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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
What is edema in the pericardial sac called?
pericardial effusion
26
List six treatments of edema
1) elevation 2) diuretics 3) albumin 4) massage 5) elastic support stockings 6) ROM exercises
27
Define Hypodipsia and list some things that can cause it.
Decrease in ability to sense thirst Causes: Age hypothalamus dmg/lesion
28
Define polydipsia and give some things that can cause it
Excessive thirst Causes: diabetes mellitus and insipidus polyuria
29
What is psychogenic polydipsia
it is a psychologic cause of extreme thirst with no pathological reason.
30
Describe what diabetes incipidus is.
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.
31
list 5 symptoms of diabetes insipidus
1) polyuria 2) dec fluid volume in the body 3) intense polydipsia 4) hypernatremia 5) dehydration
32
Describe treatment for diabetes insipidus
ADH therapy DIURETICS (b/c it pulls sodium and then the body tries to retain it and fluid) WTF.... check this
33
Describe what Syndrome of Inappropriate ADH is. (SIADH)
It is the failure of the negative feedback system regulating ADH results in water retention and dilutional hyponatremia
34
What are some causes or triggers of SIADH?
stress, temp changes, surgery, lung tumors
35
Describe the bodies response to high osmolality in the blood (high protein and low water content). What about when the blood has low osmolality?
THIRST: to inc water intake ADH release: inc water reabsorption from urin opposite effect for low
36
What is the normal level for sodium?
135 to 145 mEq/L
37
What are the two types of hyponatremia?
HYPERTONIC hyponatremia HYPOTONIC hyponatremia
38
Describe hypertonic hyponatremia and list some causes
Water shifts from ICF to ECF Some causes: elevated blood glucose decreased renal function diuretics
39
Describe hypotonic hyponatremia and list some causes.
It is dilutional, resulting in cellular edema. Some causes: Heart failure/water retention, excessive intake of water
40
What is more common, hypertonic or hypotonic hyponatremia?
Hypotonic hyponatremia is more common
41
Describe the 7 manifestations of hyponatremia
1) fingerprint edema 2) cramps 3) weakness 4) fatigue 5) disorientation 6) seizures 7) coma
42
List three causes of hypernatremia
1) water loss 2) sodium gain 3) not replacing water
43
Describe the manifestations for hypernatremia.
ECF Fluid Loss: thirst, fever, tachycardia Cellular Dehydration: dry skin and mucous membranes, decrease salivation/lacrimation CNS: dec reflexes, agitation, headache, seizures, coma
44
What are the normal levels for potassium?
3.5 - 5.0
45
List 3 things that potassium is necessary for.
1) maintaining intracellular osmolality 2) needed for Na/K pump 3) exchanged for H+ to buffer changes in pH
46
List 3 general causes of hypokalemia.
1) inadequate intake 2) excessive loss (diuretics) 3) movement of K from bloodstream (alkalosis, insulin elevation)
47
What is one type of medication that can cause excessive loss of potassium resulting in hypokalemia.
Diuretics
48
Describe how insulin can cause hypokalemia.
Insulin pushes K into cells resulting in hypokalemia
49
Describe the manifestations of hypokalemia
usually gradual GI: anorexia, nausea, vomiting, constipation CNS: muscle weakness, fatigue, paresthesia, paralysis CVS: ventricular arrhythmias ECG changes: digoxin toxicity
50
What is paresthesia?
decreased sensation.
51
List three general causes for Hyperkalemia
1) decreased excretion 2) increased intake 3) increased movement of K from cells into blood stream
52
What can cause hyperkalemia related to decreased excretion?
Adrenal insufficiency ACE inhibitors Chronic disease
53
What can cause hyperkalemia related to increased movement of K from cells into bloodstream?
Acidosis Tissue injury Dec insulin B-blockers
54
Describe the manifestations of hyperkalemia
CVS: bradycardia, cardiac arrest CNS: weakness, paresthesia, paralysis GI: cramps, diarrhea, N and V
55
What does parathyroid hormone do?
increases blood Ca2+ by stimulating release from bone by osteoclasts stimulates activation of Vit D by kidney to increase Ca2+ absorption
56
What vitamin deficiency can result in hypoparathyroidism?
Magnesium deficiency
57
Describe the common causes of primary hyperparathyroidism.
usually d/t tumor or hyperplasia
58
Describe the common causes of secondary hyperparathyroidism.
VIT D deficiency: which is necessary for absorption of Ca in GI RENAL failure: can't reabsorb
59
What are the three things that regulate Ca
Parathyroid hormone Calcitonin VIt D
60
Describe the manifestations of hypocalcemia
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
Describe what Trousseau's sign is.
spasms of the hand when BP cuff is inflated. Hand curls and thumb tucks in
62
Describe what Chvostek's sign is.
Tap the face just anterior to the ear see twitching of the ipsilateral facial muscles
63
list 3 common causes of hypercalcemia
Neoplasms of parathyroid glands Immobilization Poor absorption
64
Describe the effects of calcium on Skeletal muscle, nerves, and smooth muscle.
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
Describe the manifestations of hypercalcemia.
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
List 3 ways that you can have hypomagnesium.
1) insufficient intake 2) excessive losses 3) movement between ECF and ICF
67
What might cause hypermagnesia?
1) excessive intake | 2) renal insufficiency
68
What is the definition of an acid?
a molecule that dissociates to release a hydrogen ion
69
What is the definition of a base?
Ion or molecule that can accept or combine with a hydrogen ion
70
Described the 3 forms that CO2 is found in the body.
1) dissolved pase pCO2 2) as bicarbonate HCO3- 3) as carbaminohemoglobin
71
What is the normal pH of the ECF (body's pH)?
7.35 - 7.45
72
What is it called when you have an increased pH? What about lower?
INCREASED: alkalemia DECREASED: acidemia
73
What is the formula for pH?
pH = - log(H+)
74
What are the three ways that the body regulates pH in the body? Discuss their relative speed
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
Describe the Henderson-hasselbach equation.
CO2 + H20 H2CO3 HCO3- + H+
76
Explain how the kidneys and respiratory system compensates for eachother.
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
How are pH imbalances described?
first by cause, resp or metabolic. then acidosis or alkalosis there is a 5th type called combined
78
What are 3 general ways that can cause metabolic acidosis?
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
What values would you expect for pH and HCO3- for metabolic acidosis?
pH < 7.35 | HCO3- < 22 mEq/L
80
What is the normal range for HCO3-?
22-26
81
What is the normal range for PaCO2?
35-45
82
List the adverse effects of metabolic acidosis.
CNS: H/A, lethargy, stupor, kussmaul's respirations RESPIRATORY: hyperventilation CVS: hypotension GI: anorexia
83
What are the 3 ways that you can get metabolic alkalosis?
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
List the manifestations for metabolic alkalosis.
CNS: hyperactive reflexes, tetany, confusion, seizures Carphology (picking) and troussou's sign RESP: shallow, bradypnea CVS: hypotension, arrhythmia GI: N and V
85
List the three general ways that respiratory acidosis can occur.
1) Overproduction - sepsis, burns, hyperthermia 2) inhalation of CO2 3) dec exhalation of CO2
86
List 5 ways that you can have decreased expiration of CO2
1) obstruction 2) lung/chest wall damage 3) Hypoventilation, asphyxia 4) Denervation of muscles 5) Damage to muscles
87
What is something that could cause denervation of respiratory muscles leading to resp acidosis?
Brain stem infarct Opiates Peripheral nerve disease (gullaine-barre)
88
What is something that could damage the resp muscles leading to resp acidosis?
Myasthenia gravis
89
What are the 2 causes of respiratory alkalosis?
Hyperventilation - anxiety, pain, fever, anemia, altitude - medullary stimulation - mechanical ventilation - disease processes Medication
90
What type of medication overdose commonly causes resp alkalosis?
Salicylates
91
In respiratory alkalosis, how does the body attempt to compensate?
by pulling H+ out of cells to attempt to maintain pH H+ binds to HCO3- to create CO2
92
List the manifestations of resp alkalosis
CNS: dizziness, agitation, parathesia, tetany, twitching, muscle weakness RESP: deep rapid respirations CVS: increase HR
93
What test is used to assess respiratory and metabolic function
arterial blood gas analysis

Pathophysiology I (16 decks)

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