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Chemistry lectures (Sun) > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Average range for blood gases pH, PaO2 and PaCO2

A

pH 7.35 - 7.45
PaO2 80 - 100 mmHg
PaCO2 35-45 mmHg

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2
Q

Average range for blood gases, O2 saturation, Bicarbonate, total CO2, and base excess

A

O2 saturation >95%
Bicarbonate 22 - 26 mmol/L
Total CO2 23 - 27 mmol/L
Base excess -2 to +2 mmol/L

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3
Q

What does PaCO2 and pH tell us?

A

Acid/base status

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4
Q

What does PaO2 tell us?

A

oxygenation status

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5
Q

Hydrogen range in blood

A

38 - 42 nmol/L

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6
Q

Hydrogen survivable range

A

16 - 160 nmol/L

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7
Q

What is an acid?

A

A substance that can yield a hydrogen ion or hydronium ion when dissolved in water

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8
Q

What is a base?

A

A substance that can yirl hydroxyl ions or that can accept a proton

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9
Q

Dissociation constant

A

K, the relative strengths of acids and bases

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10
Q

pK

A

the negative log of the dissociation constant

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11
Q

buffer

A

combination of a weak acid or weak base and its salt is a system that resists changes in pH

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12
Q

pH equation

A

pH = -log[H+]

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13
Q

pH of draino

A

14

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14
Q

pH of battery acid

A

0

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15
Q

Normal blood pH

A

7.4

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16
Q

Gastric fluid pH

A

1.5

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17
Q

Buffer equation

A

HA = H+ + A-
HA is conjugate acid
A- is conjugate base

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18
Q

Henderson-Hasselbach equation

A

pH = pK + log [base]/[acid]

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19
Q

When pH = pK

A

[base] = [acid]

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20
Q

Dissociation constant equation

A

[H=] = Ka [HA]/[A-]

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21
Q

Body’s buffers

A

bicarbonate, proteins, phosphates, bone

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22
Q

Bicarbonate-carbonic system

A

CO2 + H2O = H2CO3 = H+ + HCO3-

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23
Q

Acid/Base balance in plasma

A

small amounts of Co2 remain as dissolved CO2 or combine with proteins to form carbamino compounds, most of the CO2 reacts with H2O to form H2CO3 which dissociates

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24
Q

CO2 in tissues

A

enters the RBC and reacts with H2O to form carbonic acid

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25
Q

Dissociation of H2CO3

A

causes the HCO3- concentration to increase in the RBCs and diffuse into plasma, followed by chloride diffuses into the RBCs to maintain neutrality

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26
Q

H+ and HbO2

A

react and form HHb and release O2 into plasma and tissues

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27
Q

Acid/Base regulation by lungs

A

H= carried on reduced hemoglobin in venous and released to react wit HCO3- to form H2CO3, which converts to H2O and CO2, CO2 diffuses into alveoli and exhaled

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28
Q

If CO2 is not exhaled at rate of production

A

CO2 accumulates in blood, increasing H+ concentration

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29
Q

If CO2 is exhaled too fast

A

H+ concentration decreases

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30
Q

Acid/Base regulation by kidneys

A

HCO3- is reabsorbed in proximal tubules, exchange of Na+ for H+ in the tubular cell, combining H+ with HCO3 in filtrate to form H2CO3, converted to H2O and CO2. CO2 diffuses into tubule and reacts with H2O to form H2CO3 and then HCO3 which is reabsorbed.

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31
Q

Diuretics

A

favor excretion of HCO3-

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32
Q

Bicarbonate equation

A

Bicarbonate = total CO2 - 0.03 x PaCO2

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33
Q

Henderson-Hasselbach for bicarbonate system

A

pH = 6.1 + log [HCO3-]/[0.03 x PaCO2]

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34
Q

respiratory acidosis

A

Increases PaCO2, so bicarbonate is increased as compensation

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35
Q

Respiratory alkalosis

A

Decreases PaCO2, so bicarbonate is decreased as compensation

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36
Q

Metabolic acidosis

A

decreases bicarbonate, so PaCO2 is increased as compensation

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37
Q

Metabolic alkalosis

A

increased bicarbonate, so PaCO2 is increased as compensation

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38
Q

Respiratory acidosis causes

A

decreased central drive, pulmonary issues

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39
Q

Respiratory alkalosis causes

A

sepsis, liver disease, salicylate intoxication, anxiety, high altitudes

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40
Q

Metabolic acidosis causes

A

GI loss of bicarbonate, metabolic derangements, exogenous intoxicants, renal disease

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41
Q

Lactic acidosis causes

A

circulatory failure, acute hypoxemia, carbon monoxide, malignancies, liver disease

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42
Q

Ketoacidosis causes

A

increased lipolysis and FA as seen in diabetes, starvation and alcoholism

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43
Q

renal failure

A

Decreased ammonium ion excretion due to renal tubular drop out

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44
Q

Type 1 renal tubular acidosis

A

Distal tubule

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45
Q

Type 2 renal tubular acidosis

A

Proximal tubule

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46
Q

Type 4 renal tubular acidosis

A

reduced aldosterone secretion

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47
Q

Metabolic alkalosis causes

A

loss of gastric fluid, diuretics, hypokalemia, aldosterone excess, volume depletion

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48
Q

Air at sea level

A

pressure: 760 mmHg
N2: 79%
O2: 21%
CO2: 0%
CO: 0%

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49
Q

Oxygen range for 2 day old to 60 year old

A

83 - 108 mmHg

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50
Q

> 90 year old oxygen range

A

> 50 mmHg

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51
Q

Oxygen saturation for adults

A

94 - 98%

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52
Q

Hypoxia

A

low oxygen in tissues

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53
Q

Hypoxemia

A

low pressure of oxygen in blood

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54
Q

O2 diffusion gradient

A

PaO2 - PaO2 <= 10 mmHg

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55
Q

Alveolar arterial diffusion gradient

A

Aa = (BP-pH2O) x FiO2 - (1.25 x PaCO2) - PaO2

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56
Q

What is needed for adequate tissue oxygenation?

A

available atmospheric oxygen, adequate ventilation, gas exchange between the lungs and arterial blood, loading of O2 onto hemoglobin, adequate hemoglobin, adequate transport, release of O2 to the tissues

57
Q

Factors influencing the PO2 in the alveoli

A

% of O2 concentration inspired, the amount of PCO2 in the expired air, ratio of the volume of inspired air to the volume of the dead space air

58
Q

Factor affecting the amount of O2 that reach the tissues

A

Destructi9on of alveoli, pulmonary edema, airway blockage, inadequate blood supply

59
Q

O2 in arteria blood

A

transported to tissues by hemoglobin

60
Q

Amount of O2 loaded onto hemoglobin

A

depends on availability of O2, concentration and types of hemoglobin, presence of CO, pH and T, and levels of PCO2 and 2,3-DPG

61
Q

100% saturated hemoglobin

A

increase in O2 to the alveoli serves only to increase the concentration of dissolved O2 in arterial blood, may cause O2 toxicity and decreased ventilation and increased PCO2

62
Q

HHb

A

reduced hemoglobin

63
Q

O2Hb

A

oxygenated hemoglobin

64
Q

COHb

A

carboxyhemoglobin

65
Q

MetHb

A

methemoglobin

66
Q

SulfHb

A

sulfhemoglobin

67
Q

Oxygen saturation equation

A

SO2 = cO2Hb/(cO2Hb + cHHb) x 100%

68
Q

Fractional or % oxyhemoglobin

A

FO2Hb = cO2Hb/(cO2Hb + cHHb + dysHb)

69
Q

dysHb

A

COHb, MetHb, SulfHb, etc

70
Q

Right shift

A

Causes increased CO2, increased temp, increased [H+], and increased 2,3-DPG

71
Q

Left shift

A

Causes decreased CO2, decreased temp, decreased [H+], and decreased 2,3-DPG

72
Q

Carbon Dioxide normal range

A

35 - 45 mmHg

73
Q

Hypercapnea

A

High level of CO2

74
Q

Hypocapnea

A

low level of CO2

75
Q

Carbon monoxide normal ranges

A

Normal: <0.5%
Smokers: <6%

76
Q

10% CO

A

shortness of breath

77
Q

40-50% CO

A

headache, confusion, fainting

78
Q

> 80% CO

A

rapidly fatal

79
Q

Methemoglobin normal range

A

< 1.5%

80
Q

1.5% to <20% methemoglobin

A

cyanosis

81
Q

20 - 50% methemoglobin

A

weakness, fainting

82
Q

> 70% methemoglobin

A

lethal

83
Q

Na+

A

Major cation of extracellular fluid with serum concentration of 136-145 mmol/L, gradient across membrane maintained by ATPase pumps

84
Q

Regulation of Na+

A

Intake of water in response to thirst, stimulated by high serum osmolality, excretion of water affected by ADH level

85
Q

Hyponatremia

A

Serum Na+ < 130 meq/L

86
Q

Isotonic hyponatremia

A

Serum Na+ <130 meq and normal osmolality

87
Q

Hypotonic hyponatremia

A

serum Na+ <130 meq/L and osmolality < 280 mosm/kg

88
Q

Hypertonic hyponatremia

A

Serum Na+ < 130 meq/L and osmolality > 295 mosm/kg

89
Q

Hypernatremia

A

Excess water loss accompanied by impaired thirst mechanism, sodium excess greater than water

90
Q

K+

A

Major intracellular cation, regulates neuromuscular excitability, contraction of skeletal and cardiac muscles

91
Q

K+ regulation

A

Initially reabsorbed by proximal tubules, excretion regulated by aldosterone in distal tubules and collecting ducts, distribution between cells and extracellular fluid affected by Na-K ATPase and Insulin

92
Q

Hypokalemia

A

serum K+ concentration < 3.5 mmol/L, may present with muscle weakness and cardiac arrhythmias

93
Q

Causes of hypokalemia

A

therapy with thiazide diuretics, GI loss through vomiting, diarrhea and gastric suction and discharge

94
Q

Hyperkalemia

A

Serum K+ concentrations > 5 mmol/L, renal insufficiency, diabetes, metabolic acidosis, drugs, enhanced tissue breakdown or acute oral load of K+

95
Q

Cl-

A

major extracellular anion, shifts second to a movement of sodium or bicarbonate ions, filtered out by glomerulus and passively reabsorbed with sodium by proximal tubules, maintain osmolality, blood volume and electro-neutrality with sodium and through chloride shift

96
Q

Hyperchloremia

A

Due to excess loss of bicarbonate ion

97
Q

Hypochloremia

A

Due to excess loss of chloride from prolonged vomiting, diabetic ketoacidosis and salt-losing renal diseases

98
Q

HCO3-

A

2nd most abundant anion in the ECF, account for 90% of total CO2, major component of the buffering system in the blood, converts CO2 in plasma to an effective buffer and buffers excess H ion by combining with acid to form CO2 which is eliminated in the lungs, reabsorbed by proximal and distal tubules, plasma level changes based on acid-base imbalance

99
Q

Osmolality

A

2 [Na+] + [glucose]/20 + BUN 3

100
Q

Ca++

A

Found in the skeleton 99%, soft tissues and ECF 1%, 3 physiochemical states in plasma: Free or ionized 50%. Plasma protein (albumin) bound 40%, and complexed with small diffusible anions 10%

0.5% in ECF is the plasma protein, 0.5% in ECF is complexed

101
Q

Metabolism of Ca++

A

Absorbed by specific calcium-binding proteins controlled by vitamin D, deposited in bone regulated by PTH, excreted mainly through the kidneys under the control of PTH

102
Q

Physiological functions of Ca++

A

Bone mineralization, muscle contraction, hormone secretion, glycogen metabolism, cell division, coag cascade, plasma membrane potential

103
Q

Regulation of Ca++ by PTH

A

Stimulate osteoclasts to reabsorb bone and release calcium, increase renal tubular reabsorption of Ca++, promote renal production of active Vitamin D

104
Q

Fundamental of bone physiology

A

Function in support and maintenance of mineral homeostasis, achieved by continuous bone remodeling, balance between reabsorption and formation is affected by many factors

105
Q

Osteoblasts

A

Bone forming cells

106
Q

Osteoclast

A

Reabsorb bone through a degradation process

107
Q

Osteocytes

A

Bone cells

108
Q

Activation of Vitamin D

A

Obtain in diet or from exposure of skin to sunlight, transported to liver by Vitamin D binding protein, converted to 25-Vit-OH-D2 or 25-Vit-OH-D3 in the liver and to 1,25-(OH)2-D2 or 1,35-(OH)2-D3 in the kidney

109
Q

Functions of Vitamin D

A

Facilitate calcium and phosphate absorption in the intestine, increase bone reabsorption by increasing osteoclast activity, enhance the renal reabsorption of calcium and phosphorous

110
Q

Vitamin D testing

A

Measured by RIA, HPLC, and LC-MS, most tests don’t differentiate D2 and D3, 25-hydroxyvitamin D is recommended marker for determining vitamin D deficiency

111
Q

Regulation of calcium by calcitonin

A

Secreted from the medullary cells of the thyroid glands in response to increased calcium, decreases the flux of calcium and phosphorus from bone into the circulation, down-regulate the renal reabsorption of calcium, phosphorous, sodium, potassium and magnesium, elevated calcitonin seen in medullary thyroid carcinoma

112
Q

Hypercalcemia

A

Serum total calcium > 10.0 mg/L, presented with neurologic, GI and renal symptoms or asymptomatic, treatment depends on cause byt biphosphates are the main class of drug

113
Q

Primary hyperparathyroidism

A

Most common cause of hypercalcemia in out-patient population, caused by hypersecretion of PTH due to adenoma or carcinoma of the parathyroid gland, seen frequently in elderly females, may show clinical signs or be asymptomatic, characterized by elevated PTH secretion with hypercalcemia

114
Q

Secondary hyerparathyroidism

A

Seen in patients with chronic renal disease, show elevated serum calcium level with altered levels of others like phosphate, magnesium and creatinine, secondary increase of PTH level

115
Q

Malignant diseases

A

Most common cause of hypercalcemia in in-patient population, have hypercalcemia as a common complication, more prevalent in breast cancer, multiple myeloma and squamous cell carcinomas of the lung and renal carcinoma, may be caused by PTHrP

116
Q

Hypocalcemia

A

Serum total calcium level < 8.5 mg/dL, present with irritability and cardiac irredularities, muscle cramps and seizures in serum calcium level less than 7.5 mg/mL, treat with oral or parenteral calcium therapy

117
Q

Hypermagnesemia

A

Caused by renal failure, result from magnesium sulfate therapy

118
Q

Hypomagnesemia

A

Caused by magnesium loss (GI), malabsorption and bypass surgery for obesity, renal tubular loss, dialysis, hyperaldosteronism, alcohol, diabetes, aminoglycoside antibiotics

119
Q

Osteoporosis

A

Usually in older men and women after menopause, characterized by gradual loss of bone mass, which renders less dense bone, due to increased bone reabsorption and decreased bone formation, present with pain, skeletal deformity and fractures, featured by normal serum calcium, phosphorous, magnesium, alkaline phosphatase and PTH levels

120
Q

Paget’s disease

A

Individuals older than 40 and increases with advancing age, excessive reabsorption of bone in a random fashion, causing irregular pattern of bone deposition, elevated serum ALP activity due to stimulation of the osteoblasts

121
Q

Osteolytic phase of Paget’s disease

A

Osteoporosis circumscripta

122
Q

Bone softening

A

Bowing, protrusion acetabuli or greenstick fracture

123
Q

Mixed phase

A

Generalized bone enlargement

124
Q

Sclerotic phase

A

Increased density, trabeculae and cortical thickening

125
Q

Rickets/Osteomalacia

A

Result of vitamin D deficiency, associated with deposition of uncalcified bone matrix in rickets (children) and osteomalacia (adults), increase in serum ALP, low calcium, high PTH

126
Q

Phosphate

A

Major intracellular anion, 80% in bone, absorbed in the intestine from diet, important for synthesis of DNA, RNA, ATP, creatine phosphate and 2,3-BPG, mostly regulated by PTH which overall lower blood phosphate by increasing renal excretion and Vit D which increases blood phosphate

127
Q

Hyperphosphatemia

A

Caused by a decrease in renal phosphate excretion, increased breakdown of cells, neoplastic disorders, intravascular hemolysis and lymphoblastic leukemia

128
Q

Hypophosphatemia

A

Seen in transcellular shift, nutritional recovery syndrome, use of antacids that bind phosphate and alcohol withdrawl

129
Q

Anion gap

A

The difference between unmeasured anion and unmeasured cations, useful in indicating an increase in one or more of the unmeasured anions in serum, may serve as a form of quality control for the analyzer used to measure these electrolytes

130
Q

AG calculation

A

AG = (Na+ + K+) - (Cl- + HCO3-)

131
Q

Low anion gap

A

Rare but seen in multiple myeloma or instrument error

132
Q

High anion gap

A

Seen in ketoacidosis, uremia causing PO4-3 and SO4-3 retention, ingestion of methanol, ethylene glycol, salicylate, lactic acidosis, and severe dehydration

133
Q

Sodium determination

A

Chemical method, atomic absorption spectrophotometry, flame emission spectrophotometry, ion selective electrode

134
Q

Ion selective electrode

A

Use a semipermeable membrane, glass membrane to develop a potential produced by having different ion concentrations on either side of membrane, have 2 electrodes with 1 having constant potential and make it the reference electrode and the other indicator electrode. Use the difference in potential to calculate concentration of ion

135
Q

Potassium measurement

A

With ISE as the current method of choice, liquid ion-exchange membrane that incorporates valinomycin that selectively binds K+, can use serum, plasma and urine as long as not hemolyzed

136
Q

Total calcium determination

A

Use orthocresolphthalein complexone or arsenazo III dye to form complex with calcium which can be measured through color reaction, affected by serum albumin concentration, use either serum or lithium heparin plasma

137
Q

Ionized calcium determination

A

Use membranes impregnated with special molecules that selectively bind calcium ions, measure electric potential developed across the membrane to calculate the ionized calcium concentration, affected by pH, may use whole blood or serum collect anaerobically

138
Q

Chloride determination

A

With ISE as most common where an ion-exchange membrane is used to selectively bind chloride ions, may use serum or plasma, other methods are amperometric-coulometric titration, mercurimetric titration and colorimetry

Chemistry lectures (Sun) (5 decks)

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