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CSB336 > Metabolic system > Flashcards

Metabolic system Flashcards

1
Q

What is the total body water of an average 60 year old male?

A

45%

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2
Q

What is the serum K value range of moderate hyperkalaemia?

A

6.1 to 6.9mmol/L

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3
Q

What is osmosis?

A

Spontaneous net movement of a solvent from a low concentration through a semi-permeable membrane to a higher solute concentration

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4
Q

What other stimuli besides increased plasma osmolarity can activate RAAS?

A

Stimulation of the sympathetic nervous system Low blood pressure in the kidneys (decreased glomerular filtration rate)

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5
Q

What are isotonic fluids used for?

A

To increase extracellular fluid volume

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6
Q

Is diffusion a spontaneous or activated process?

A

Spontaneous

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7
Q

What are two situations where hypotonic solutions might be used?

A

Diabetic ketoacidosis Hyperosmolar hyperglycaemia

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8
Q

What is metabolic alkalosis? *Note: physiological change*

A

Increased bicarbonate (>26mEq/L) and elevated pH (>7.45)

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9
Q

Name three other isotonic fluids

A

5% dextrose in water (also used as a hypotonic solution but it is considered isotonic) 5% dextrose in 0.225% saline Lactated Ringer’s solution

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10
Q

Neuron function and osmoregulation between cells and ECF are accomplished by what two things?

A

Na/K-ATPase Na/K channels

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11
Q

What are contributing factors to metabolic alkalosis?

A

Bicarbonate accumulation from exogenous sources Renal acid loss

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12
Q

Is the respiratory buffer mechanism fast or slow to respond to pH changes?

A

Fast

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13
Q

Name some examples of hypertonic fluids

A

3% sodium chloride/saline 5% sodium chloride/saline 10% dextrose in water 5% dexrose in 0.9% saline 5% dextrose in 0.45% saline 5% dextrose in Lactated Ringer’s solution 50% dextrose

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14
Q

What are anions?

A

Electrolytes that generate a negative charge

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15
Q

What are some examples of insensible fluid loss?

A

Transepidermal diffusion (sweating) Respiratory evaporative water loss (breathing)

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16
Q

What is the meaning of isotonic fluid?

A

Isotonic fluids have a concentration (tonicity) of dissolved particules equal to that of intracellular fluid

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17
Q

What is the mechanism of altered breathing to counter pH changes called?

A

Respiratory buffer mechanism

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18
Q

What is the osmotic pressure of a solution?

A

The pressure by which water is drawn into it through the semi-permeable membranes

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19
Q

Angiotensin II acts on the ____.

A

Hypothalamus

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20
Q

What is the serum potassium level of hyperkalaemia (general)?

A

>5.5mmol/L

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21
Q

How is metabolic alkalosis managed (general)?

A

Correct depletions Control underlying causes

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22
Q

What are the two roles of the kidneys in maintaining the acid-base balance?

A

Bicarbonate reabsorption and hydrogen excretion

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23
Q

Describe the presentation of hypokalaemia

A

“A SIC WALT” - Alkalosis - Shallow respirations - Irritability, decreased intestinal motility - Confusion - Weakness - Arrhythmia - Lethargy - Thready pulse

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24
Q

What usually causes hyperkalaemia?

A

Reduced renal excretion or the release of potassium from cells

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25
Q

What is the most prevalent metallic ion in ECF?

A

Sodium

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26
Q

What is anion gap used for?

A

Estimation of the unaccounted for anions in the blood in cases of metabolic disturbance

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27
Q

What is the most common isotonic fluid?

A

0.9% sodium chloride (normal saline)

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28
Q

Extracellular fluid contains the…

A

Ions and nutrients needed by the cells to maintain life

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29
Q

What are some causes of resp acidosis?

A

Respiratory depression Malignant hyperthermia Sepsis Liver failure Rebreathing expired gas Insufflation

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30
Q

What are some possible causes of resp alkalosis?

A

Hyperventilation Anxiety Exercise Fever Early sepsis Altitude sickness Pain Pregnancy (normal to a degree) Lung diseases

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31
Q

What do the macula densa cells stimulate?

A

The juxtaglomerular apparatus (JGA)

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32
Q

High plasma osmolarity is often a sign of what?

A

Low blood volume

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33
Q

What are the two likely causes of metabolic alkalosis?

A

Overuse of antacids/some diuretics GIT acid loss

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34
Q

What is the most plentiful chemical buffer in the body?

A

Protein

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35
Q

What is the thirst mechanism that begins in the renal system called?

A

Renin-angiotensin system mediated thirst *Note: also called the renin-angiotensin-aldosterone system (RAAS)*

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36
Q

At what serum level is hypokalaemia considered severe?

A

<2.4mmol/L

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37
Q

What two activities/habits are risk factors for hyponatraemia?

A

Endurance athletes MDMA (methylenedioxymethamphetamine) users

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38
Q

What is resp alkalosis? *Note: physical event and the physiological change*

A

Excessive elimination of CO2; alveolar hyperventilation. Decreased PaCO2 with an increased pH (>7.45)

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39
Q

List four functions of water in the body

A

Medium for metabolic reactions within cells Transporter for nutrients, waste products, and other substances Lubricant One way of regulating and maintaining body temperature

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40
Q

What is the total body water of a premature infant?

A

90%

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41
Q

What is an example cause of chronic/secondary resp acidosis?

A

COPD

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42
Q

Describe the presentation of hyperkalaemia

A

“MURDER” - Muscle cramps/weakness/twitches/paraesthesia - Urine abnormalities - Respiratory distress - Decreased cardiac contractility (hypotension) - ECG changes, palpitations - Reflex changes (lethargy, confusion)

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43
Q

What is the role of the lungs in the bicarbonate buffer system?

A

Regulate carbonic acid production

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44
Q

Carbonic acid results from combining what two substances?

A

Carbon dioxide and water

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45
Q

What are the two types of metabolic alkalosis?

A

Chloride responsive and non-chloride responsive

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46
Q

What other nutrients does extracellular fluid contain?

A

Oxygen Glucose Fatty acids Amino acids

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47
Q

Is the respiratory buffer mechanism a sustainable mx for pH changes?

A

No

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48
Q

What is the role of the bicarbonate buffer system?

A

Decrease the strength of potentially damaging acids and bases (damaging pH changes)

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49
Q

What are other causes of hyperkalaemia?

A

“MACHINE” - Medications (ACE inhibitors, NSAIDS) - Acidosis (metabolic, respiratory) - Cellular destruction (burns, trauma) - Hypoaldosteronism, haemolysis - Intake (excessive) - Nephrons, renal failure - Excretion (impaired)

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50
Q

What is the meaning of hypotonic fluids?

A

Hypotonic fluids have a tonicity less than that of intracellular fluid

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51
Q

What increases the risk of hypernatraemia?

A

Poorly controlled diabetes

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52
Q

Describe the pathophysiology of acute resp acidosis

A

CO2 is continuously produced by cellular respiration and rapidly accumulates if not adequately expelled through alveolar ventilation by the lungs, leading to hypercapnia

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53
Q

The RAAS regulates concentration of which electrolyte in the body?

A

Sodium

54
Q

Bicarbonate (HCO3) buffers which two body fluids?

A

Blood ISF

55
Q

What are cations?

A

Electrolytes that generate a positive charge

56
Q

Do cells expand or contract when blood plasma has a higher contraction?

A

Contract

57
Q

What is the value and physiological description of hypokalaemia?

A

Serum potassium <3.5mmol/L K+ depletion or shift into cells

58
Q

Describe the presentation of acute resp acidosis

A

Confusion Fatigue Lethargy SOB Sweating Tachycardia Miadriasis

59
Q

True or false: water passes freely and rapidly between all intracellular and extracellular compartments in response to solute changes

A

True

60
Q

Where are osmoreceptors primarily found?

A

Hypothalamus

61
Q

RAAS: when the concentration of sodium increases, does the production of renin increase or decrease?

A

Decrease

62
Q

Do cells expand or contract when blood plasma is more dilute?

A

Expand

63
Q

What does angiotensin II stimulation of the hypothalamus trigger?

A

Thirst sensation Vasoconstriction Aldosterone release

64
Q

What is the total body water of a neonate?

A

80%

65
Q

What are some examples of sensible fluid loss?

A

Urine output V+D Haemorrhage

66
Q

What is the role of the kidneys in the bicarbonate buffer system?

A

Regulate bicarbonate production

67
Q

Which are faster to compensate for pH changes, the renal or respiratory buffer system?

A

Respiratory

68
Q

Extracellular fluid contains large amounts of which three ions?

A

Sodium Chloride Bicarbonate

69
Q

What is the effect of carbon dioxide elimination?

A

The more CO2 eliminated the less carbonic acid is made - this causes pH to rise

70
Q

What is the Na/K-ATPase?

A

An active transporter that pumps ions against the gradient

71
Q

What is an osmoreceptor?

A

A sensory receptor that detects changes in osmotic pressure (plasma osmolarity)

72
Q

What is sensible fluid loss?

A

Loss of measurable fluid volumes

73
Q

Describe the osmotic pressure state of isotonic fluid infusion and the effect on cells

A

Osmotic pressure is the same inside and outside the cells, so they neither shrink nor swell with fluid movement

74
Q

Extracellular fluid is mixed with blood and tissue fluids by which mechanism?

A

Diffusion through the capillary walls

75
Q

Movement of fluid between intracellular and extracellular compartments is in response to what?

A

Changes in solutes

76
Q

What are the two types of metabolic acidosis?

A

Anion gap and non-anion gap

77
Q

What does aldosterone do (in general terms)?

A

Increases water reabsorption

78
Q

Where does phosphate (mainly) exist in the body?

A

Renal tubules

79
Q

What is the presentation of hyponatraemia?

A

Lethargy Seizures Coma

80
Q

Intracellular fluid dissolves ____ and ____.

A

Solutes and proteins.

81
Q

True or false: the more concentrated the solution, the weaker the osmotic pressure

A

False

82
Q

Breathing faster or deeper eliminates what from the lungs?

A

Carbon dioxide

83
Q

Intracellular fluid contains large amounts of which three ions?

A

Potassium, magnesium, and phosphate

84
Q

What is the total body water of an obese adult?

A

40-50%

85
Q

Which is the major homeostatic control point for maintaining a stable pH balance?

A

Renal excretion

86
Q

What is the definition of homeostasis?

A

The physiological process by which the internal systems of the body are maintained at equilibrium despite variations in external conditions

87
Q

Names some examples of hypotonic fluids

A

0.45% saline 0.225% saline 0.33% saline

88
Q

What are the osmoreceptors in the walls of the ascending loop of Henle of the nephron called?

A

The macula densa cells

89
Q

Is cellular energy expended in the process of diffusion?

A

No

90
Q

What is metabolic acidosis? *Note: physical event and the physiological change*

A

Increased acid within the body due to excessive production or ineffective elimination of acids Reduced bicarbonate (<22mEq/l) and low pH (<7.35)

91
Q

At what serum K level is hyperkalaemia classified as ‘severe’?

A

>7.0mmol/L

92
Q

What is the overall chemical effect of breathing slower/shallower?

A

pH reduction (becomes more acidic)

93
Q

How do proteins act as a buffer?

A

Binding with and neutralising acids

94
Q

The mechanism of aldosterone’s effect is similar to what hormone?

A

Anti-diuretic hormone (ADH)

95
Q

What is respiratory acidosis? *Note: physical event and the physiological change*

A

Hypoventilation of the alveoli; CO2 retention. Increased PaCO2 with a decreased pH (<7.35)

96
Q

Describe the osmotic pressure state of hypertonic fluid infusion and the effect on cells

A

Osmotic pressure is greater outside the cells so water is drawn out of them, making them shrink

97
Q

What does the JGA do when the macula densa detects high plasma osmolarity?

A

Releases renin into the bloodstream

98
Q

Water will always follow which solute?

A

Sodium

99
Q

Describe the osmotic pressure state of hypotonic fluid infusion and the effect on cells

A

Osmotic pressure is greater inside the cells so water is drawn into them, making them swell which can cause them to burst or lyse.

100
Q

What is angiotensin I converted into?

A

Angiotensin II

101
Q

What is insensible fluid loss?

A

Loss of immeasurable fluid volumes

102
Q

Hypotonic fluids should never be given to patients with any of what three conditions?

A

ICP Extensive burns Trauma (already hypovolaemic)

103
Q

What is diffusion?

A

The tendency of molecules to spread out in order to occupy available space

104
Q

What is hypernatraemia and how does it effect cells?

A

High serum sodium (>150mmol/L) Causes cellular shrinkage, which can cause tearing

105
Q

What is the meaning of hypertonic fluids?

A

Hypertonic fluids have a tonicity greater than that of intracellular fluid

106
Q

Hypokalaemia commonly results from what two causes?

A

Excessive GIT or renal loss

107
Q

What does renin do in the bloodstream?

A

Cleaves angiotensinogen into angiotensinogen I

108
Q

What is hyponatraemia and how does it effect cells?

A

Low serum sodium (<130mmol/L) or excess of body water Expands intracellular volume

109
Q

Carbonic acid rapidly dissociates to form what ion?

A

Bicarbonate

110
Q

What converts angiotensin I to angiotensin II and where in the body does this occur?

A

Angiotensin-converting enzyme (ACE) in the lungs

111
Q

What is the meaning of a higher anion gap measurement?

A

An increase in the percentage of one or more unmeasured anions in the bloodstream

112
Q

What is the term for high serum sodium levels?

A

Hypernatraemia

113
Q

What are the three components of homeostasic maintenance?

A

Receptor, control centre, and effector

114
Q

What is the overall chemical effect of breathing faster/deeper?

A

pH elevation (becomes more alkaline)

115
Q

What occurs when osmoreceptors detect high plasma osmolarity, and what is this mechanism called?

A

They send signals to the hypothalamus which creates the biological sensation of thirst Hypothalamus-mediated thirst

116
Q

True or false: RBCs with H+ acts a buffer

A

True

117
Q

Describe the presentation of resp alkalosis

A

Lip/extremity paraesthesia Carpal/pedal spasm Muscle cramps Dizziness/light-headedness Syncope

118
Q

Molecules in liquid have a tendency to diffuse from a (more/less) concentrated environment to a (more/less) concentrated environment

A

More Less

119
Q

What is a solute?

A

A substance that dissolves (salts is one example)

120
Q

Non-anion gap metabolic acidosis is likely to have one of which three sources?

A

Iatrogenic Renal Gastrointestinal

121
Q

What are the two most important mechanisms sodium is involved in?

A

Neuron function Osmoregulation between cells and extracellular fluid

122
Q

Chemical buffers are present in ____, ____, and ____.

A

Blood ICF ISF

123
Q

True or false: resp acidosis can be chronic or acute

A

True

124
Q

What is the presentation of hypernatraemia?

A

“FRIED SALT” - Flushed - Restless, confused - Increased BP and fluid retention - Edema (oedema *Note: stupid American mnemonics…*) - Decreased urine, dry - Skin (flushed) - Agitation - Low fever - Thirst

125
Q

What is the total body water of an average female?

A

50%

126
Q

True or false: the anions responsible for anion gap metabolic acidosis depend on the cause

A

True

127
Q

What is the total body water of an average male?

A

60%

128
Q

What is the definition of osmotic pressure?

A

The pressure required to maintain an equilibrium, with no net movement of solvent.

129
Q

What is the term for low serum sodium levels?

A

Hyponatraemia

130
Q

What causes renal tubular acidosis?

A

Impaired ability to secrete H+ or absorb HCO3

CSB336 (14 decks)

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