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Patho: neuro, pain, fluid balance > Fluid Balance, pH, Elecrtolytes > Flashcards

Fluid Balance, pH, Elecrtolytes Flashcards

1
Q

What electrolyte is pH dependent on (specifically acids)?

If you have more H+ are you more or less acidic? What pH value will you be closer to?

A

H+

more H+ = more acidic (0-6)
neutral (7)
less H+ = more basic (8-14)

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2
Q

What % of the body is H2O?

A

60%

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3
Q

Intracellular Fluid (ICF)
what % TBW
where is it

A

(inside cells), 2/3 total body water

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4
Q

Extracellular Fluid (ECF)
what % TBW
where is it

-Interstitial Fluid
-Intavascular Fluid
where it is

A

(outside cells) 1/3 total body water

  • Interstitial: surrounding and permeating cells
  • Intavascular: blood plasma, delivers nutrients etc to all other cells
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5
Q

what is the relationship between Sodium and water balance?

A

water has no charge and is very attracted to sodium. “Water always follows sodium”
If Na+ increases, H2O increases
If Na+ decreases, H2O decreases

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6
Q

what is Tonicity

A

change in concentration of solutes (salt) with relation to solvent (water)

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7
Q

Isotonic (iso-osmolar)
what does it mean
What is an example of an isotonic solution

A

Equal concentration H2O and Na+ inside and outside of cell.
Equal movement of H2O and Na+ in and out of cell
normal saline (ECF = 0.9% NaCl to H2O)

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8
Q

Hypertonic
what does it mean
what does it do to a cell

A

Less H2O in the cell and more Na+ out of cell = cells shrink

H2O follows Na+ out of the cell causing it to shrink

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9
Q

Hypotonic
what does it mean
what does it do to a cell

A

More H2O out of the cell and less Na+ in the cell = cells swell
H2O follows Na+ into the cell causing it to swell

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10
Q

Why would you NEVER put a patient on an IV of pure tap water?

A

B/c when you change you blood plasma to a hypotonic solution, the cells swell and lyse open.
Hyponatremia

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11
Q

What is the main electrolyte outside of cells (and what 2 electrolytes follow it)

What is the major intracellular cation electrolyte?

A

Na+ most abundant (90%) positing cation (followed by H2O and Cl-)

K+ (98%)

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12
Q

What is sodium in Latin?

A

Natrium

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13
Q

What do you say instead of “normal” when reading labs

A

“it is within range”

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14
Q 
Hypernatremia
what does this mean
where is fluid moving
what type of fluid tonicity
symptoms
A

> 145 mEq/L:

  • excess of Na+ or not enough H2O
  • fluid is moving from ICF (in cell) to ECF (interstitial)
  • hypertonic (cell will shrink)

-intracelluar dehydration: thirst (b/c crave H2O to return to an isotonic state), weakness, lethargy, confusion, hypertension

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15
Q 
Hyponatremia
what does this mean
where is fluid moving
what type of fluid tonicity
symptoms
A

<135 mEq/L:

  • not enough Na+ or an excess of H2O
  • fluid is moving from ECF (interstitial) into ICF (in cell)
  • hypotonic (cell will swell)

-Headache, nausea, lethargy, confusion, seizures, coma, hypotension, muscle cramps

Most life threatening!! cerebral edema and increased ICP leading to coma

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16
Q

Hypochloremia
what does this mean
cause

A

not enough chloride

  • Result of hyponatremia or increased HCO3
  • If you do not have enough Na+ you are not attracting enough Cl- (Cl- follows Na+)
  • Typically found when Na+ is low

-Vomiting = loss HCl (hydrochloric acid in the stomach)= loss of Cl- in blood

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17
Q

What electrolyte provides electroneutrality with Na+?

A

Cl-

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18
Q

What is the normal range for potassium concentration?

why is the range lower than Na+

A
  1. 5 - 5.0 mEq/L
    - much lower range than Na+ measurement b/c taken from the Interstitial fluid, NOT inside the cell (where K+ mostly resides)
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19
Q

What is potassium in Latin?

A

Kalium

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20
Q

how do changes in K+ affect resting potential?

A

If you raise resting potential it becomes more excitable and requires less stimulation to reach threshold and trigger depolarization.

If you lower resting potential it becomes less excitable and requires more stimulation.

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21
Q

Hypokalemia
what does this mean
what type of change in pH
symptoms

A

K+ < 3.5 mEq/L

  • Reads as low K+ b/c K+ has moved inside of the cell
  • lower resting potential it becomes less excitable and requires more stimulation.
  • Alkolosis

-Decrease neuromuscular excitability: cardiac dysrhythmias (**heart rhythm, and heart neuromuscular activity)
Also, skeletal muscle weakness and smooth muscle atony (constipation)

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22
Q

Alkolosis

A

Decreased H+ inside the cell causes K+ to move into the cell

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23
Q

Acidosis

A

Increased H+ inside the cell causes K+ to move out of the cell (electroneutrality)

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24
Q

Hyperkalemia
what does this mean
what type of change in pH
symptoms

A

K+ > 5.0 mEq/L

  • Reads as high K+ b/c K+ has moved outside of the cell
  • raises resting potential and becomes more excitable and requires less stimulation
  • cell trauma leads to Hyperkalemia b/c K+ has burst out of the cell into the ECF
  • Acidosis

-neuromuscular irritability/activity: cardiac dysrythmias (potential for cardiac arrest eg: lethal injection),
tingling of lips & fingers, restlessness, intestinal cramps/diarrhea

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25
Q

What does a change in pH greatly affect?

A

K+ balance

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26
Q

What electrolyte provides electroneutrality with H+?

A

K+

Increased H+ inside the cell causes K+ to move out of the cell (Acidosis)

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27
Q

What is electroneutrality?

A

a zero net charge

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28
Q

Where does Ca++ mostly reside?

What is it needed for?

A

Abundance outside of cell (like Na+)

Needed for bone, teeth, blood clotting, muscle contractions (sliding muscle theory), neurotransmitter release, hormone secretion, cell receptor function

29
Q

Hypocalcemia
what does this mean
symptoms

A

Increase neuromuscular excitability

eg: muscle cramps/spasms, intestinal cramping

30
Q

Hypercalcemia
what does this mean
symptoms

A

Decrease neuromuscular excitability

eg: muscle weakness, fatigue/lethargy, kidney stones, constipation

31
Q

How does Calcium affects threshold potential?

A

Decreased threshold potential = more excitability (Hypocalcemia)

Increased threshold potential = less excitability (Hypercalcemia)

32
Q

Sodium, chloride and water are regulated primarily by what?

A

Water: hypothalamus (osmotic receptors)- posterior pituitary- ADH

Na+ and Cl- : adrenal gland (kidney)- Aldosterone and Arterial muscle- natriuretic (Na, urine) hormones

33
Q

what is the primary job of the Kidneys?

A

regulate fluid, electrolytes and pH

34
Q

What does ADH do?

A

Anti-diuretic hormone

signals the kidneys to increase H2O absorption by reducing the amount of H2O passed out in the urine.

35
Q

What does aldosterone do?

A

Increases Na+ absorption by reducing the amount passed out in the urine.
B/c water follows sodium, you will also absorb water!

36
Q

what do natriuretic hormones do?

A

ANH works with aldosterone to increase Na+ loss and therefore H2O loss

37
Q

What contributes to intake and output fluid balance?

A

Intake: drinking, food, metabolism (glucose + O2 = CO2 + H2O + ATP)

Output: Urine, breathing (water vapor), skin, feces

38
Q

Hydrostatic fluid balance force
force due to what
what type of force
example

A
  • Force due to fluid pressure
  • Fluid on one side of a compartment pushes fluid to the other compartment
  • Pushing pressure
    eg: the heart drives hydrostatic pressure (BP)
39
Q

Oncotic/ Osmotic fluid balance force
force due to what
what type of force
example of each

A
  • attraction to protein (oncotic) or electrolytes (osmotic)
  • attracting and pulling force

eg: main oncotic electrolyte (pull and attract water IN THE BLOOD STREAM): albumin
main osmotic electrolyte: Na+

40
Q

Fluid movement between ICF and ECF is driven by what?

A

Osmotic forces (tonicity)!
ECF pulls Na+
ICF pulls K+

Isotonic, hypertonic, hypotonic

41
Q 
Fluid movement between plasma (capillaries) and tissues through the interstitial fluid (IF):
Capillary Hydrostatic Pressure (CHP)
-what type of force
-what it does
-example
A

(strongest pressure)

  • hydrostatic is a push out force
  • pushes fluid out of the capillary, “filtration” into the IF

-eg: blood pressure = ‘fluid out of blood’

42
Q 
Fluid movement between plasma and tissues through the interstitial fluid (IF):
Capillary Oncotic Pressure (COP)
-what type of force
-what it does
-example
A

(strong pressure)

  • Oncotic is a pulling force into the capillary b/c of the presence of albumin in the blood stream
  • Pulls fluid back into the capillaries, “reabsorption” from the IF

-eg: water attraction to plasma proteins = ‘fluid into blood

43
Q

Fluid movement between plasma and tissues through the interstitial fluid (IF):
Intersitial Fluid Hydrostatic Pressure (IFHP)
-what type of force
-what it does
-explain strength rating
-example

A

(weak pressure)

  • hydrostatic is a push out force
  • pushing IF back into the capillary
  • not very strong b/c there is more pressure in the blood (CHP is stronger)

-eg: Interstitial fluid pressure = ‘fluid out of tissues’

44
Q

Fluid movement between plasma and tissues through the interstitial fluid (IF):
Intersitial Oncotic/ Osmotic Pressure (IFOP)
-what type of force
-what it does
-explain strength rating
-example

A

(weakest pressure)

  • Oncotic/ osmitic is a pulling force
  • pull of proteins and electrolytes into the IF
  • weak b/c electrolytes are pretty balanced in the IF and blood but proteins are higher in the blood

-eg: water attraction to interstitial proteins/electrolytes = ‘fluid into tissues’

45
Q

For proper fluid balance CHP and IFOP (fluid movement out of blood) should equal COP and IFHP (fluid movement into blood).
But why can this NEVER HAPPEN?

What helps with this?

A

CHP and IFOP > COP and IFHP

-CHP/IFOP = 100% fluid transfer
COP/IFHP = 90%
-forces are not equal
-BP (push) is > than Oncotic/ Osmotic Pressure (pull)
-more fluid is being pushed out into the tissues than being pulled into the blood stream

-Lymphatic vessels!

46
Q

how does edema relate to proper fluid balance?

A

more fluid is being pushed out into the IF space than being pulled into the blood stream

47
Q

Lymphatic vessels
what are they
what is their function in the IF
what is obligatory load

A
  • Open ended vessels that drain the extra fluid from the IF -IFHP (pushes fluid into the lymph)
  • Obligatory load: obligated to clear the remaining 10% of fluid pushed into tissues (IF)
  • The lymph will later dump this remaining 10% back into the blood stream
48
Q

What is IFOP driven by?

what is it responsible for

A
  • Sodium in the IF space
  • K+ inside the cell
  • contributes to the pulling of water out of cells and into the IF space

-Thus it is responsible for fluid balance inside/ outside of cells

49
Q

What are 4 ways to develop edema?

A 
1- increase capillary hydrostatic pressure
Venous obstruction (DVT, hepatic obstruction), salt and water retention (renal failure, HTN)

2- decrease oncotic pressure
Decrease albumin – liver (makes albumin) disease, malnutrition, kidney disease, burns, hemorrhage

3- increase capillary permeability
(caused by inflammation)– trauma, burns, neoplastic and allergic reactions

4- lymph obstruction
(return fluid to blood)– removal of nodes (surgery, mastectomy), inflammation or tumors

50
Q

what is the Physiologic Range of Blood

what range is acidic and which is basic

A

pH = 7.35 - 7.45
Really it should be exactly 7.40 (slightly basic)
pH < 7.4 = acidic
pH > 7.4 = basic

51
Q

When the pH is low, it is called?
When the pH is high, it is called?
and what is the pH value of each

A

< 7.35= acidosis

> 7.45= alkalosis

52
Q

When are acids formed?

A

CONSTANTLY as end products of protein, carbohydrate and fat metabolism.
As a result we care constantly to balance to a pH of 7.4

53
Q

what are the major regulatory organs of acidosis?

A

kidneys (main one)
lung
blood
Bone- phosphate regulation

54
Q

What 2 forms do body acids exist in?

A
  • Volatile: H2CO3 (carbonic acid, eliminated as CO2) by the lungs through breathing
  • Nonvolatile: eliminated by kidneys sulfuric, phosphoric
55
Q

what are the 2 most important plasma buffering systems

A

Carbonic acid – bicarbonate system (lungs)

Protein (Hemoglobin) (blood)

56
Q

Effects of pH on CNS
Acidosis

Alkylosis

A

ACIDOSIS: CNS depression
eg: tupor to confusion to coma

ALKYLOSIS: CNS irritability (excitability)
eg: restlessness to seizures

57
Q

What is a “buffer”

A

Buffer is a chemical that binds excess H+ without a significant change in pH

Consists of a PAIR of a weak acid and its conjugate base

58
Q

What are the two most important excretory systems for pH balance?

A

1) Lungs: though CO2 regulation:
increase CO2 excretion = increase pH
decrease CO2 excretion = decrease pH

2) Kidney: through H+ excretion:
increase H+ excretion = increase pH
decrease H+ excretion = decrease pH

increase HCO-3 excretion = decrease pH
decrease HCO-3 excretion = increase pH

59
Q

Metabolic Acidosis:

A

(inability of kidney to excrete acid or conserve base) increasing H+ retention or increasing HCO3- removal
-Hyperkalemia

60
Q

Metabolic Alkalosis:

A

(kidney) increasing H+ removal or increasing HCO3- retention

- Hypokalemia

61
Q

Respiratory Acidosis:

A

(retention of CO2 by the lungs) decrease CO2 removal (not breathing enough)
-Hyperkalemia

62
Q

Respiratory Alkalosis:

A

(lungs) increase CO2 removal (breathing too much)

- Hypokalemia

63
Q

How does the Respiratory regulate acidosis?

How do the kidneys regulate acidosis?

A
  • increase or decrease CO2 through breathing

- increase or decrease acidity / alkalinity of urine

64
Q

The most important buffer is what

why?

A
  • bicarbonate (HCO3-) in blood
  • because it as a base and can “soak up” free H+ decreasing acidosis
  • acts immediately
65
Q

Increasing CO2 in the blood causes what to happen?

A

Increase in carbonic acid (acidosis)

66
Q

why is the HCO3-/CO2 buffer system extremely important?

A

because it can be rapidly readjust alkalosis and acidosis

67
Q

How is carbonic acid made from CO2?

How is bicarbonate made from CO2?

A

CO2 acts as an acid by donating hydrogen ions when it dissolves in water: H2O + CO2 = H2CO3

H2CO3 disassociates into H+ and HCO3-

68
Q

What is the normal range for bicarbonate concentration?

A

22 - 26 mEq/L

69
Q

Arterial Blood Gases
What is the normal range for bicarbonate?

What is the normal range for carbon dioxide?

What is the normal range for pH levels?

A
  • 22 - 26 mEq/L
  • 35- 45 mmHg
  • 7.35 - 7.45

Patho: neuro, pain, fluid balance (4 decks)

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