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Chemistry > Electrolytes and Acid Base Balance > Flashcards

Electrolytes and Acid Base Balance Flashcards

1
Q

Definition of Electrolytes

A

Substance that ionize (dissociates) in blood stream and body fluids

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2
Q

Examples of Electrolytes

A

Acids (H+)
Bases (HCO3-, PO4-2)
Inorganic Salts (K+, Na+, Cl-)
Mineral Ions (Mg2+, Fe2+, Fe3+, Ca2+)

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3
Q

Electrolytes Function

A

Maintain osmotic pressure of body fluid compartments
Regulate osmotic movement of H2O
Acid-Base Regulation
Found in tissues
Co-enzymes
Neuromuscular reactions

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4
Q

Imbalances in Electrolytes Caused By

A

Vomiting
Diarrhea
Sweating
Kidney Loss
Hormonal Imbalance
Acid-Base Imbalance
Tissue Destruction

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5
Q

Electrolyte Panel Ordered

A

Called “lytes”
Na+
K+
Cl-
HCO3- (noted as TCO2 on Blood Gas Report)
Calculated by Anion Gap

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6
Q

Sodium Function

A

Create Osmotic Pressure
Most Abundant in ECF - Major Extracellular cation
Essential for electrical activity of neurons and muscle cells

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7
Q

Hormonal Regulation of Na and H2O

A

Aldosterone
- controls Na+ reabsorption by kidneys
Juxtaglomerular apparatus turns on renin-angiotensin system

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8
Q

Decrease Aldosterone Production

A

Addison’s Disease

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9
Q

Increase Aldosterone Production

A

Cushing’s Disease

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10
Q

Hyponatremia

A

Decreased Plasma Na+
Associated with regulation of blood volume
Skin turgor, Venous Pressure, and Urine Na+ concentration

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11
Q

Hypovolemic Depletion Hyponatremia

A

Result of excess Na loss and excess H20 loss

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12
Q

Renal Loss Hypovolemic

A

Diuretics
Primary or secondary Addison’s disease

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13
Q

Non-renal loss Hypovolemic

A

GI loss from vomiting or diarrhea
Skin loss from burns or trauma

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14
Q

Hypervolemic Dilutional Hyponatremia

A

Relative change in measured Na+ due to increased H2O volume
- Syndrome of inappropriate ADH secretion
- Generalized edema (congestive heart failure, cirrhosis, nephrotic syndrome)
- Uncontrolled diabetes (high blood glucose) mellitus

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15
Q

Hypernatremia

A

Increased Plasma Sodium
Result of excess water loss or Na+ gain (rare)

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16
Q

Fluid loss of Hypernatremia

A

Loss of fluid by: GI tract, excessive sweating, hromone disorder
Diabetes insipidus

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17
Q

Absolute Na+ Gain Hypernatremia

A

Ingestion or infusion of NaCl or NaHCO3
Hyperaldosteronism
Acute Renal Failure

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18
Q

Function of Potassium

A

Creates Osmotic pressure in ICF
Must abundant cation in ICF
- Major Intracellular Cation
Electrical activity of neurons and muscle cells
Hydrogen Ion buffering

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19
Q

Kidney-Aldosterone Regulation Potassium

A

Decreased Plasma concentration by increasing rate of K+ secretion in the proximal convoluted tubules and duct
Cellular breakdown increase K+ released
Tied to H+ during metabolic acidosis

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20
Q

Effect of K+ on Heart

A

Increased plasma slows heart rate by decreasing resting membrane potential of heart
Decreased extracellular, causes myocardial excitability

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21
Q

Critical high K+ levels

A

Cause Cardiac shutdown
Too much Potassium

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22
Q

Critical low K+ levels

A

Causes arrythmia

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23
Q

Hypokalemia

A

Decreased plasma K+

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24
Q

Causes of Hypokalemia

A

Excessive GI loss, N-G tube, diarrhea, and laxative abuse
Renal losses hyperaldosteronism, renal tubular acidosis
Decreased dietary intake
Increased cellular uptake in alkalosis
Insulin excess

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25
Q

Symptoms of Hypokalemia

A

Muscle weakness
Cardia arrhythmia
Paralysis

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26
Q

Hperkalemia

A

Increased plasma K+

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27
Q

Causes of Hyperkalemia

A

Increased dietary intake
Increased tissue destruction
Altered cellular uptake in acidosis
Insuling deficiency
Impaired renal excretion in renal problems & hypoaldosteronism

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28
Q

False Cause of Hyperkalemia

A

Hemolyzed blood sample

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29
Q

Symptoms of Hyperkalemia

A

Muscle weakness
Slow or irregular pulse
EKG changes
Tingling

30
Q

Chloride Function

A

Most abundant anion in ECG
- Major extracellular anion
Moves in and out of cells passively in association with Na+
Helps regulate osmotic pressure and thus H2O balance
Helps regulate electric neutrality
Component of HCl in gastric juice

31
Q

Chloride balance

A

Passively follows Na+
Acid base balance and electric neutrality within the body
- Cl- ion shift is secondary to Na+ and HCO3- movement
Ingested in diet and absorbed in intestines

32
Q

Hypochloremia

A

Decreased plasma Cl- levels

33
Q

Causes of Hypochloremia

A

GI losses in prolonged comiting & nasogastric suction
Loss from traumatized skin in burns
Renal losses with diuretics
Metabolic acidosis

34
Q

Hyperchloremia

A

Increased Plasma Cl- levels

35
Q

Causes of Hyperchloremia

A

Dehydration
Renal Tubular Acidosis
Metabolic acidosis from prolonged diarrhea
Loss of NaHCO3
Salicylate Intoxication (Aspirin)

36
Q

Sweat Chloride Test

A

Screening for Cystic Fibrosis
Characterized by excessive mucus secretion causing lung and upper respiratory obstruction & blockage
Increase of Na+ and Cl- in sweat

37
Q

Sweat Chloride Test Measured

A

Pilocarpine Iontophoresis

38
Q

Bicarbonate Function

A

Major component of bicarbonate buffer system
- 2nd largest anion found in ECF
Acid base balance as component of bicarbonate
- Carbonic acid buffer system

39
Q

Bicarbonate Balance

A

Kidney reabsorption
Lungs - control through respiration

40
Q

Decreased HCO3-

A

Results in Metabolic Acidosis

41
Q

HCO3- Primary metabolic acidosis

A

Buffered during diabetes
Renal disease
Lactic acidosis
Other acidic conditions

42
Q

Increased HCO3-

A

Results in Metabolic Alkalosis

43
Q

HCO3- Primary metabolic alkalosis

A

Due to medications

44
Q

Anion Gap Formula

A

Na - (Cl + HCO3)

45
Q

Anion Gap <7

A

Low anion gap
Instrument error
Patient Condition
- Multiple myeloma w/ pos charged abnormal proteins
- Very rare

46
Q

Anion Gap >16

A

High anion gap
Instrument error
Patient Condition
- Diabetic ketoacidosis
- Lactic acidosis
- Renal azotemia and retention of acids

47
Q

Acid-Base Balance

A

State of equlibrium
pH is maintained regardless of metabolic stressors on the body

48
Q

Acid-Base Balance Maintained BY

A

Controlling hydrogen concentrations of body fluids
pH within a narrow range 7.35 - 7.45

49
Q

Hydrogen Ion homeostasis

A

Dependent on
- Bod buffer systems
- Respiratory mechanisms
- Renal function

50
Q

Acid Production Metabolism

A

Krebs Cycle - ATP +H2O +CO2

51
Q

Acid Production Metabolic Pathways

A

H+ + Anions
Excess H+ can be excreted or retained by kidneys

52
Q

Body’s Buffer Systems

A

Prevent rapid, drastic changes in pH
Maintains pH consistancy
Consists of a pair of chemicals

53
Q

Carbonic Acid-Bicarbonate Buffer System

A

CO2 + H2O = H2CO3 = HCO3- + H+
Most abundant buffer system buffer system in the ECF

54
Q

Chloride Shift

A

Occurs inside RBCs
Way of buffering H+

55
Q

Carbonic Acid-Bicarbonate Buffer Kidneys Role

A

HCO3- is reabsorbed along with Na+ for H+ under normal circumstances
Acidosis - this exchange increases
Alkalosis - this exchange is retained and more HCO3- is excreted

56
Q

Phosphate Buffer System

A

Important in intracellular fluid and in urine
Weak base is monohydrogen phosphate (HPO4)2-
Weak Acid is dihydrogen phosphate (H2PO4-)

57
Q

Protein Buffer System

A

Proteins are most important in buffering inside cells
Hgb is especially good buffer
Weak Base is Amine Group (NH2)
Weak Acid of carboxyl group (-COOH)

58
Q

Hendersohn Hasselbalch Equation

A

pH = pKa + log (HCO3-/H2CO3)

59
Q

Respiratory Acidosis Signs

A

Increased pCO2 and decreased pH

60
Q

Common Cause of Respiratory Acidosis

A

Hypoventilation - retention of CO2 in blood stream
- Emphysema
- Pulmonary edema
- Trauma to respiratory center
- Airway obstruction (choking or asthma)
- Dysfunctional respiratory muscles
- Pneumonia
- Barbiturate poisoning

61
Q

Metabolic Acidosis Signs

A

Decreased Bicarbonate and decreased pH

62
Q

Common Cause of Metabolic Acidosis

A
  • Loss of body bicarbonate due to diarrhea
  • Accumulation of acid from increased production
  • Retention due to decreased renal function
  • Diabetic ketosis
  • Lactic Acidosis
  • Renal failure
    -Ethylene glycol poisoning
  • Methanol ingestion
63
Q

Respiratory Alkalosis Signs

A

Decreased pCO2 and increased pH

64
Q

Common Cause of Respiratory Alkalosis

A

Anything that makes patient breath faster
Hyperventilation
- Oxygen deficiency
- Pulomonary disease
- Cerebral Vascular accident (CVA)
- Anxiety
- Fever
- Aspirin Overdose

65
Q

Metabolic Alkalosis Signs

A

Increased bicarbonate and increased pH

66
Q

Common Cause of Metabolic Alkalosis

A
  • Loss of acid (vomiting or Gastric suctioning)
  • Diuretic therapy
  • Hyperaldosteronism or Cushing’s Disease
  • Excessive intake of alkaline drugs
  • Citrate toxicity after massive transfusion
67
Q

Respiratory Compensation

A

Occurs in response to altered pH caused by metabolic changes

68
Q

Respiratory Mechanisms for Compensation

A

Hypoventilation
Hyperventilation
-Occurs within minutes and maximized within hours

69
Q

Blood Hydrogen Ion Concentration

A

Increase activates chemoreceptors in the medulla oblongata
- stimulates respiratory center
- Nerve impulses to respiratory muscles which contract more forcefully
- increases exhalation of CO2

70
Q

Metabolic Compensation

A

Occurs in response to altered pH caused by respiratory changes

71
Q

Metabolic Mechanisms for Compensation

A

Kidney excretion
Compensation begins in minutes but takes days to maximize

72
Q

Renal Compensation

A

Renal tubules raised blood pH by
- secretion and excretion of H+
- reabsorption of filtered HCO3-
- synthesis and absorption of newly formed HCO3-
- Formation of NH4+ (ammonium)

Chemistry (11 decks)

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