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Pathophysiology > PH, Electrolyte, and Fluid Balance > Flashcards

PH, Electrolyte, and Fluid Balance Flashcards

1
Q

distribution of fluids in the body

A
  • total body water - all fluids are 60% of body weight (your weight x .6 = lbs of water)
  • intracellular fluid ICF - 2/3 total body weight (inside cells)
  • extracellular fluid ECF - 1/3 total body weight
  • interstitial fluid: between cells
  • intravascular fluid: blood plasma in vessels
  • lymph, synovial, intestinal, CSF, sweat, urine, pleural, perioteoneal, pericardial and intraocular fluids
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2
Q

body’s PH

A
  • 7.35-7.45
  • basic
  • PH = power of hydrogen. PH measures hydrogen in body
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3
Q

Sodium/Chloride Balance

A

SODIUM (Na+)

  • primary extracellular fluid (ECF) cation
  • regulates osmotic foces
  • role = fluid movement - neuromuscular irritability, acid-base balance, cellular reactions, membrane transport
  • WATER always move with Na+*

CHLORIDE (Cl-)

  • primary ECF anion
  • provides electroneutrality
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4
Q

anion

A

negatively charged ion

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5
Q

cation

A

positively charged ion

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6
Q

tonicity

A

change in concentration of solutes (salt) with relation to solvent (water)

  • isotonic: ECF = 0.9% NaCl
  • hypertonic - ECF >0.9% NaCl. cells SHRINK. more solutes outside of cell than in. H2O moves out of cell with Na+
  • Hypotonic - ECF <0.9% NaCL. cells SWELL. more solute into cell. can cause cells to lyse.
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7
Q

Sodium Na+

A
  • regulation of fluid balance - VERY important electrolyte
  • most abundant positive ion (cation)
  • 90% ECF cations
  • Hypernatremia: more na+ outside of cell ECF
  • Hyponatremia: less na+ outside the cell ECF
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8
Q

Hypernatremia

A
  • dehydration - pulls water out of cell
  • more Na+ than water
  • intracellular dehydration, hypertension (hypervolemic = higher volume of blood)
  • H20 movement from ICF to ECF (interstitial)
  • Causes: diabetes, diarrhea
  • manifestations: increased cellular functioning - convulsions, thirst, fever, muscle twitching, hyperreflexia
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9
Q

hyponatremia

A
  • less Na+ and more H20
  • decreased BP, decreased cell fun
  • Casues: vomiting, diarrhea, GI scution, burns, diuretics
  • manifestations: decreased functioning - lethargy, confusion, depressed reflexes, seizures, coma, hypotension, tachycardia, decreased urine output
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10
Q

chloride Cl-

A
  • primary ECF anion
  • electroneutrality with Na+
  • Hypochloremia: result of hyponatremia or increased HC03
  • vomiting = loss of hydrochloric acid = loss of Cl- in blood
  • cystic fibrosis: imbalance of Na+ and Cl- transport across epithelium
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11
Q

potassium K+

A
  • major intracellular electrolyte 98% intracellular, Na/k ATPase Pump
  • affects resting membrane potential
  • transmission and conduction of nerve impulses, normal cardiac rhythm, skeletal and smooth muscle contractions, “action potentials”
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12
Q

K+ and PH

A
  • change in PH greatly affects k+ balance
  • acidosis causes: increase in H+ inside cell -> k+ moves out of the cell
  • more H+ outside cell –> H+moves into cell –> k+ is pulled out
  • acidosis = hyperkalemia
  • Alkolosis causes: decrease in H+ inside cell –> k+ into cell
  • increased PH in tissue and blood pushes K+ into cell
  • alkalosis = hypokalemia
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13
Q

hypokalemia

A
  • harder to start and action potential with low K+
  • lower resting membrane potential = less excitable cell
  • low K+ outside of cell
  • Causes: low intake of k+, increased loss of K+, increased K+ flow into cell
  • manifestations: heart cells are less excitable, weakness, atrophy, cardiac dysrhythmias,
  • decresed K+ causes decreased rest membrane potential causes decreased heart function
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14
Q

hyperkalemia

A
  • increased k+ outside cell = increased excitability
  • increased resting membrane potential
  • causes: increased shift from ICF (acidosis), decreased renal excretion
    manifestations:
  • mild heart attacks = increased neuromuscular irritability/activity. tingling of lips & fingers, restlessness, intestinal cramps/diarrhea
  • severe attacks = no repolarization = muscle weakness, decreased tone, flaccid paralysis, cardiac dysrhythmias, PVCs
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15
Q

big picture of electrolytes

A
  • low K+ = decreased excitability. Bradycardia, asystole
  • high K+ = increased excitability. cardiac dysrhythmias, PVC
  • low Ca+ = increased muscle excitability, decreased threshold, cramps, twitches
  • High Ca+ = decreased muscle excitability, increased threshold, less excitable
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16
Q

calcium Ca+

A
  • needed for bone, teeth, blood clotting, muscle contractions, neurotransmitter release, hormone secretion, cell receptor function 99% in bone
  • affects THRESHOLD potential
  • Hypocalcemia = decreased block of Na into cell
  • increased neuromuscular excitability
  • decreased threshold means more excitable
  • increased muscle function
  • Hypercalcemia = increased block of Na into cell = decreased neurotransmitter excitability
  • increased threshold potential = less excitable
  • muscle weakness, cardiac arrest, kidney stones, constipation
  • decreased muscle function
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17
Q

fluid balance

A

sodium, calcium, and water regulation

  • primarily regulated by kidneys and hormones
  • water
  • hypothalamus –> posterior pituitary –> ADH (antidiuretic hormone - tells kidneys to reabsorb more water out of urine)
  • Na/Cl
  • adrenal gland –> aldosterone
  • atrial muscle –> naturetic hormones (ANH)
  • aldosterone = reabsorbs na+ in kidney (H20 goes with it), causes decreased urine, increased BP
  • naturetic hormone = increases urine, decreases BP. antagonistic to Aldosterone. puts more na+ and H20 into urine
18
Q

ADH Functions

A

Antidiuretic Hormone
decreased circulating fluid volume –> increased thirst & ADH secretion –> increased fluid intake and decreased water excretion –> increased renal water retention –> increased circulating fluid –> decreased plasma osmolality –> decreased ADH and decreased thirst

19
Q

RAAS Pathway

A
  • release of renin causes release of aldosterone
  • renin-angiotensin-aldosterone system
  • a hormone system that regulates blood pressure and water (fluid) balance
  • sodium balance in kidneys
20
Q

naturetic hormone

A

ANH
increase in total body na+ –> increased drinking, osmotic shift of water out of cells –> increased plasma volume –> increased atrial stretching detected by atrial endocrine cells –> ANH releases –> GFR (filtration rate) increases, decrease renin angiotensin-aldosterone, decreased na+ absorption

21
Q

balance of fluids

A

metabolism: glucose (eat) + O2 (breath) = CO2 + H2) + ATP

INTAKE: metabolism (400, produces fluid for us), food (500), drinking (1500)

OUTPUT: faeces (100), skin (400, sweat), breathing (400, water releases), urine (1500)

22
Q

fluid “tug of war”

A

HYDROSTATIC PRESSURE: pushing force

  • move from high to low
  • fluid pressure = BP

ONCOTIC/OSMOTIC: pulling force

  • driven by proteins or electrolytes
  • electrolytes pull water into cell
  • plasma proteins are negatively charged
23
Q

fluid movement between ICF and ECF

A
  • water, nutrients, and waste products
    between capillaries and interstitial space
  • CHP + IFOP - work together
  • COP + IFHP - work together
  • CHD + IFOP > COP + IFHP = blood from caps into IF
  • CHD + IFOP < COP + IFHP = blood from IF into caps
  1. Capillary Hydrostatic Pressure
    - strongest
    - PUSH from capillaries into interstitial fluid
    - blood pressure = fluid out
  2. Capillary Oncotic Pressure
    - PULL from intersistial fluid into capillaries
    - water attract to plasma proteins (albumin) = fluid in
  3. Interstitial hydrostatic pressure
    - PUSH from IF fluid into caps = fluid in
  4. interstitial oncotic pressure
    - weakest
    - PULL into IF fluid
    - water attraction to interstitial proteins = fluid out
  • obligatory load: 10% of fluid in tissues cannot be reabsorbed into blood. COP isn’t as strong as CHP. IF Fluid drained by lymphoma
24
Q

Edema

A

excessive accumulation of fluids in interstitial space

4 major causes:

  1. increased capillary hydrostatic pressure
    - increased BP = increased edema
    - venous obstruction (DVT, hepatic obstruction), salt and water retention (heart, renal failure, hypertension)
  2. decreased plasma oncotic pressure
    - decreased albumin (water soluble protein) - liver disease, malnutrition, kidney disease, burns, hemorrhage
    - decreased albumin = increased edema
  3. increased capillary permeability
    - trauma, burns, neoplastic (tumorous), and allergic reactions
    - increased inflammation = increased edema
  4. lymph obstruction
    - removal of nodes (surgery), inflammation or tumors
    - 10% of fluid builds up in IF = edema
25
Q

PH

A 
power of hydrogen 0-14
0 = acidi
14 = basic
7 = neutral
7.4 = bio neutral 7.35-7.45 (basic)
each numberic goes up by 10X the PH 
range of life 6.8-7.8
acidic = hyperkalemia
basic = hypokalemia
26
Q

acids

A

formed as end products of protein, carb and fat metabolism

  • major regulatory organs; bone, LUNG, KIDNEYS< blood
  • hydrochloric acid, carbonic acid
  • BIcarbonate (HCO3) carries CO2 and blood buffer
27
Q

body acids

A

two forms:
VOLATILE: H2CO3 - gaseous and airborn, CO2, lungs
NONVOLATILE: eliminated by kidneys, sulfuric, phosphoric

28
Q

2 most important regulatory systems for fluid, electrolyte and PH balance?

A

LUNGS: C02 blows off acid, regulates acidity

KIDNEYS: biarbonate HC03 and H+ ions.

  • low blood PH = academy
  • general acidity = acidosis
  • high Blood PH = alkalemia
  • general high PH = alkalosis
29
Q

metabolic acidosis

A

kidneys retain H+ and rids too much bicarb

- low body PH

30
Q

metabolic alkalosis

A

retain more bicarb and rid H+

- high body PH

31
Q

respiratory acidosis

A

hypoventilation

- not expelling enough CO2 (acid)

32
Q

respiratory alkalosis

A
  • blowing off too much CO2 (acid)

- hypervntilation

33
Q

buffer

A
  • any substance that doesn’t allow a drastic change in PH. a chemical that binds excess H+ or OH- without any significant change in PH
  1. 1st line = chemical buffer = BLOOD
    - immediate
    - bicarbonate buffer system
    - phosphate buffer system
    - protein buffer system
  2. 2nd line = LUNGS - physiological buffer
    - minutes
    - respiratory response system
  3. 3rd line = KIDNEYS = physiologic
    - hours
    - H+ and Bicarb
    - renal response system
    * compensation
  • PROTEINS also work as a buffer and PHOSPHATE
  • best blood buffer is a mix of C02 and Bicarb
34
Q

acidosis

A
  • too much CO2 or too little HCO3
  • lower PH
    1. CO2 increases with hypoventilation (pneumonia, emphysema)
    2. Metabolic conditions = ketoacidosis due to access fat metabolism (diabetes mellitus) which will lower bicarb
  • too much CO2 = issue with lungs
  • too little HCO3 - issue with kidneys
35
Q

alkalosis

A
  • too much HCO3 or too little CO2
  • higher PH
    1. Co2 decrease via hyperventilation (respiration blows off co2)
    2. Emesis (vomiting) removes stomach acid and raises bicarb
  • too little CO2
  • too much HCO3
36
Q

compensation

A
  1. if kidneys aren’t working - respiratory compenstates by increasing or decreasing CO2
  2. if lungs aren’t working - kidneys compensate by increasing or decreasing acidity/alkalinity of urine
37
Q

metabolic acidosis

A
  • kidneys retain too much H+ or secrete too much bicarb
  • hyperkalemia
  • increased respirations - hyperventilations
  • acidic fruity breath
  • causes: severe diarrhea, renal failure, shock
38
Q

metabolic alkalosis

A
  • decreased acid or increased base
  • decreased respirations, hypoventilation
  • hypokalemia
  • causes: vomiting, diruretics
39
Q

respiratory acidosis

A
  • retention of CO2 by lungs
  • hypoventilation, hypoxia
    rapid, shallow respirations
  • hyperkalemia
  • causes: pneumonia, COPD, atelectasis
40
Q

respiratory alkalosis

A
  • increased loss of CO2 from lungs
  • increased respirations, hyperventilation
  • hypokalemia
  • causes: hypoventilation (anxiety, fear), mechanical ventilation
41
Q

normal values

A 
PH = 7.35-7.45
pCO2 = 35-45
HCO3 = 22-26

Pathophysiology (13 decks)

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