Quiz 3 Flashcards
(184 cards)
1
Q
What are buffers?
A
acid-base pairs that can resist changes in pH either weak acids or weak bases
2
Q
What do weak bases accept?
A
H+ ions
3
Q
What do weak acids donate?
A
H+ ions
4
Q
When there are too many H+ ions what happens?
A
buffers will absorb them, increasing pH
5
Q
When there are low H+ ions what happens?
A
buffers will donate some to reduce the pH
6
Q
What is the main ECF buffer?
A
carbonic acid (H2CO3)
7
Q
What is the main ICF buffer?
A
sodium carbonate and proteins
(2NAHCO2), hemoglobin, albumin
8
Q
What are the two buffers in the kidney?
A
hydrogen phosphate and ammonia
9
Q
What is the main independent urinary buffer?
A
hydrogen phosphate
10
Q
Useful for estimating the pH of a buffer solution and finding the equilibrium pH in acid-base reactions?
A
Henderson Hasselbalch equation
11
Q
What does pH depend on?
A
the ratio of weak base to the weak acid
12
Q
If there’s more weak acid, pH is ???
A
low (<7.35)
13
Q
If there’s more weak base, pH is ???
A
high (>7.45)
14
Q
What alters the pH?
A
ratio of base to the acid
15
Q
Base is ??? related to pH?
A
directly
16
Q
Acid is ??? related to pH?
A
inversely
17
Q
If a acid increases, pH goes ???
A
down (acidiotic)
18
Q
If a acid decreases, pH goes ???
A
up (alkalotic)
19
Q
What is the pk?
A
6.1 (dissociation constant)
20
Q
Acidemia?
A
blood < 7.35
21
Q
Alkalemia?
A
blood > 7.45
22
Q
What can only have one state?
A
blood (emia)
23
Q
What can occur at the same time?
A
acidosis and alkalosis
24
Q
In venous BMP what serves as the bicarb?
A
CO2
25
What is a bicarb?
a weak base
26
where is bicarb mainly produced?
kidney
27
How long does it take the kidneys to modify HCO3?
hrs to days
28
If alkalemia occurs the kidneys will ???? HCO3 to decrease pH?
dump
29
You cannot have ?? and ?? at the same time
respiratory acidosis and respiratory alkalosis
30
Anion gap is only checked in what?
metabolic acidosis
31
ROME?
Respiratory- Opposite
| Metabolic- Equal
32
In metabolic acidosis how does the body compensate?
by breathing faster (pCO2 decreases)
33
What is anion gap?
the difference between the measured cations and measured anions
34
What is the normal range for anion gap?
6-12
35
equation for albumin anion gap?
AG= Albumin x 3
36
In metabolic alkalosis how does the body compensate?
by breathing slower (pCO2 should be high)
37
How does the lungs adjust pH levels?
by altering the PaCO2
38
The lungs produce a ?? response
immediate response
39
How does the kidneys adjust pH levels?
by altering the HCO3 or other buffers
40
The kidneys produce a ?? response
delayed response
41
What is the formula used for metabolic acidosis compensation?
winter's formula
42
If actual pCO2 is less than calculated pCO2 = ?
respiratory alkalosis
43
If actual pCO2 is greater than calculated pCO2 = ?
respiratory acidosis
44
What is winter's formula?
pCO2= (1.5 x HCO3-) + 8 (-/+2)
45
What causes respiratory acidosis?
primary decrease in respiration
46
What 3 things can cause respiratory acidosis?
lung injury, neurological or muscular disease
47
What is the txt for respiratory acidosis?
mechanic ventilation
| Doxapram HCL- stimulate ventalation
48
What is the patho of respiratory acidosis?
Acute rise in CO2 causes fall in oxygen levels, dyspnea, AMS and eventually coma
49
Chronic respiratory acidosis can cause what?
bone loss and papilledema
50
What things can cause respiratory alkalosis?
```
fever
brain disease
MI
mechanical ventilation
anxiety
pregnancy
sepsis
liver disease
```
51
What is the patho of respiratory alkalosis?
breathing too fast, blowing off CO2
Serum CO2 is low
Serum pH is high
Decreased cerebral blood flow
52
What is the most common presentation of respiratory alkalosis?
neuromuscular irritability, paresthesia, and CHEST PAIN
53
Wha is the txt for respiratory alkalosis?
txt underlying cause
| exhalation of excess CO2
54
What is the txt for panic attacks?
relaxation, rebreathing
55
What condition is panic attacks seen in ?
respiratory alkalosis
56
What condition is hyperchloremic metabolic acidosis seen in?
metabolic acidosis
57
What is seen in non-anion gap or normal anion gap?
decrease in bicarb w/ increase in chloride
58
What happens to bicarb in metabolic acidosis?
it DUMPED! loss by gut or renal loss
59
What diseases is hyperchloremic seen in?
```
ARF
CKD
High salt intake
Respiratory alkalosis
txt of DKA
```
60
What are s/s of metabolic acidosis?
```
fatigue
muscle weakness
excessive thirst
dry mucous membranes
high bp
```
61
What symptoms is seen in metabolic acidosis with DKA?
Kussmaul's respiration
62
"A CAT'S MUDPILE"
Anion gap acidosis
63
"FUSED CARD TIP"
Normal gap acidosis
64
What is seen in chronic metabolic acidosis?
osteoporosis and fractures
65
Txt for metabolic acidosis?
correct primary problem
IV bicarbonate (caution)
txt hyperkalemia
consult nephrology (dialysis)
66
A pH < ?? is an emergency in metabolic acidosis?
7.1
67
Txt for DKA?
fluids, insulin, judicious replacement of bicarb
68
Txt for salicylate overdose?
judicious bicarb txt
69
Txt for alcoholic MA?
thiamine w/ glucose to prevent Wernicke encep.
70
Txt for methanol intoxication?
fomepizole w/wo dialysis
71
Txt for RTA non gap MA?
large amounts of alkali replacements w/ salts, thiazides, potassium
72
What is metabolic alkalosis?
too much HCO3 (Tums) due to decrease in H+ concentration or increase in bicarb
73
What are the two classifications of metabolic alkalosis?
chloride responsive
74
What is chloride responsive?
acid loss w/ chloride depletion
75
What is chloride resistant?
excessive aldosterone- no chloride depletion
76
Black licorice- glycyrrhizinic acid?
metabolic alkalosis
77
What does black licorice do?
upgrades renal mineralocorticoid receptors
| Hypokalemic metabolic alkalosis and HTN
78
What are the s/s of metabolic alkalosis?
muscle cramps, weakness, dysrhythmias, diminished breath sounds but adequate oxygenation
79
What is the txt for metabolic alkalosis- chloride responsive?
chloride and volume replacement
txt renal problems
hypokalemia
80
What is the txt for non-chloride responsive?
spironolactone or amiloride
| oxygen ventilation w/ inspired CO2 and O2
81
A pH of ?? is severe alkalosis?
7.60
82
What is the txt of primary aldosteronism?
CAN ONLY BE TXT w/ potassium replacement
83
What is the txt of primary hyperaldosteronism?
surgical removal of mineralocorticoid producing tumor
| ACEI or spironolactone
84
High anion gap?
metabolic acidosis
85
Hyperglycemia?
DKA w/ ketones w/ metabolic acidosis
86
Hypokalmeia/ hypochloremia?
metabolic alkalosis
87
Hyperchloremia alone?
normal anion gap acidosis
88
What are two things you can do in metabolic acidosis?
winter's formula and anion gap
89
Normal Cl- indicates?
Hyperchloremic metabolic acidosis
90
Extreme metabolic acidosis is ?
a EMERGENCY! (lethargy, stupor, coma, seizures)
91
What is hyperkalemia associated with?
metabolic acidosis
92
Most abundant compartment?
Intracellular (ICF)
93
What compartment shouldn't have fluid?
3rd spacing
94
Third spacing compartments?
```
Lymph
Pleural
Peritoneal
Pericardium
CSF
GU
GI
```
95
Net movement of molecules (STUFF) from a high concentration to a low concentration
Diffusion
96
Movement of a substance down a concentration gradient
Diffusion
97
Spontaneous movement of fluid through a selective semi-permeable membrane from a low concentration to a high concentration to equalize both sides
Osmosis
98
Membrane not permeable to solutes
Osmosis
99
Minimum amount of pressure, needed to stop osmosis across a membrane
Osmotic pressure
100
Keep fluid from leaking out of blood vessels
hydrostatic pressure
101
Pulls water into the blood vessels
oncotic pressure (proteins)
102
Most important protein for exerting oncotic pressure in blood vessels
Albumin
103
What opposes hydrostatic pressure?
oncotic pressure
104
What is osmolarity based on?
temperature and pressure
105
What is serum osmolality?
measure of the number of dissolved particles per unit of water in serum
106
A low serum osmolality means ?
increase of water <285
107
A high serum osmolality means?
decrease of water > 295
108
Measure of dissolved particles per unit of water in the urine
urine osmolality
109
Response of cells immersed in an external solution
tonicity
110
What is the difference between osmolality versus tonicity?
BUN
111
What is the calculation for Osmolality?
2NA + Glucose/18 + BUN/2.8 = 285
112
What is tonicity calculation?
2NA + glucose/18 without BUN/2.8
113
Excess fluid in the interstitial tissue is in what space?
2nd space
114
normal distribution of fluid in both ECF and ICF compartments is in what space?
1st space
115
Normal range for sodium
135-145
116
The most abundant ECF electrolyte?
Sodium
117
Normal range for potassium?
3.5-5.0
118
The most abudant ICF electrolyte?
Potassium
119
Chloride is a ICF or ECF electrolyte?
ECF
120
Normal range for chloride?
95-105
121
Normal range for Ca2+?
8.5-10.5
122
Causes extracellular excitation?
Sodium
123
Causes intracellular excitation?
Potassium
124
What is the first thing that is tested in hyponatremia?
serum osmolarity
125
What are the 3 types of hyponatremia?
Isotonic, Hypotonic, Hypertonic
126
Most common electrolyte abnormality is hospitalized pts?
Hyponatremia
127
Osmolality for isotonic?
285-295
128
Osmolality for hypertonic?
>295
129
Osmolality for hypotonic?
<285
130
What is the most common hyponatremia?
Hypotonic (90%)
131
Pseudohyponatremia?
Isotonic Hyponatremia
132
What is the txt for isotonic hyponatremia?
no txt
| txt high protein and cholesterol
133
Seen with DKA and mannitol txt?
hypertonic hyponatremia
134
Txt for hypertonic hyponatremia?
get rid of extra components
135
For txt of hypotonic hyponatremia what is needed?
patient's volume status
136
What is released in hypovolemic hypotonic?
ADH/ vasopressin
137
Severe vomiting, diarrhea, dehydration
hypovolemic hypotonic hyponatremia
138
SIADH
Euvolemic hypotonic hyponatremia
139
What are the 3 most severe consequences of hyponatremia?
seizures, coma and death
140
What is the txt for euvolemic hyponatremia?
free water restriction alone
141
What is the txt for hypervolemic hyponatremia?
loop diuretics, dialysis if severe
142
What is the txt for hypovolemic hyponatremia?
normal saline 0.9% or lactated ringers (judiciously)
143
Neuro problem found in hypovolemic txt?
Central pontine myelinolysis (CMP)
144
Txt for cerebral wasting syndrome?
hypertonic saline (3%)
145
Txt for severe hyponatremia?
vaptans
146
What are 3 types of hypernatremia?
Hypovolemic, Euvolemic, Hypervolemic
147
In hypernatremia why isn't serum osmolaity needed?
bc sodium determines tonicity so all are hyperosmolality > 285
148
What is the least likely thing to cause hypernatremia?
excessive oral intake of sodium
149
What cause hypernatremia to happen?
lose water and salt, then start losing more water than salt
150
What is the txt for hypernatremia?
correct fluid loss
| replace free water and electrolytes
151
Cerebral edema
hypernatremia
152
Txt for euvolemia hypernatremia?
oral replacement or D5W
153
Txt for hypovolemic hypernatremia?
normal saline
154
Hypervolemic hypernatremia txt?
D5W and loop diuretic
155
What is the most common cause of K+ loss in developing countries?
GI loss from infectious diarrhea
156
Which electrolyte if low can cause potassium not to be reuptaked?
magnesium
157
What does a EKG for hypokalemia look?
BROADEN T waves, depressed ST segments, Prominent U waves, PVCs
158
What is the txt for hypokalemia?
```
Oral potassium (20-40m/d)
IV potassium for severe loss <3.0
```
159
Txt for refractory hypokalemia?
magnesium
160
What is the most common cause of hyperkalemia?
impaired renal execretion of K+
161
What is hyperkalemia?
> 5.5
162
Fist clenching and Trousseau sign?
Hyperkalemia
163
Peaked T WAVES, prolonged PR interval?
hyperkalemia
164
Txt for chronic K+?
Partiromer (FDA approved)
165
What does sodium polystyrene txt cause?
colonic necrosis
166
What is the emergent txt for hyperkalemia?
IV calcium, insulin, bicarb, beta agonists
167
What percentage of america is dehydrated?
75%
168
What is the minimum water intake?
1600 ml/day
169
How much water is lost in urine?
500ml
170
Where is more water lost?
urine and skin
171
Where is most water intaked?
Food
172
What is sensible loss?
fluid loss that can be measured
173
What is insensible loss?
fluid loss that cannot be measured
174
Who is at the highest risk for dehydration?
infants and elderly
175
How is dehydration diagnosed?
concentrated urine
176
What is the txt for dehydration?
prevention- stay hydrated
oral fluid replacement w/ pure water
IV hydration w/ crystalloids- severe
177
What is hypovolemia?
state of decreased plasma (blood volume)
178
What is the most common fluid imbalance seen?
hypovolemia
179
What is given first in the txt of hypovolemia?
oxygen
180
What is hypervolemia?
fluid overload
181
What is the most common result of fluid overload?
CHF
182
What is the txt for hypervolemia?
furosemide
183
What are the most commonly used crystalloids?
NS and LR
184
A mixture of insoluble particles suspended throughout another substance?
Colloids
