Basic Principles Flashcards
Electrolytes of the low volume state
Inc total Na Dec serum Na (dilutional effect) Dec Cl Dec K Dec Ca (bound to albumin)
pH of low volume state
Alkolotic
(Except diarrhea, RTA Type II, and DKA)
because Aldosterone pumps H+
pH of vomiters
Alkolotic because vomiting out H+, low volume state
pH from diarrhea
Acidotic because stool has bicarb from pancreas
What happened if pulse inc >10 on standing?
Hypovolemic shock
What happened if pulse inc <5 on standing?
Autonomic dysfunction
Most common signs of the low energy state?
Tachypnea and dyspnea
Most common symptoms of the low energy state?
Weakness and SOB
Most common infections of the low energy state?
UTI and respiratory infections
Most common cause of death in the low energy state?
Heart failure
What are the symptoms of the low energy state?
Rapidly dividing cells CNS: mental retardation, dementia, dec activity CV: heart failure, pericardial effusion Muscle: weakness, SOB, vasodilation, impotence, urinary retention, constipation Skin: dry Nails: brittle Hair: dry, brittle, alopecia Bone marrow: suppressed Vascular endothelium: vasculitis Lungs: infection, dec cilia, SOB Kidney: PCT affected first GI: N/V/D Bladder: urinary retention Sperm: decreased Germ cells: predisposed to cancer Breasts: atrophic Endometrium: amenorrhea, atrophic
What organ is sacrificed first in the low energy state?
Kidney, followed by the heart, followed by the brain
What organ are we worried about/most protected in the low energy state?
Brain, followed by the heart, followed by the kidney
What feels the most effects of the low energy state?
Bone marrow - most rapidly dividing cell lines
What cancers does the low energy state predispose to?
Skin, GI, bone marrow
What cancers are most common?
Breast/prostate
Lung
Colon
What cancers have the highest mortality?
Lung
Breast/prostate
Colon
Explain all Restrictive Lung Diseases
Interstitial problem, non bacterial: dec diffusion and perfusion
Small stiff lungs (dec VC) Trouble breathing in —> FEV1/FVC > 0.8 ABG: dec pO2 —> inc RR, dec pCO2, inc pH CXR: reticulo-nodular pattern, ground glass appearance MC COD: cod pulmonale
Ex. NM diseases (breathing out is passive), drugs, autoimmune disease
Tx: pressure support on vent, inc O2, inc RR, inc inspiratory time, dec TV
Explain all Obstructive Lung Diseases
Airway problem, bacterial
Big, mucus filled lungs (inc RV, inc Reid index = inc airway thickness/airway lumen)
Trouble breathing out —> FEV1/FVC < 0.8
ABG: inc pCO2 —> inc RR, dec pH
MC COD: bronchiectasis
Ex: COPD
Tx: manipulate rate on vent, inc RR, inc expiratory time, inc O2 only if needed
Symptoms of a “more likely to depolarize” state?
Brain: psychosis, seizures, jitteriness
Skeletal muscle: muscle spasms, cramps
Smooth muscle: diarrhea
Cardiac: tachycardia, arrhythmias
Symptoms of a “less likely to depolarize “ state?
Brain: lethargy, mental status changes, depression
Skeletal muscle: weakness, SOB
Smooth muscle: constipation
Cardiac: hypotension, bradycardia
What is the humoral immune response?
B cells and neutrophils patrol the blood looking for bacteria
What is the cell-mediated immune response?
T cells and macrophages patrol the tissue looking for non bacteria
What are macrophages called in each area of the body?
Blood: monocytes Brain: microglia Lung: T1 pneumocytes Liver: Kupffer cells Spleen: RES cells Lymph: dendritic cells Kidney: mesangial cells Peyer’s patches: M cells Skin: Langerhans cells Bone: osteoclasts Connective tissue: histiocytes, giant cells, epitheloid cells
What is the CBC for every vasculitis?
Dec RBC, platelets
Inc WBC, T cells, MP, ESR
Schistocytes
Time course of the inflammatory response?
1 hr: swelling 4.5 hrs: neutrophils show up 24 hrs: neutrophils predominate 3 days: neutrophils peak 4 days: T cells and macrophages show up 7 days: T cells and macrophages peak, fibroblasts show up 30 days: fibroblasts peak 3-6 months: fibrosis complete
Necrosis
Non programmed cell death
Noisy, inflammation, nucleus destroyed first
Apoptosis
Programmed cell death
Quiet, no inflammation, nucleus guided
Pyknosis
Nucleus turns into blobs “pick blobs”
Karyohexxis
Nucleus fragments
Karyolysis
Nucleus dissolves
What state does estrogen mimic?
The neuromuscular disease state. Estrogen is a muscle relaxant.
What does high GABA levels lead to?
Bradycardia, lethargy, constipation, impotence, and memory loss
What are the 4 bad things all acids do? Ex. Alcohol
Denatures proteins, Kussmaul breathing, increases GABA
