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Patho Pharm > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

What is total body water?

A

Sume of fluids within all body compartments

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2
Q

Difference between intra/extracellular fluids

A

intra: fluid within the cell

extra: interstitial and intravascular fluid

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3
Q

Name some specific types of fluids in the body

A

lymph, synovial, cerebrospinal, urine, pleural, pericardial

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4
Q

What percentage of water in pediatric patients?

A

Pediatric water is 75-80% of body weight. They are susceptible to significant changes in body fluids quickly. Newborns can become dehydrated quickly.

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5
Q

How does aging affect the distribution of body fluids?

A

Decreased percent of total body water

decreased muscle mass, decreased free fat mass

renal decline

They do not have an ideal sense of thirst perception.

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6
Q

Describe the four ways water moves between fluid compartments

A

Hydrostatic pressure: pushing force exerted by the water in bloodstream. Pressure pushes water put of the intravascular space PUSH

Osmotic pressure: solutes pull water into the blood stream PULL electrolytes

Oncotic pressure: (colloidal) albumin exerts pressure on vasculature and pushes water out of blood stream

Aquaporins: water channel proteins

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7
Q

What are the two main processes for the movement of fluids?

A

Filtration: Capillary hydrostatic pressure (PUSH) (blood pressure, caused by force of cardiac contraction, pushes water out of capillary), interstitial oncotic pressure (protiens/salt pushes only a little out)

Reabsorption: Oncotic pressure caused by plasma proteins and salt (PULL) interstitial oncotic pressure pushes a little back in (need more electrolytes)

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8
Q

Define edema

A

accumulation of fluid in the interstitial space. Caused by leaky capillaries, decreased capillary oncotic pressure, lymphatic obstruction

dependent edema is from gravity.

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9
Q

Describe the importance of the sodium/chloride balance

A

Na+ cation most important extracellular fluid cation. Regulates osmotic forces, neuromuscular function, acid base balance, chemicals reactions, and membrane transport.

Cl- is negatively charged primary extracellular fluid anion. It provides electroneutrality to sodium.

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10
Q

Describe how salt and water imbalances can affect the body

A

Salt and water are often lost together. ADH (from the hypothalamus pit gland) regulates when to get rid of water.

Sodium is regulated by aldosterone (adrenal cortex released).

The RAAS system (renin-angiotensin-aldosterone system)is a hormone system that regulates blood pressure, fluid and electrolyte balance, and systemic vascular resistance

Natriuretic hormones (from cardiac monocytes)Natriuretic peptides act as endocrine and paracrine hormones to regulate extracellular fluid volume and blood pressure at all levels of the circulation. Atrial and brain natriuretic peptides, circulating hormones secreted in response to increased stretch within the cardiac atrium and ventricle, respectively, induce comparable natriuresis, vasodepression, and inhibition of aldosterone

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11
Q

What increases ADH secretion?

A

thirst perception

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12
Q

Describe the physiological process of RAAS

A
  1. liver secretes angiotensin into the blood
  2. The juxta glomerulus in the kidneys release renin into the blood when it senses low BP, low ECF, low blood sodium, and high urine sodium. Renin turns it into angiotensin 1
  3. The lungs release an angiotensin converting enzyme into the blood which turns angiotensin 1 into angiotensin 2.
  4. Angiotensin 2 causes vasocontraction (increase BP) and also enters the adrenal cortex to be turned into aldosterone.
  5. Aldosterone travels back to the kidney through the blood and increases sodium/water retention which increases extracellular fluid. This increases the BP even further
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13
Q

Summarize the function of a natriuretic hormone

A

Protect cardiovascular system from volume overload due to excessive sodium and water retention. It increases blood volume/pressure by making the kidneys excrete sodium (natriuresis) and water (diuries). Increases vascular permeability and moves fluid to the interstiual space.

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14
Q

What are the two types of natriuretic hormone?

A

Mainly produced by the myocardium (myocytes) of the heart.

Atrial natriuretic hormone.

BNP Brain natriuretic hormone

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15
Q

T/F: Brain natriuretic hormone is produced by the brain

A

False, it was only discovered in the brain. It is produced by the myocytes in the ventricles of the heart.

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16
Q

T/F: Hypovolemia means there is an electrolyte balance in your blood that is causing you to become thirsty, lose weight, and have dry skin.

A

False. Hypovolemia can be isotonic. You don’t have to have high salinity to become dehydrated. You may have isotonic blood with less volume. This happens with sweating and hemorrhage.

If water loss is greater in comparison to sodium loss, then the serum sodium concentration increases, resulting in hypernatremic (or hypertonic) dehydration. This happens when you continue to ingest sodium but do not drink water proportionally.

If water loss is accompanied by excessive sodium loss, then the serum sodium concentration decreases, resulting in hyponatremic (or hypotonic) dehydration. When you hydrate with water but do not ingest sodium proportionally. Happens with marathon runners.

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17
Q

What causes isotonic fluid excess?

A

Excessive IV therapy

Increases in aldosterone (Aldosterone signals certain organs, like your kidneys and colon, to increase the amount of sodium they send into your bloodstream or the amount of potassium released in your urine (pee). Aldosterone’s effect on sodium increase causes your body to retain water in your blood, which increases blood volume.)

Prednisone decreases inflammation via suppression of the migration of polymorphonuclear leukocytes and reversing increased capillary permeability. By decreasing capillary permeability it increases fluid retention.

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18
Q

What are symptoms of isotonic fluid excess?

A

weight gain, increased bp, JVD, crackles in lungs (pulmonary edema/heart failure)

Your liver makes albumin and is responsible for transporting vitamins, enzymes and hormones throughout your body. This becomes diluted with excess fluid in the body.

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19
Q

What is a hyponatremia sodium serum level?

A

Less than 135 mEq/L

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20
Q

What is a hypernatremia sodium serum level?

A

Greater than 145 mEq/L

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21
Q

How does hyperaldosteronism (Cushing disease) cause hypernatremia?

A

Increased aldosterone causes increased sodium reabsorption.

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22
Q

Describe the clinical manifestations of Hypernatremia

A

muscle twitching, hyperactive reflexes, confusion, coma, convulsions, bounding pulses, cerebral hemorrhage.

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23
Q

What can you expect to increase in the blood if bicarbonate is high due to it’s negative charge?

A

Cl- (chloride)

24
Q

How do sodium levels affect chloride levels in the blood?

A

Chloride passively follows sodium unless it is sodium bicarbonate. If there is significant sodium loss, chloride levels usually go down as well.

25
Q

What is the medical Dx for high bicarbonate levels?

A

metabolic alkalosis. Happens with hyponatremia

26
Q

What is the medical Dx for low bicarbonate levels?

A

metabolic acidosis. Happens with hypernatremia

27
Q

Where is K+ (Potassium) located in your body?

A

Intracellular, not extracellular

28
Q

What is the normal range for K+?

A

3.5-5.0 mEq/L

29
Q

How are levels of potassium maintained in the cell?

A

Na+/K+ pump (active transport against a gradient. 3 sodium ions and ATP (ATP releases phosphate that forces protein to change shape) 3 sodium ions leave after shape changes and replaced with 2 K+ ions which forces protein to change shape and expel phosphate. Aft phosphate released the K+ move out. For every 3 sodium 2 potassium.)

30
Q

What cells are most impacted by potassium levels?

A

Cardiac and nerve cells. Primarily maintains acid/base balance in the body. Also necessary to maintain cell membranes which is why its mostly intracellular.

31
Q

What is the major route of K+ excretion?

A

The kidneys

32
Q

When would you see hypokalemia

A

When the kidneys are functioning intensely during major loss of fluids. Ex: Intake of diuretics, vomiting, or diarrheas’. Also if the cells take up most of potassium from intravascular space.

33
Q

Why would cellular trauma cause hyperkalemia?

A

Potassium used to maintain cell membranes are released into the intravascular space because the cell has sustained trauma.

Examples of cellular trauma:
Physical agents of cell injury include mechanical trauma, temperature extremes, radiation, and electric shock. Trauma can damage cells directly (e.g., crushing or tearing), or indirectly by disruption of the blood supply to these cells and tissues. Low-intensity heat can damage blood vessels, accelerate certain cellular reactions, or halt those reactions with temperature-sensitive enzymes. Extreme heat denatures enzymes and other proteins. Cold causes vasoconstriction, limiting the blood supply to cells and tissues; extreme cold literally freezes cells with formation of ice crystals within the cytosol that disrupt cell membranes. Ionizing and ultraviolet radiation are the most important types of radiation causing cellular injury. Ionizing radiation, with its frequencies above the ultraviolet range, ionizes atoms or molecules, which then cause direct cell membrane or organelle damage or the production of free radicals that react with other cellular components, especially DNA. Ionizing radiation injury is a localized side effect of radiation therapy for cancer. Ultraviolet (frequencies just above that of visible light) radiation injury develops from exposure of sparsely haired and lightly pigmented skin (or other minimally pigmented tissues, such as the conjunctiva) to sunlight. Ultraviolet radiation can disrupt cellular bonds with the formation of reactive oxygen species (ROS). It also damages DNA, mainly through the formation of pyrimidine dimers. Electrical currents generate heat as they pass through tissues (e.g., skin, with high resistance), which can result in burns. Once the current enters the body, it is conducted through tissues of least resistance, especially the nervous system, where disruption of impulses in brainstem respiratory centers, the cardiac conduction system, or neuromuscular junctions results in indirect injury to cells and tissues.

34
Q

What is the normal PH for the body?

A

7.35-7.45

35
Q

How are acids produced to maintain our PH balance?

A

Produced during metabolism of proteins and fats and carbs. Acids are excreted through the lungs and kidneys.

36
Q

What is PH?

A

The negative logarithm of H plus concentration. If you have more H+ ions, the PH is low which is acidic. If PH is high its alkaline.

37
Q

If PH is low it is…

A

acidic

38
Q

If PH is high its…

A

alkaline

39
Q

What are the two forms on acids?

A

Volatile (easily eliminated as a gas via the lungs, CO2) and nonvolatile (eliminated by the kidneys Bicarb and hydrogen ions)

40
Q

Define a buffer

A

a chemical that can bind to either H+ or H-, but in the process it does not change the PH very much.

41
Q

Describe the most important plasma buffering system, the carbonic bicarbonate pair

A

Operate in the lungs AND kidneys.

Bicarb combines with hydrogen ions to form Carbonic acid (CO2 and water) can be manipulated in the lungs/kidneys so that water releases more CO2 from water or we combine more CO2 with water so it stays in us and can be turned back into bicarb/H ions

42
Q

How do proteins serve as a buffer?

A

Proteins are negatively charged. They can join with H+ through an intracellular process. An example if hemoglobin.

43
Q

How does the renal buffering system work?

A

Kidneys secrete H+ into the urine if acidotic. If it needs acid, (we don’t absorb bicarb, only CO2 so) it will reabsorb HCO3 (bicarb) back into the blood by taking water and CO2 from the urine, absorb the CO2, and use and enzyme (carbonic anhydrase) to remake it into hydrogen and bicarbonate.

You can also sneak bicarb back in by combining it with ammonia or phosphate.

Overall there’s less H+ and more bicarb.

44
Q

How does the lungs vs. the kidneys maintain PH balance?

A

Lungs=respritory alterations affected by carbon dioxide levels in blood. H+ ions = acidic = more carbonic acid to breath out.

Kidneys=metabolic alterations affected by bicarbonate levels in blood. HCO3 = basic = less K+ spasming confusion

45
Q

Difference in symptoms between respiratory acidosis and respiratory alkalosis

A

R Acidosis: elevation of pCO2 (cause ph to go down, increasing bicarb as well through renal compensation only as little at first (1 bicarb per 10 PCO2) and more as condition continues(3 bicarb per 10 PCO2), ventilation depression

R alkalosis: depression of pCO2 results from hyperventilation so PH goes up and kidneys compensate by causing bicarb excretion (acute compensations 2 bicarb every 10 PCO2, chronic compensation 4 bicarb every 10 PCO2)

46
Q

What is the mnemonic to remember the relation to PH, CO2, and whether its resp/meta alk/acidosis.

A

PH IS DOWN ITS ACIDOSIS, PH IS UP ITS ALKALOSIS

If the arrow are the same its METABOLIC. Example: PH DOWN CO2 DOWN, PH UP CO2 UP

If the arrows are different its RESPRITORY. Example: PH DOWN CO2 UP, PH UP CO2 DOWN

47
Q

T/F: The lungs and kidneys can work overtime to compensate for the others inability to offload acid

A

Yes, although the lungs can compensate within minute whereas the kidneys don’t show signs of compensating for hours, or days.

48
Q

The accumulation of lactic acid and ketoacidosis would be an example of respiratory acidosis or metabolic acidosis?

A

Metabolic because it covers all acids besides CO2.

Can also be caused by loss of bicarb from diarhea

49
Q

When we measure PH are we measuring the PH of:

  1. Total blood
  2. Extracellular fluid
  3. Intracellular fluid
A
  1. Extracellular fluid/plasma
50
Q

Describe the physiology behind the lungs compensating for metabolic acidosis/alkalosis

A

m acidosis: hyperventilate

m alkalosis: hyperventilate

51
Q

Describe the physiology behind the lungs compensating for respiratory acidosis/alkalosis

A

r acidosis: kidneys cause HCO3 retention

r alkalosis: kidneys cause HCO3 excretion

52
Q

What PaCO2 and HCO3 levels indicate alkalemia?

A

PaCO2 less than 38mmHg

HCO3 greayer than 40mmHg

53
Q

What PaCO2 and HCO3 levels indicate acidemia?

A

PaCO2 greayer than 44mmHg

HCO3 less than 32mmHg

54
Q

What would you use lactated ringers/normal saline w/ potassium chloride for to stabilize PH

A

LR is an alkalizing agent that can be used to provide bicarb when pt is acidotic. It gets metabolized into water and CO2. In order to do that it uses H+.

NS w/ KCl. K throws out H+ from the cell making the surrounding plasma more alkaline in nature, while also preventing hypokalemia.

55
Q

Why would you lose metabolic acid?

A

Upper GI losses, H+ moving into the cell, accumlation of bicarb.

56
Q

Why would a respiratory acidosis patient be hypo ventilating?

A

If the body is unable to throw out CO2, after a while the patient will become respiratory depressed and you will have to mechanically ventilate the patient.

57
Q

How does breathing into a paper bag help with hyperventilation?

A

You rebreathe the CO2 you expelled so you don’t become alkalotic

Patho Pharm (15 decks)

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