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121 Cards in this Set
- Front
- Back
Filtered out into Bowman’s capsule:
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Salts,
Water, Amino acids Glucose Nitrogenous waste: urea (from breakdown of amino acids), uric acid (from breakdown of old nucleic acids), creatinine (waste from creatinine phosphate) Bilirubin (urochrome) (should never see: RBCs, WBCs, plasma proteins) |
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Totally reabsorbed:
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Amino acids
Glucose |
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_______ clearance is a good indicator of how the kidneys are doing
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creatinine
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complete renal clearance –
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all of the substance that goes into the kidney comes out in the urine. None of it stays in the blood.
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Transport maximum –
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Max about of a substance that can be reabsorbed. Can be overwhelmed.
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Glomerular Filtration rate:
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Volumes of filtrate formed each minute by both kidneys:125 mL
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Low GFR –
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dehydration, blood loss.
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High GFR caused by...
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high blood pressure. Proteins get out.
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Fenestrated –
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leaky
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Filtrate composition is similar to _________
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plasma
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Proximal convoluted tubule:
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~90% of all reabsorption occurs (total reabsorption of glucose and amino acids). Lots of active transport, requiring ATP. Water is passively transported by following solutes. Secretion of H+ ions for acid/base balance
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Thin descending limb of the loop of henle allows _______ reabsorption of H2O
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passive
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The _______ the loop of Henle, the more can concentrate the urine
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longer
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Thick ascending loop of Henle actively pumps out _________ (reabsorption)
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salt
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Thick ascending loop of Henle has cells that are ___________ to water
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impermeable
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The three jobs of the DCT:
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1) Most sensitive to aldosterone (causes salt reabsorption), 2) Secretion of excess hydrogen ions, and 3) Abuts corpuscle and can release erythropoietin when blood volume is low (makes more red blood cells) and rennin
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Collecting duct –
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most sensitive to ADH which allows reabsorption of water.
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Without ADH, you would pee ______L/day. With max ADH, down to 0.5L day
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25
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Three substance mostly reabsorbed:
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water, amino acids, and glucose
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Three substances never filtered out:
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Whit blood cells, albumin, and red blood cells.
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Acid-base balance in important because...
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acidity and alkine-ness can change the shape of protien
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Alkalosis –
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pH higher than 7.45
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Acidosis –
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pH lower than 7.35
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An increase in exhalation of carbon dioxide results in inc. blood pH and a decrease in exhalation causes...
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... decrease in blood pH.
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Extracellular Fluid (ECF) –
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interstitial fluid, plasma, lymph, CSF, synovial fluid, serous fluid, etc.
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The production of hydrogen ions by metabolism must be matched by loss of these H+ ions at the ____________ and ______________
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kidney (protons: H+) and lungs (carbonic acid)
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Antidiuretic Hormone (ADH) –
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Osmoreceptors in the hypothalamus monitor the ECF and release ADH in response to high osmotic concentration
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↑ Osmotic concentration =
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↑ ADH levels
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Primary effects of ADH:
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A) Stimulate water conservation at kidneys
B) Stimulate thirst center |
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Aldosterone –
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Released by the adrenal cortex to regulate Na+ absorption and K+ loss in the DCT and collecting system in the kidney
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Retention of Na+ will result in H2O ___________
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conservation
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Aldosterone is released in response to:
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A) high K+ or low Na+ in ECF (e.g. renal circulation)
B) activation of the renin-angiotensin system due to a drop in BP or blood volume C) decline in kidney filtrate osmotic concentration at the DCT (more water less solutes) |
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Addison’s Disease =
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hypoaldosteronism: results in massive loss of NaCl and H2O in the urine; must adjust diet to compensate
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Hydrostatic pressure –
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pushes water from the plasma into the interstitial fluid
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Colloid osmotic pressure –
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draws water from the interstitial fluid to the plasma
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Edema -
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abnormal amount of water leaves the plasma and accumulates in the interstitial fluid
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Hyponatremia –
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hypotonic hydration: condition of low Na+ concentration (i.e. excess water).
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Four causes of hyponatremia:
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1) Ingestion of a large volume of fresh water or injection of a hypotonic solution.
2) Inability to eliminate excess water at the kidney 3) Endocrine disorder (e.g. too much ADH) 4) Excessive sweating |
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Hyponatremia results in water moving from the ______to the ______causing cellular damage and possibly plasmolysis
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ECF…ICF
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Hypernatremia –
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dehydration: condition of high Na+ concentration (i.e. water depletion). This results in decreased plasma volume and blood pressure that can lead to hypovolemic shock (inadequate circulation) and confusion
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Na+ is the dominant cation in the ______ cellular fluid
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extra
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The total amount of Na+ in the ECF is due to a balance between Na+ uptake in the digestive system and Na+ excretion in _____ and __________
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urine…perspiration
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ECF volume too low → ______-_______ system is activated to conserve water and Na+
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renin-angiotensin
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ECF volume too high → natriuretic peptides released: block _____ and _______ resulting in water and Na+ loss
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ADH…aldosterone
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K+ is the dominant cation in the ___cellular fluid (98% of the total body K+ is inside cells)
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Intra-
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The concentration of K+ in the ECF depends on absorption in the GI vs. _________
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excretion in urine
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The exchange pump at the kidney tubules secrete K+ (or H+) in order to reabsorb ____
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Na+
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The rate of tubular secretion of K+ in the kidney is controlled by three factors:
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1. Changes in the K+ concentration of the ECF ↑ K+ in ECF = ↑ K+ secretion
2. Changes in blood pH at low pH, H+ is used for Na+ reabsorption instead of K+ at the exchange pump ↓ pH in ECF = ↓ K+ secretion 3. Aldosterone levels↑ aldosterone = ↑ Na+ reabsorption and ↑ K+ secretion |
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Hypokalemia –
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low K+ concentration in the ECF: will cause muscular weakness and mental confusion
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Hypokalemia caused by:
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1. Inadequate dietary K+ intake
2. Some diuretic drugs 3. Excessive aldosterone 4. Increased pH of ECF |
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Hyperkalemia –
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high K+ concentration in the ECF: will cause cardiac arrhythmia and flaccid paralysis
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Hyperkalemia caused by:
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1. Renal failure
2. Diuretics that block Na+ reabsorption 3. A decline in pH |
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______ functions to lower blood Ca2+ levels
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Calcitonin
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Gout –
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A kind of arthritis that occurs when uric acid builds up in the joints
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Ketoacidosis –
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results from starvation or diabetus mellitus
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Function of Glomerulus –
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Selective filtration
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Function of Proximal convoluted tubule (PCT) -
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Reabsorption of 90% of electrolytes and water; reabsorption of all glucose and amino acids; reabsorption of HCO3-; secretion of H+ and creatinine
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Function of Loop of Henle -
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reabsorption of water in descending loop; Reabsorption of Na+ and Cl- in ascending limb; concentration of filtrate
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Function of Distal convoluted tubule (DCT) -
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Secretion of K+, H+, ammonia; reabsorption of water (regulated by ADH); reabsorption of HCO3-; regulation of Ca2+ and PO42- by parathyroid hormone, reabsorption of Na+ (regulated by aldosterone)
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Function of Collecting duct -
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Reabsorption of water (ADH required)
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Look of Henle: Descending limb is ________ to water, ascending limb is _________ to water
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permeable…impermeable
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Water is reabsorbed in ________ limb (concentrates urine)
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descending
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Salt is actively reabsorbed in the _______ limb (establishes ability to concentrate even further)
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ascending
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_________ convoluted tubule reabsorbs even more salt under the influence of aldosterone.
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Distal
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The _________ _______ reabsorbs water under the influence of antidiuretic hormone (ADH)
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collecting duct
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Kidney’s effect on low BP: Rennin released, which…
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…converts angiotensinogen into angiotensin I which is converted by ACE into angiotensin II
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Three roles of angiotensin II:
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1)Potent vasoconstrictor, 2) stimulates release of aldosterone, and 3) stimulates release of ADH
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ADH increase _______ reabsorption and secretion of ________
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water…potassium
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Erythropoietin –
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hormone that stimulates erythropoiesis, RBC production
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Renal failure leads to anemia because…
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…of a lack of erythropoietin (EPO)
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Fluid breakdown: Male adult –
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60% of BW
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Fluid breakdown: Female adult –
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55% of BW
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Fluid breakdown: Overweight adult –
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40% of BW
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Fluid breakdown: Elderly adult –
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40% of BW
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Three fluid compartments:
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1) Intracellular (ICF) – 60%
2) Interstitial (ECF) – 30% 3) Plasma (ECF) – 10% |
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Electrolytes –
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substances that disassociate in water
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Key ion found IN the cell (ICF)
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– Potassium (K+) 3.5-5.1 mEq/L
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Key ion found OUTside of the cell (ECF) –
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sodium (NA+) Normal concentration: 136-145 mEq/L
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Three types of solutes:
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colloids, ions/electrolytes, and non-electrolytes
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Colloids –
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proteins that are charged and act like an electrolyte. Amine and carboxyl group
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Non-eletrolytes –
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glucose
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Adding a hypotonic solution –
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water is attracted to the salts in the cells and the cell swells/possibly bursts (plasmolysis)
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Adding a hypertonic solution –
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Water leaves the cell and it shrinks. Crenation.
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Adding an Isotonic solution –
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a good idea
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Edema is caused by fluid ____________ in the interstitial compartment
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accumulation
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4 Causes of Edema:
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1) Decrease in capillary osmotic pressure
2) Increased capillary pressure 3) Leaky capillaries 4)Obstruction of lymph capillaries |
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Decrease in capillary osmotic pressure –
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caused be a lack of albumin which can happen if the liver fails
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Increased capillary pressure –
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High blood pressure pushes water out of blood vessels
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Leaky capillaries –
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due to inflammation (red, hot, swollen, painful) like a sprained ankle
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Obstruction of lymph capillaries –
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removal of lymph nodes
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Hyponatremia –
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decrease of Na+ in the plasma
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Hypernatremia –
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increase in plasma levels of sodium
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What hormone works on the kidney to absorb salt?
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Aldosterone
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Major stimulus for the release of aldosterone:
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angiotensin II
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Hormone necessary for the reabsorption of water –
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ADH
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Causes secretion of potassium –
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ADH
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An increase in ADH will lead to a ________ of plasma levels of potassium
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decrease
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Some diuretics will cause a _______ in plasma levels of potassium
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decrease
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Hyperkalemia could be caused by:
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acidosis, diuretics, kidney failure, or increased potassium intake.
exchange for _________. |
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Hypokalemia could be caused by:
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alkalosis, diuretics, decreased potassium intake.
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When the blood is acidic, cells pump inH+ in exchange for _________. This is called the hydrogen-_________ pump
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potassium
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Tetany –
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result of hypocalcemia
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_____________ hormone increases plasma levels by increasing osteoclasts
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parathyroid
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Symptoms of hypernatremia –
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confused, tired, and possibly dehydrated
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Symptoms of hyperkalemia –
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cardiac arrest, cramping, and restlessness
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Symptoms of hypokalemia –
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ECG abnormalities, muscle weakness, and respiratory arrest.
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3 Mechanisms to restore blood pH:
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1) Chemical buffers (seconds),
2) Respiratory buffers (within minutes), and 3) Kidneys (hours and days. But most powerful) |
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3 Important Chemical pH Buffer Systems:
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1) Phosphate buffer system, 2) Carbonic acid/bicarbonate system, 3) Proteins
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Carbonic acid/bicarbonate’s effect on blood pH:
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can go from HCO3- to H2CO3 by absorbing an extra H+ ion
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Protein’s effect on pH:
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Protein resists pH change intracellularly.
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Carboxyl (COO-) can accept an extra
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H+ ion.
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Amine groups can also add or drop
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H+ ions (NH3 <--> NH2 + H)
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Respiratory Buffer systems –
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breathing harder and faster lets us breath off more CO2, preventing acidosis
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Renal mechanisms in acidosis -
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tubules secrete more H+ and reabsorb more HCO3
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Renal mechanisms in alkalosis –
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tubules secrete more HCO3 and H+
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Respiratory acidosis –
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caused by rapid, shallow breathing, a build up of CO2
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Respiratory alkalosis –
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caused by hyperventilation
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Metabolic acidosis –
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low blood pH and HCO3- levels. Caused by too much alcohol, diarrhea, intense exercise (lactic acid), or ketosis (starvation/diabetes)
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Metabolic alkalosis –
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high blood pH and HCO3. Caused by vomiting or excessive antacids.
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Death occurs when pH is above _____ and below _____
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7.8…7.0
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Milliequivilant (mEq) –
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(mmol/L)(valence electrons)
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