and vascular resistance

Question 7

Interstitial fluid

Answer 7

ECF, 25% of total body water , fluid between cells, lymph, GI, spinal, eye, synovial fluids, between plasma and interstitial 4 starting forces

Question 8

Intercellular fluid

Answer 8

ICF, 67% of total body water, inside cell, water moves freely across plasma membrane through aquaporins, ions through channel or transporter

Question 9

Respiratory acidosis

Answer 9

Decreased pH, increased CO2, decreased bicarbonate
S/s-HA, restlessness, muscle twitching, sz, lethargy, change in mental status
Cause by hypercapnia due to COPD, decreased respirations due to OD, Brain injury, paralysis trauma

Question 10

Respiratory alkalosis

Answer 10

Increased pH, decreased CO2, increased bicarbonate
Due to hypocapnia, high altitudes, increased vent rate, fever, anemia, salicylate OD, anxiety
S/s-dizzy, confusion, sz, tachypnea, confusion

Question 11

ROME

Answer 11

Respiratory opposite
Metabolic equal

Question 12

Blood ph

Answer 12

7.35-7.45
Acidic-alkaline

Question 13

3 mechanisms to maintain acid base balance

Answer 13

1 physiologic (chemical) buffer system in plasma first line
2 respiratory acid base control is quick to response in seconds to minutes
3 renal acid base control responds slow hours to days

Question 14

ABG

Answer 14

PH 7.35-7.45
CO2 35-45
O2 80-100
HCO3 21-28
CO2 highly acidic, lungs
Bicarbonate HCO3 highly alkaline, kidneys
CO2 + H20< -> H2CO3<->H and HCO3

Question 15

Metabolic acidosis with high anion gap

Answer 15

Serum K plus Na - serum Cl + HCO3
Normal is 6-12 gap
Greater than 12 is acidosis
Caused by MUDPILES
Methanol, uremia, DKA, paraldehyde/phenformin/propofol toxicity, Iron, lactic acidosis, ethylene glycol, salicylates
Less than 12 non ion gap could be due to renal loss, GI loss, volume overload, high sodium, renal function issues

Question 16

Metabolic acidosis

Answer 16

PH decreased
HCO3 decreased
CO2 decreased
Due to lactic acidosis, renal disease, ingestion of acid precursors, starvation, DKA, GI loss
S/s- decreased MI contractility, decreased CO, hypotension, high potassium, high respiratory rate, HA, lethargy, change in mental status

Question 17

Metabolic alkalosis

Answer 17

Elevated pH
Elevated HCO3
Elevated CO2
Caused by hyper aldosteronism, enema, diuretic use, tums OD, enemies
S/s- potassium low, weakness, cramps, decreased Ca, hypoventilation, hyperactive reflexes, sz

Question 18

Total body water

Answer 18

Sum of fluids within all compartments usually as a %
Reasons someone’s TBW might not be 60%
Age (infants have more 70-80) decreases as we age
Women have about 50%
OB
Obesity 40-50

Question 19

Osmolality

Answer 19

Number of solute particles per 1 kg if solvent
TBW likes to be In equilibrium

Question 20

Hydrostatic pressure

Answer 20

Pressure excreted by a fluid at equilibrium at any point of time due to force of gravity, ICF, BP

Question 21

Oncotic pressure

Answer 21

Also called colloid osmotic pressure, a type of osmotic pressure induced by plasma proteins like albumin

Question 22

Osmotic pressure

Answer 22

The pressure that must be applied to a solution to halt the flow of solvent molecules through a semi permeable membrane (osmosis) interstitial fluid

Question 23

Mechanism to move fluids solvents

Answer 23

Osmosis- process by which molecules of a solvent tend to pass through a semi permeable membrane form a less concentrated solution into a more concentrated one thus equalizing the confection of each side of the membrane
Diffusion movement of a solute molecule from an area of greater solute concentration to an area of lesser solute concentration, free movement
Active transport- movements of ions or molecules across a cell membrane into a region of higher concentration assisted by transporters and requires energy

Question 24

Edema

Answer 24

Excessive accumulation of fluid within interstitial spaces
Capillary lymphatic vessels to tissue

Question 25

Increases capillary hydrostatic pressure in edema

Answer 25

Either venous obstruction or sodium water retention, venous obstruction ->increased hydrostatic pressure->pushes fluid into interstitial space Causes include thrombophlebitis, blood clot, hepatic venous obstruction, CHF, tight clothing, prolonged standing

Question 26

Decreased capillary oncotic pressure in edema

Answer 26

Loss of plasma proteins like albumin like in liver diseases, malnutrition

Question 27

Increased capillary membrane permeability in edema

Answer 27

Inflammation and immune response

Question 28

Lymph channel obstruction in edema

Answer 28

Lymphatic channels are blocked due to tumor or infection or lymphedema

Question 29

Sodium potassium transport

Answer 29

Sodium is extra cellular K is intercellular Sodium maintains homeostasis through osmosis K maintains homeostasis through active transport

Question 30

Isotonic fluid

Answer 30

Relating to a solution having the same osmotic pressure as one in a cell or body fluid 5% dextrose in water, 0.9 NaCl

Question 31

Hypotonic

Answer 31

Having a lower osmotic pressure than a particular fluid typically a body fluid or intracellular fluid H2O, water consistently being pulled to cell cause edema or bursting “Hippo”

Question 32

Hypertonic

Answer 32

Having a higher osmotic pressure than a particular fluid, typically a body fluid or intracellular fluid 3% saline

Question 33

Plasma

Answer 33

Components-bicarbonate and carbonic acid and hgb Roles- HCO3 is first line, albumin is negatively charged binds to Ca (high calcium results from acidosis albumin binds to H ions, decreased calcium more albumin to bind with calcium, Alkalosis) Hgb carries H2CO3 which dissociates and hgb buffer H ions in lungs CO2 is expelled (released from hgb)

Question 34

Intracellular

Answer 34

Competents-proteins, phosphate Roles- inorganic phosphates Hydrogen phosphate and dihydrogen phosphate and organic phosphates, AMP, glucose/phosphate, and 2,3 DPG

Question 35

Lungs

Answer 35

Component- CO2 Roles- lungs compensate when the chemical buffer fails to achieve homeostasis, minute ventilation is increased (blow off CO2) if fails kidneys take over

Question 36

Kidneys

Answer 36

Components-HCO3, ammonia, phosphates Role- secrete H ions for removal in urine, reabsorption of filtered HCO3 ions, production of more HCO3 ions

Question 37

Low protein

Answer 37

Inadequate iron intake, liver disease, absorption, diarrhea, burns, starvation Seen with low albumin loss of albumin in the urine

Question 38

Elevated protein

Answer 38

Due to dehydration, lupus, chronic infections, multiple myeloma, sarcoidosis, tuberculosis, leukemia, or other cancers, lipid disorders If globulins are increased, check serum, protein, electrophoresis for alpha, one alpha, two beta and gamma If alpha one is high associated with chronic inflammatory, degenerative, and malignant disease Increase in gamma seen in myeloma lymphoma, chronic infection, collagen disorder, and chronic liver disease

Question 39

Urine protein

Answer 39

Normal 10-140 in 24 hours Trace albumin and globulins Persistent protein or albumin in urine is indicator for Renal diseases or anemia, leukemia, preeclampsia, abdominal tumors, heart, disease, hyperthyroid, liver, disease, or opiate poisoning If associated with white blood cells in urine think infection If associated with white blood cells and red blood cells think non-infectious inflammatory disease Do a fence Jones protein to look for multiple myeloma lymphoma or amyloidosis