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Pathophysiology I > Chapter 8: fluid, electrolytes, and acid base balance > Flashcards

Chapter 8: fluid, electrolytes, and acid base balance Flashcards

1
Q

What ratio of the body’s fluid is ICF (intracellular fluid)

A

2/3 of the body’s water

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2
Q

What ratio of the body’s fluid is ECF (extracellular fluid)

A

1/3 of the body’s measure

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3
Q

What are the two sub categories of extracellular

fluid?

A

plasma

interstitial fluids

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4
Q

What is ICF abundant in?

A

K+
phosphate
some Mg2+

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5
Q

What is the ECF abundant in?

A

Na+, Cl-, Ca2+ and some bicarbonate

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6
Q

What type of body fluid do lab tests evaluate?

A

ECF

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7
Q

What happens when a cell is in a hypertonic solution?

A

The cell becomes crenated:

water leaves the cell and follows to the solutes in the solution

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8
Q

What happens when a cell is placed into a hypotonic solution?

A

It swells: water moves from solution into the cell towards the solutes

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9
Q

What is edema?

A

increased interstitial fluid volume

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10
Q

What are the four general causes of edema?

A

1) Increased capillary pressure
2) decreased capillary colloidal osmotic pressure
3) Increased capillary permeability
4) Obstruction to lymph flow

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11
Q

List 3 ways the capillary pressure could increase to cause edema.

A

1) inc vascular volume
2) venous obstruction
3) decreased arterial resistance (meds)

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12
Q

List 2 ways the capillary colloidal osmatic pressure could decrease to cause edema

A

1) loss of plasma proteins
ex burns, renal disease

2) decreased production of plasma proteins
ex. malnutrition, liver disease

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13
Q

What are some things that could cause increased capillary permeability?

A

inflammation, allergic reaction, and burnsf

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14
Q

What are some things that could cause an obstruction to lymph flow?

A

malignancy

lymph node removal

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15
Q

Give an example of something that can cause localized edema

A

histamine release causing hives and dilation

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16
Q

What is an example of something that can cause generalized edema?

A

CHF

Renal failure

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17
Q

What is another name for generalized edema?

A

Anasarca

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18
Q

What are the six areas of the body that can be life threatening if edema forms there?

A 
Brain
Larynx
Lungs
Pericardial sac
Pleural cavity
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19
Q

List 4 consequences of edema.

A

1) increased distances for diffusion of oxygen, nutrients and waste. Therefore, dec efficiency.
2) tissues more susceptible to injury (pressure ulcers)
3) compresses blood vessels and nerves (like a tourniquet)
4) disfigurement

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20
Q

Describe how to determine if edema is pitting or non pitting. What is a pitting +5 edema

A

push on the area with your finger for 15-30 s and remove

+5 if it remains indented 20-30 seconds

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21
Q

Describe the 3 types of spacing of edema

A

1ST SPACE: intravascular (in vessels)

2ND SPACE: extravascular (interstitial and extracellular)

3RD SPACE: areas where fluid doesn’t normally collect in large amounts. (causes them to be physiologically non-functional)

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22
Q

Give some examples of areas that would be considered 3rd spacing edema.

A

Peritoneal cavity
Pleural cavity
Pericardial sac

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23
Q

What is edema in the peritoneal cavity called?

A

ascites

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24
Q

What is edema in the pleural cavity called?

A

hydrothorax or pleural effusion

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25
Q

What is edema in the pericardial sac called?

A

pericardial effusion

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26
Q

List six treatments of edema

A

1) elevation
2) diuretics
3) albumin
4) massage
5) elastic support stockings
6) ROM exercises

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27
Q

Define Hypodipsia and list some things that can cause it.

A

Decrease in ability to sense thirst

Causes:
Age
hypothalamus dmg/lesion

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28
Q

Define polydipsia and give some things that can cause it

A

Excessive thirst

Causes:
diabetes mellitus and insipidus
polyuria

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29
Q

What is psychogenic polydipsia

A

it is a psychologic cause of extreme thirst with no pathological reason.

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30
Q

Describe what diabetes incipidus is.

A

It is an ADH disorder where their is a deficiency in ADH or response to it

1) NEUROLOGIC/CENTRAL DI:
defect in synthesis/release of ADH

2) NEPHROGENIC DI: kidneys unable to respond

result in inability to concentrate urine; 3-20 L/day output.

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31
Q

list 5 symptoms of diabetes insipidus

A

1) polyuria
2) dec fluid volume in the body
3) intense polydipsia
4) hypernatremia
5) dehydration

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32
Q

Describe treatment for diabetes insipidus

A

ADH therapy

DIURETICS (b/c it pulls sodium and then the body tries to retain it and fluid) WTF…. check this

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33
Q

Describe what Syndrome of Inappropriate ADH is. (SIADH)

A

It is the failure of the negative feedback system regulating ADH

results in water retention and dilutional hyponatremia

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34
Q

What are some causes or triggers of SIADH?

A

stress, temp changes, surgery, lung tumors

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35
Q

Describe the bodies response to high osmolality in the blood (high protein and low water content). What about when the blood has low osmolality?

A

THIRST: to inc water intake

ADH release: inc water reabsorption from urin

opposite effect for low

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36
Q

What is the normal level for sodium?

A

135 to 145 mEq/L

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37
Q

What are the two types of hyponatremia?

A

HYPERTONIC hyponatremia

HYPOTONIC hyponatremia

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38
Q

Describe hypertonic hyponatremia and list some causes

A

Water shifts from ICF to ECF

Some causes:
elevated blood glucose
decreased renal function
diuretics

39
Q

Describe hypotonic hyponatremia and list some causes.

A

It is dilutional, resulting in cellular edema.

Some causes:
Heart failure/water retention, excessive intake of water

40
Q

What is more common, hypertonic or hypotonic hyponatremia?

A

Hypotonic hyponatremia is more common

41
Q

Describe the 7 manifestations of hyponatremia

A

1) fingerprint edema
2) cramps
3) weakness
4) fatigue
5) disorientation
6) seizures
7) coma

42
Q

List three causes of hypernatremia

A

1) water loss
2) sodium gain
3) not replacing water

43
Q

Describe the manifestations for hypernatremia.

A

ECF Fluid Loss: thirst, fever, tachycardia

Cellular Dehydration: dry skin and mucous membranes, decrease salivation/lacrimation

CNS: dec reflexes, agitation, headache, seizures, coma

44
Q

What are the normal levels for potassium?

A

3.5 - 5.0

45
Q

List 3 things that potassium is necessary for.

A

1) maintaining intracellular osmolality
2) needed for Na/K pump
3) exchanged for H+ to buffer changes in pH

46
Q

List 3 general causes of hypokalemia.

A

1) inadequate intake
2) excessive loss (diuretics)
3) movement of K from bloodstream (alkalosis, insulin elevation)

47
Q

What is one type of medication that can cause excessive loss of potassium resulting in hypokalemia.

A

Diuretics

48
Q

Describe how insulin can cause hypokalemia.

A

Insulin pushes K into cells resulting in hypokalemia

49
Q

Describe the manifestations of hypokalemia

A

usually gradual

GI: anorexia, nausea, vomiting, constipation

CNS: muscle weakness, fatigue, paresthesia, paralysis

CVS: ventricular arrhythmias

ECG changes: digoxin toxicity

50
Q

What is paresthesia?

A

decreased sensation.

51
Q

List three general causes for Hyperkalemia

A

1) decreased excretion
2) increased intake
3) increased movement of K from cells into blood stream

52
Q

What can cause hyperkalemia related to decreased excretion?

A

Adrenal insufficiency

ACE inhibitors

Chronic disease

53
Q

What can cause hyperkalemia related to increased movement of K from cells into bloodstream?

A

Acidosis

Tissue injury

Dec insulin

B-blockers

54
Q

Describe the manifestations of hyperkalemia

A

CVS: bradycardia, cardiac arrest

CNS: weakness, paresthesia, paralysis

GI: cramps, diarrhea, N and V

55
Q

What does parathyroid hormone do?

A

increases blood Ca2+ by stimulating release from bone by osteoclasts

stimulates activation of Vit D by kidney to increase Ca2+ absorption

56
Q

What vitamin deficiency can result in hypoparathyroidism?

A

Magnesium deficiency

57
Q

Describe the common causes of primary hyperparathyroidism.

A

usually d/t tumor or hyperplasia

58
Q

Describe the common causes of secondary hyperparathyroidism.

A

VIT D deficiency: which is necessary for absorption of Ca in GI

RENAL failure: can’t reabsorb

59
Q

What are the three things that regulate Ca

A

Parathyroid hormone
Calcitonin
VIt D

60
Q

Describe the manifestations of hypocalcemia

A

Muscular-skeletal:
tetany, muscle cramps, bone pain, cardopedal spasm (trousseau’s sign)

CNS:
Chvostek’s sign
Parathesia
Confusion, lethargy, anxiety

CVS
prolonged QT
resistance to digitalis
hypotension

61
Q

Describe what Trousseau’s sign is.

A

spasms of the hand when BP cuff is inflated.

Hand curls and thumb tucks in

62
Q

Describe what Chvostek’s sign is.

A

Tap the face just anterior to the ear

see twitching of the ipsilateral facial muscles

63
Q

list 3 common causes of hypercalcemia

A

Neoplasms of parathyroid glands

Immobilization

Poor absorption

64
Q

Describe the effects of calcium on Skeletal muscle, nerves, and smooth muscle.

A

SKELETAL: calcium is involved in creating the resting membrane potential (it is in the ECF) therefore dec Ca results in a dec in resting membrane potential approaching threshold therefore inc excitation.

NEURONS: same as skeletal

SMOOTH MUSCLE: influx is of Ca and not Na. Therefore greater Ca results in increase excitation

65
Q

Describe the manifestations of hypercalcemia.

A

Musculoskeletal: muscle weakness, ataxia

CNS: lethargy, personality changes, stupor, coma

GI: anorexia, N and V, constipation

GU: interferes with ADH so can’t concentrate urine

66
Q

List 3 ways that you can have hypomagnesium.

A

1) insufficient intake
2) excessive losses
3) movement between ECF and ICF

67
Q

What might cause hypermagnesia?

A

1) excessive intake

2) renal insufficiency

68
Q

What is the definition of an acid?

A

a molecule that dissociates to release a hydrogen ion

69
Q

What is the definition of a base?

A

Ion or molecule that can accept or combine with a hydrogen ion

70
Q

Described the 3 forms that CO2 is found in the body.

A

1) dissolved pase pCO2
2) as bicarbonate HCO3-
3) as carbaminohemoglobin

71
Q

What is the normal pH of the ECF (body’s pH)?

A

7.35 - 7.45

72
Q

What is it called when you have an increased pH? What about lower?

A

INCREASED: alkalemia

DECREASED: acidemia

73
Q

What is the formula for pH?

A

pH = - log(H+)

74
Q

What are the three ways that the body regulates pH in the body? Discuss their relative speed

A

1) CHEMICAL BUFFER: fast but short acting
2) LUNGS: eliminates CO2, faster than kidneys
3) KIDNEYS: controls elimination of H+ ions and absorption/generation of HCO3-

75
Q

Describe the Henderson-hasselbach equation.

A

CO2 + H20 H2CO3 HCO3- + H+

76
Q

Explain how the kidneys and respiratory system compensates for eachother.

A

Resp: by doing to CO2 what was done to HCO3-

Kidney: by doing to HCO3- what was done to CO2

if one inc, the other will inc to compensate. If one dec, the other will dec to compensate

77
Q

How are pH imbalances described?

A

first by cause, resp or metabolic. then acidosis or alkalosis

there is a 5th type called combined

78
Q

What are 3 general ways that can cause metabolic acidosis?

A

1) loss of bicarbonate via kidney or GI tract (diarrhea)
2) access accumulation/production of acids (hepatic disease, ketoacidosis, drugs, rhabomyolysis (breakdown of skeletal muscle)
3) inability of kidney to excrete excess acids (renal disease)

79
Q

What values would you expect for pH and HCO3- for metabolic acidosis?

A

pH < 7.35

HCO3- < 22 mEq/L

80
Q

What is the normal range for HCO3-?

A

22-26

81
Q

What is the normal range for PaCO2?

A

35-45

82
Q

List the adverse effects of metabolic acidosis.

A

CNS: H/A, lethargy, stupor, kussmaul’s respirations

RESPIRATORY: hyperventilation

CVS: hypotension

GI: anorexia

83
Q

What are the 3 ways that you can get metabolic alkalosis?

A

1) excess H+ ion loss
- vomiting or suctioning

2) Excess HCO3- gain
- ingestion of base, IV HCO3-

3) Loss of K+ related to renal excretion
- hyperaldosteronism, diuretics

84
Q

List the manifestations for metabolic alkalosis.

A

CNS: hyperactive reflexes, tetany, confusion, seizures
Carphology (picking) and troussou’s sign

RESP: shallow, bradypnea

CVS: hypotension, arrhythmia

GI: N and V

85
Q

List the three general ways that respiratory acidosis can occur.

A

1) Overproduction
- sepsis, burns, hyperthermia

2) inhalation of CO2
3) dec exhalation of CO2

86
Q

List 5 ways that you can have decreased expiration of CO2

A

1) obstruction
2) lung/chest wall damage
3) Hypoventilation, asphyxia
4) Denervation of muscles
5) Damage to muscles

87
Q

What is something that could cause denervation of respiratory muscles leading to resp acidosis?

A

Brain stem infarct
Opiates
Peripheral nerve disease (gullaine-barre)

88
Q

What is something that could damage the resp muscles leading to resp acidosis?

A

Myasthenia gravis

89
Q

What are the 2 causes of respiratory alkalosis?

A

Hyperventilation

  • anxiety, pain, fever, anemia, altitude
  • medullary stimulation
  • mechanical ventilation
  • disease processes

Medication

90
Q

What type of medication overdose commonly causes resp alkalosis?

A

Salicylates

91
Q

In respiratory alkalosis, how does the body attempt to compensate?

A

by pulling H+ out of cells to attempt to maintain pH

H+ binds to HCO3- to create CO2

92
Q

List the manifestations of resp alkalosis

A

CNS: dizziness, agitation, parathesia, tetany, twitching, muscle weakness

RESP: deep rapid respirations

CVS: increase HR

93
Q

What test is used to assess respiratory and metabolic function

A

arterial blood gas analysis

Pathophysiology I (16 decks)

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