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Advanced Pathophysiology > Quiz1 Fluid Electrolytes & Acid Base > Flashcards

Quiz1 Fluid Electrolytes & Acid Base Flashcards

1
Q

Functions of body fluid

A

​

  • Surrounds and permeates the cells
  • Lubricate and solvent for metabolic chemical reactions
  • Transport oxygen, nutrients, chemical messengers, and waste products to their destinations
  • Important in regulating body temperature
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2
Q
A
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3
Q

Percentage of body weight for an infant in fluid?

A

75%

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4
Q

Percentage of body fluid for Woman vs. Man

A

Men 60%

Women 50%

different based on body mass

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5
Q

Fluid intake is triggered by thirst is controlled by:

A

ECF osmolality (concentration)

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6
Q

Where does fluid absorption take place?

A

Small bowel

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7
Q

What are the two major fluid compartments?

A
  1. ECF - Extra Cellular Fluid
  2. Intracellular Fluid
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8
Q

ECF

Extra Cellular Fluid

A
  • Fluid outside the cell
  • 1/3 body fluid in adults
  • Infants have more ECF as compared to ICF
  • (Infants are EXTRA)
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9
Q

ICF

Intracellular Fluid

A
  • Inside the cell
  • 2/3 body fluid in adults
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10
Q

How does fluid distribution occur between interstitial and intracellular

A

Occurs by osmosis

Cell membranes are permeable to water but not electrolytes

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11
Q

Water goes to

A

The area of higher osmolality (concentration

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12
Q

Where is fluid excreted?

A
  • Urinary tract (largest volume excreated)
  • Bowels (inc. w/diarrhea)​
  • Lungs (exhalation)
  • Skin (visible swear, insensible perspiration)
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13
Q

How does the movement of fluid take place from interstitial space to vascular space?

A

Osmotic pressure

&

Hydrostatic Pressure

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14
Q

Osmotic Pressure

A

inward- pulling force into the vascular space

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15
Q

Hydrostatic pressure

A

Outward push of fluid into the interstitial space

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16
Q

Occurs when particle concentration (Osmolality) of the interstitial fluid becomes higher than the particle concentration inside cells

A

Water moves out of the cells

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17
Q

Occurs when the osmolality of the interstitial fluid becomes lower than the osmolality of the intracellular fluid

A

Water movement into the cells

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18
Q

What controls the amount of fluid excreted in the urine:

A
  • Antidiuretic Hormone (ADH)
  • Aldosterone
  • Natriuretic peptides (ANP & BNP)
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19
Q

ADH

Antidiuretic Hormone

A
  • Released from the posterior pituitary gland
  • Controls reabsorption of H20
  • Changes fluid reabsorption or excretion
  • Concentrates or dilutes the urine
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20
Q

Increased release of ADH

A
  1. Increased osmolality - high concentration of ECF - less vascular volume
  2. Results in decreased and concentrated urine and increased diluted vascular compartment
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21
Q

Decreased release of ADH

A
  1. Decreased osmolality (low concentration) of ECF
  2. Causes a diluted large urine volume
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22
Q

Aldosterone

A
  • Secreted by cells in the adrenal cortex
  • The release is stimulated by decreased blood volume
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23
Q

The stimulus for the release of Aldosterone

A
  • Decreased blood volume
  • Angiotensin II from the renin-angiotensin system stimulates the release
  • Increased concentration of potassium ions in the plasma
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24
Q

Aldosterone causes renal tubules to reabsorb

_____ & _____

A

Sodium & Water

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25
Q

ADH is the ____ _____ hormone and _____ body fluids

A

ADH is the tap water hormone and dilutes body fluids

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26
Q

Aldosterone is the _____ hormone. It _____ ECF

A

Aldosterone is the saltwater hormone and expands ECF

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27
Q

A-type Natriuretic Peptide (ANP)

A

Normally secreted from cells in the heart when the atria are stretched

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28
Q

B-type natriuretic peptides (BNP)

A

Released from ventricular cells when ventricular diastolic pressure increases abnormally, as in heart failure.

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29
Q

Natriuetic peptides ____ urine sodium excreation and _____ Aldosterone

A

Natriuretic peptides increase urine sodium excretion and oppose Aldosterone

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30
Q

Infant Variations in Fluid Balance

A
  • Glomerular filtrate is lower than in adults
  • Kidneys have limited ability to concentrate urine = unable to excrete large loads of urine effectively or conserve fluids when needed
  • Focus on tension of fontanelles
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31
Q

Geriatric variations of fluid and electrolyte balance

A
  • Decreased GFR
  • Kidneys less able to concentrate urine = less able to conserve fluid when needed - contributes to nocturia
  • Reduced thirst response may lead to dehydration
    *
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32
Q

Transcellular Fluids

A

In body compartments ( peritoneal cavity, joint spaces, CSF)

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33
Q

Cations +++++++

A

Positive charge

  • Sodium (Na+)
  • Potassium (K+)
  • Calcium (Ca++)
  • Magnesium (Mg++)
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34
Q

Anion ———-

A

Negative charge

  • ​Chloride (CL-)
  • Bicarb (HC03-)
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35
Q

Sodium, Chloride, and Bicarb control osmotic pressure in the

A

ECF

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36
Q

Potassium, ATP, and Phosphate control osmotic pressure in the

A

ICF

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37
Q

Controls colloid osmotic pressure also known as oncotic pressure

A

Albumin

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38
Q

_____ have high hydrostatic pressure to push into interstitial space and cells

A

Arterioles

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39
Q

_____ have high _____ pressure to pull fluid from the interstitial space back into capillaries

A

Venules have high oncotic pressure to pull fluid from the interstitial space back into capillaries

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40
Q

Isotonic fluid

A

Concentration equal to vascular compartment so fluid shifts into cells

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41
Q

Hypotonic fluids

A

Lower concentration than vascular compartment so fluid shifts into cells

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42
Q

Hypertonic fluids

A

Higher concentration than vascular compartment so fluid shifts from cells into the vascular space

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43
Q

Hypovolemia

Hypervolemia

A

Hypovolemia - decreased intravascular volume

Hypervolemia - increased intravascular volume

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44
Q

Clinical manifestations of fluid and electrolyte imbalances

Fluid Excess

A

Often a problem with fluid distribution, not overload.

Edema - hydrostatic forces greater than osmotic (push vs pull)

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45
Q

Clinical Manifestations of Fluid Excess

A
  • Edema
  • Dyspnea
  • Bounding pulse, tachycardia, hypertension
  • Jugular vein distension
  • Bulging fontanelles
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46
Q

Water intoxication

A

Fluid excess in the intracellular space

Ingesting water faster than it’s eliminated

Kidney excretion abilities

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47
Q

Fluid deficit

A
  • Decreased skin turgor
  • Dry MM
  • Postural blood pressure with tachycardia
  • Flat neck veins
  • Lightheadedness
  • Dizzyness & Syncope
  • Oliguria or small volume of concentrated urine
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48
Q

Most common issue with fluid deficit

A

Too little sodium with inability to retain water

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49
Q

Sodium

Na+

A

Serum Sodium 135 - 145

  • most significant cation
  • most electrolyte in ECF
  • controls serum osmolality and water balance
  • helps maintain acid/base balance when combined with bicarb
  • regulated by kidneys and the SNS (Aldestrone and RAAS)
  • Sodium Potassium pump for transport across cell membrane
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50
Q

Hyponatremia

A

< 135

  • Lethargy, HA, confusion, irritability, seizures, and coma
  • Imbalance and dizziness in elderly
  • Caused by - inadequate dietary intake, diuretics
  • Management focused on treating underlying cause
51
Q

Hypernatermia

A

​> 145

  • Lethargy, HA, confusion, irritability, seizures, coma
  • caused by excessive dietary intake and hyperaldosteronism
52
Q

Chloride

(CL-)

A

98 -108

Mineral electrolyte

Extracellular anion

53
Q

Potassium

(K+)

A

3.5 - 5

  • Primary intracellular cation
  • Electrical conduction, acid-base balance, metabolism
  • Excreted by kidneys
54
Q

Hyperkalemia

A

>5

  • Muscle & cardiac excitability - increased DTR’s and cardiac arrhythmias
  • Caused from: Renal failure, medication (K sparing diuretics, ACE inhibitors, ARBs
  • Salt substitutes
  • Diabetic keto acidosis
55
Q

Hypokalemia

A

<3.5

  • ​Results in cardiac and muscle depression - decreased DTR’s and cardiac arrhythmias
  • Caused from: Thiazide and loop diuretics
  • Vomiting and diarrhea
  • Malnutrition and alchololism
56
Q

Calcium

Ca++

A
  1. 8 - 10.3 (measures all Ca bound and unbound)
  2. 5 - 5.5 Ionized (unbound)

Requires Vit D for absorption

Binds with Vitamin Kin the bone

Inverse relationship with Phosphorus

57
Q

3 forms of Calcium

A
  1. Bound to plasma proteins (albumin)
  2. Bound to small organic ions (citrate)
  3. Unbound
58
Q

Hypercalcemia

Causes

A
  1. Increase Ca intake
  2. Hyperparathyroidism, bone tumors
  3. Thiazide diuretics cause decreaesd excretion
59
Q

Hypercalcemia

Clinical Manifestations

A
  • Decreased neuromuscular excitability
  • Muscle weakness, diminished reflexes, cardiac dysrhythmias
  • anorexia, emesis, fatigue
  • Constipation
  • Ha, confusion, lethargy
  • Renal calculi
  • Pathologic fractures
60
Q

Hypocalcemia

Causes

A

​

  • Poor diet (lack of Vit D)
  • Decreased physiologic availability of calcium due to hypoparathyroidism
  • Increased calcium excretion (steatorrhea & pancreatitis)
61
Q

Hypocalcemia

Clinical Manifestations

A

Hyperexcitability of neuromuscular cells

Paresthesias, muscle twitching, and cramping

Hyperactive reflexes: carpal spasam (Trousseau sign)

Facial spasm (Chvoslak sign)

Tetany

Seizures

Cardiac dysrhythmias - Prolonged QT interval

62
Q

Phosphorus

(P)

A

2.5 - 4.5

Bone and tooth mineralization

Cellular metabolism

Acid-base balance

Cell membrane formation

Regulated by urine excretion

Inverse relationship with calcium

63
Q

Hyperphosphatemia

Causes:

A

<2.5

Renal failure

Hypocalcemia

Hypoparathyroidism

Metabolic acidosis

Clinical manifestations similar to Hypocalcemia

64
Q

Hyperphosphatemia

Causes:

A

> 4.5

Hyperparathyroidism

Hypercalcemia

Vitamin D deficiency

Alcoholism

Metabolic alkalosis

Clinical manifestations similar to hypercalcemia

65
Q

Magnesium

Mg++

A

1.8 - 3

Intracellular cation mostly stored in bone and muscle

Bound to protein in the vascular system

Functions: muscle and nerve fx, cardiac rhythm

Excretion through renal system

Direct relationship with Ca

66
Q

Hypermagnesemia

Causes

A

>3

Renal failure

Magnesium laxatives

Hypocalcemia

67
Q

Hypermagnesemia

Clinical Manifestations

A
  • Decreased neuromuscular and cardiovascular system effects

Decreased DTRs and Shortened QT interval, bradycardia

68
Q

Hypomagnesemia

Causes

A

>3

Alcoholism or malnutrition

Diuretics

Diarrhea

Hypocalcemia

69
Q

Hypomagnesemia

Clinical Manifestations

A

Increased neuromuscular and cardiovascular system affects

Increased DTRs , tremors, muscle cramps

QRS widening

70
Q

Bicarbonate-carbonic acid system

A

Most significant buffering mechanism

Process of the lungs and kidneys working together

71
Q

Bicarbonate Buffer System

A

Most important buffer in the ECF

Primary defense against acid-base disorders

72
Q

Components of the Barbconate Buffer System

A

Base: bicarbonate ions (HCO3-)

Weak acid: carbonate acid (H2CO3)

20:1 ratio of bicarbonate ions to carbonic acid necessary for a normal pH

73
Q

Functions of Bicarbonic Buffer System

Too much acid

A

Bicarbonate (HCO3-) ions take up hydrogen ions (H+) released by the acid; become carbonic acid (H2CO3)

CARBONIC ACID RELEASED AS CARBON DIOXIDE THROUGH THE LUNGS

74
Q

Bicarbonate Buffer System

Functions: Too little acid (alkaline)

A

Bicarbonate buffer releases hydrogen ions from the weak acid to decrease pH

75
Q

Respiratory Contribution

A

Second defense against acid-base disorders

76
Q

What is the respiratory contribution in maintaining acid/base balance?

A

The lungs excrete CO2 and Water (H20) from the body

Rid the body of carbonic acid (H2CO3)

Excessive carbonic acid accumulation increases the rate and depth of respiration to remove carbonic acid (hyperventilation - decreases acidity)

Insufficient carbonic acid decreases the respiratory rate and depth to allow carbonic acid to accumulate

(hypoventilation - increase acidity)

77
Q

Respiratory Compensation

A

Respiratory response to an imbalance of any metabolic acid (except carbonic acid)

78
Q

What is the Respiratory compensatory response to a acid/base disorder

A

Does not correct a pH disorder (have to find out underlying issue)

Does compensate for it by adjusting the pH back toward normal

79
Q

Renal Contribution

3rd system

A

Third defense against acid/base disorder

Can excrete any acid from the body except CARBONIC ACID (carbonic acid can only be excreted by the lungs)

Slowest mechanism to react to changes but last the longest

80
Q

Only system for removing hydrogen (acid) ions​

A

Renal system

81
Q

Urinary buffers necessary to eliminate hydrogen

A

Phosphate and ammnonia

82
Q

Hydrogen is:

A

an acid

83
Q

Increased excretion of hydrogen results in an increased production of ammonia, what happens next?

A

Hydrogen combines with ammonia and is excreted in the urine which raises the pH (alkaline)

84
Q

A decreased excretion of hydrogen results in a decreased production of ammonia, what happens next?

A

Excrete less H; reasorb hydrogen back into the blood lowering the pH (acidic)

85
Q

HCO3

A

Bicarb

(reflects the amount of metabolic acid in the blood)

86
Q

Decreased HCO3-

A

Indicates a excess of metabolic acids in the blood

87
Q

Increased HCO3

(Bicarb)

A

Indicates a deficit of metabolic acids in the blood

(less acids to buffer so you have an excess of base)

88
Q

Renal response is for

A

Carbonic Acid imbalances

(Respiratory Problems)

89
Q

When you have a high carbonic acid level the body…

A

Increases the excretion of metabolic acids and H (raise the pH)

Retain HCO3 (Bicarb)

90
Q
A
91
Q

When you have a low carbonic acid level (alkaline) to compensate your body…..

A

Decreases the excretion (retain) metabolic acids and Hydrogen (H+) (lower pH)

Excrete HCO3 (Bicarb)

92
Q

Respiratory takes care of carbonic acid by

A

Blowing it off or saving it by adjusting your pH

93
Q

Respiratory can only take care of carbonic acid by

A

Blowing off or saving to adjust pH

94
Q

Kidneys can only control

A

H+ (hydrogen)

and

HCO3 (bicarb)

95
Q

Metabolic Acidosis

A

Deficiency of bicarbonate or excess of hydrogen

pH <7.35

96
Q

Metabolic Acidosis

Causes:

A
  • ketoacidosis
  • starvation
  • diabetes
  • alcoholism
  • severe hyperthyroidism
  • burns
  • circulatory shock
  • oliguric renal failure
97
Q

Metabolic Acidosis is caused by:

A

Anything that causes a decrease or removal in bicarbonate (base)

Examples: Diarrhea, Gastrointestinal fistula

98
Q

Clinical manifestations of Metabolic Acidosis

A
  • HA
  • confusion, lethargy, stupor, coma
  • Severe metabolic acidosis:
  • tachycardia
  • ventricular dysrhythmias (from myocardial intracellular acidity)
  • decreased cardiac contractility
  • death from brainstem dysfunction usually occurs in pH falls below 6.8
99
Q

Three major mechanisms that regulate acid-base status of the body

A
  1. Buffers
  2. Respiratory System
  3. Renal System
100
Q

Arterial blood gas (ABG) measures acid-base status

A

in the ECF

101
Q

Normal Range for;

PaCO2

The partial pressure of carbon dioxide

A

35-45

Respiratory Function

102
Q

HCO3

Bicarbonate

Normal Range

A

22 - 26

Renal (metabolic) function

103
Q

pH does not tell us what’s going on _____ because we are measuring ______ _______

A

pH does not tell us what’s going on inside the cell because we are measuring extracellular fluids (ECF)

104
Q

What is the difference between compensated vs uncompensated

Acidosis or Alkalosis?

A

Has the other system kicked in the help

105
Q

Metabolic Alkalosis

A

pH >7.45

106
Q

Causes of Metabolic Acidosis

A

Increase in base

  • Antacids (Baking soda)
  • Transfusion with citrated blood
  • LR infusion

Decrease in acid

  • Emesis or gastric sx
  • Hyperaldosteronism - excretes H+
  • Hypokalemia - causes H+ to shift into cells
  • Excessive diuretics cause H+ loss
107
Q

Metabolic Alkalosis

Clinical Manifestations

A

Postural hypotension

Hypokalemia - bilateral muscle weakness

Cardiac dysrhythmias

Increased neuromuscular excitability - Paraesthesia of fingers & toes, tetany - seizures, ionized hypocalcemia

Severe metabolic alkalosis - central nervous system depression; confusion, lethargy, coma, death usually occurs if pH rises to 7.8

108
Q

Respiratory Acidosis

Causes

A

Any condition that causes an excess of carbonic acid (retain CO2)

Caused by impaired removal of carbonic acid by the lungs - impaired gas exchange

  • COPD
  • Pneumonia
  • Severe Asthma
  • Pulmonary edema
  • Drug overdose - Anesthesia
  • Acute respiratory distress syndrome
109
Q

Respiratory Acidosis

Clinical Manifestations

A

Headache

Tachycardia

Cardiac dysrhythmias

Neurologic abnormalities - blurred vision, tremors, vertigo, disorientation, lethargy, somnolence

Severe respiratory acidosis - peripheral vasodilation with hypotension

110
Q

Respiratory Alkalosis

Causes:

A

Any condition that tends to cause a carbonic acid deficit (decreased CO2)

  • Hyperventilation
  • Hypoxemia
  • Acute pain
  • Fever
  • Anxiety, psychological distress
111
Q

Respiratory Alkalosis

Clinical Manifestations

A

Dizziness

Syncope

Confusion

Paresthesia

Twitching

Tetany

Seizures

112
Q

When interpreting ABG’s in what order do you access the lab values

A

1st check the pH for Acidosis <7.35 or Alkalosis >7.45

2nd check the PaCO2 for Acidosis or Alkalosis

3rd Examine the HCO3 for Acidosis or Alkalosis

If pH is low or high you will know if it is acidosis or alkalosis if the PaCO2 is abnormal it will be respiratory if the HCO3 is abnormal it will be metabolic

when one is abnormal the other is still normal it is because it is UNCOMPENSATED

113
Q

Geriatric Variations

A

At risk for respiratory acidosis b/c drugs (Barbiturates) build up in system (increased half-life)

At risk for metabolic acidosis: kidneys less able to excrete large acid load, chronic laxative overuse that results in chronic diarrhea, use a lot of homemade remedies for reflux

114
Q

John is a 54 yo male seen in the ER due to sign pain form an ankle fx. He is SOB.

ABGs show

pH 7.48 PaCO2 32 HCO3 25

What acid/base abnormality does he have?

  1. Respiratory Acidosis - compensated
  2. Respiratory Alkalosis - compensated
  3. Respiratory Acidosis - uncompensated
  4. Respiratory Alkalosis - uncompensated
A
  1. Respiratory Alkalosis - uncompensated
115
Q

Mary is a 55 yo female who presents to the office with c/o headache and diarrhea for 2 days. She admits to using a colon cleanse to lose weight while dieting.

ABGs show:

pH 7.33 PaCO2 40 HCO3 - 20

  1. Metabolic alkalosis - compensated
  2. Metabolic acidosis - compensated
  3. Metabolic alkalosis - uncompensated
  4. Metabolic acidosis - uncompensated
A
  1. Metabolic acidosis - uncompensated
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Advanced Pathophysiology (8 decks)

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