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30 Cards in this Set
- Front
- Back
metabolic acidosis (video) |
does or doesn't matter if there is an anion gap. drop in serum bicarbonate (CO2)- drops because of the law of mass action |
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law of mass action |
in an equilibrium reaction, if one species drops, the equilibrium will change to one side to replenish that species |
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compensation |
when the lung changes its actions to make up for an acid base disturbance. |
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overcompensation |
a second acid base disturbance or disorder |
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winter's formula |
CO2= 15 (HCO3)+8(+or-)2 |
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acids are |
proton donors |
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volatile acids |
can be removed as a gas by the lungs |
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which metabolic process leads to a build up of acids |
anaerobic pathways |
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ion trapping |
process of which we can keep and hold on to molecules in cell so it can't be lost by diffusion glucose is brought into cell and then a molecule binds to it so it can't leave. this requires a specific pH so that the protein can do it's job. |
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histidine |
in a lot of proteins. an important amino acid buffer in a lot of hemoglobin molecules |
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carbonic anhydrase |
buffer in the kidneys. very fast. regulates reabsorption of HCO3 and excretion of H+ |
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normal anion gap |
less than 16. if it's more than this, probably metabolic acidosis |
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metabolic acidosis |
when production of acid is more than what the buffering system can take care of. leads to an anion gap could be from diabetes, ethanol and alcohol, toxin treated by reversing the underlying condition, IV fluids, IV bicarbonate, antidotes for a toxin |
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metabolic alkalosis |
Increase loss of organic acids can be caused by excessive vomiting, antacids, diuretics, which leads to loss of chloride ions which shifts the kidneys to hold on to bicarbonate shifting pH to an alkalytic environment leads to weakness, muscle cramps, tetany, confusion treatment: underlying cause, kidney holds on to bicarbonate which shifts pH s/s weakness, muscle cramps, confusion, tetany |
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respiratory acidosis |
less oxygen diffusing across alveoli so become hypoxic and increase CO2 in lungs so respiratory acidosis results. hypoventilation and a lack of oxygen and opiate overdose can lead to it confusion, agitation, tachycardic, or tachypnic, cyanosis treat reversible causes: oxygen supplementation, dilate bronchi alveolar hypoventilation- oxygen doesn't diffuse across alveoli leading to retaining of carbon dioxide and hypoxic hypercapnia- high levels of CO2 from accumulation of carbonic acid- hypoventilation, COPD, asthma, opiate overdose, pneumonia s/s confusion, agitation, tachycardic, tachypnic |
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respiratory alkalosis |
increase respiratory rate results in low levels of carbon dioxide and leads to an increase in pH. hyperventilation, hyperthyroidism, sepsis, aspirin overdose can all lead to this. reverse underlying cause from hyperventilation s/s hypocapnia (low levels of carbon dioxide), phosphate is out of cell which results in increase in pH |
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hydrostatic pressure |
pressure from a fluid exerted from gravity has effect on how water moves by leaving or entering extracellular space |
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oncotic pressure |
form of osmotic pressure. exerted from proteins in serum. too big to go through blood vessel wall so create a force to get water out. most of the pressure is created from albumin which is most of plasma proteins high oncotic pressure draws fluid into pressure low pressure makes fluid leave vessel |
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starling's forces |
movement of fluid secondary to filtration (through a membrane). takes into account oncotic and hydrostatic pressure in capillaries |
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osmoreceptors |
detect changes in osmolitity |
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baroreceptors |
detect changes in blood pressure |
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ADH and water needs |
if water is needed, more ADH is secreted by the pituitary gland |
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how does ADH work |
inserts aquaporins into the distal tube of the kidneys- allow for reabsorption of water and water retention. osmoreceptors and baroreceptors send signals about retaining or secreting water. if water needs to be retained, adh is secreted. ADH low- aquaporins down regulated SIADH- syndrome of inappropriate anti diaretic hormone - pulmonary edema, volume overload |
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SIADH |
sindrome of inappropriate ADH excess of water retention leading to edemas |
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edema |
can be from decrease in plasma oncotic pressures, if proteins (albumin) aren't available, water will leak out into interstitial tissue.- happens in liver failure because liver produces albumin- increase in intravascular oncotic pressure leading water to leave vessels. can be from increased capillary hydrostatic pressure- secondary to increased water retention or water intake- could be from back up of blood volume into pulmonary vasculature- pulmonary edema- increased volume in vessels- left ventricular hypertrophy leading to back up of blood volume increaseing capillary pressures. pulmonary edema can be from increased capillary permeability- possibly from burns. fluid leaks out of capillaries. can also be from lymphatic channel obstruction- leads to back up of lymph flow, increase of pressure and fluids leak out. can be from high altitude difficulties. hypoxia leads to pulmonary artery vasoconstriction which increases pressure leading to fluid leakage |
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how does sodium play a role in water regulation |
big component of extracellular fluid. regulates osmotic forces and water balance normally in serum is 135-145 mEg/L regulated by aldosterone hormone |
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how is sodium manipulated |
through secreting or retaining. water follows sodium. juxtaglomerular cells are in smooth muscles which secrete renin which goes into central circulation and activates angiotensinogen which cleaves into angiotensin 1 which is then metabolized by ACE into angiotensin 2 which then interacts with renal arterioles to cause them to constrict and initiates secretion of aldosterone causing kidneys to retain sodium which water will follow. (look at cartoon on slide) |
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hypokalemia |
low potassium level. potassium is important intracellular. important for resting membrane potential of cell. leads to change in resting membrane potential. vomiting, diarrhea, burns restlessness and fatigue, cardiac arrhythmia, delayed repolarization of ventricles, strange EKG's s/s lethargy, weakness, fatigue because muscles can't depolarize, dysrhythmia, susceptible to ventricle arrhythmias |
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aldosterone |
controls sodium levels and therefore water levels |
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renin-angiotensin system |
manipulates sodium through excreting or retaining. water follows sodium so if water or blood loss occurs, sodium is retained to increase water levels juxtaglomerular cells harbor beta 1 receptors that secrete renin to and can form angiotensin 1 when in contact with angiotensinogen aldosterone makes kidneys retain sodium to increase water |