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61 Cards in this Set

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