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Pathophysiology > Exam 1: Ch 8 > Flashcards

Exam 1: Ch 8 Flashcards

1
Q

extracellular fluid

A

interstitial fluid and plasma

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2
Q

mEq

A

milliequivalents

mEq/L = # of millimoles of charges/L = (mg/L x valence) / AW

mMol/L = # of millimoles of particles/L = (mg/L) / AW = (mEq/l) / valence

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3
Q

is osmosis water moves to the side…

A

with more solute particles

measures as mOsm/L or osmolatity

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4
Q

extent of osmotic pressure measured by…

A

mOsmoles = mMol of non-diffusable particles

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5
Q

tonicity

A

effect of osmotic pressure on a cell

hypotonic solutions have > osmolarity than the cell (swell)

hypertonic solutions have < osmolarity than the cell (shrink)

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6
Q

distribution of body fluids

A

total body water: 60% of weight

intracellular fluid is 2/3, extracellular 1/3

interstitial fluid is 2/3 of extracellular (rest is plasma, and transcellular fluid)

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7
Q

transcellular fluid

A

CSF

peritoneal

pleural

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8
Q

capillary filtration pressure (hydrostatic pressure)

A

BP in a capillary

higher at arterial end than venous end

outward force - pushes blood into interstitium

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9
Q

interstitial fluid pressure

A

low but normally negative

outward force

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10
Q

interstitial colloid osmotic pressure

A

low

outward force

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11
Q

capillary colloid osmotic pressure

A

mostly from proteins (albumin made in liver) in plasma

electrolytes pass freely, no net pressure

inward force - pulls blood back into veins

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12
Q

exchange in capillaries

A

at arterial end out > in, net filtration

at venous end in > out, net reabsorption

fluid or protein not reabsorbed, returns to circulation in lymph

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13
Q

edema

A

swelling caused by excess interstitial fluid

increased capillary filtration (hydrostatic) pressure

more fluid leaves capillary space

usually from increased venous pressure (HF) or increased pressure at arterial end of capillary

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14
Q

decreased capillary colloid osmostic pressure

A

causes edema

less fluid returns to capillary (low albumin)

liver failure or heart disease

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15
Q

increased capillary permeability

A

causes edema

plasma proteins leak out of capillaries

inflammation

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16
Q

obstructed lymph flow

A

causes edema

prevents return of proteins and fluids to circulation

malignancy or surgery

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17
Q

assessment/treatment of edema

A

weight, visual assessment, measurement of affected part

elevate lower extremities, support stockings, diuretics

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18
Q

third space fluid accumulation

A

trapping in transcelular space

peritoneal, pleural, or pericardial

may require drainage

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19
Q

TBW of water in lean adults vs. infants

A

60% lean adults

75-80% in infants

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20
Q

how is water taken in and excreted?

A

intake: drink, food, metabolism
output: urine, respiratory, skin, feces

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21
Q

regulation of Na balance

A

most plentiful extracellular cation

intake: GI
output: renal, skin, lungs

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22
Q

RAAA system

A

renin angiotensin-aldosterone system

lowers sodium concentration, blood volume

BP activates

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23
Q

ADH stimulates ____ ____ while Aldosterone stimulates ____ ____

A

water retention

sodium retention

released together

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24
Q

aldo effect and ADH effects

A

aldo: increased urinary Na retention

ADH: increase thirst –> increase H2O intake & decreased urine water loss

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25
Q

if low BP (and low blood volume) due to ECF fluid loss and/or Na loss

A

renin and angiotensin II released and activated

increase aldo and ADH release

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26
Q

if high BP and high blood volume due to excess ECF and or Na gain

A

increased NP release

decrease aldo and ADH release

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27
Q

thirst controlled by

A

thirst center in hypothalamus, which has osmoreceptors

ADH released by hypothalamus to retain water if ECF is low or there is cellular dehydration

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28
Q

hypodipsia

A

decreased ability to sense thirst

lesions on hypothalamus

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29
Q

polydipsia

A

excessive thirst

CRF or HF from high angiotensin

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30
Q

true thirst

A

accompanies dehydration from blood loss or diabetes mellitus

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31
Q

psychogenic polydipsia

A

compulsive drinking in psychiatric disorders

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32
Q

2 ADH disorders

A

diabetes insipidus

syndrome of inappropriate ADH secretion

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33
Q

2 types of diabetes insipidus and definition in general

A

decreased ADH, leading to high urine output, dehydration, and high serum sodium (only losing H2O, not ions)

neurogenic

nephrogenic

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34
Q

neurogenic diabetes insipidus

A

caused by trauma, solve with ADH administration

decreased ADH, leading to high urine output, dehydration, and high serum sodium (only losing H2O, not ions)

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35
Q

nephrogenic diabetes insipidus

A

renal response off ADH decreased

decreased ADH, leading to high urine output, dehydration, and high serum sodium (only losing H2O, not ions)

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36
Q

what does ADH do cellularly

A

inserts aquaporins that are impermeable to ions

causes H2O to leave urine and enter the blood, causing low serum Na (diluted by the H2O)

decreases urine output

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37
Q

syndrome of inappropriate ADH secretion

A

causes dilutional hyponatremia

tumor can secrete extra ADH

treat with diuretics and fluid restriction

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38
Q

physiological effects of dilutional hyponatremia caused by syndrome of inappropriate ADH secretion

A

reabsorb H2O so low urine output

low serum sodium

high BP

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39
Q

isotonic fluid volume deficit

A

loss of isotonic fluid from ECF

ICF not impacted

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40
Q

causes, symptoms, and treatment of isotonic fluid volume deficit

A

causes: vomiting, diarrhea, NG suction
symptoms: thirst, weight loss, oliguria, increased urine specific gravity
treatment: correct problem and administer isotonic fluid

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41
Q

isotonic fluid volume excess

A

gain of isotonic fluid into ECF

ICF not impacted

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42
Q

causes, symptoms, and treatment of isotonic fluid volume excess

A

causes: renal or HF, corisol excess
symptoms: weight gain, edema, distended neck veins, pulmonary edema, ascites
treatment: sodium restriction and diuretics

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43
Q

hyponatremia

A

low serum Na of less than 135 mEq/L and low serum osmolarity

results from loss of Na in excess of (or without) H2O loss and gain of H2O without sodium

44
Q

causes, symptoms, and treatment of hyponatremia

A

SIADH, renal disease that increases water retention

neuro (headache, disorientation), muscle cramps, weakness

limit H2O intake, give hypertonic sodium solutions if sever

45
Q

water enters ICF by _____

A

osmosis

produces cellular edema (includes cerebral edema)

46
Q

hypernatremia

A

serum Na less than 145 mEq/L and serum osmolarity > 295 mOsm/L

results from gain of sodium or loss of H2O

47
Q

causes, symptoms, and treatment of hypernatremia

A

lack of H2O access, hypodypsia, excess sodium bicarb

weight loss, polycythemia, thirst, neuro symptoms

give rehydration fluids –> slowly to avoid cerebral edema

48
Q

water leaves ICF by ____

A

osmosis

causes cellular dehydration

49
Q

normal serum volume of potassium

A

3.5-4.5 mEq/L

50
Q

regulation of potassium balance

A

renal regulation: K+ filtered and partially reabsorbed

excretion fine tuned by aldosterone-sensitive sodium reabsorption/potassium secretion in DCT

51
Q

how are Na/K gradients maintained

A

Na/K ATPase pump

cellular dehydration –> increase K shift out of cells

intracellular acidosis –> increase K shift out of cells

Insulin and Epi stimulate pump –> increase K movement into cells

52
Q

2 disorders of potassium imbalance

A

hyperkalemia

hypokalemiaq

53
Q

hyperkalemia effect on resting membrane potential

A

reduces ratio so RMP is closer to threshold for AP

54
Q

hypokalemia effect on resting membrane potential

A

increases ratio so RMP is further from threshold for AP

55
Q

hyperkalemia

A

K+ > 5 mEq/L

causes: decreased renal elimination (CRF), increased movement from ECF (acidosis)
symptoms: peaked T wave, short QT, wide QRS!!!! weakness and muscle cramps
treat: CaCl2 to reverse ECG changes, beta-agonists, insulin

56
Q

hypokalemia

A

K+ < 3.5 mEq/L

causes: decreased intake, vomiting, diarrhea, renal loss (diuretics), shifts into cells (epi & insulin), treatment of ketoacidosis
symptoms: PR prolonged, premature ventricular contractions, weakness, fatigue, muscle cramps
treat: replace with IV rapidly if needed

57
Q

2 regulators of calcium

A

PTH increases calcium

calcitonin decreases calcium

58
Q

PTH

A

increases calcium

increased absorption by gut (Vit D)

decreases renal elimination

stimulates osteoclasts (breakdown of bone)

59
Q

calcitonin

A

decreases calcium

60
Q

2 PTH disorders

A

hyperparathyroidism

hypoparathyroidism

61
Q

hyperparathyroidism

A

excess PTH –> high calcium

parathyroid adenoma

skeletal abnormalities that may be asymtomatic

62
Q

hypoparathyroidism

A

PTH deficit so low calcium

congenital absence of gland, acquired (surgery or radiation)

symptoms: tetany, prolonged QT
treat: IV calcium gluconate, Vit D

63
Q

most calcium stored in ____

A

bone

64
Q

calcium in ECF

A

1/2 calcium bound to albumin and 1/2 free

65
Q

hypocalcemia

A

serum calcium less than 8.5 mg/dL

treat: replace calcium

66
Q

causes and symptoms of hypocalcemia

A

causes: renal loss (failure) and hypoparathyroidism
symptoms: nerve and muscle excitability, tingling, spasms, and seizures b/c Ca stabilizes membranes

67
Q

2 signs of hypocalcemia

A

Chvostek: contracture of facial muscles from light tap

Trousseau: carpal spasms from inflating BP cuff

68
Q

hypercalcemia

A

serum calcium greater than 10.5 mg/dL

causes: bone resorption (cancer) and hyperparathyroidism
symptoms: decreased neural exitability

69
Q

regulation of magnesium balance

A

reabsorption in DCT stimulated by PTH

70
Q

hypomagnesemia

A

serum Mg less than 1.8 mg/dL

caused by diarrhea, malabsorption, laxatives

symptoms: tachycardia and HTN

71
Q

hypermagnesemia

A

serum Mg greater than 2.6 mg/dL

caused by renal disease, and magnesium containing meds like antacids

symptoms: hypotension and cardiac arrest

72
Q

why is pH important

A

enzymes are sensitive

cardiac and neural function is decreased when pH is low

73
Q

acids are generated by ________

A

metabolism

74
Q

fixed acids

A

sulfuric

phosphoric

lactic

ketone bodies

75
Q

sulfuric and phosphoric acid

A

produced in metabolism of AA, NA, and phospholipids

excreted by kidney

76
Q

lactic acid

A

from pyruvic acid in anaerobic metabolism

77
Q

ketone bodies

A

from fat and protein during catabolism

78
Q

volatile acid

A

CO2

end product of aerobic metabolism

H2O + CO2 –> H2CO3 –> H+ + HCO3-

79
Q

high pCO2

A

acidosis

80
Q

low pCO2

A

alkalosis

81
Q

3 lines of defense against acidosis/alkalosis

A

1: chemical buffering
2: respiratory response by breathing out CO2
3: renal response

82
Q

CO2 is produced in ____ and diffuses into ____

A

cells, plasma

83
Q

CO2 in RBC and enzyme

A

H2O + CO2 –> H2CO3 –> H+ + HCO3-

by carbonic anhydrase

84
Q

CO2 is carried in 3 forms

A

bicarb 70%

dissolved in plasma 10%

bound to hemoglobin 20%

85
Q

calculation of pH

A

Henderson-Hasselbach

rate of bicarb to CO2 determines pH

pH = 6.1 + log [HCO3-] / (.03 * pCO2)

86
Q

the log of a bigger # = a

A

bigger #

87
Q

causes of acidosis bicarb/CO2

A

low biarb

high CO2

88
Q

causes of alkalosis bicarb/CO2

A

high bicarb

low CO2

89
Q

buffer systems

A

1st line of def

bicarbonate buffer system most important

H2O + CO2 –> H2CO3 –> H+ + HCO3-

if high pH, moves to right to release H+

if low pH, moves to left to absorb H+

90
Q

protein buffer systems

A

albumin and globulins (major plasma proteins)

91
Q

potassium H+ ion exchange

A

in metabolic acidosis H+ inc. in cells so K+ moved out

treatment of ketoacidosis requires K+ replacement

92
Q

respiratory control of CO2

A

2nd line of def

increased production of metabolic acids or CO2 stimulates chemoreceptors

respiratory centers are stimulated to increase minute respiration (breathe more CO2 out to inc. pH)

rapid response… 12-24 hrs

93
Q

acidosis means you breathe…

A

harder

94
Q

alkalosis means you breathe

A

slower

95
Q

renal control mechanisms

A

3rd line of def

kidney changes excretion of acid or base to compensate for pH changes

H+/bicarb exchange (requires carbonic anhydrase)

96
Q

H+/bicarb exchange

A

H+ ions secreted into tubular fluid in exchange for Na

bicarb reabsorbed into blood

stimulated by acidosis

97
Q

diamox

A

diuretic and carbonic anhydrase inhibitor

moves Na into urine and H2O follows

98
Q

tubular buffer systems

A

prevent urine from becoming too acidic (excretes H+ ions)

phosphate buffer system

ammonia buffer system…. NH4+ produced and secreted and NH3 acts as buffer

99
Q

lab tests for acid/base abnormalities

A

use arterial blood

pH and pCO2 measured, bicarb calculated

100
Q

interpretation of lab acid/base tests

A

pH determines acidosis or alkalosis

if abnormal CO2, problem is respiratory

if abnormal HCO3-, problem is metabolic

101
Q

_____ system can adjust CO2 to compensate for a _____ disorder

A

respiratory, metabolic

102
Q

_____ system can adjust HCO3- to compensate for a _____ disorder

A

renal, respiratory

103
Q

is mixed acidosis/alkalosis possible?

A

yes

104
Q

anion gap

A

serum concentration of unmeasured anions (phosphate, sulfate, organic acids, protein)

calculated as sodium - (chloride + bicarb)

use to confirm diagnosis

105
Q

anion gap is increased in…

A

lactic acidosis

ketoacidosis

b/c large amounts of lactate and ketone present (anions)

106
Q

anion gap is normal from ______

A

diarrhea

Cl retained as bicarb is lost

107
Q

anion gap is decreased in…

A

hypoalbuminemia

Pathophysiology (24 decks)

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