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Pathophysiology > Exam 1: Ch 8 > Flashcards

Exam 1: Ch 8 Flashcards

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1
Q

extracellular fluid

A

interstitial fluid and plasma

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2
Q

mEq

A

milliequivalents

mEq/L = # of millimoles of charges/L = (mg/L x valence) / AW

mMol/L = # of millimoles of particles/L = (mg/L) / AW = (mEq/l) / valence

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3
Q

is osmosis water moves to the side…

A

with more solute particles

measures as mOsm/L or osmolatity

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4
Q

extent of osmotic pressure measured by…

A

mOsmoles = mMol of non-diffusable particles

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5
Q

tonicity

A

effect of osmotic pressure on a cell

hypotonic solutions have > osmolarity than the cell (swell)

hypertonic solutions have < osmolarity than the cell (shrink)

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6
Q

distribution of body fluids

A

total body water: 60% of weight

intracellular fluid is 2/3, extracellular 1/3

interstitial fluid is 2/3 of extracellular (rest is plasma, and transcellular fluid)

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7
Q

transcellular fluid

A

CSF

peritoneal

pleural

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8
Q

capillary filtration pressure (hydrostatic pressure)

A

BP in a capillary

higher at arterial end than venous end

outward force - pushes blood into interstitium

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9
Q

interstitial fluid pressure

A

low but normally negative

outward force

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10
Q

interstitial colloid osmotic pressure

A

low

outward force

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11
Q

capillary colloid osmotic pressure

A

mostly from proteins (albumin made in liver) in plasma

electrolytes pass freely, no net pressure

inward force - pulls blood back into veins

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12
Q

exchange in capillaries

A

at arterial end out > in, net filtration

at venous end in > out, net reabsorption

fluid or protein not reabsorbed, returns to circulation in lymph

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13
Q

edema

A

swelling caused by excess interstitial fluid

increased capillary filtration (hydrostatic) pressure

more fluid leaves capillary space

usually from increased venous pressure (HF) or increased pressure at arterial end of capillary

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14
Q

decreased capillary colloid osmostic pressure

A

causes edema

less fluid returns to capillary (low albumin)

liver failure or heart disease

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15
Q

increased capillary permeability

A

causes edema

plasma proteins leak out of capillaries

inflammation

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16
Q

obstructed lymph flow

A

causes edema

prevents return of proteins and fluids to circulation

malignancy or surgery

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17
Q

assessment/treatment of edema

A

weight, visual assessment, measurement of affected part

elevate lower extremities, support stockings, diuretics

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18
Q

third space fluid accumulation

A

trapping in transcelular space

peritoneal, pleural, or pericardial

may require drainage

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19
Q

TBW of water in lean adults vs. infants

A

60% lean adults

75-80% in infants

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20
Q

how is water taken in and excreted?

A

intake: drink, food, metabolism
output: urine, respiratory, skin, feces

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21
Q

regulation of Na balance

A

most plentiful extracellular cation

intake: GI
output: renal, skin, lungs

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22
Q

RAAA system

A

renin angiotensin-aldosterone system

lowers sodium concentration, blood volume

BP activates

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23
Q

ADH stimulates ____ ____ while Aldosterone stimulates ____ ____

A

water retention

sodium retention

released together

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24
Q

aldo effect and ADH effects

A

aldo: increased urinary Na retention

ADH: increase thirst –> increase H2O intake & decreased urine water loss

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25
if low BP (and low blood volume) due to ECF fluid loss and/or Na loss
renin and angiotensin II released and activated increase aldo and ADH release
26
if high BP and high blood volume due to excess ECF and or Na gain
increased NP release decrease aldo and ADH release
27
thirst controlled by
thirst center in hypothalamus, which has osmoreceptors ADH released by hypothalamus to retain water if ECF is low or there is cellular dehydration
28
hypodipsia
decreased ability to sense thirst lesions on hypothalamus
29
polydipsia
excessive thirst CRF or HF from high angiotensin
30
true thirst
accompanies dehydration from blood loss or diabetes mellitus
31
psychogenic polydipsia
compulsive drinking in psychiatric disorders
32
2 ADH disorders
diabetes insipidus syndrome of inappropriate ADH secretion
33
2 types of diabetes insipidus and definition in general
decreased ADH, leading to high urine output, dehydration, and high serum sodium (only losing H2O, not ions) neurogenic nephrogenic
34
neurogenic diabetes insipidus
caused by trauma, solve with ADH administration decreased ADH, leading to high urine output, dehydration, and high serum sodium (only losing H2O, not ions)
35
nephrogenic diabetes insipidus
renal response off ADH decreased decreased ADH, leading to high urine output, dehydration, and high serum sodium (only losing H2O, not ions)
36
what does ADH do cellularly
inserts aquaporins that are impermeable to ions causes H2O to leave urine and enter the blood, causing low serum Na (diluted by the H2O) decreases urine output
37
syndrome of inappropriate ADH secretion
causes dilutional hyponatremia tumor can secrete extra ADH treat with diuretics and fluid restriction
38
physiological effects of dilutional hyponatremia caused by syndrome of inappropriate ADH secretion
reabsorb H2O so low urine output low serum sodium high BP
39
isotonic fluid volume deficit
loss of isotonic fluid from ECF ICF not impacted
40
causes, symptoms, and treatment of isotonic fluid volume deficit
causes: vomiting, diarrhea, NG suction symptoms: thirst, weight loss, oliguria, increased urine specific gravity treatment: correct problem and administer isotonic fluid
41
isotonic fluid volume excess
gain of isotonic fluid into ECF ICF not impacted
42
causes, symptoms, and treatment of isotonic fluid volume excess
causes: renal or HF, corisol excess symptoms: weight gain, edema, distended neck veins, pulmonary edema, ascites treatment: sodium restriction and diuretics
43
hyponatremia
low serum Na of less than 135 mEq/L and low serum osmolarity results from loss of Na in excess of (or without) H2O loss and gain of H2O without sodium
44
causes, symptoms, and treatment of hyponatremia
SIADH, renal disease that increases water retention neuro (headache, disorientation), muscle cramps, weakness limit H2O intake, give hypertonic sodium solutions if sever
45
water enters ICF by _____
osmosis produces cellular edema (includes cerebral edema)
46
hypernatremia
serum Na less than 145 mEq/L and serum osmolarity > 295 mOsm/L results from gain of sodium or loss of H2O
47
causes, symptoms, and treatment of hypernatremia
lack of H2O access, hypodypsia, excess sodium bicarb weight loss, polycythemia, thirst, neuro symptoms give rehydration fluids --> slowly to avoid cerebral edema
48
water leaves ICF by ____
osmosis causes cellular dehydration
49
normal serum volume of potassium
3.5-4.5 mEq/L
50
regulation of potassium balance
renal regulation: K+ filtered and partially reabsorbed excretion fine tuned by aldosterone-sensitive sodium reabsorption/potassium secretion in DCT
51
how are Na/K gradients maintained
Na/K ATPase pump cellular dehydration --> increase K shift out of cells intracellular acidosis --> increase K shift out of cells Insulin and Epi stimulate pump --> increase K movement into cells
52
2 disorders of potassium imbalance
hyperkalemia hypokalemiaq
53
hyperkalemia effect on resting membrane potential
reduces ratio so RMP is closer to threshold for AP
54
hypokalemia effect on resting membrane potential
increases ratio so RMP is further from threshold for AP
55
hyperkalemia
K+ > 5 mEq/L causes: decreased renal elimination (CRF), increased movement from ECF (acidosis) symptoms: peaked T wave, short QT, wide QRS!!!! weakness and muscle cramps treat: CaCl2 to reverse ECG changes, beta-agonists, insulin
56
hypokalemia
K+ < 3.5 mEq/L causes: decreased intake, vomiting, diarrhea, renal loss (diuretics), shifts into cells (epi & insulin), treatment of ketoacidosis symptoms: PR prolonged, premature ventricular contractions, weakness, fatigue, muscle cramps treat: replace with IV rapidly if needed
57
2 regulators of calcium
PTH increases calcium calcitonin decreases calcium
58
PTH
increases calcium increased absorption by gut (Vit D) decreases renal elimination stimulates osteoclasts (breakdown of bone)
59
calcitonin
decreases calcium
60
2 PTH disorders
hyperparathyroidism hypoparathyroidism
61
hyperparathyroidism
excess PTH --> high calcium parathyroid adenoma skeletal abnormalities that may be asymtomatic
62
hypoparathyroidism
PTH deficit so low calcium congenital absence of gland, acquired (surgery or radiation) symptoms: tetany, prolonged QT treat: IV calcium gluconate, Vit D
63
most calcium stored in ____
bone
64
calcium in ECF
1/2 calcium bound to albumin and 1/2 free
65
hypocalcemia
serum calcium less than 8.5 mg/dL treat: replace calcium
66
causes and symptoms of hypocalcemia
causes: renal loss (failure) and hypoparathyroidism symptoms: nerve and muscle excitability, tingling, spasms, and seizures b/c Ca stabilizes membranes
67
2 signs of hypocalcemia
Chvostek: contracture of facial muscles from light tap Trousseau: carpal spasms from inflating BP cuff
68
hypercalcemia
serum calcium greater than 10.5 mg/dL causes: bone resorption (cancer) and hyperparathyroidism symptoms: decreased neural exitability
69
regulation of magnesium balance
reabsorption in DCT stimulated by PTH
70
hypomagnesemia
serum Mg less than 1.8 mg/dL caused by diarrhea, malabsorption, laxatives symptoms: tachycardia and HTN
71
hypermagnesemia
serum Mg greater than 2.6 mg/dL caused by renal disease, and magnesium containing meds like antacids symptoms: hypotension and cardiac arrest
72
why is pH important
enzymes are sensitive cardiac and neural function is decreased when pH is low
73
acids are generated by ________
metabolism
74
fixed acids
sulfuric phosphoric lactic ketone bodies
75
sulfuric and phosphoric acid
produced in metabolism of AA, NA, and phospholipids excreted by kidney
76
lactic acid
from pyruvic acid in anaerobic metabolism
77
ketone bodies
from fat and protein during catabolism
78
volatile acid
CO2 end product of aerobic metabolism H2O + CO2 --> H2CO3 --> H+ + HCO3-
79
high pCO2
acidosis
80
low pCO2
alkalosis
81
3 lines of defense against acidosis/alkalosis
1: chemical buffering 2: respiratory response by breathing out CO2 3: renal response
82
CO2 is produced in ____ and diffuses into ____
cells, plasma
83
CO2 in RBC and enzyme
H2O + CO2 --> H2CO3 --> H+ + HCO3- by carbonic anhydrase
84
CO2 is carried in 3 forms
bicarb 70% dissolved in plasma 10% bound to hemoglobin 20%
85
calculation of pH
Henderson-Hasselbach rate of bicarb to CO2 determines pH pH = 6.1 + log [HCO3-] / (.03 * pCO2)
86
the log of a bigger # = a
bigger #
87
causes of acidosis bicarb/CO2
low biarb high CO2
88
causes of alkalosis bicarb/CO2
high bicarb low CO2
89
buffer systems
1st line of def bicarbonate buffer system most important H2O + CO2 --> H2CO3 --> H+ + HCO3- if high pH, moves to right to release H+ if low pH, moves to left to absorb H+
90
protein buffer systems
albumin and globulins (major plasma proteins)
91
potassium H+ ion exchange
in metabolic acidosis H+ inc. in cells so K+ moved out treatment of ketoacidosis requires K+ replacement
92
respiratory control of CO2
2nd line of def increased production of metabolic acids or CO2 stimulates chemoreceptors respiratory centers are stimulated to increase minute respiration (breathe more CO2 out to inc. pH) rapid response... 12-24 hrs
93
acidosis means you breathe...
harder
94
alkalosis means you breathe
slower
95
renal control mechanisms
3rd line of def kidney changes excretion of acid or base to compensate for pH changes H+/bicarb exchange (requires carbonic anhydrase)
96
H+/bicarb exchange
H+ ions secreted into tubular fluid in exchange for Na bicarb reabsorbed into blood stimulated by acidosis
97
diamox
diuretic and carbonic anhydrase inhibitor moves Na into urine and H2O follows
98
tubular buffer systems
prevent urine from becoming too acidic (excretes H+ ions) phosphate buffer system ammonia buffer system.... NH4+ produced and secreted and NH3 acts as buffer
99
lab tests for acid/base abnormalities
use arterial blood pH and pCO2 measured, bicarb calculated
100
interpretation of lab acid/base tests
pH determines acidosis or alkalosis if abnormal CO2, problem is respiratory if abnormal HCO3-, problem is metabolic
101
_____ system can adjust CO2 to compensate for a _____ disorder
respiratory, metabolic
102
_____ system can adjust HCO3- to compensate for a _____ disorder
renal, respiratory
103
is mixed acidosis/alkalosis possible?
yes
104
anion gap
serum concentration of unmeasured anions (phosphate, sulfate, organic acids, protein) calculated as sodium - (chloride + bicarb) use to confirm diagnosis
105
anion gap is increased in...
lactic acidosis ketoacidosis b/c large amounts of lactate and ketone present (anions)
106
anion gap is normal from ______
diarrhea Cl retained as bicarb is lost
107
anion gap is decreased in...
hypoalbuminemia

Pathophysiology (24 decks)

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