- high plasma sodium - low plasma water

- Low Renal Perfusion - Renal Disease - High Protein Intake - Dehydration

Chemistry Exam 1 Flashcards by Luke Morton-Yates

The proximal convoluted tubule (PCT) reabsorbs

Glucose, Amino acids, Proteins

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Disease state: High ADH

Inappropriate ADH Secreation

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Disease state: Low ADH

Diabetes insipidus

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ADH is secreted when

high plasma sodium
low plasma water

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ADH causes what effect to happen where

Water reabsorption to increase in the Collecting Ducts of the Kidneys

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Osmolality

Measure of osmotic pressure across body membranes

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Osmolarity

Measure of osmoles of solute (dissolved particles) per kilogram of solvent

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When are osmolality and osmolarity equivalent?

When the solvent is water, like in the body

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Formula 1 for Osmolality

2.0[Na+] + [glucose]/20 + [BUN]/3

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Units for Osmolality formula

[Na] in mEq/L
[Glu] and [BUN] in mg/dL

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Osmolar Gap - definition and significance

Difference between calculated and measured osmolalities
May indicate unaccounted for solutes, most commonly alcohol, mannitol, glycine, methanol, or ethylene glycol
Larger gap = poorer prognosis

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Colligative Properties

More dissolved particles causes:
- Freezing point down
- Vapor pressure down
- Boiling point up
- Osmotic pressure up

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1000 mOsmole results in how much freezing point depression?

1.86 °C

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What are the body’s fluid compartments? What do they include?

Intracellular Fluid Compartment (ICF) - fluid within cells
Extracellular Fluid Compartment (ECF) - plasma and interstitial spaces

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Creatinine Clearance formula

UV/P x 1.73/A

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Renal threshold for glucose

160-180 mg/dL

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Classifications of Renal Disease

Pre-renal (cardiac output)
Renal (kidneys)
Post-renal (blockage like stones or tumors)

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Non-protein Nitrogen (NPN) compounds

BUN
Uric Acid
Creatinine/creatine
Ammonia

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Increase in one more more NPN is called

Azotemia

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Creatinine vs Creatine for disease states

Creatinine = Renal Disease
Creatine = Muscular Disorders

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Jaffe Reaction

Detects creatinine by color formation as it complexes with alkaline picrate

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Ornithine Cycle

Ammonia from protein degradation is converted to BUN, which is soluble for excretion in urine

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How are azotemia and uremia related?

Azotemia is high BUN in plasma
Uremia is high BUN in urine (renal failure)

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High BUN occurs in

Low Renal Perfusion
Renal Disease
High Protein Intake
Dehydration

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Low BUN occurs in

- Low protein intake - sever liver disease - Sever vomiting or diarrhea

Urease converts

Urea to ammonia

Berthelot reaction

Detects BUN indirectly by converting to ammonium with urease, then reacting with phenol. Indophenol is produced, which is a blue chromophore.

BUN Enzymatic Assay

Detects BUN indirectly by converting to ammonium with urease, then reacting with enzyme to convert NADPH to NADH. NADPH is more colored than NADH, so more BUN = less color in the products.

BUN Chemical Method

Urea reacted directly with diacetyl. Produces diazine chromaphore.

BUN:Creatinine Ratio

- Healthy = 10:1 to 20:1 - Pre-renal azotemia = 20:1 to 30:1 - Post-renal azotemia = >>20:1 with high creatinine (proportional increase) - Low BUN from liver disease or malnutrition = <10:1

Uric Acid Chemical Method

Uric Acid + Phosphotungstic acid to make Tungsten blue

Uric Acid Enzymatic Method

Uricase converts uric acid to allantoin and peroxide. Peroxide reacts with NADP to make NADPH chromagen

What organ converts ammonia to BUN?

Liver

Ammonia Methodology

Ion Selective Electrode

"Lytes" includes

- Na+ - K+ - CL- - HCO3-

Major Extracellular Cation

Sodium

Where is Aldosterone produced? What does it control?

- Produced in adrenal gland - Sodium reabsorption in kidneys

Disease State: low aldosterone

Addison's Disease

Disease State: high aldosterone

Cushing's Disease

Name and Function of ACE

- Angiotensin Converting Enzyme - Converts Angiotensin I to Angiotensin II

What activates the renin-angiotensin system? What is the result of this activation?

- Juxtaglomerular Apparatus - Increase to blood pressure and sodium levels

Major Intracellular Cation

Potassium

Low Potassium is caused by

- low intake - insulin excess - vomiting or diarrhea

Potassium Critical Values

<2.8 or >6.0 mmol/L

High Potassium is caused by

- high intake - tissue destruction - hemolysis of sample - impaired renal excretion

Major Extracellular Anion

Chloride

Cl- ion shift

is secondary to Na+ and HCO3- movement in and out of cells

Low Chloride is associated with

- prolonged vomiting - skin trauma/burns - renal lost to diuretics - metabolic acidosis

High Chloride is associated with

- dehydration - renal tubular acidosis - loss of NaHCO3 - salicylate intoxication (aspirin)

Equation for equivalence of H2CO3 to pCO2 in the blood

H2CO3 = 0.03 x pCO2

Sweat Chloride Testing

- Screening test for cystic fibrosis (high in these patients) - Measured with pilocarpine iontophoresis

2nd largest anion in the ECF

Bicarbonate (HCO3-)

Control of HCO3- levels happens in

- Kidneys through reabsorption - Lungs through respiration rate

Low HCO3- results in

Metabolic Acidosis

High HCO3- results in

Metabolic Alkalosis

Anion Gap formula

[Na+] - ([Cl-] + [HCO3-])

The body pH centerpoint is

7.4

The Krebs Cycle produces

ATP + H2O + CO2 (acid)

What cation moves with HCO3-?

Na+

Bicarbonate Buffer System Equillibrium

CO2 + H2O <-> H2CO3 <-> HCO3- + H+

Phosphate Buffer System Equillibrium

(HPO4)2- + H+ <-> (H2PO4)-

Effect of Acidosis on CNS

Suppression

Effect of Alkalosis on CNS

Excitation

pKa of Bicarbonate

6.11

Where is the respiratory center of the brain?

Hypothalmus

Respiratory Acidosis

Increased pCO2 - issues breathing - barbiturate poisoning - brain damage

Metabolic Acidosis

Decreased bicarbonate - loss to diarrhea - ethylene glycol/methanol poisoning - decreased kidney function

Respiratory Alkalosis

Decreased pCO2 from hyperventilation - oxygen deficiency - anxiety - aspirin overdose - brain damage

Metabolic Alkalosis

Increased bicarbonate - Loss of acid (vomiting) - Cushing's Disease - Citrate toxicity from massive transfusion

A patient is compensating for acid/base imbalance if

- they are within the reference range - the levels of pCO2 and HCO3- are on the same side of normal (both high/both low)

Respiratory Compensation

- occurs in minutes, maxed within hours - can't handle long-term stress

Metabolic Compensation

- occurs in hours, maxed within days - better handles long-term stress

Chemistry Exam 1 Flashcards

(72 cards)