fluid-electrolyte and acid-base imbalances

Question 1

FLUID=

Answer 1

water and electrolytes

Question 2

anions=

Answer 2

-
bicarbonate (HC03)- neutralize stomach acid, maintain acid-base balance
chloride (Cl)- component of stomach acid, maintain acid-base balance, maintain water balance
phosphate (PO4)- maintain acid-base balance, protein and energy metabolism, structure of cell membranes

Question 3

cations=

Answer 3

\+ 
calcium 
magnesium 
potassium 
sodium
hydrogen

Question 4

what is CHP

Answer 4

capillary hydrostatic pressure
the PUSH pressure
-pressure fluid EXERTS on vessel walls OUT of capillaries

Question 5

what is OP

Answer 5

osmotic pressure
-change in plasma protein concentration (amt of plasma protein or changes in H20 volume)
PULL pressure
-pressure coming from solutes drawing fluid IN to capillaries

Question 6

NFP=

Answer 6

net filtration pressure (CHP-BCOP)

Question 7

there is a net…

Answer 7

LOSS of fluid from capillaries into interstitial space

Question 8

movement of fluid is _____

Answer 8

OUT OF capillaries

Question 9

what returns the fluid from the interstitial tissues to blood?

Answer 9

LYMPHATIC system

Question 10

what is edema?

Answer 10

extra fluid (excessive/abnormal) accumulation in interstitial space

Question 11

where can edema be LIFE threatening?

Answer 11

BRAIN!, lungs! heart!

Question 12

causes of edema? (4)

Answer 12

1. increased capillary hydrostatic pressure
2. decreased colloid osmotic osmotic pressure
3. increased capillary permeability
4. obstructed lymph flow

Question 13

how does increased capillary hydrostatic pressure cause edema?

Answer 13

• INCREASED vascular volume (HF, kidney disease, premenstrual sodium retention, pregnancy, envrionmental stress, thiazolidinedione therapy)
• venous obstruction
• decreased arteriolar resistance (calcium blocking drug response)

Question 14

how does decreased colloid osmotic pressure occur?

Answer 14

• increased loss of plasma proteins

- decreased production of plasma proteins

Question 15

increased capillary permeability as a cause of edema?

Answer 15

-inflammation, allergic rection, malignancy, issue injurys and burns cause INCREASED permeability

Question 16

obstructed lymph flow occurs from?

Answer 16

malignant obstruction, surgical removal of lymph nodes

Question 17

what is dehydration?

Answer 17

decreased interstitial and intravascular fluids

-KIDNEY not fx properly or losing fluid (draws from IS and cells)= DEHYDRATED cells

Question 18

causes of dehydration?

Answer 18

-decreased intake of fluid, third spacing, perspiration, vomiting/diarrhea, flirtration in kidneys

Question 19

what is third spacing?

Answer 19

two NORMAL spaces for fluid= intravascular space and interstitial space
—-> continually exchange fluid
3rd space= ABNORMAL, transcellular space
example. ascites in abdomen, bleeding into a cavity or joint, pleural space
difficult to happen and just as difficult to get OUT

Question 20

measure of pH is measure of

Answer 20

hydrogen ions

Question 21

normal pH of extracellular fluid

Answer 21

7.35-7.45

Question 22

pH is constantly changing because of?

Answer 22

reactions in body, generating H+

MANY compensatory mechanisms

Question 23

ABGs?

Answer 23

arterial blood gases= test blood from an artery for:

• certain gases amt (CO2 and O2) dissolved in blod.
• measures PH

Question 24

what is alkalosis?

Answer 24

increased BASE pH greater than 7.45

-LOW hydrogen

Question 25

what is acidosis?

Answer 25

increased ACID pH less than 7.35 | -HIGH hydrogen

Question 26

4 types of metabolic imbalances?

Answer 26

1. metabolic alkalosis 2. respiratory alkalosis 3. respiratory acidosis 4. metabolic acidosis

Question 27

pH is dependent on?

Answer 27

BALANCE between bicarbonate and carbonic acid

Question 28

what is the homeostatic balance of bicarbonate ion and carbonic acid?

Answer 28

20:1 ratio 20 bases, 1 acid

Question 29

NORMAL pH is maintained by what 3 systems?

Answer 29

BUFFERing system LUNGS KIDNEYS

Question 30

how does the buffer system work?

Answer 30

- carbonic acid-bicarbonate buffer is used in the blood - chemicals in ICF and ECF providing IMMEDIATE response - weak base + conjugate acid pair, or weak acid + conjugate base pair (to prevent large changes in pH, system TRADES strong acid for weak acid or strong base for weak base) - pick up extra H+ if levels are HIGH - release H+ if levels are LOW - buffers cannot get RID of H+, so if buffering capacity exceeded, OTHER mechanisms needed!

Question 31

how do the lungs work to maintain pH?

Answer 31

- CO2 exhaled by lungs - if lungs FAIL= BUILD up of C02, acidosis - CHEMORECEPTORS in brainstem and peripheral chemoreceptors sense change in pCO2 and ALTER ventilation rate to MAINTAIN acid-base balance - RAPID response (minutes) - only 50-75% as effective as buffer system - PREVENTS large pH changes while waiting for slower acting kidneys to respond

Question 32

how do the kidneys work to maintain pH?

Answer 32

- SLOWEST response (hours to days) - EXCRETE more or less H+---> H+ from fixed acids resulting from protein and lipid metabolism - REABSORB more or less HCO3, filtered in glomerulus so that it is not lost in urine - generates new HCO3 and releases in blood

Question 33

equation

Answer 33

CO2 + H20 H2CO3 H+ + HCO3-

Question 34

the direction of the reaction is determined by?

Answer 34

concentration of reactants and products | moves TOWARD side with LOWER concentration (LE CHATELIERS principle)

Question 35

carbonic acid is volatile... which means

Answer 35

as soon as it forms it dissociates (so HARD to measure conc in blood) only volatile acid in body

Question 36

how is ABG measured?

Answer 36

small volume of blood drawn from artery (most commonly radial artery on wrist) - interpreted to determine acid-base imbalances - can also measure lactate, hemoglobin, electrolytes and others

Question 37

metabolic imbalances occur when

Answer 37

any fixed acids involved lactic acid, HCl

Question 38

respiratory imbalances occur when

Answer 38

carbonic acid is involved

Question 39

metabolic acidosis=

Answer 39

``` too much acid or too little base causes= severe diarrhea (lose HCO3), diabetes (ketones broken into acid, strenous exercise (lactic acid) or renal failure response: buffers PICK up extra H resp increases (H20 and CO2 exhaled) kidneys (secrete more H, reabsorption) ```

Question 40

metabolic alkalosis=

Answer 40

too much base or too little acid causes= vomiting (lose H from stomach), excess intake of antacids (increase HCO3) response: buffers drop off H ventilation decreases (less Co2 lost) kidneys secrete less H, reabsorb less HCO3

Question 41

what is respiratory acidosis=

Answer 41

lungs FAILING, not adequately ventilating! CO2 not exhaled and builds up causes: lung disease, depression of resp centers due to drug, nerve/muscle disorders decrease resp, holding breath results in increased PCO2, excess CO2 combined with water to form carbonic acid response: buffers pick up excess H+ kidneys excrete H, reabsorb HCO3

Question 42

what is respiratory alkalosis=

Answer 42

hyperventilation, CO2 exhaled EXCESSIVELY, reactant conc drops so more H2CO3 converted into CO2 causes: fever, anxiety, aspirin positioning, high altitude response: buffers drop off H kidneys excrete less H, reabsorb more HCO3

Question 43

compensation is what?

Answer 43

LUNGS and KIDNEYS will compensate for each others FAILURE! to maintain pH - LUNGS failing not exhaling CO2, rxn moves right and kidneys excrete excess H+ - KIDNEYS failing and retaining H not excreting, rxn moves left so carbonic acid formed and dissociated into CO2 to be exhaled by lungs

Question 44

treatment for acid-base imbalances?

Answer 44

``` administer solutions (oral or IV) to normalize pH -must address underlying problem though! ```