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100 Cards in this Set
- Front
- Back
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What do altered cell and tissue biology result from?
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adaptation, injury, neoplasia, aging or death
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What happens during adaption that causes the alteration?
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while cells adapt long term stressors can overwhelm the process of adaption, stressors can lead to cell injury or death
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What happens before cells necrose? **
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before cells die or necrose they morph into pathogenic state, they adapt, adaption takes place before necrosis or death **
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** Cellular adaption term: atrophy
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atrophy-decrease in cell size
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** Cellular adaption term: hypertrophy
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hypertrophy-increase in cell size which causes enlarged tissue
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** Cellular adaption term: hyperplasia
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hyperplasia-increase in rate of cell division, increase in the number of cells
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** Cellular adaption term: metaplasia
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metaplasia-reversible replace of one cell for another, don't confuse with dysplasia or pathogenesis, doesn't necessarily lead to pathogenic state but is a setup for dysplasia
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** Cellular adaption term: dysplasia
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dysplasia-abnormal shape size or organization, deranged cellular growth
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A closer look at dysplasia
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metaplasia-original cells not robust enough, cells are changing and adapting to new environment, if the stimulus causing dysplasia is removed cells often move back to normal
-not necessarily leads to dysplasia, not necessarily directly carcinogenetic, it may be part of process that leads to carcinogenesis but not synonymous, often metaplasia is the road to pathogenic change (know pathologic and physiologic examples, see slide) |
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Examples of atrophy
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•physiologic example of atrophy-thymus gland
•severe Alzheimers-an entire organ can become atrophic, causes may be decreased workload, pressure can cause atrophy, diminished blood supply, diminished nutrition, loss of endocrine stimulation, aging process •the mechanisms of atrophy are not entire clear, but atrophic cells usually have autophagia |
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A closer look at hypertrophy
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•gain in cellular substance, increased in cell size i.e. from increased demand like the heart in HTN, over time as it gets more hypertrophy gets less efficient
•not only affects size but phenotype of cells |
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A common example of hyperplasia
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•BPH-overgrowth of the prostate from the increase in number of cells
•pathologic hyperplasia-usually the result of excessive endocrine stimulation, sometimes a predisposing condition for metaplasia oBPH not necessarily connected to prostate cancer, but it is in some cases |
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Stages of cell injury
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don't have to memorize, just know that it is a process.. of sources of injury, mechanisms of injury, consequences, cellular death
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Cellular Injury - What is a major source of injury?
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hypoxia-or loss of the ability to carry on sufficient aerobic respiration is the most common cause of cell injury and death, prototype of the process
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Sources of cellular injury - examples of oxygen deficiency
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hypoxia and ischemia
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Sources of cellular injury - examples of chemical agents
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alcohol, drugs, acetaminophen
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Sources of cellular injury - examples of nutrition-related injury
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obesity, vitamin D deficiency
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Sources of cellular injury - aging
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degeneration due to repeated trauma
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Sources of cellular injury - example of immunologic injury
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immunologic - anaphylaxis
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Sources of cellular injury - other two sources
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Infection and Genetic (inborn)
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Sources of Cellular Injury - what is the general biochemical mechanism?
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Loss of energy - ATP depletion or oxygen depletion
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** What is ATP?
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* ATP is nucleotide that contains a large amount of chemical energy that it relates when broken down, energy used for many metabolic processes, universal currency for metabolism, ATP is produced via cellular respiration in mitochondria, problems are associated with hypoxia, cell division, chemical and toxic injuries
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Cellular adaption - why might cells die in this process?
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cells actively control the composition of their immediate environment, which is the point of adaptation, when immediate environment changes they adapt, but they adapt within a narrow physiologic range
adaptation is a new steady state, it is compatible or not with the cells' viability in new environment, if it is compatible that's good, if they can't adapt then the cell when stimulated by new environment dies |
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Cellular response to injury is a...
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process, it's not "all or nothing"
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What does the response to injury depend on? **
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* response to injury depends on type, status, and genetic makeup of cell
•cellular injury is cell's response to stimuli, depends on the nature of injury, duration, severity |
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What are some other effects of cellular injury?
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•cells are complex and interconnected, injuries can result in multiple secondary and tertiary affects
•cells adapting is big dysfunctional family, affects everyone around it, i.e. cyanide indirectly affects other cascade of events that stimulates necrotic process •professor emphasizes the interconnectedness of cellular injury |
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What is ROS?
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Reactive Oxygen Species - also called free radicals
-associated with cell damage, ROS is a byproduct of normal metabolism of oxygen |
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What is the problem with free radicals?
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•Free radicals-chemical species with single unpaired electron, chemically unstable, react with different molecules leading to change, initiate catalytic reactions, free radicals themselves are not bad but that they stimulate other molecules to convert to free radicals, so they can quickly overwhelm cell, common pathway to a variety of cell injury, i.e. inflammation
ofree radicals can be converted to toxic metabolites |
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What is reprefusion damage to cells?
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reperfusion damage to cells-if cells are reversibly damaged by ischemia, restoration of blood flow can result in accelerated injury, can expose cells to high calcium resulting in more free radicals
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What is the theme of cellular injury?
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ATP depletion (loss of energy), free radicals (lead to mitochondrial damage), intracellular calcium, membrane permeability defects, latter two have to do with lipid breakdown and membrane damage
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What is a common target of chemical agent? And what kind of damage results?
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•a common target for chemical injury is the liver, i.e. in alcohol
•chemical agents can cause reversible and irreversible injury |
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What is the theme of cellular injury?
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ATP depletion (loss of energy)
free radicals (lead to mitochondrial change) intracellular calcium membrane permeability defects latter two have to do with lipid breakdown and membrane damage -know slide 38 |
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Necrosis vs apoptosis
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apoptosis-programmed cell death
necrosis-unprogrammed cell death, from assault or injury |
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Mechanisms-what is the first to change?
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ATP is the first to change
ATP is a nucleotide, encapsulation of cellular chemical injury, produced in cellular respiration, functions are for intracellular transport, metabolic processes, depletion of even a small amount has widespread effects that can set off cascade of events leading to cellular necrosis and death **know algorithm slide 40 |
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Mitochondrial damage is a...
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mitochondrial damage is an environmental disaster within the cell, mitochondria produces ROS or free radicals and ATP has energy that cell needs to survive, so loss leads to environmental disaster
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What is the mitochondrial theory of energy?
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mitochondrial theory of energy- damaged mitochondria from overproduction from free radicals that lead to cell destruction, mitochondria are necessary for cell production but ultimately cause death, catch 22
-healthy lifestyle causes more efficient mitochondria |
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More about free radicals-how do they affect other atoms?
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A free radical is an atom with unpaired electron in outer ring, free radicals indiscriminately pick up electrons from other atoms, causing them to then be free radicals
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What do defects in membrane permeability do?
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membrane permeability affects function and integrity of cell, anything that is a threat to membrane permeability can set up cascade leading to cell injury and death
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What causes damage to membrane permeability?
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Damage can be caused by ATP depletion, calciated mediation activation, directly by bacterial toxins, physical and chemical agents
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What happens when DNA and/or proteins are severely damaged?
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If damage is too overwhelming and severe, i.e. after exposure to radiation or DNA damaging drugs, cells essentially initiate suicide by apoptosis that leads to ischemic and hypoxic injury
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What are the 4 components of the cellular injury process?
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sources of injury
mechanisms of injury consequences cell death |
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What is an indication of early cellular stress?
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cells can accumulate pigments and other substances as a result of a variety of pathologic and/or physiologic processes, these are early indicators of cellular stress
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What does increased cellular accumulation suggest?
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Increased amounts of endo or exogenous accumulation suggest injury or stress
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What happens with endogenous accumulation?
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endogenous substances are produced rapidly or in excess amounts so that the cell cannot keep up and break down, this is often due to a missing necessary enzyme
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What happens with exogenous accumulation?
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exogenous substances are difficult or impossible for cell to break down
-accumulation can be reversible if it can be controlled or stopped, if not it is progressive and can lead to further injury and death |
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What is the problem with accumulated calcium within mitochondria?
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calcium is most likely the medium of irreversibility, currently blamed for activating endogenous chemicals that cause damage, so the amount of calcium within the cell may give clue to reversibility or irreversibility of process
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Pathologic calcification- what is dystrophic calcification?
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Dystrophic calcification is abnormal deposition of calcium in dead or dying tissue, important in atherosclerosis
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Pathologic calcification- what is metastatic calcification?
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Metastatic calcification- occurs in normal tissue as a result of hypercalcemia, increased PTH, bone destruction, vitamin D deficiency, renal issues
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What is lipid accumulation?
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Lipid accumulation is triglycerides in the cell
-hepatocytes are the most common, i.e. in alcohol abuse -byproduct of metabolism alters the fatty acids -too much FFA or triglycerides in cells can have pathogenic effect, can alter metabolism and alter movement of lipoproteins in and out of cell |
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What is the process of normal apoptosis?
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Normal apoptosis:
cell shrinks, chromatin increases, apoptotic bodies phagocytized, can lead to necrosis when cell starts to swell, cell becomes leaky and dies **know slide 57: distinguish between apoptosis (physiologic) and necrosis (pathologic) |
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Does apoptosis occur in diseases?
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Yes, apoptosis occurs in a variety of diseases and cancers, it is a naturally occurring phenomenon but can become pathologic
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When does necrosis occur?
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Necrosis occurs after extensive damage, it is not programmed, it is premature** death caused by factors external to cell-chemical, toxins, trauma, etc.
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What is pyknosis?
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irreversible condensation of chromatin in the nucleus of cell
(chromatin is DNA plus proteins and make up the nucleus of cell) **know terms in slide 65 |
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What is karyorrhexis?
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karyorrhexis is destructive fragmentation of nucleus in a dying cell
-usually is preceded by pyknosis -usually followed by karyolysis -can occur from apoptosis or necrosis -irreversible |
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What is the most common morphological change in the cell?
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adaption
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End of altered cell
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13 questions
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FLUID and ELECTROLYTES:
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12 questions
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Labs to know: potassium
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potassium: 3.5-5.0
a main component of cellular fluid, this positive electrolyte helps to regulate neuromuscular function and osmotic function (ICF osmolarity) |
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labs to know: sodium
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sodium:
135-145 a positively charged electrolyte that helps to balance fluid levels in the body and facilitates neuromuscular functioning |
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labs to know: magnesium
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magnesium:
1.6-2.6 a cation that influences muscle contractions and intracellular activity |
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labs to know: phosphate:
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phosphate:
2.8-4.5 negative electrolyte that impacts metabolism and regulates acid-base balance and calcium levels |
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labs to know: calcium
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calcium:
9-11 a cation, or positively charged electrolyte, calcium affects neuromuscular performance and contributes to skeletal growth and blood coagulation |
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Where are ionized molecules found?
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ionized molecules are found throughout the blood, cells, and tissues of the body
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Ionized molecules can either be ___ or ___.
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Ionized molecules can either be:
positive (cations) or negative (anions) |
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What do electrolytes do?
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Electrolytes facilitate the passage of fluid between and within cells through a process known as osmosis and play a part at regulating the function of the neuromuscular, endocrine, and excretory systems
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Labs to know: chloride
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Chloride:
97-107 an anion, or negatively charged electrolyte, that regulates blood pressure |
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Labs to know: bicarbonate
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Bicarbonate (HCO3) is a negatively charged electrolyte that assists in the regulation of blood pH levels
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What is hypernatremia?
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Sodium
Hypernatremia: Sodium helps the kidneys to regulate the amount of water the body retains or excretes. Consequently, individuals with elevated serum sodium levels also suffer from a loss of fluids, or dehydration. The high sodium in the blood vessels pulls water out of brain cells into the blood vessels, causing brain cells to shrink.** |
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What are the causes of hypernatremia?
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Causes of hypernatremia:
-can be caused by inadequate water intake -excessive fluid loss (i.e. diabetes insipidus, kidney disease, severe burns, prolonged vomitting and diarrhea), sodium retention (caused by excessive sodium intake or aldosteronism) -certain drugs, such as loop diuretics, corticosteroids, and antihypertensive medications may cause elevated sodium levels |
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What are symptoms of hypernatremia?
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-thirst
-orthostatic hypotension -dry mouth and mucous membranes -dark, concentrated urine -loss of elasticity of the skin -irregular heartbeat (tachycardia) -irritability -fatigue -lethargy -heavy, labored breathing -muscle twitching and/or seizures --for the most part, think of symptoms of dehydration** |
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What is hyponatremia?
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Hyponatremia is a metabolic condition in which there is not enough sodium (salt) in the body fluid outside the cells. Hyponatremia is the most common electrolyte in the US.
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Patho of hyponatremia
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-sodium is found mostly in the body fluids outside the cells.
-When the amount of sodium in fluids outside the cell drops, water moves inside the cell to balance out the levels -this causes to cells to swell with too much water -although most cells can handle the swelling, brain cells cannot, because the skull bones confine them. -**brain celling causes most of the symptoms of hyponatremia* |
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Pathogenesis (causes) of hyponatremia:
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-hyponatremia is most often a complication of other pathologies in which excess water accumulates in the body at a higher rate that can be excreted (for example, in liver cirrhosis, CHF, syndrome of inappropriate antidiuretic hormone-SIADH, or polydipsia),
-sometimes it may be a result of over-hydrating -In the vast majority of cases, hyponatremia occurs as a result of excess body water diluting the serum sodium -lack of sodium is virtually the cause of hyponatremia, although it can promote hyponatremia indirectly. -sodium loss can lead to volume depletion serving as signal for the release of ADH (anti-diuretic hormone) ***-as a result of ADH-simulated water retention, blood sodium becomes diluted and hyponatremia results** |
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The three conditions of hyponatremia-list them:
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In hyponatremia, the imbalance of water to salt is caused by one of three conditions:
1) euvolemic hyponatremia 2) hypervolemic hyponatremia 3) hypovolemic hyponatremia |
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What is euvolemic hyponatremia?
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total body water increases, but the body's sodium content stays the same
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What is hypervolemic hyponatremia?
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hypervolemic hyponatremia:
both sodium and water content in the body increase, but the water gain is greater |
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What is hypovolemic hyponatremia?
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hypovolemic hyponatremia:
water and sodium are both lost from the body, but the sodium loss is greater |
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What are common clinical manifestations of hyponatremia?
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Clinical manifestations of hyponatremia:
*abnormal mental status including cerebral edema and convulsions*, confusion, hallucinations, decreased consciousness and possible coma -convulsions, fatigue, HA, irritability, loss of appetite, muscle spasm or cramps, muscle weakness, nausea, vomiting, and restlessness |
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What is the treatment of hyponatremia?
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*Treatment revolves around the calculation of sodium and water loss to determine the appropriate replacement solution and will depend on the underlying cause*
-also depends on whether the cause is euvolemic, hypervolemic, or hypovolemic -in hypovolemic, IV normal saline can be effective, but caution must be used to not raise the serum sodium level too quickly |
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Potassium: causes of hyperkalemia
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Causes of hyperkalemia:
-hyperkalemia may be caused by ketoacidosis (diabetic coma) -may be caused by MI, severe burns, kidney failure, bulimia nervosa, GI bleeding, adrenal insufficiency, or Addison's disease -diuretic drugs, cyclosporins, lithium, heparin, ACE inhibitors, and trimethoprim can increase serum potassium levels -the condition may also be secondary to hypernatremia |
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What are some clinical manifestations of hyperkalemia??
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Symptoms of hyperkalemia:
-weakness -nausea and/or abdominal pain -irregular heartbeat (arrhythmia) -diarrhea -muscle pain |
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What are some causes of hypokalemia?
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Hypokalemia
-severe dehydration -aldosteronism -Cushing's Syndrome -kidney disease -long-term diuretic therapy -laxative abuse -CHF -adrenal gland impairments all can cause depletion of potassium levels |
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What are some symptoms of hypokalemia?
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Symptoms of hypokalemia:
-weakness -paralysis -increased urination -irregular heartbeat (arrhythmia) -orthostatic hypotension -muscle pain -tetany |
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What are some causes of hypercalcemia?
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Blood calcium levels may be elevated in cases of:
-thyroid disorder -metastatic CA -multiple bone fractures -milk-alkali syndrome -Paget's syndrome -excessive use of calcium-containing supplements and certain OTC meds (i.e. antacids) may also cause hypercalcemia |
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Symptoms of hypercalcemia include:
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Symptoms of hypercalcemia:
-fatigue -constipation -depression -confusion -muscle pain -nausea and vomiting -dehydration -increased urination -irregular heartbeat (arrhythmia) |
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What are some causes of hypocalcemia?
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Causes of hyocalcemia:
-thyroid disorders -kidney failure -severe burns -sepsis -vitamin D deficiency -medications such as heparin and glucagon can deplete blood calcium levels |
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Clinical manifestations of hypocalcemia:
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symptoms of hypocalcemia:
-muscle cramping and spasms -facial twitching -tetany and/or convulsions -mood changes (depression, irritability) -dry skin -brittle nails |
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Magnesium: Hypermagnesemia may occur with:
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excessive magnesium levels may occur with:
-end-stage renal disease -Addison's disease -an overdose of magnesium salts |
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Clinical manifestations of hypermagnesemia:
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symptoms of hypermagnesemia:
-lethargy -hypotension -decreased heart and respiratory rate -muscle weakness -diminished tendon reflexes |
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Causes of hypomagnesemia:
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Hypomagnesemia:
-inadequate dietary intake of magnesium, often caused by chronic alcohol abuse or malnutrition, other causes: -malabsorption syndromes -pancreatitis aldosteronism -burns -hyperparathyroidism -digestive system disorders -diuretic use |
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Clinical manifestations of hypomagnesemia:
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symptoms of hypomagnesemia:
-leg and foot cramps -weight loss -vomiting -muscle spasms, twitching, and tremors -seizures -muscle weakness -arrhythmias |
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What does hypomagnesemia usually result from?
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Hypomagnesemia usually results from decreased absorption or increased loss of magnesium from either the kidneys or intestines (diarrhea).
-Alterations in thyroid hormone function and certain medications (eg pentamidine, diuretics, alcohol) can also induce hypomagnesemia |
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Hypomagnesemia interferes with ____ resulting in ____
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**Hypomagnesemia interferes with the effects of parathyroid hormone, resulting in hypocalcemia**
-It may also cause hypokalemia |
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What are some symptoms of hypomagnesemia?
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symptoms of low serum magnesium are:
-muscular tremors and fasciculations -ocular nystagmus -tetany -altered mental state cardiac arrhythmias such as torsades de pointes (multifocal ventricular tachycardia) other possible symptoms: -ataxia -vertigo -seizures -dysphagia |
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What are some causes of hyperchloremia?
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Causes of hyperchloremia:
-severe dehydration -kidney failure -hemodialysis -traumatic brain injury -aldosteronism -drugs such as boric acid and ammonium chloride and IV infusion of sodium chloride can also boost chloride levels, resulting in hyperchloremic metabolic acidosis |
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What are clinical manifestations of hyperchloremia?
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-weakness
-HA -nausea -cardiac arrest |
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What are the usual causes of hypochloremia?
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hypochloremia usually results from sodium and potassium depletion (hyponatremia, hypokalemia)
-severe depletion of serum chloride levels causes metabolic alkalosis |
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What is the alkalization of the bloodstream characterized by in hypochloremia?
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-mental confusion
-slowed breathing -paralysis -muscle tension or spasm |
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What are some causes of hypophosphatemia?
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causes of Hypophosphatemia:
-skeletal fractures or disease -kidney failure -hemodialysis -diabetic ketoacidosis -acromegaly -systematic infection -intestinal obstruction -all these can cause phosphate retention and build-up in the blood **-hypoposphatemia occurs concurrently with hypocalcemia** |
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What are some clinical manifestations of hypophosphatemia?
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Individuals with hypophosphatemia are usually asymptomatic, but those with severe hypophosphatemia may have the following:
-tinging of hands and fingers -muscle spasm and cramps -convulsions -cardiac arrest -muscle weakness -weight loss -bone deformity |
