Unit 1 Flashcards
1
Q
Cellular Adaptation
A
Cells change to:
- Adapt to a new environment
- Escape
- Protect Themselves
2
Q
What is Atrophy?
A
Atrophy is a decrease in cell size
- may even result in the complete loss of cells
- it is a sign of pathophysiology rather than a sucessful adaptation
- is not a normal adaptation, is always a sign of a problem
3
Q
What are the causes of atrophy?
A
It is usually caused by disease or ischemia (an inadequate blood supply to an organ or part of the body)
- reduced blood supply, reduced oxygen and glucose to tissues, cellular shrinkage and death
May also result from:
- diminished nerve stimulation
- poor nutrition
- other diseases (Alzheimer’s disease in brain)
4
Q
Hypertrophy
A
- An increase in the mass of the cell, but not in the number of cells
- An increase in the number of muscle proteins (not fluid) to allow muscle fibers to do more work
- Common tissues: cardiac muscles, skeletal muscles, and kidneys
5
Q
Hyperplasia
A
- An increase in the number of cells of a tissue or organ from an increased rate of cell division
- The cells involved must have mitotic ability
In any given organ, it’s possible for both hyperplasia and hypertrophy to occur
- Uterine muscle enlargement during pregnancy (hypertrophy)
- Hyperplasia of the uterine endometrium during pregnancy (and also during every menstrual cycle
6
Q
Metaplasia
A
An adaptive substitution to a different, “hardier” cell line
- usually changes to a hypertrophied or hyperplastic tissue
Example: Replacement of ciliated columnar epithelium with stratified squamous epithelium in the respiratory tract of a smoker
7
Q
Dysplasia
A
A change to an abnormal cell line
- Dysplastic cells are not normal and not found anywhere in the body
- This is a precancerous change
Examples include:
- Cervical dysplasia from human papilloma virus (HPV)
- Bronchial dysplasia from smoking
8
Q
What are dysplasia cells characterized by?
A
Atypical changes in the size, shape and appearance, an of the cells (atypical hyperplasia)
9
Q
What is Dysplasia caused by?
A
Caused by persistent injury or irritation progressing towards neoplasia (new, abnormal proliferation of cells)
10
Q
Cellular Injury
A
Cells become injured in many ways
- membrane permeability changes
- interruption of oxidative metabolism (ATP production)
- Diminished protein synthesis
- Leakage of digestive enzymes
11
Q
Hypoxia
A
Tissue hypoxia is when cells are deprived of oxygen
- hyp[o]- = low
- -oxia = oxygen
It is probably the most common cause of non-adaptive cellular injury
12
Q
What is Hypoxia caused by?
A
Can be caused by:
- Low levels of oxygen in the air
- Poor or absent hemoglobin function (hyp[o]- + -ox- + -emia = low oxygen blood
- Respiratory or cardiovascular diseases
- Ischemia: reduced supply of blood, which carries oxygen
13
Q
How does Hypoxia affect the creation of ATP?
A
Because of the reduction of oxidative metabolism, ATP levels decline
- this causes decreased Na+/K+ pump activity
- Na+ begins to accumulate in cells
- Water follows Na+ and also accumulates in cells, which causes the cell to swell
- Ca++ starts to come inside the cells (gap junctions shut off, other cell notices this one has a problem)
- Intracellular K+ decreases approaching levels outside cell which results in: decreased protein synthesis, decreased membrane transport (symport and antiport), and increased lipids (lipogenesis)
14
Q
What does Hypoxia do to the cell once ATP systems decrease in function?
A
- There is a change in membrane permeability (Ca++ rushes in). This impairs mitochondrial function.
- Cells accumulate excess water, lipids, and proteins
- Decreased protein synthesis (as ribosomes are separated from the ER by increased fluid levels)
- Glycolysis increases (anaerobic metabolism) because of low O2.
- Lactic acid accumulates and causes low cellular pH (acidosis)
- Lysosomes swell and dump, chromatin clumps, proteins denature
15
Q
Free Radicals
A
- A free radical is an atom or molecules that has an unpaired electron. This radical makes the atom very unstable and active
- To gain stability, the radical gives up or steals an electron
- Superoxide ion (O2-)
- Hydroxyl (OH+)
- Peroxinitrite ion (ONOO-)
16
Q
Free Radical Formation
A
Formation of Free Radicals
- Normal metabolism, ionizing radiation, drug metabolism
Mechanisms of Injury
- Lipid peroxidation: Destruction of unsaturated fatty acids (the ones with kinks in them) by free radicals
- Protein destruction: fragmentation of polypeptide change and denaturation
- DNA Alteration: Breakage of DNA strands
17
Q
Free Radical Inactiviation
A
Antioxidants
- Block synthesis or inactive free radicals
- Vitamin E, Vitamin C, albumin, cerulopasmin (carries copper), and transferrin (carries iron)
Enzymes
- Superoxide dismutase (SOD): This is usually inactivated by the enzyme superoxide dismutase (SOD). SOD converts superoxide to HO
- Catalase: SOD makes H2O2.
- Glutathione peroxidase (GPx)
18
Q
Lead Poisoning
A
Acts like iron, calcium,and zinc
- Interferes with neurotransmitters in the CNS (may cause wrist, finger, and foot paralysis in the peripheral nervous system.
- Interferes with hemoglobin synthesis
- Accounts for a significant number of childhood poisonings (sources include paint, dust and soil, contaminated tap water, dyes, pottery glazes, gasoline
19
Q
Toxic Chemical Agents
A
Cellular injury by chemical agents can be caused by direct contact of the chemical, with molecular components of the cell, formation of free radicals, or lipid peroxidation
- For example, carbon monoxide (CO), has a very high affinity for Hgb (would rather have the CO, rather than the O2)
- It is colorless and odorless
- CO causes nausea and vomiting, headache, weakness, and tinnitus (ringing in the ears)
20
Q
Ethanol
A
A form of alcohol found in mood-altering beverages
- In the liver, ethanol is converted to acetaldehyde which is toxic to the liver (free radical damage)
- This toxicity leads to a deposition of fat, hepatomegaly, interruption of protein transport, decreased fatty acid oxidation, increased membrane rigidity, and liver cell necrosis
21
Q
Trauma
A
- Blunt force injuries are mechanical injuries resulting in tearing, shearing, or crushing of tissues
- The most common blunt injuries are caused by falls and auto accidents
- Contusion: Bleeding into the skin or underlying tissue
- Hematoma: A collection of blood in an enclosed space (subdural and epidural hematomas in the skull)
22
Q
What are 5 types of trauma wounds?
A
- Abrasion: Removal of superficial layers of the skin
- Laceration: A rip or tear in the skin or tissue
- Incised Wound: A cut that is longer than it is deep
- Stab Wound: A cut that is deeper than it is long
- Gunshot Wound (GSW):Can be penetrating (bullet remains in the body), or perforating (bullet exits the body)
23
Q
Asphyxia as a means to Hypoxia
A
Asphyxia is lack of oxygen to the lungs. Asphyxial injuries can occur because of a failure of airflow (oxygen) to the lungs
- Suffocation
- Strangulation
- Chemical
- Drowning
24
Q
Nutritional Imbalances
A
For adequate cellular function and integrity, adequate amounts of proteins, lipids & carbohydrates are required.
- Low levels of plasma proteins, like albumin, encourages movement of water into the tissues, thereby causing edema
- Hyperglycemia and hypoglycemia
- Vitamin deficiencies
25
Name 5 Physical Agents
1. Extreme Temperatures
2. Atmospheric Pressure
3. Water Pressure
4. Ionizing Radiation
5. Noise
26
Extreme Temperatures
Hypothermia
- Vasoconstriction
- Ice crystal formation causing cellular swelling
Hyperthermia
- Loss of fluids and plasma proteins
27
Atmospheric Pressure
Blast Injuries
- Compressed waves of air
- Thorax collapses; organs hemorrhage and rupture
28
Water Pressure
- Causes nitrogen to dissolve in blood
| - When pressure removed, nitrogen released and forms gas emboli
29
Ionizing Radiation
When we form ions we strip electrons
- Electron removal from active cells
- DNA is the most vulnerable target (during mitosis)
30
Noise
Acute sound noise or cumulative effect
31
What are 8 Cellular Accumulations?
1. Water
2. Lipids
3. Carbohydrates
4. Glycogen
5. Protein
6. Pigments
7. Calcium
8. Urate
32
What are 5 Types of Necrosis?
Necrosis is local cell death and is irreversible. It involves the process of self/auto digestion and lysis
1. Coagulative
2. Liquefactive
3. Caseoous
4. Fat necrosis
5. Gangrenous
33
Coagulative Necrosis
- Common is kidneys, heart, and adrenal glands
- Coagulation is caused by protein denaturation (these cells have large amounts of proteolytic enzymes (proteases))
- Albumin is changed from a gelatinous, transparent state to a firm, opaque state.
- It is suspected that high levels of intracellular calcium play a role in coagulative necrosis
34
Liquefactive Necrosis
Occurs in neurons and glial cells of the CNS
- Brain cells have a large amount of digestive enzymes (hydrolases). These enzymes cause the neural tissue to become soft and liquefy
Liquefactive necrosis can also occur with certain infections (pus)
- Hydrolytic enzymes are released from neutrophils to fight an invading pathogen
35
Caseous Necrosis
Combination of coagulative and liquefactive necrosis
- Results from pulmonary infection with Mycobaterium tuberculosis (TB)
- The tissue is destroyed, but it is not completely digested
- The remaining tissue resembles clumped cheese
36
Fat Necrosis
Occurs in the breast, pancreas, and abdominal tissues
- Caused by lipases, which are found in very high levels in "lipo" (fat) tissues
- Lipases break down triglycerides, releasing free fatty acids
- The fatty acids combine with calcium, magnesium, and sodium to form soaps.
37
Gangrenous Necrosis
Refers to the wide-spread death of tissue or tissues due to hypoxia
- Wet (liquefactive)
- Dry (coagulative)
- Gas Gangrene: Infection caused by many species of Clostridium bacteria (anaerobic). The enzymes and toxins released by these bacteria cause bubble of gas to form and spread very quickly
38
Cellular Death
Apoptosis
- Cell death involved in normal & pathologic conditions
- Apoptosis depends on cellular signals
- These signals cause protein cleavage (proteases) within the cell, causing cell death
39
How is Apoptosis different from Necrosis?
It is an active process (we recycle parts of cells in apoptosis to be re-used)
- Apoptosis: the cell is a "suicide victim" (a normal death)
- Necrosis: the cell is a "homicide victim"
It affects scattered, individual cells
- Apoptosis: gene activation in "chosen" cells
- Necrosis: death is widespread
It results in cell shrinkage, not lysis and swelling
- Apoptosis: cells shrink
- Necrosis: cells swell and lyse
40
Aging and Cellular Death
Theories:
- Aging is caused by accumulations of injurious events (environment)
- Aging is the result of a genetically-controlled developmental program
Mechanisms:
- Genetic, environmental, and bahavioral
- Changes in regulatory mechanisms
- Degenerative alterations
41
Somatic Death
Is the death of an entire organism
- Cessation or respiration and circulation
1. Algor Mortis
2. Livor Mortis
3. Rigor Mortis
4. Potmortem Autolysis
42
Algor Mortis
Skin becomes pale and the body temperature falls
43
Livor Mortis
Purplish discoloration in peripheral tissues
44
Rigor Mortis
- Depletion of ATP keeps contractile proteins from detaching causing muscle stiffening
- Within 12-14 hours, rigor mortis gradually diminishes
45
Postmortem Autolysis
Breaks down muscle and other tissues
46
The Cross-Bridge Cycle - Rigor Mortis
What happens if ATP is absent?
- Myosin remains permanently bound to actin, muscles cannot move
- Muscles are stuck between step 5 and step 1
- Rigor mortis results
- Eventually, enzymes and microbes destroy muscle structure and corpse becomes loose again.
47
What is the distribution of body fluids in males and females?
Female:
- 45 % solids
- 55% fluids
Male
- 40% solids
- 60 % fluids
Intracelluar vs. Extracellular
- 2/3 Intracellular Fluid (ICF)
- 1/3 Extracellular Fluid (ECF)
- The fluid content is not equal, but the concentration is equal
48
What are 3 types of Osmotic Forces?
1. Isosmotic
2. Hyperosmotic
3. Hyposmostic
49
Isosmotic
Concentrations (not volumes) of two fluids separated by a membrane are equal
50
Hyperosmotic
The concentration of the ECF is higher than the ICF. The net movement of water is from the ICF to the ECF
- The ECT has a high (hyper) concentration
- We can only measure the ECT concentration
- Cells undergo crenation (crenated cell - shriveled)
51
Hyposmotic
The concentration of the ICF is higher than the ECF. The net movement of water is from the ECF to the ICF.
- The ECT has a low (hypo) concentration
- We can only measure the ECT concentration
- Cells undergo hemolysis (enlarged cell)
52
How much water to we gain and lose everyday?
We gain about 2500 mL (2.5 liters) everyday, and we lose about 2500 mL (2.5 liters) everyday. They must be equal.
53
Capillaries
Capillaries join arterioles (smallest arteries) and venules (smallest veins)
- This is the only place where the exchange of "stuff" takes place
- Capillaries occur as capillary beds of interconnected vessels
- Capillaries small enough that RBCs must fold to pass through
- Precapillary sphincters are smooth muscle cuffs that regulate flow of blood through the capillary bed
54
Capillary Exchange
Capillaries are specialized for exchange of materials (they are a single layer thick, have a semipermeable membrane that works kind of like a filter)
- Oxygen, glucose, and other nutrients must be delivered to cells (filtration)
- Carbon dioxide, acid, urea, and other wastes must be carried away to be excreted (reabsorption)
55
Starling's Law of the Capillary - Hydrostatic Pressure
The pressure from the "pump" that pushes blood around (like water pressure in pipes)
Hydrostatic Pressure = Blood Pressure
56
Starling's Law of the Capillary - Osmotic Pressure
The concentration force of water trying to dilute out a higher concentration of solutes in blood (net osmotic pressure)
- This forces water from the tissues (lower solute concentration) toward the bloodstream (higher solute concentration)
57
Dehydration
Occurs when reabsorption exceeds filtration
- Water loss exceeds gains
- Decreases blood pressure
- Increases blood osmolarity
58
Edema
Occurs when filtration exceeds reabsorption
59
Starling's Law of the Capillary - Permeability
This is how many holes are in the capillaries, and how large those holes are.
- Disease conditions can increase the size and number of holes in the capilliaries (e.g. inflammation, burns, allergies)
60
What are the 3 factors of Starling's Law of the Capillary
1. Hydrostatic Pressure
2. Osmotic (oncotic) Pressure
3. Permeability
- The balance between these forces is called the Starling Forces and the equation which relates them is called Starling's Law of the Capillary
- Interstitial fluid osmotic pressure about the same throughout the capillary, but hydrostatic pressure drops
- This means the capillary delivers nutrients on the arteriole side, and picks up wastes on the venule side.
61
Pathology: Hypertension - Starling's Law of the Capillary
High blood pressure
| - The blood hydrostatic pressure is increased, favoring filtration, and inadequate reabsorption, which leads to edema
62
Pathology: Decreased Plasma Protein - Starling's Law of the Capillary
The blood would be less concentrated with decreased plasma proteins.
- The blood osmotic pressure is decreased, favoring filtration, and inadequate reabsorption, which leads to severe edema.
63
Pathology: Increased Vascular Permeability
In the case of inflammation and burns, we need increased permeability so that the substances we need that are in the blood (white blood cells, platelets, and proteins) can move into the tissue to help the problem.
64
Regulation of Daily Water Gain
The thirst center is located in the hypothalamus. It detects increases in the blood osmolarity (concentration)
- Dehydration
- Other receptors for dehydration include the kidneys, baroreceptors in the arteries, and neurons in the mouth that detect dryness
65
Hypovolemic
Not enough volume of blood. If water losses exceed gains, that decrease blood volume, so there is less liquid in the same about of space. Blood osmolarity increases and this decreases blood pressure
66
Water Movement
Changes in osmolarity (concentration). Kidneys can excrete water at a rate of 15 ml/min
Excessive Water Consumption
- A decrease in plasma and interstitial osmolarity causes water to move into the intracellular environment, resulting in cellular swelling
- Water Intoxication
67
What is an Electrolyte
A substance that dissociates into ions in aqueous solutions and conductions
Common electrolytes are:
- Cations: Na+,K+, Ca++, Mg++
- Anions: Cl-, HCO3-, PO4-3
Functions: Volume and osmotic regulation, myocardial function, enzyme cofactors, and acid-base balance
68
Molarity
Molarity = moles (mol) per liter
A 1 molar (1M) solution = 1 mole of a solute in 1 liter of solution
69
Equivalent Weight
- 1 mole is Avogrado's number (6.023 x 10^23) of something (molecules, atoms, ions
- The term "equivalent" is only used for ionic compounds: acids, bases, and salts (Equivalent = # of charges)
- In water, these compounds ionize into cations and anions
- An equivalent weight of something is the amount of that compound that will liberate one mole of charge as cations or anions.
70
Equivalent and Millequivalents
In the body, there are very small amounts (by weight) of ions, so they are listed on mOsm/L or mEq/L
- Simply move the decimal like you do for liters and milliliters
Examples:
- Na+ = 0.14 M = 0.14 moles/L = 140 mmoles/L = 136 - 146 mEq/L
- K+ = 3.4 - 5.0 mEq/L
71
Sodium
The plasma concentration of sodium is kept within a very narrow range (136 - 146 mEq/L)
The body's sodium concentration is maintained primarily by the kidney
1 - glomerular filtration
2 - renin-antiotensin-aldosterone system
Aided by hormones produced by the heart, brain, and kidney that also influence sodium reabsorption/excretion
3 - natriuretic peptides
72
As Goes Sodium
- Sodium accounts for 90% of the ECF cations
- Sodium together with chloride (Cl-) and the bicarbonate ion regulates osmotic forces and therefore regulates water balance
- In ECF: As sodium goes, so goes water
- Sodium also works with potassium to maintain (neuromuscular "irritability" for conduction of nerve impulses and muscle contraction
73
What are 2 abnormal levels of Sodium?
1. Hypernatremia
| 2. Hyponatremia
74
Hypernatremia
Sodium (>146 mEq/L)
- Cellular shrinking
- Hypertension
- Thirst
- Oliguria and Anuria
75
Potassium
- Potassium has a major influence on ICF osmolality and maintenance of electroneutrality in relation to Na+ and H+
- Potassium is required for maintaining the resting membrane potential, transmission and conduction of nerve impulses, maintaining normal cardiac rhythms, and muscle contraction
- The kidney plays the largest role in maintaining potassium levels
- Normal plasma potassium: 3.4 - 5.0 mEq/L
76
What are the 2 types of abnormal levels of potassium?
1. Hyperkalemia
| 2. Hypokalemia
77
Hyperkalemia
Potassium (>5.5 mEq/L)
- Altered conductivity in the heart
- Cell membrane is depolarized (more positive than normal). Mild attacks (muscular irritability). Severe (muscle weakness)
- Can be caused by blood transfusions
- Associated with metabolic acidosis (K+ for H+)
- Lethal injections (big dose of potassium)
78
How does Hypokalemia affect the ECG?
Hypokalemia causes a reversal of the cardia action potential (completely upsidedown)
79
How does Hyperkalemia affect the ECG?
Hyperkalemia (depolarization) slows, and even stops, the heart
80
Calcium
Calcium (8.6 -10.5 mg/dl) is necessary in many metabolic processes
- Main cation in bones and teeth
- Cofactor in the clotting pathways
- KEY: Calcium blocks sodium channels
The concentration of calcium and phosphate are inversely related; if one increases, the other decreases
- The renal system maintains these levels
81
Phosphate
Phosphate (2.5 - 4.5 mg/dl) is found throughout the body
- Bone (calcium phosphate = hydroxyapatite)
- Phospholipids
- Creatine phosphate (brain and muscle energy source)
- ATP (energy currency)
The concentration of calcium and phosphate are inversely related; if one increases, the other decreases
- The renal system maintains these levels
82
What 3 hormones are involved in the hormonal control of blood?
1. Calcitonin
2. Parathyroid Hormone (PTH)
3. Calcitriol (active vitamin D)
83
What does Calcitonin do in the hormonal blood control process?
Calcitonin: comes from the thyroid gland
- Inhibits osteoclasts
- stimulates osteoblasts
- decreases blood (Ca+)
- increases bone formation
84
What does the Parathyroid Hormone (PTH) do in the hormonal blood control process?
The Parathyroid Hormone:
- stimulates osteoclasts
- inhibits osteoblasts
- increases blood (Ca++)
- decreases bone formation
85
What does Calcitriol do in the hormonal blood control process?
Calcitriol (Active Vitamin D)
- Not directly involved with bone
- However, PTH stimulates kidneys to release calcitriol, which increases absorption of Ca++ from foods
- Vitamin D is also important in intestinal absorption of Ca++
86
What happens in the absence of Vitamin D?
In the absence of vitamin D, blood Ca++ levels drop and bones become soft and flexible (bones are mostly collagen because the mineral portion is lacking.
- In children, rickets result
87
What are 2 abnormal levels of Calcium?
1. Hypercalcemia
- Hypophosphatemia
2. Hypocalcemia
- Hyperphosphatemia
88
Hypercalcemia
Hypercalcemia (> 12.0 mg/dl) (Hypophosphatemia)
- Decreased neuromuscular excitability (hyperpolarization)
- Increased bone fractures
- Kidney stones
89
How does abnormal calcium (Hyper or Hypocalcemia) affect the ECG?
Abnormal calcium has an effect on the ECG, but it is much more subtle than the effects of abnormal potassium
90
Magnesium
- An intracellular cation
- Plasma concentration 1.8 - 2.4 mEq/L
- Acts as a cofactor in cellular reactions (important for protein &nucleic acid synthesis
- Required for ATPase activity
- KEY: decreased acetylcholine release at the neuromuscular junction (NMJ)
- Example: given in pre-eclampsia
91
What are the 2 abnormal levels of Magnesium?
1. Hypermagnesemia
| 2. Hypomagnesemia
92
Hypermagnesemia
Hypermagnesemia (> 2.5 mEq/L)
- Skeletal muscle depression
- Bradycardia
- Muscle weakness
93
pH Levels
pH is measuring the Hydrogen Ion Concentration
| - pH 7.0 is alkaline/basic (more OH- than H+)
94
What does a buffer do in the body?
A buffer acts as an H+ and/or OH- "sponge" so that pH is kept relatively constant
The most important buffer system in human biology is the carbonic acid-bicarbonate buffer system
95
What are the 2 organ systems that regulate the acid/base balance?
1. Lungs (respiratory): retain or excrete CO2
- first part of carbonic-acid-bicarbonate buffer system
2. Kidneys (metabolic): retain or excrete HCO3-
- second part of carbonic-acid-bicarbonate buffer system
96
Maintaining Acidosis and Alkalosis
The respiratory system and renal system must work together to maintain an appropriate pH for the body
- The respiratory system affects pH by changing the PCO2 level (PCO2 is the same as carbonic acid H2CO3)
- The kidneys affect pH by retaining or dumping HCO3-
97
What are the 4 categories of Acid/Base Imbalance?
Respiratory:
- Acidosis: elevation of PCO2
- Alkalosis: depression of PCO2
Metabolic:
- Acidosis: depression of HCO3-
- Alkalosis: elevation of HCO3-
98
Respiratory Acidosis
- Hypoventilation
- Asthma, Emphysema
- Pneumonia
- Coma
- Snickers stuck in throat
The kidneys will compensate (over a period of hours) by conserving HCO3- and excreting H+ ions
99
Respiratory Alkalosis
- Hyperventilation
- Drugs
- Excitement
- Anxiety
The kidneys will compensate (over a period of hours) by retaining H+ and excreting HCO3- ions
100
Metabolic Acidosis
- Renal failure
- Shock
- Ketoacidosis
- Lactic acidosis
- salicylate overdose
The lungs will immediately begin to compensate by "wasting" CO2 (hyperventilation)
101
Metabolic Alkalosis
- Ingestion of bicarbonate
- Vomiting (losing gastric juice high in H+ ions)
- Chloride depletion
- Diuretic therapy
The lungs will immediately begin to compensate by holding on to CO2 (hypoventilation)
102
Normal pH Level
7.35 - 7.45
103
Normal PO2 Level
68 - 72 mmHg
104
Normal PCO2 Level
35 - 45 mmHg
105
Normal HCO3- Level
22 - 36 mEq/L
106
In general, in determining whether something is more acidic or more basic....?
- Anything above 7.40 is alkalotic
| - Anything below 7.40 is acidotic
107
How to determine if the compensation is full or partial
Fully Compensated:
- pH within normal 7.35 - 7.45 range
- Never goes beyond 7.40
Partially Compensated:
- pH is not back into the normal range
108
Hypocalcemia
Calcium (> 4.5 mg/dl) (hyperphosphatemia)
- increased neuromuscular excitability (partial depolarization)
- muscle cramps
109
Hypomagneseima
Magnesium (
110
Hyponatremia
Sodium (
111
Hypokalemia
Potassium (
