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Hematology & Anaphylaxis > Fluids, Electrolytes and Acid-Base Balancing > Flashcards

Fluids, Electrolytes and Acid-Base Balancing Flashcards

1
Q

What constitutes extracellular fluid? (6)

A 
Plasma
Interstitial fluid
Lymph
CSF
Synovial fluid
Humors of the eye
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2
Q

What is intracellular fluid?

A

Water inside the cell

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3
Q

What must exist for homeostasis to happen?

A

A constant balance between the fluids and electrolytes

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4
Q

What are the three things required to maintain the constant balance in homeostasis?

A

Water

Electrolytes

Non-electrolytes

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5
Q

What are three positively charged electrolytes (cations) found in the intracellular space?

A

Potassium K+

Calcium Ca++

Magnesium Mg++

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6
Q

What is one positively charged electrolyte (cation) found in the extracellular space?

A

Sodium Na+

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7
Q

What is one negatively charged electrolyte (anion) in the intracellular space?

A

Phosphate PO4 3-

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8
Q

What are two negatively charged electrolytes (anion) in the extracellular space?

A

Chloride Cl-

Bicarbonate HCO3-

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9
Q

What are two ways that water enters the body?

A

Digestive system

Cellular metabolism

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10
Q

What are the four ways water exits the body?

A

Kidney’s

Lung’s

Sweat

Feces

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11
Q

What is net filtration?

A

Pressure-driven movement of fluid and solutes from blood capillaries into the interstitial fluid

Fluid is moved from blood to interstitial fluid within the capillary bed (filtration) and then reabsorbed as necessary

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12
Q

What are the six forces that affect net filtration?

A

Tonicity
Blood hydrostatic pressure (BHP)
Blood colloid osmotic pressure (BCOP)
Interstitial fluid colloid osmotic pressure (IFCOP)
Interstitial fluid hydrostatic pressure (IFHP)
Membrane permeability

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13
Q

What is the equation for net filtration pressure?

A

NFP=(BHP+IFOP) - (IFHP+BCOP)

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14
Q

What are the three types of fluid in tonicity?

A

Isotonic
Hypotonic
Hypertonic

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15
Q

What is the definition of an isotonic fluid?

A

It has an equal solute concentration

It is the same pressure

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16
Q

What is the definition of a hypotonic fluid?

A

It has a lesser solute concentration

It has less pressure

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17
Q

What is the definition of a hypertonic fluid?

A

It has a higher solute concentration

It has more pressure

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18
Q

What is blood hydrostatic pressure (BHP)?

A

It is the mechanical force of water against cellular membranes

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19
Q

What does the blood hydrostatic pressure represent in the capillary network?

A

The blood pressure of the capillary network

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20
Q

What is the mmHg within the capillary network, caused by blood hydrostatic pressure?

A

25-30 mmHg

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21
Q

Where is the pressure for blood hydrostatic pressure created?

A

The contraction of the left ventricle

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22
Q

What is the blood colloid osmotic pressure?

A

It is the overall osmotic effect of colloids (plasma proteins) in the vasculature

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23
Q

What does the blood colloid osmotic pressure oppose?

A

The filtration of larger solutes

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24
Q

What does the blood colloid osmotic pressure maintain?

A

It maintains levels of intravascular fluids

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25
Q

What is the interstitial fluid colloid osmotic pressure? (IFOP)

A

IFOP pulls fluid out of the capillaries into the interstitial fluid

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26
Q

Why is interstitial fluid colloid osmotic pressure present?

A

It is present due to the solute concentration in the interstitium

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27
Q

What is interstitial fluid hydrostatic pressure?

A

IFHP pushes fluid from interstitial spaces back into the capillaries

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28
Q

What is the membrane permeability?

A

It allows only a small portion of plasma proteins to cross the capillary membranes

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29
Q

What are three factors that change the amount of total body water?

A

Age

Sex

Fat content

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30
Q

What is ADH?

A

Anti-diuretic hormone

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31
Q

What is water balance and the perception of thirst regulated by?

A

ADH

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32
Q

What are the three reasons ADH is released?

A

Increased plasma osmolality

Decreased circulating blood volume

Lowered venous and arterial pressure

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33
Q

What happens after the release of ADH?

A

Water is reabsorbed from the renal tubules and collecting ducts of the kidneys

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34
Q

What does aldosterone regulate? (3)

A

Na+

K+

Water retention

35
Q

Where does aldosterone stimulate the secretion of K+?

A

The tubular lumen

36
Q

When aldosterone stimulates Na+ and water, what happens?

A

The water reabsorption from the gut, salivary and sweat glands in exchange for K+

37
Q

What is regulated when aldosterone stimulates H+?

A

H+ is secreted in the collecting duct, regulating plasma bicarbonate (HCO3-) levels and its acid/base balance

38
Q

What gland does aldosterone stimulate to release ADH?

A

Posterior pituitary gland

39
Q

What is RAAS?

A

Renin-Angiotensin-Aldosterone-System

40
Q

What is the natriuretic hormone?

A

It promotes urinary secretion of Na, decreasing tubular reabsorption and supports water and Na excretion

41
Q

What are the basic steps of RAAS? (4)

A
  1. Decrease in renal perfusion is detected and the juxtaglomerular apparatus activates renin
  2. The renin meets with angiotensinogen from the liver to form Angiotensin I
  3. The pulmonary and renal endothelium release ACE to meet with angiotensin I to create angiotensin II
  4. Angiotensin II acts in the following five areas:
    It increases sympathetic activity,
    Tubular Na+, Cl- reabsorption and K+ excretion, H20 retention, aldosterone is secreted,
    arteriolar vasoconstriction increasing blood pressure,
    the posterior lobe of the pituitary gland secretes ADH
42
Q

What is hypervolemia?

A

Overhydration

43
Q

What is isotonic hypovolemia (dehydration)?

A 
It is an excessive loss of equal amounts of Na and water
It can be caused by the following:
- Severe or long term vomiting/diarrhea
- Systemic infection
- Intestinal obstruction
44
Q

What is hyponatremic hypovolemia?

A

It is a serum decrease in Na due to excessive loss of Na or a decrease in Na relative to water

45
Q

What are the causes of hyponatremic hypovolemia? (5)

A 
Use of salt-washing diuretics
Excessive perspiration
Salt losing renal disorders
Increased water intake
Excessive use of water enemas
46
Q

What are the signs and symptoms of hyponatremic hypovolemia? (7)

A 
Muscle cramps
N/V
Postural BP changes
Poor skin tugor
Fatigue
Dyspnea
Confusion, hemiparesis, seizures and coma
47
Q

What are the causes of hypernatremic hypovolemia?

A

It is an elevation of serum levels due to loss of water in excess of Na, or elevated Na levels

48
Q

What are the causes of hypernatremic hypovolemia? (7)

A 
Lack of fluid intake
Diabetes insipidus
CHF
Renal failure
Excessive misuse of diuretics
Na intake in absence of water
Profuse watery diarrhea
49
Q

What are the signs and symptoms of hypernatremic hypovolemia? (5)

A 
Similar to hyponatremia
Thirst
Disorientation
Lethargy
Seizures
50
Q

What is over hydration?

A

It is an increased body water with a decrease in solute concentration

51
Q

What are the four causes of over hydration?

A

Excessive IV fluid administration
Impaired cardiac function
Impaired renal function
Endocrine dysfunction

52
Q

What is the role K+?

A

Nerve, muscle and cardiac function

53
Q

What is the role of Ca++? (6)

A 
Neurotransmission
Cell membrane permeability
Hormone secretion
Growth
Ossification of bones
Muscle contractions
54
Q

What is the role of PO42-?

A

Used for buffering

55
Q

What is the role of Mg+?

A

Activates enzymes
Nervous system effects
MSK effects similar to Ca++

56
Q

What is one of the most important balances in the body hemostatic mechanisms?

A

The acid-base balance

57
Q

What are acids (proton donators)?

A

Hydrogen ions (H+)

58
Q

What are bases (protons acceptors)?

A

Hydroxide ions (OH-)

59
Q

What is the pH scale? (4)

A

It is a hydrogen ion concentration
It is measured in moles/L
Acidity/alkalinity increases tenfold with every unit change
The extremes of the pH scale are 0-14

60
Q

What is a normal pH scale?

61
Q

What is considered compatible with life with the pH scale?

62
Q

If the pH is below 7, what is it considered?

63
Q

If the pH is above 7, what is it considered?

64
Q

What are the chemical buffering systems to maintain the pH? (3)

A

Carbonic acid
Phosphate buffering
Protein buffering

65
Q

What are the physiological buffering systems in maintaining pH? (2)

A

Respiratory buffering

Renal buffering

66
Q

What is the normal carbonic acid to bicarbonate ratio?

67
Q

What does carbonic anhydrase cause?

A

CO2 to dissolve in water of blood to form carbonic acid (H2CO3)

68
Q

What is the chemical composition of carbonic acid?

69
Q

What does H2CO3 break down into?

A

H+ and HCO3-

70
Q

What is an increase of H2CO3?

71
Q

What is an increase in HCO3-?

72
Q

What is protein buffering?

A

Negative charges allow proteins to serve as buffers for alterations in H+

73
Q

Where does protein buffering primarily occur?

A

Intracellularly

74
Q

What is renal buffering?

A

It is the recovery of bicarbonate and filtered into the tubules

75
Q

What are metabolic causes?

76
Q

What are respiratory causes?

77
Q

What is a mnemonic to remember acidosis/alkalosis?

A 
ROME
Respiratory Opposite (pH and HCO3-/CO2 opposite)

Metabolic Equal (pH and HCO3-/CO2 equal)

78
Q

What is the metabolic balance equation?

A

H+ + HCO3- H2CO3 CO2 + H2O

79
Q

What is metabolic acidosis?

A

It is caused by excessive accumulation of acid or deficiency in the base
It affects the bicarbonate side of the equation

80
Q

What are common types of metabolic acidosis? (4)

A

Lactic acidosis
Diabetic ketoacidosis
Renal failure
Ingestion of toxins

81
Q

What is respiratory alkalosis?

A

It results from decreased PCO2 through hyperventilation

82
Q

What are some causes of respiratory alkalosis? (6)

A 
Sepsis
Peritonitis
Shock
CO poisoning
Head injury
DKA
83
Q

What does a blood gas analysis determine? (2)

A

Blood oxygenation

Acid-base balance

Hematology & Anaphylaxis (8 decks)

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