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61 Cards in this Set
- Front
- Back
2/3 of the body's water is found here.
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Intracellularly
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1/3 of the bodys water is found here.
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Extracellular
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ECF is divided into...
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Interstitial fluid and intravascular fluid
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Total body water is __% of body mass or about __L of fluid in a male.
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60, 42L
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Describe the Starling HYpothesis
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net filtration = (forces favoring filtration) - (forces opposing filtration)
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What are the forces that favor and oppose filtration?
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Favor: capillary hydrostatic pressure and interstitial onconic pressure.
Opposing plasma oncotic pressure and inerstitial hydrostatic pressure. |
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What is osmotic pressure?
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The amount of hydrostatic pressure required to oppose the osmotic movement of water.
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What is oncotic pressure?
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The osmotic effect of all colliods in the fluid.
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4 different mechanisms behind edema?
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Increased hydrostatic pressure
decreased plasma oncotic pressure Increased capillary membrane permeability (inflammation) lymphatic obstruction |
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Water balance is regulated by ___ that comes from ________.
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ADH, aka vasopressin from posterior pituitary.
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Sodium is regualted by _______ from _____. This mineralcorticoid does...
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Aldosterone from the adrenal cortex. Aldosterone increases the reabsorption of Na and K secretion at distal tubule of kidney.
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ADH secretion is in response to what?
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Increased plasma osmolality or a decrease in blood pressure/blood volume.
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The site of action for ADH is where?
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Distal tubules in kidney.
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What are the major ECF electrolytes?
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Sodium (90%) Chloride, and bicarb
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Say something about Cl levels,
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Cl follows Na so it is always in proportion to Na levels.
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Describe the RAAS system.
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When circulating blood volume is reduced, renin (enzyme f/ juxtaglomerular cells of kidney) is released and stimulates angiontensin I --> angiotension II which acts as a hormone to stimulate secretion of aldosterone (which causes Na and H2O reabsorption)and cause vasoconstriction. Once this happens, the further scretion of renin is inhibited.
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What is natriuretic peptide, who secretes it and what does it do?
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It is a hormone secreted by heart, brain, and kidney. It works to decrease BP and increase Na and H2O excretion (opposite of aldosterone).
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Hypertonic fluid alterations ocurrs when...and what is the cellular response
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when the osmolarity of the ECF is above normal. Water leaves the cells.
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Normal Na levels =
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135-145mEq/l
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In someone with a true Na deficit, their labs would look...
Na: H/H: Urine Spec Grav? |
Na: <135
H/H: elevated (h2o follows na) Spec grav: <1.010 (kidneys holding on to all the Na) |
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What hormone can be used to treat hyperkalemia?
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Insulin, it activates the Na/K pump and puts K back in the cells.
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What happens to intramuscular excitiability with hypokalemia?
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Neuromuscualr excitability is decreased because the membrane is hyperpolarized.
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What is the normal range for K?
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3.5-5.5
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IF a person becomes, hyperkalemic, what is the body's response?
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Increase cellular uptake if K and aldosterone secretion increases K excretion in the kidneys.
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Why does hyperK often accompany acidosis?
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As H lvls increase in the ECF, the cells will take in one H in exchange for K so serum K levels go up.
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What happens neurmuscularly with hyperkalemia?
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The cell is hypopolarized and if K levels continue to rise, it is not able to repolarize and oes not respond to stimuli at all--->cardiac standstill
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Where is intracellular Ca mostly found?
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in the mitochondria!
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What 3 horomones regulate Ca and HPO4 levels?
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Parathyroid hormone, vitamin D, and calcitonin.
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The parathyroid glands secrete PTH in response to what?
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low Ca levels, PTH tells kidneys to hold on to K and excrete HPO4
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How does Vitamin D work?
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After PTH is increased, vit D ciruculates in plasma and increasesabsorption of Ca in small intesting, enhances bone abssorption of Ca and increases renal tubular reabsorption of Ca.
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What is one thing you will see clinically in a pt who is hypocalcemic?
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neuromuscular excitiability because dec. Ca cause partioal depolarization of nerves and muscles.
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How can you assess for hypocalcemia clinically?
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Trousseau's sign: contraction of hand with bp cuff applied for 5 mins
Shvostek: tap on facial nerve w/ + twitch. |
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What is a big thing to consider when evlauating someone for hypercalcemia?
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Tumors secrete parathyroid hormone and elevate Ca levels.
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This intracellular cation is a cofactor in intracellular enzymatic rxns, protein synthesis, nucleic acid stabilty and neurmuscular excitability.
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What is Mg? It is also requried for ATPase activity and decreases ACh release at neuromuscular jxns.
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What are the s/s of hypomagnesemia?
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Like htose for hyper calcemia...neuromuscularirritability, tetany, convulsions, hyperactive reflexes.
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What are the s/s of hypermagnesemia?
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Skeletal muscle depression, muscle weakness, hypotension, dec. RR, lethargy, bradycardia.
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What does the buffer system in the body do?
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Aborbs excessive H+ or OH- wihtout changing pH very much.
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What is the buffer pair at work in the lung and kidney?
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Carbonic acid (H2CO3)- bicarb pair (HCO3)
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What proteins can act as intracellular buffers?
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Hemoglobin, binds iwth H+ to form HHb and HHbCO2.
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How does hte kidney regulate acid-base balance?
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The distal tubule secretes hydrogen into urine and reabsorbs bicarb.
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What exactly happens in metabolic acidosis?
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Either decreased base (HCO3) or increase in acids. The bufer systems try to keep aterial pH within normal range by buffering with bicarb.
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How is metabolic acidosis buffered?
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The respiratory system compensates by increasing respiratory rate lowering PaCO2 and the Amount of H2CO3 (carbonic acid) inthe blood. Kidneys secrete excess acid as NH4+
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What is a normal anion gap?
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The differnce between the sum of Na+K and HCO3+Cl should be about 10-12mEq/L
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What kind of anion gap would you see with metabolic acidosis?
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Elevated anion gap.
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What is a normal blood pH?
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7.4
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What causes metabolic alkalosis?
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Increased bicarb, often due to loss of metabolic acids. (vomitting, GI suctioning, diruetics)
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How do the lungs try to compensate for metabilic alkalosis?
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Increased pH inhibits the respiratory center and RR is decreased --> holding on to CO3-->HCO3 and H2CO3. NOt very effecive though, better treated with NaCl+K
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Why might you see decreased K in a pt with met alk?
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H is relased form cells in exchange for K to help regulate pH and K goes out in urine.
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How does resporatory acidosis happen?
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Ventilation is depressed and CO2 is retaine, increasing H+ as H2CO3. this can result from conditions that cause depression or respiraotry center and disorders of hte lung.
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Compensation for respiratory acidosis?
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It takes time for the kidneys to kick in and excrete the extra CO2. (if there is compensation, you'll ee increased bicarb (HCO3).
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What causes respiratory alkalosis?
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Hyperventilation, blowing off all the acid.
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How is respiratory alkalosis buffered?
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Shift of H+ from ICF to ECF and eventual renal compensation by decreasing H+ excretion and bicar absportion.
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What hormone is implicated in diabetes insipidus?
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Antidiuretic hormone. Can be of "central" (hypothalamic) origin or of local (nephrogenic) origin when kidnwys can't respond to ADH
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ADH is released from _____.
Aldosterone is released from _____. |
ADH from posterior pituitary.
Aldosterone from adrenal cortex. |
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What are the primary 2 mechanisms of water regulation?
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Thirst and ADH
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How can diabetic ketoacidosis result in hypokalemia?
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H+ goes in the cell and K comes out and is peed out.
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Can other kinds of acidosis also cause hyperkalemia?
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Yes! By the same mechanism, K serum in the blood increases-->hyperkalemia.
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What is a normal Mg Level?
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1.8-2.4
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IS Mg a major intracellular or extracellular cation?
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Intracellular
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How do you calculate the anion gap?
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(Na+K)-(HCO3+Cl)
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How do you calculate the compensation of acidosis/alkalosis?
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pCO2=1.5(HCO3)+8+/-2
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