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Pathophysiology > Chapter 3: Acid Base, Lytes > Flashcards

Chapter 3: Acid Base, Lytes Flashcards

1
Q

TBW definition :

A

The sum of fluids in all body compartments

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2
Q

H20 distribution : ICF&ECF

A

Icf 2/3
Ecf 1/3

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3
Q

What are the two main ECF compartments ?

A

Interstitial
Intravascular
(Others include lymph/trans cellular like saliva, sweat, CSF)

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4
Q

Movement of h2o managed by:

A

OSMOTIC FORCES

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5
Q

Osmotic force factors

A

Diffusion (lipid bilayer)
Aquaporins

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6
Q

Lyte responsible for ECF osmotic balance:

A

SODIUM

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7
Q

Lyte responsible for ICF osmotic balance

A

POTASSIUM

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8
Q

What is hydrostatic pressure ?

A

The force created by standing water against a fluid membrane

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9
Q

What is osmotic pressure ?

A

Related to the protein concentration on either side of a membrane pulling water towards the highest concentration

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10
Q

What four forces determine fluid movement ?

A
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11
Q

What determines osmotic balance ?

A

Blood pressure
Blood volume

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12
Q

Four alterations in water movement

A
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13
Q

Sodium is what percent of ECF CATIONS?

A

90%

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14
Q

Sodium balance maintained by:

A

1) renal tubule reabsorption
2) aldosterone (renal cortex)

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15
Q

Chloride is the major what of ECF?

A

ANION
electroneutrality

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16
Q

Potassium is the major ____ _____?

A

INTRAcellular CATION

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17
Q

90% of K+ is absorbed where ?

A

GI TRACT

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18
Q

What regulates gradient movement of k+ from ECF to ICF?

A

Sodium potassium pump
concentration determines resting membrane potential

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19
Q

Normal osmolality:

A

280-294

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20
Q

What regulates water balance ?

A
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21
Q

Isotonic alteration examples

A

TBW loss = proportional electrolyte loss
Ex: hemorrhage
Wound drainage
Sweating
ALL = HYPOVOLEMIA

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22
Q

Isotonic hypervolemia examples

A

Increased IVF
KIDNEY failure
Aldosterone hypersecretion
Cortisone

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23
Q

Hypertonic alteration examples

A

HyperNa+
Ecf free water deficit

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24
Q

What organ regulates K+?

A

Kidneys .

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25
What renal cell reabsorbs K+?
Proximal tubule - 90% and loop of Henle Principal cells SECRETE Intercalated cells REABSORB
26
Causes of HYPOK+
Decreased intake Increased losses Cellular shifts
27
How does resp. Alkalosis cause ECF hypokalemia?
Hydrogen moves out of cell —- potassium moves in, causing ECF hypokalemia.
28
Hypokalemia symptoms below 2.5:
😴Decreased NM excitability 🫁 respiratory arrest ♥️ dysrhythmias Smooth muscle atony Skeletal muscle weakness
29
Cardiac ♥️ sx: of hypokalemia
Bradycardia AVB PAT DELAYED repolarization : flat T/ST depression/U-wave Severe: Peaked P waves, prolonged QRS
30
Hyperkalemia causes
Increased uptake ICF to ECF shift Decreased renal excretion
31
Cellular shift causes :
INSULIN deficiency, cell hypoxia , acidosis , crush injuries , burns
32
Hyperkalemia sx
Muscle weakness Paralysis NM irritability (paresthesia, diarrhea, cramps, tingling of lips)
33
❤️ symptoms of Hyperkalemia:
Depressed ST PROLONGED PR WIDE QRS VFIB PEAKED T’s 🫡calcium gluc helps correct - hypocalcemia worsens sx
34
Calcium major ___ for bone and teeth
Cation
35
Ca+ functions #1:
Enzymatic clotting factor Cell receptor function Hormone secretion
36
Calcium functions #2:
Nerve impulse transmission Plasma membrane stability Mitochondrial IC cation
37
Phosphate mostly stored :
85% in bones
38
Phosphate functions
Phospholipids ATP ANION buffer
39
Calcium /phosphate regulated by:
PTH Calcitonin Vitamin D
40
Hypocalcemia common causes :
Blood 🩸 transfusion (ca citrate binds to ca+) Pancreatitis Alkalosis
41
Sx of hypocalcemia
NM excitability (carpopedal spasm, sz, hyperreflexia ) Cramps, hypo BS Chvostek sign Trousseau sign Prolonged QT TETANY (SEVERE hypo)
42
What is Chvostek sign
Twitch of nose or lip when tapping facial nerve by ear
43
What is trousseau sign ?
Contracted hand w/ cuff inflation
44
Treatment for hypocalcemia
Calcium gluconate
45
What causes hypercalcemia?
Hyperparathyroidism Cancer Excess Vit D Sarcoidosis
46
Sx of hypocalcemia
Decreased NM excitability Fatigue, weakness, lethargy , anorexia, nausea, constipation, confusion
47
Heart ❤️ sx of hypercalcemia
Short QT DEPRESSED WIDE T WAVE ♥️ block Bradycardia
48
Hypophosphatemia causes
Vitamin D deficiency Malabsorption in gut Mag/alum antacids Hyperparathyroid
49
Symptoms of hypophosphatemia
🩸 related to reduced o2 RBC XPORT and decreased ATP
50
Symptoms of hypophosphatemia
Hypoxia Bradycardia ♥️block Platelet dysfunction Nerve/muscle derangement
51
Hyperphosphatemia causes:
CKD chemo (cell destruction) Phosphate enemas Low calcium usually follows
52
Hyperphosphatemia sx
Mostly related to hypocalcemia Calcification of lung 🫁 kidney and joints can occur
53
Magnesium is second to ___ as major __ cation
Potassium INTRAcellular
54
Where is mag stored and what %
40-60% 🦴 30% cells 1% serum
55
Hypomag causes
ETOH Renal tubule dysfunction Loop /HCTZ diuretics PPIs
56
How does hypomag cause hypok
🛑 mag inhibits K channels Potassium moves out of cell 😭K+ excreted by kidney
57
Symptoms of hypomagnesemia
Depression Confusion ⬆️ reflexes Nystagmus 👁 Convulsions Tetany Ataxia Tachydysthymia
58
Hypermagnesemia causes
Usually renal failure related
59
Hypermagnesemia sx
💪🏻Depressed skeletal muscle function CNS depression N/V bradycardia Hypotension Muscle weakness
60
Three types of hyponatramia
Hypovolemic Euvolemic Hypervolemic
61
Hypovolemic hyperNA+ causes
More water 💦 lost than NA+ - loop diuretics -Osmotic diuresis (such as DM) -GI loss -kidneys don’t concentrate urine
62
Euvolemic hyperNA+ causes
*Most common* sweating, hyperventilating, burns, DI, diarrhea
63
Hypervolemic hyperNA+ causes
Rare!! Increased sodium and water intake (Cushings, ⬆️ACTH, salt water drowning)
64
Symptoms of hyperNA related to:
RELATED TO IC dehydration !! Cells shrink , ⬇️action potential of membranes
65
Symptoms of hyperNA
Weakness Lethargy Hyperreflexia Twitching Confusion Coma Seizures
66
What solution is given for hyperNA
Salt free D5W
67
What is the most common electrolyte disorder in hospital pts
Hyponatremia
68
Sx of hypoNA
IC overhydration Cerebral edema Pulmonary edema N/V, lethargy , confusion **ECF volume depletion = Hypovolemic sx**
69
What determines Ph
Hydrogen ion concentration
70
Two body acid forms
Volatile (carbonic acid ➡️CO2➡️lung) Nonvolatile (metabolic acids ➡️kidneys /liver )
71
What is a buffer?
Can absorb H+ acid or bases Exists in ECF and ICF
72
What are the 3 buffer systems
Bicarbonate/carbonic acid buffer Protein buffering Renal /respiratory buffering
73
Where does the carbonic acid bicarbonate buffer operate
🫁 and kidney ⬆️ CO2 = ⬆️ carbonic acid production
74
How do the lungs 🫁 get rid of carbonic acid
Lungs exhale CO2 And leave H2O (Carbonic acid is H2CO3) Kidneys can reuse h2o or make more bicarbonate !
75
Protein buffering facts: charge is __
Proteins IC and EC have negative charges
76
Why is hemoglobin a good IC blood buffer?
Can bind with H+ and CO2 and becomes a weak acid when binding w hydrogen
77
What part of the kidney regulates acid base balance ?
The distal tubule (Secretes hydrogen in urine and regenerates bicarbonate )
78
Why is ammonia a good renal buffer?
Does not carry a charge (not ionized) Crosses lipid membrane into renal tubule and joins with hydrogen to excrete in urine
79
What is metabolic acidosis
Decreased 20:1 ratio of bicarb/carbonic acid -buildup of non carbonic acids -Bicarb loss or kidneys don’t make
80
What happens w hydrogen and K+ in metabolic acidosis ?
H+ moves in to IC space K+ moves out
81
What does anion gap measure ?
Negative ions not taken in lab values (sulfate, lactate, keto acid, albumin etc )
82
How do you calculate gap?
NA+ and K+ MINUS bicarb and chloride
83
Metabolic acidosis sx
Neuro : lethargy, coma, confusion Kussmaul RR vomiting, diarrhea, abd pain Ventricular dysrhythmia
84
What causes metabolic acidosis
Anion gap acidosis : Lactic acidosis (Sepsis, shock) Ingestion Decreased H+ excretion Ketoacidosis Normal gap: Bicarb loss
85
Metabolic alkalosis causes
⬆️ bicarb concentration Loss of metabolic acids such as NGT suction, vomiting 🤮 or diuretics
86
Metabolic alkalosis sx:
Similar to hypocalcemia or Hypovolemia 🫁Slow shallow RR ❤️ atrial tachycardia
87
RESPIRATORY acid base disorders are caused by …
⬆️ or ⬇️ of alveolar ventilation in relation to METABOLIC production of C02
88
Respiratory acidosis causes:
Alveolar hypoventilation: 🧠 brain stem trauma Oversedation Flail chest COPD, PNA Resp muscle paralysis
89
Symptoms of respiratory acidosis
Headache Restless 😬 Blurred vision Progress to lethargy , sz, coma
90
What causes neuro sx in respiratory acidosis
⬇️pH of CSF ➡️➡️ vasodilation
91
Respiratory alkalosis causes
Alveolar hyperventilation Hypermetabolic states ASA Intoxication
92
Respiratory alkalosis sx
Related to irritated CNS/PNS dizzy, confused , parasthesia , (convulsions and coma advanced)

Pathophysiology (6 decks)

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