Acid Base/fluid Flashcards
Carbonic acid
Aerobic metabolism CO2 + carbonic anhydrase
Lactic acid
Anaerobic metabolism
Sulfuric acid
Sulphur containing amino acids (methionine, cysteine, noneocystine, tourine)
Phosphoric acid
Phospho proteins, ribonucleic acids
Ketone bodies
Acetoacetic acid, beta hydroxybutyric acid
Synthesized form of acetylcoa by product of mitochondrial beta oxidation of fatty acids
Intravascular fluid
ECF, 8 % of total body water, blood plasma
BP and vascular resistance
Interstitial fluid
ECF, 25% of total body water , fluid between cells, lymph, GI, spinal, eye, synovial fluids, between plasma and interstitial 4 starting forces
Intercellular fluid
ICF, 67% of total body water, inside cell, water moves freely across plasma membrane through aquaporins, ions through channel or transporter
Respiratory acidosis
Decreased pH, increased CO2, decreased bicarbonate
S/s-HA, restlessness, muscle twitching, sz, lethargy, change in mental status
Cause by hypercapnia due to COPD, decreased respirations due to OD, Brain injury, paralysis trauma
Respiratory alkalosis
Increased pH, decreased CO2, increased bicarbonate
Due to hypocapnia, high altitudes, increased vent rate, fever, anemia, salicylate OD, anxiety
S/s-dizzy, confusion, sz, tachypnea, confusion
ROME
Respiratory opposite
Metabolic equal
Blood ph
7.35-7.45
Acidic-alkaline
3 mechanisms to maintain acid base balance
1 physiologic (chemical) buffer system in plasma first line
2 respiratory acid base control is quick to response in seconds to minutes
3 renal acid base control responds slow hours to days
ABG
PH 7.35-7.45
CO2 35-45
O2 80-100
HCO3 21-28
CO2 highly acidic, lungs
Bicarbonate HCO3 highly alkaline, kidneys
CO2 + H20< -> H2CO3<->H and HCO3
Metabolic acidosis with high anion gap
Serum K plus Na - serum Cl + HCO3
Normal is 6-12 gap
Greater than 12 is acidosis
Caused by MUDPILES
Methanol, uremia, DKA, paraldehyde/phenformin/propofol toxicity, Iron, lactic acidosis, ethylene glycol, salicylates
Less than 12 non ion gap could be due to renal loss, GI loss, volume overload, high sodium, renal function issues
Metabolic acidosis
PH decreased
HCO3 decreased
CO2 decreased
Due to lactic acidosis, renal disease, ingestion of acid precursors, starvation, DKA, GI loss
S/s- decreased MI contractility, decreased CO, hypotension, high potassium, high respiratory rate, HA, lethargy, change in mental status
Metabolic alkalosis
Elevated pH
Elevated HCO3
Elevated CO2
Caused by hyper aldosteronism, enema, diuretic use, tums OD, enemies
S/s- potassium low, weakness, cramps, decreased Ca, hypoventilation, hyperactive reflexes, sz
Total body water
Sum of fluids within all compartments usually as a %
Reasons someone’s TBW might not be 60%
Age (infants have more 70-80) decreases as we age
Women have about 50%
OB
Obesity 40-50
Osmolality
Number of solute particles per 1 kg if solvent
TBW likes to be In equilibrium
Hydrostatic pressure
Pressure excreted by a fluid at equilibrium at any point of time due to force of gravity, ICF, BP
Oncotic pressure
Also called colloid osmotic pressure, a type of osmotic pressure induced by plasma proteins like albumin
Osmotic pressure
The pressure that must be applied to a solution to halt the flow of solvent molecules through a semi permeable membrane (osmosis) interstitial fluid
Mechanism to move fluids solvents
Osmosis- process by which molecules of a solvent tend to pass through a semi permeable membrane form a less concentrated solution into a more concentrated one thus equalizing the confection of each side of the membrane
Diffusion movement of a solute molecule from an area of greater solute concentration to an area of lesser solute concentration, free movement
Active transport- movements of ions or molecules across a cell membrane into a region of higher concentration assisted by transporters and requires energy
Edema
Excessive accumulation of fluid within interstitial spaces
Capillary lymphatic vessels to tissue
Increases capillary hydrostatic pressure in edema
Either venous obstruction or sodium water retention, venous obstruction ->increased hydrostatic pressure->pushes fluid into interstitial space
Causes include thrombophlebitis, blood clot, hepatic venous obstruction, CHF, tight clothing, prolonged standing
Decreased capillary oncotic pressure in edema
Loss of plasma proteins like albumin like in liver diseases, malnutrition
Increased capillary membrane permeability in edema
Inflammation and immune response
Lymph channel obstruction in edema
Lymphatic channels are blocked due to tumor or infection or lymphedema
Sodium potassium transport
Sodium is extra cellular
K is intercellular
Sodium maintains homeostasis through osmosis
K maintains homeostasis through active transport
Isotonic fluid
Relating to a solution having the same osmotic pressure as one in a cell or body fluid
5% dextrose in water, 0.9 NaCl
Hypotonic
Having a lower osmotic pressure than a particular fluid typically a body fluid or intracellular fluid
H2O, water consistently being pulled to cell cause edema or bursting
“Hippo”
Hypertonic
Having a higher osmotic pressure than a particular fluid, typically a body fluid or intracellular fluid
3% saline
Plasma
Components-bicarbonate and carbonic acid and hgb
Roles- HCO3 is first line, albumin is negatively charged binds to Ca (high calcium results from acidosis albumin binds to H ions, decreased calcium more albumin to bind with calcium, Alkalosis)
Hgb carries H2CO3 which dissociates and hgb buffer H ions in lungs CO2 is expelled (released from hgb)
Intracellular
Competents-proteins, phosphate
Roles- inorganic phosphates
Hydrogen phosphate and dihydrogen phosphate and organic phosphates, AMP, glucose/phosphate, and 2,3 DPG
Lungs
Component- CO2
Roles- lungs compensate when the chemical buffer fails to achieve homeostasis, minute ventilation is increased (blow off CO2) if fails kidneys take over
Kidneys
Components-HCO3, ammonia, phosphates
Role- secrete H ions for removal in urine, reabsorption of filtered HCO3 ions, production of more HCO3 ions
