water , PH , electrolytes balance ( rework )

Question 1

Explain the blood ph , df , norm abnormality

Answer 1

-df:The blood pH • The pH of any fluid is the measure of the hydrogen ion (H*) concentration.
-norm : Normal level of the blood pH is 7,37-7,45
-abnormalities:
1-acidosis: 7.2
2-alkalosis : 7,47 and above
3-death : 7.0

Question 2

What ph of blood depends on ?

Answer 2

1) acidic and alkaline foods;
2) metabolism state;
3) pathological factors.

Question 3

Explain the buffer system

Answer 3

• A buffer is a chemical system that prevents a radical change in fluid pH by dampening the change in hydrogen ion concentrations in the case of excess acid or base. Most commonly, the substance that absorbs the ions is either a weak acid, which takes up hydroxyl ions, or a weak base, which takes up hydrogen
ions.

Question 4

Explain the phosphate buffer systems

Answer 4

• Important in intracellular fluid and urine pH regulation
• Consists of two phosphate ions
- Monohydrogenphosphate ions act as a weak base and combine with hydrogen ions to form dihydrogenphosphate
- Dihydrogenphosphate dissociates to release hydrogen ions

Question 5

Explain protein buffer system

Answer 5

• Abundant in intracellular fluids & in plasma
- hemoglobin very good at buffering H+ in RBCs
- albumin is main plasma protein buffer
• Amino acids contains at least one carboxyl group
(-COO) and at least one amino group (-NH2)
- carboxyl group acts like an acid & releases H+
- amino group acts like a base & combines with H+
- some side chains can buffer H+
• Hemoglobin acts as a buffer in blood by picking up Co2 or H+

Question 6

Explain the Acid-base balancing by the kidney

Answer 6

—The response of the kidney to acid-base imbalances is governed by the relative magnitudes of proton secretion and HCO, filtration because these two factors affect the rates of acid and alkall excretion.
+If Pco2 rises, proton secretion becomes dominant and the kidney excretes acid, raising blood ph.
+ If [HCO3] rises, HCO, filtration increases and the kidney excretes alkali, reducing blood pH.

Question 7

Explain the Gastrointestinal tract and liver function in regulation of ph

Answer 7

• 1) Secretion of HCL in stomach;
2) Secretion of NaHCO3 in the intestine;
3) Excretion of acidic and alkaline products with bile.

Question 8

Explain classification of blood ph

Answer 8

-there is 2 classification:

• By type:
1) acidoses are conditions in which hydrogen ions are accumulated in the body and there is a tendency to acidification of the internal environment; there are:
a) respiratory acidosis;
b) metabolic acidosis.
2) alkaloses are conditions in which the level of hydrogen ions in the body is decreased and there is a tendency to alkalization of the internal environment, there are:
• by the degrees:
1- Compensated acidosis and alkalosis (pH-7.37-7.45)
2-• Subcompensated (alkalosis at pH 7.45-7.48; acidosis at pH 7.3-7.37)
3-• Uncompensated (alkalosis, pH > 7.48; acidosis pH<7.3).

Question 9

Explain metabolic acidosis , causes , and diagnostics

Answer 9

-Causes of metabolic acidosis:
• ketoacidosis (an increase in ketone bodies blood level);
• lactic acidosis (increased lactic acid);
• intestinal acidosis (in case of diarrhea);
• glomerular acidosis (with renal failure);
• renal tubular acidosis (violation of the reabsorption of bicarbonates);
• taking medications (diacarb).
——
-Diagnostics :
• decrease in ph;
• decrease in BE;
• decrease in AB;
• decrease in BB;
• pCO2 decreasing;
• increase in p02.

Question 10

Explain Respiratory acidosis , causes , diagnostics

Answer 10

-Causes:
• obstructive disorders in bronchi;
• restrictive changes in lungs (severe pneumonia, pulmonary edema, pneumothorax);
• inhibition of respiratory center (barbiturates, morphine, alcohol)
—diagnostics
• decrease in pH;
• pCO2 increasing;
• decrease in p02;
• AB is normal or increased;
• BB is normal or increased;
• BE is normal or increased.

Question 11

Explain metabolic alkalosis , causes , diagnostics

Answer 11

—Causes:
• enteral or parenteral intake of a large numb of alkalis (overdose during infusion, frequent intake of soda during heartburn);
• vomiting;
• hypokalemia.
—- diagnostics
• increase in pH;
• pCO2 increasing;
• decrease in p02;
• AB is increased;
• BB is increased;
• BE is increased.

Question 12

Explain Respiratory alkalosis , causes , diagnostics

Answer 12

-Causes:
• emoutinal arousal;
• fever;
• encephalitis, encephalomyelitis;
• brain tumors;
• cerebral hemorrhages;
• stay in highlands;
• use of respiratory analeptics
——-
-Diagnostics :
• increase in pH;
• decrease in AB;
• decrease in BB;
• BE is normal or
• decreased;
• pCO2 is decreaseed;
• increase in p02.

Question 13

Explain Sodium, indication for analysis , hypo,hyper

Answer 13

-SODIUM (135-155 mmol/L)
-Indications for analysis:
• gastrointestinal disorders (vomiting, diarrhea);
• kidney disease;
• adrenal insufficiency;
• dehydration;
• monitoring treatment with diuretics.
—
-Causes of hyponatriemia
•-salt-free diet;
-increased excretion in urine (taking diuretics);
-violation of reabsorption (renal failure);
-dehydration with sodium loss;
-heart failure;
-hyperglycemia.
—Causes of hypernatriemia:
• the use of large amounts of salt (> 30 g per day);
• dehydration with water loss;
Conn disease;
• adrenogenital syndrome.

Question 14

Explain chlorine , indication for analysis , hypo,hyper

Answer 14

-Chlorine (97-110 mmol / L)
-Indications for the analysis:
monitoring and dynamic observation of acid-base disorders in various diseases;
kidney disease;
diabetes insipidus;
pathology of the adrenal glands.
-Causes of hypocloremia
• salt-free diet;
• edema (swelling);
• excessive sweating,
• vomiting, diarrhea;
• severe infectious diseases;
• taking diuretics.
—Causes of Hyperchloremia
Hypoalbuminemia
/ Bromism, lodidism
/ Unmeasured non-Na+ cations
/ GI losses of bicarb
-Diarrhea
-GI tract fistulas
-Ureterosigmoidostomy
-Ileal loop conduit
- CaCI2 or MgC12 ingestion
-Cholestyramine ingestion
/ Renal losses of bicarb
-Renal tubular acidosis
-Hypoaldosteronism
-Hyperparathyroidism
-Carbonic anhydrase inhibitors
/ Miscellaneous
-Dilutional acidosis
-Hyperalimentation
-Sulfur ingestion
-Compounds with CI- anion
-Chronic respiratory acidosis

Question 15

Explain Potassium, indication for analysis , hypo,hyper

Answer 15

-Potassium (3.6-5.2 mmol/L)
-Indications for the analysis:
• study of kidney function in their pathology;
• cardiovascular pathology (arrhythmias, arterial hypertension);
• adrenal insufficiency;
• control of potassium in the blood with the appointment of diuretics, cardiac glycosides.
-Five Most Common Causes of
Hypokalemia:
-Renal loses: Diuretic use, drugs, steroid use, metabolic acidosis, hyperaldost‹ renal tubular acidosis, diabetic ketoacidosis, alcohol consumption
-Increased nonrenal losses:
Sweating, diarrhea, vomiting, laxative use
-Decreased intake: Ethanol, malnutrition
-Intracellular shift:
Hyperventilation, metabolic alkalosis, drugs
-Endocrine: Cushing’s disease, Barter’s syndrome, insulin therapy
—Causes of hyperkaliemia
• Acute renal failure and chronic renal failure;
• cell necrosis;
• enhanced protein catabolism;
• metabolic acidosis;
• adrenal insufficiency;
• tumor process;
• anaphylactic shock.

Question 16

Explain calcium, indication for analysis , hypo,hyper

Answer 16

-Calcium (2.2-2.62 mmol/L)
-Indications for the analysis:
• diagnosis and screening of osteoporosis;
• muscle hypotension;
• convulsive syndrome;
• paresthesia;
• gastrointestinal tract diseases;
• polyuria.
—. Common Causes of Hypocalcemia
Hypoparathyroidism
Vitamin D deficiency or insufficiency
Altered vitamin D metabolism due to medication usage
Diseases affecting the kidneys and/or the liver
-Pseudohypoparathyroidism
Hypomagnesemia or hypermagnesemia
Hungry bone syndrome
Infusion of phosphate
Rapid citrated blood transfusion
Medications
—Causes of Hypercalcemia:
Calcium supplementation
-Hyperparathyroidism
-latrogenic, immobilization
-Multiple myeloma, milk-alkali syndrome, medication (e.g Lithium)
-Parathyroid hyperplasia or adenoma
-Alcohol
-Neoplasm (e.g breast cancer, lung cancer)
-Zollinger Ellison syndrome
-Excessive vitamin D
-Excessive vitamin A
-Sarcoidosis

Question 17

Explain phosphorus, indication for analysis , hypo,hyper

Answer 17

-hosphorus (0.81-1.58 mmol/L)
-Indications for the analysis:
• bone disease;
• kidney disease;
• diseases of the parathyroid glands.
—The reasons for the decrease in P:
• hyperparathyroidism;
• hypovitaminosis D;
• malabsorption syndrome, diarrhea, vomiting;
• alcoholism;
• tubulopathy.
-The reasons for the increase in P:
• renal failure;
• hypoparathyroidism;
• acromegaly;
• acidosis.

Question 18

explain water in the body distribution

Answer 18

-The water in the body is distributed in two spaces: intracellular (about 2/3 of the water of the human body) and extracellular (1/3 of the total water).
-Extracellular water space includes two sectors:
1) intravascular water sector, which is almost completely represented by blood plasma (about 8% of the total body water), A small amount of water falls on the body cavity fluid: abdominal, pleural, etc., and forms a cerebrospinal, intraocular, intra-articular fluid.
2) interstitial water sector (25% of all body water). It is the most mobile, changing volume with excess or lack of water in the body. All body water is renewed in about a month, and extracellular water space — in a week.
–In addition, the form of binding water in the body is:
1) free, it forms the basis of extracellular fluid (blood, lymph, interstitial fluid);
2) related (located in complex with colloids);
3) constitutional (included in the structure of protein molecules, fats and carbohydrates).

Question 19

EXPLAIN HORMONAL REGULATION OF WATER AND ELECTROLYTE METABOLISM

Answer 19

-Slim-regulation of water content and electrolytes provided by a number of hormones, antidiuretic and antinatriuretic components of the system. The main active organ of both systems are the kidneys.
-Aldosterone is a hormone that regulates blood sodium levels. Aldosterone specifically increases sodium reabsorption in the distal convoluted tubule and collecting duct of the nephrons in the
kidneys. The result of this mechanism is to conserve sodium. Because “water follows salt,” this may
also lead to water retention when ADH is present.
-Atrial natriuretic peptide (ANP) is a hormone that promotes both fluid and sodium loss by the kidneys , The name natriuretic actually means “salt excreting.” ANP release from the atria is stimulated when blood volume and pressure are elevated. ANP has three major effects:
1) it decreases aldosterone release, resulting in a decrease in sodium reabsorption and increased sodium loss in the urine;
2) it decreases ADH release, which decreases water reabsorption and increases water loss to lower blood volume and pressure; and 3) it decreases thirst.
-The level of calcium in blood is regulated primarily by two hormones:
1-Parathyroid hormone: Parathyroid hormone does the following:
* Stimulates bones to release calcium into blood
* Causes the kidneys to excrete less calcium in urine
* Stimulates the digestive tract to absorb more calcium
* Causes the kidneys to activate vitamin D, which enables the digestive tract to absorb more calcium
2-Calcitonin : is produced by cells of the thyroid gland. It lowers the calcium level in blood by slowing the breakdown of bone, but only slightly

Question 20

explain water disorders df , types ,

Answer 20

-Disorders of water metabolism are divided into Hypo - and dehydration (dehydration) – reducing the amount of liquid and hypergidratation is characterized by excessive accumulation of fluid in the body
-Disorders of water metabolism are divided into Hypo - and dehydration (dehydration) – reducing the amount of liquid and hypergidratation is characterized by excessive accumulation of fluid in the body

Question 21

explain Hypohydration

Answer 21

-Hypohydration - a form of violation of water-electrolyte metabolism, in which the removal of water
from the body exceeds its intake. Depending on the fluid deficiency, a light, medium and severe degree
of dehydration is isolated. Light degree occurs when the loss of 5-6% body fluid (1-2 l), the average – 5-
10% (2-4 l) and heavy – more than 10% (over 4-5 l). The extreme degree of dehydration is called exsicosis.
1-Hypertonic hypohydration occurs when the loss of water exceeds the loss of electrolytes (primarily sodium) This
condition occurs when:
1) long-term forced diuresis without water deficiency replenishment;
2) profuse perspiration;
3) loss of saliva (saliva is hypotonic in relation to blood);4) diarrhea with the release of watery stool (cholera);
5) insufficient intake of water into the body
-Labortary signs: increased levels of blood urea, creatinine, sodium (hypernatraemia), reduces urinary output.
2-Isotonic hypohydration occurs due to the loss of interstitial fluid space this pathological condition occurs when:
1) acute and chronic gastrointestinal diseases;
2) peritonitis;
3) pancreatitis;
4) extensive burns;
5) polyuria.
-Laboratory signs:
Increased urine osmolality,
Increased urine specific gravity,
Elevated hemoglobin and hematocrit,
Serum sodium: normal,
High serum osmolality,
Elevated blood urea nitrogen
3-Hypotonic hypohydration occurs when the body loses a large amount of water and electrolytes with a predominant loss of salts This syndrome occurs when:
1) loss of gastric and intestinal juices (indomitable vomiting, pregnancy, profuse diarrhea);
2) profuse perspiration;
3) loss of salts by the kidney in violation of Central or hormonal regulation (the effects of encephalopathy, brain injuries, lesions of the adrenal glands with symptoms of hypoaldosteronism);
4) fasting;
5) insufficient intake of salt in the body.
-Laboratory signs: Increased urine osmolality,
Increased urine specific gravity,
Elevated hemoglobin and hematocrit,
Serum sodium: decreased,
High serum osmolality,
Elevated blood urea nitrogen

Question 22

explain Hyperhydration

Answer 22

-Hyperhydration-a form of violation of water-electrolyte metabolism, which occurs due to excessive water intake into the body or its insufficient excretion.
1-Hyperhydration-a form of violation of water-electrolyte metabolism, which occurs due to excessive water intake into the body or its insufficient excretion ,This condition occurs when:
1) forced use of sea water as drinking water;
2) the introduction of large amounts of hypertensive solutions in the body with preserved renal excretory function;
3) the introduction of isotonic solutions in patients with impaired renal excretory function.
2- isotonic hyperhydration is an increase in the volume of interstitial fluid against the background of proportional delay in the body of sodium and water. The osmotic pressure of
the plasma does not change. Isotonic gipergidratace most likely to occur:
1) against the background of diseases accompanied by edema syndrome;
2) as a result of excessive administration of isotonic salt solutions.
—
3-Hypotonic hyperhydration is associated with the accumulation of water when its intake exceeds the excretory capacity of the kidneys. This condition may occur when:
1) single-stage reception of very large amounts of water;2) long-term/in the introduction of salt-free solutions;
3) edema on the background of chronic heart failure, liver cirrhosis, AKI;
4) frequently repeated cleansing enemas;
5) after surgery (when kidney function is reduced and oliguria occurs).

Question 23

Explain Magnesium, indication for analysis , hypo,hyper

Answer 23

-Magnesium (normal blood content 0.65-1.10 mmol/l)
-Indications for the purpose of analysis:
1) depletion of the body;
2) neurological pathology;
3) tachycardia;
4) kidney disease
–The reasons for the decline of magnesium (hypomagnesemia):
1) cirrhosis of the liver;
2) chronic alcoholism;
3) acute pancreatitis;
4) polyuric OPN stage;
5) intestinal fistula;
(6) fasting;
7) malabsorption of magnesium in the intestine;
8) taking diuretic, antifungal and anticancer drugs.
–The reasons for the increase of magnesium (hypermagnesemia):
1) ketoacidosis;
2) increased catabolism;
(3) OPN;
4) taking large amounts of drugs containing magnesium.

Question 24

EXPLAIN OSMOLARITY OF THE PLASMA , DF , Determination of osmolarity helps WITH WAHT , decreased , increased

Answer 24

-df :Osmolarity refers to the number of particles (ions and undissociated molecules) in 1 kg of water. In accordance with the international system (SI), the amount of substances in the solution is usually expressed in millimols per 1 liter (mmol/l).
-Determination of osmolarity helps:
1) to diagnose Hyper - and Hypo symptoms;
2) to identify and purposefully to treat hyperosmolar coma Hypo-and hyperhydration;
3) evaluate the effectiveness of transfusion-infusion therapy;
4) to diagnose acute intracranial hypertension.
-Reasons for the decrease of osmolarity in serum (gipoosmolarnosti):
1) hypofunction of the adrenal cortical layer;
2) hypopituitarism;
3) water intoxication;4) excessive fluid injection (postoperative period);
5) burns
-Reasons for the increase in osmolarity in serum (giperosmolarnosti):
1) diabetic non-ketoacidotic hyperosmolar coma;
2) depletion of water in the body;
3) diabetic ketoacidosis;
4) alcohol intoxication;
5) dumping syndrome;
6) diabetes insipidus;
7) hypercalcemia;
8) brain damage;
(9) uremia;
10) hypernatremia.