Patho Chapter 4

Front 1

about 60% of body weight;
somewhat less in females than males; less in obese persons
Somewhat more than 60% in leaner individuals & infants

Back 1

Total body water

Front 2

Very_____ water in adipose cells

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little

Front 3

About ____ of TBW is intracellular fluid (ICF)
About ____ of TBW is extracellular fluid (ECF)

Back 3

2/3
1/3

Front 4

ECF includes the

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nterstitial fluid & intravascular fluid (also synovial fluid, CSF, urine, sweat, etc.)

Front 5

TBW volume is on average about

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42 liters (11 gallons)

Front 6

Starlings Law of the Capillaries or Starling’s Forces
describes & quantifies this movement

Back 6

(referred to as
“net filtration”)

Front 7

Capillary hydrostatic pressure

Back 7

BP) pushes water out of
the capillary into the interstitial spaces

Front 8

osmotically draws water back into the capillary from the interstitial spaces

Back 8

Capillary oncotic pressure

Front 9

pushes water back into the
capillary from the interstitial spaces

Back 9

Interstitial hydrostatic pressure

Front 10

osmotically draws water into the
capillary from interstitial spaces

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Interstitial oncotic pressure

Front 11

Net Filtration=

Back 11

(forces favoring filtration)-(forces opposing filtration)

Front 12

forces favoring filtration =

Back 12

Cap. Hydrostatic press. plus interstitial oncotic press

Front 13

forces opposing filtration =

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Cap. Oncotic press. plus interstitial hydrostatic press.

Front 14

net movement is outward into the interstitial spaces (filtration)

Back 14

Arterial end of capillaries -

Front 15

Net movement is back into capillaries (reabsorption of 90%)

Back 15

Venous end of capillaries -

Front 16

What moves out (or back into) the capillaries?

Back 16

water

Front 17

Water moves in and out of cells (through aquaporin
channels in the plasma membrane) mainly due to

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osmotic forces.

Front 18

Na+ is responsible for osmotic force balance in

Back 18

ECF

Front 19

K+ is responsible for osmotic force balance in

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ICF

Front 20

Normally the osmotic pressure in the ECF and ICF
are

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equal (in equilibrium)

Front 21

excess interstitial fluid accumulation

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Edema –

Front 22

Edema is Caused by:

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- increased capillary hydrostatic pressure
- lowered plasma oncotic pressure
- increased capillary permeability
- lymphatic channel obstruction

Front 23

Normally water and sodium intake equals

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output

Front 24

increased capillary hydrostatic pressure results from

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venous obstruction or (2) salt & water retention

Front 25

Venous obstruction occurs due to:

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Thrombophlebitis, DVT (deep vein thrombosis)
Hepatic obstruction (hepatic fibrosis or cirrhosis)
External compression of veins (tight clothing, pregnancy)
Prolonged standing

Front 26

Fluid overload occurs in:

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Congestive heart failure
Renal failure (salt & water retention)
Excessive salt intake
IV therapy (hypervolemia)
Protein malnutrition
6) Trauma inflammation/immune response- histamine

Front 27

low oncotic pressure in blood
__________ capillary reabsorption of fluid

Back 27

decreases

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edema restricted a particular site or organ system
sprained ankle, cerebral edema, pulmonary edema,
pleural effusion, pericardial effusion, ascites

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Localized

Front 29

a more uniform distribution of excess interstitial
fluid over a larger area such as an entire leg (or legs)
due to “dependent edema”

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Generalized

Front 30

edema May be _________ or _________

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localized
generalized

Front 31

pressing on the skin with a finger causes an
indentation that persists after the release of the pressure

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pitting edema

Front 32

Water balance – mainly regulated by ADH

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Water balance –

Front 33

antidiuretic hormone =

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vasopressin

Front 34

Na+ balance is regulated by ___________ action in the kidney

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aldosterone’s

Front 35

– usually passively follows Na+

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Cl- balance

Front 36

causes the body to conserve water

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ADH

Front 37

ADH is released into the bloodstream when

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plasma osmolality increases or
blood volume decreases and BP drops

Front 38

ADH site of action in the kidney is on __________ and _____________
where it increases water reabsorption from the forming urine and returns it
to blood (increasing blood volume increases BP)

Back 38

the distal tubules and collecting ducts

Front 39

ADH is also a moderate vasoconstrictor and this also _________ BP

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increases

Front 40

causes the kidneys to conserve Na+

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Aldosterone

Front 41

A steroid hormone made in the adrenal cortex (zona
glomerulosa) and released into the bloodstream when Na+
levels are depressed or K+ levels are increased

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Aldosterone

Front 42

Made in atrial myocytes and released in response to high BP or hypervolemia (causes increased atrial stretch)

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ANP

Front 43

ANP _________ GFR & _______ Na+ reabsorption in kidney
tubules both of which increasing excretion of Na+ and water by the kidneys (diuresis & natriuresis)

Back 43

increases
decreases

Front 44

ANP ________ the renin-angiotensin-aldosterone system

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inhibits

Front 45

All effects of ANP together ____ blood volume and BP

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lower

Front 46

Normal osmolality is

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280-294 mOsm

Front 47

osmolality remains the same if the water loss (or gain) is proportional to the electrolyte loss. This occurs when isotonic body fluids are lost (hemorrhage, excessive
sweating) or gained (rapid infusion of an isotonic IV)

Back 47

Isotonic changes –

Front 48

Loss of fluids as in hemorrhage causes ______________ with the
concommitant decrease in BP, increase in HR, decreased
urinary output. Severe cases (loss of more than 20% of blood volume) result in hypovolemic shock, a medical emergency

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hypovolemia

Front 49

Rapid increase in plasma volume causes __________,
increased BP, increased urine output, edema, decreased
hematocrit, heart failure & pulmonary edema may occur.

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hypervolemia

Front 50

Increased atrial stretch would cause release of ?

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ANP

Front 51

occur when ECF osmolality exceeds 294 mOs, most often due to an increase in ECF Na+ or deficit of ECF water. This increase
in osmotic pressure in the ECF attracts water from the ICF. Cells would shrink as they become dehydrated.

Back 51

Hypertonic alterations

Front 52

What determines how much water will be lost from the cells to the extracellular space?

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balanced osmotic pressure

Front 53

hypovolemia

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deficit of ECF water

Front 54

hypervolemia

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increase in ECF Na+

Front 55

Hypernatremia is a serum Na+ concentration above

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147 mEq/L.

Front 56

How would you expect Cl- levels to be affected by hypernatremia?

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increase in Cl-

Front 57

Regardless of the cause of hypernatremia, cells become

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dehydrated

Front 58

Na+ deficit (hyponatremia) or water excess; both result
in cellular edema (overhydration) & cellular swelling

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causes of Hypotonic alterations

Front 59

If Na+ is deficient in ECF the osmolality of the ECF _______ & water moves into cells. This __________ the plasma volume
(hypovolemia).

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decreases
decreases

Front 60

If there is excess water in the ECF (hypervolemia), the
osmolality of the ECF is _________ & water moves into cells. Cerebral & pulmonary edema may develop.

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decreased

Front 61

serum Na+ concentration below 135 mEq/L

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Hyponatremia

Front 62

_________ is the most common electrolyte derangement occurring in hospitalized patients.

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Hyponatremia

Front 63

Low Na+ interferes with _______ &_________ of
neurons & muscle cells. Patients may be lethargic, confused,
have seizures, be comatose

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polarization & depolarization

Front 64

-caused by excessive water intake also results
in hyponatremia

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Water intoxication

Front 65

decreased renal
excretion of water caused by ADH release in response to
something other than high osmolality or hypovolemia

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Syndrome of Inappropriate secretion of ADH

Front 66

Common causes of ADH dysregulation:

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bronchogenic cancer,
but also fear, pain, brain trauma, acute infection, surgery, such
drugs

Front 67

Symptoms of SIADH

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confusion, muscle twitching, nausea, convulsions.

Front 68

Excess water is in the ECF ( results in hyponatremia);
the urine is

Back 68

more concentrated

Front 69

is the major intracellular ion (electrolyte)

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Potassium

Front 70

98% of the K+
in the body is

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inside cells

Front 71

K+ maintains the ____________ (muscle cells & neurons)

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resting membrane potential

Front 72

___________ is needed for glycogen & glucose deposition in liver &skeletal muscle

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Potassium

Front 73

Movement of K+ into cells is facilitated by

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insulin, aldosterone,
epinephrine, & alkalosis

Front 74

Movement of K+ out of cells is stimulated by

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insulin deficiency,
aldosterone deficiency, acidosis, strenuous exercise

Front 75

_________ blocks K+ entry into cells

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Glucagon

Front 76

______________ promote K+ excretion.

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Glucocorticoids

Front 77

The kidney regulates K+ balance by

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secretion, filtration, &
reabsorption

Front 78

Hypokalemia =

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serum K+ < 3.5 mEq/L

Front 79

Neuromuscular and cardiac effects occur with severe
hypokalemia. Why?

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Because K+ maintains the resting membrane potential (muscle cells & neurons)

Front 80

Effects of hypokalemia include

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muscle weakness, muscle aches, cramps,
smooth muscle atony, & cardiac dysrhythmias (delayed
ventricular repolarization)

Front 81

potassium enters the body through .

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dietary intake

Front 82

Hyperkalemia =

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ECF K+ > 5.5 mEq/L

Front 83

______ is a lethal dose of potassium

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100 mg/kg

Front 84

Acid-base imbalances can be defined as

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acidosis or alkalosis

Front 85

_________ is a systemic increase in [H+]
acidemia=arterial blood pH<7.4

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Acidosis

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_________ is a systemic decrease in [H+]
alkalemia=arterial blood pH>7.4

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Alkalosis

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- resist pH change by absorbing H+ (hydrogen ions) or OH- (hydroxyl ions).

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Buffers

Front 88

Operates in lung & kidney; Major extracellular buffer system

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Carbonic acid-bicarbonate buffering

Front 89

Lungs regulate how much CO2 they exhale by

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changing respiratory
rate & depth

Front 90

Kidneys can regulate how much H+ they secrete into _____

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urine

Front 91

Primarily intracellular buffers.

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Protein buffers:

Front 92

________ is an excellent buffer in RBCs because it can bind
H+ and CO2 (both of these unbound make fluids more acidic)

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Hemoglobin

Front 93

H+ + HCO3- =

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carbonic acid

Front 94

Kidneys

Back 94

eliminate non-volatile acids (H2SO4, H3PO4)
secrete H+ into the urine
reabsorbs HCO3- (bicarbonate)
generates new HCO3-