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FA2 Clinical Pathology > Lecture 13 10/22/24 > Flashcards

Lecture 13 10/22/24 Flashcards

1
Q

What are the general principles of electrolytes and acid/base?

A

-blood pH should be maintained in a narrow range
-electrolytes are closely linked to acid/base balance
-electroneutrality must always be maintained

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2
Q

What are the categories of acid/base disturbances?

A

-metabolic acidosis/ low HCO3-
-metabolic alkalosis/ high HCO3-
-respiratory acidosis/ high pCO2
-respiratory alkalosis/ low pCO2

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3
Q

What is a primary acid/base disturbance?

A

pathophysiologic state causing alkalosis or acidosis

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4
Q

What is a compensatory acid/base disturbance?

A

-body’s response to a primary acid/base disturbance
-goal is to keep pH as close to normal as possible
-usually the opposite of the primary disturbance

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5
Q

What is a mixed acid/base disturbance?

A

more than one primary disturbance at the same time

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6
Q

What are the compensatory mechanisms for each acid/base disturbance?

A

-metabolic acidosis <-> respiratory alkalosis
-metabolic alkalosis <-> respiratory acidosis

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7
Q

What are the characteristics of respiratory compensation?

A

-in response to primary metabolic disturbance
-change in resp. rate or volume results in change in pCO2
-starts within minutes

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8
Q

What are the characteristics of metabolic compensation?

A

-in response to primary respiratory disturbance
-kidney adjusts H+ and HCO3- secretion/resorption
-may take several days

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9
Q

What are the key points about compensation?

A

-does not bring pH back to completely normal
-aims to return blood pH as close to normal as possible during mixed disturbances

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10
Q

What are the cations of importance?

A

-sodium
-potassium

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11
Q

What are the anions of importance?

A

chloride
-bicarb.

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12
Q

What are the characteristics of neutrality?

A

-cations must equal anions
-gain of a cation requires either gain of an anion or loss of a different cation

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13
Q

Which hormones impact sodium conc.?

A

-ADH
-aldosterone

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14
Q

What are the effects of aldosterone?

A

-resorption of 3Na+ and 1Cl- in exchange for the secretion of 2K+
-overall increase in Na+ concentration

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15
Q

What are the effects of ADH?

A

-resorption of water
-overall decrease in Na+ conc. due to dilution

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16
Q

How are changes in sodium conc. interpreted?

A

in conjunction with body water

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17
Q

What can lead to hypernatremia?

A

-decreased water intake (dehydration)
-loss of water that is greater than loss of sodium (ADH issue)

18
Q

What can lead to hyponatremia?

A

-increased total body water (edema)
-loss of sodium that is greater than loss of water (hypoadrenocorticism)

19
Q

What are the characteristics of Cl- changes in response to Na+ changes?

A

-Cl- moves with Na+ to maintain neutrality
-change in Cl- is proportional to Na+

20
Q

What are the characteristics of Cl- changes in response to acid-base status?

A

-Cl- can exchange for HCO3- to maintain electroneutrality
-change in Cl- is NOT proportional to Na+

21
Q

What are the causes of hyperchloremia?

A

-processes that lead to increased Na+ (inc. Cl- and Na+)
-metabolic acidosis (inc. Cl-, dec. HCO3-)

22
Q

What are the causes of hypochloremia?

A

-processes that lead to decreased Na+ (dec. Cl- and Na+)
-metabolic alkalosis (inc. HCO3-, dec. Cl-)

23
Q

What are the factors affecting blood levels of K+?

A

-degree of renal excretion
-translocation
-GI losses
-intake

24
Q

What can cause hyperkalemia?

A

-decreased renal excretion
–dec. urine production
–hypoadrenocorticism
-ICF to ECF
–metabolic acidosis
-artifact in large animals

25
Q

What can cause hypokalemia?

A

-increased renal loss
–polyuria
-ECF to ICF
–metabolic alkalosis
-increased GI loss
–diarrhea
-decreased intake

26
Q

What are the characteristics of bicarbonate?

A

-major body buffer
-produced by cells with carbonic anhydrase
-total CO2 is about equal to HCO3- conc.

27
Q

What is the equation for bicarb. formation?

A

H2O + CO2 <> H2CO3 <> H+ + HCO3-

28
Q

What are the unmeasured cations included in anion gap?

A

-H+
-calcium
-magnesium
-immunoglobulins

29
Q

What are the unmeasured anions included in anion gap?

A

-albumin
-lactate
-phosphates and sulfates
-ketones
-ethylene glycol metabolites

30
Q

What are the two equations for anion gap?

A

-AG = UA - UC: how AG is interpreted
-AG = (Na+ + K+) - (Cl- + HCO3-): how AG is calculated

31
Q

What causes increased anion gap?

A

-increased unmeasured anions
-decreased unmeasured cations

32
Q

What causes decreased anion gap?

A

-decreased unmeasured anions
-increased unmeasured cations

33
Q

What is the most common cause of an abnormal anion gap?

A

increased unmeasured anions

34
Q

What are the differentials for increased unmeasured anions and thus increased anion gap?

A

-lactic acidosis
-renal acidosis
-ketoacidosis
-ethylene glycol toxicosis

35
Q

What are the analytes for blood gas analysis?

A

-blood pH
-pCO2
-HCO3-
-base excess
-pO2

36
Q

What are the characteristics of blood gas sample collection?

A

-stringent
-need special heparinized syringe
-protect sample from air
-analyze promptly

37
Q

What are the characteristics of pH?

A

-tightly regulated
-buffer systems include carbonic anhydrase and hemoglobin

38
Q

What are the characteristics of acidemia?

A

-blood pH below ref. interval
-at least one primary acidosis is present
-every acidosis in the patient is primary

39
Q

What is acidosis?

A

process promoting acidemia

40
Q

What are the characteristics of alkalemia?

A

-blood pH above ref. interval
-at least one primary alkalosis is present
-every alkalosis in the patient is primary

41
Q

What is alkalosis?

A

process promoting alkalemia

42
Q

What are the characteristics of pCO2?

A

-proportional to dissolved CO2 in blood
-acts as a respiratory acid
-measurement on blood gas is the only way we can evaluate the resp. component of acid/base

FA2 Clinical Pathology (21 decks)

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