Pathophysiology Module 2

Front 1

metabolic acidosis (video)

Back 1

does or doesn't matter if there is an anion gap.

drop in serum bicarbonate (CO2)- drops because of the law of mass action

Front 2

law of mass action

Back 2

in an equilibrium reaction, if one species drops, the equilibrium will change to one side to replenish that species

Front 3

compensation

Back 3

when the lung changes its actions to make up for an acid base disturbance.

Front 4

overcompensation

Back 4

a second acid base disturbance or disorder

Front 5

winter's formula

Back 5

CO2= 15 (HCO3)+8(+or-)2

Front 6

acids are

Back 6

proton donors

Front 7

volatile acids

Back 7

can be removed as a gas by the lungs

Front 8

which metabolic process leads to a build up of acids

Back 8

anaerobic pathways

Front 9

ion trapping

Back 9

process of which we can keep and hold on to molecules in cell so it can't be lost by diffusion

glucose is brought into cell and then a molecule binds to it so it can't leave.

this requires a specific pH so that the protein can do it's job.

Front 10

histidine

Back 10

in a lot of proteins. an important amino acid buffer

in a lot of hemoglobin molecules

Front 11

carbonic anhydrase

Back 11

buffer in the kidneys. very fast. regulates reabsorption of HCO3 and excretion of H+

Front 12

normal anion gap

Back 12

less than 16. if it's more than this, probably metabolic acidosis

Front 13

metabolic acidosis

Back 13

when production of acid is more than what the buffering system can take care of.

leads to an anion gap

could be from diabetes, ethanol and alcohol, toxin

treated by reversing the underlying condition, IV fluids, IV bicarbonate, antidotes for a toxin

Front 14

metabolic alkalosis

Back 14

Increase loss of organic acids

can be caused by excessive vomiting, antacids, diuretics, which leads to loss of chloride ions which shifts the kidneys to hold on to bicarbonate shifting pH to an alkalytic environment

leads to weakness, muscle cramps, tetany, confusion

treatment: underlying cause,

kidney holds on to bicarbonate which shifts pH

s/s weakness, muscle cramps, confusion, tetany

Front 15

respiratory acidosis

Back 15

less oxygen diffusing across alveoli so become hypoxic and increase CO2 in lungs so respiratory acidosis results.

hypoventilation and a lack of oxygen and opiate overdose can lead to it

confusion, agitation, tachycardic, or tachypnic, cyanosis

treat reversible causes: oxygen supplementation, dilate bronchi

alveolar hypoventilation- oxygen doesn't diffuse across alveoli leading to retaining of carbon dioxide and hypoxic

hypercapnia- high levels of CO2 from accumulation of carbonic acid- hypoventilation, COPD, asthma, opiate overdose, pneumonia

s/s confusion, agitation, tachycardic, tachypnic

Front 16

respiratory alkalosis

Back 16

increase respiratory rate results in low levels of carbon dioxide and leads to an increase in pH.

hyperventilation, hyperthyroidism, sepsis, aspirin overdose can all lead to this.

reverse underlying cause

from hyperventilation

s/s hypocapnia (low levels of carbon dioxide), phosphate is out of cell which results in increase in pH

Front 17

hydrostatic pressure

Back 17

pressure from a fluid exerted from gravity

has effect on how water moves by leaving or entering extracellular space

Front 18

oncotic pressure

Back 18

form of osmotic pressure. exerted from proteins in serum. too big to go through blood vessel wall so create a force to get water out. most of the pressure is created from albumin which is most of plasma proteins

high oncotic pressure draws fluid into pressure

low pressure makes fluid leave vessel

Front 19

starling's forces

Back 19

movement of fluid secondary to filtration (through a membrane).

takes into account oncotic and hydrostatic pressure in capillaries

Front 20

osmoreceptors

Back 20

detect changes in osmolitity

Front 21

baroreceptors

Back 21

detect changes in blood pressure

Front 22

ADH and water needs

Back 22

if water is needed, more ADH is secreted by the pituitary gland

Front 23

how does ADH work

Back 23

inserts aquaporins into the distal tube of the kidneys- allow for reabsorption of water and water retention.

osmoreceptors and baroreceptors send signals about retaining or secreting water. if water needs to be retained, adh is secreted.

ADH low- aquaporins down regulated

SIADH- syndrome of inappropriate anti diaretic hormone - pulmonary edema, volume overload

Front 24

SIADH

Back 24

sindrome of inappropriate ADH

excess of water retention leading to edemas

Front 25

edema

Back 25

can be from decrease in plasma oncotic pressures, if proteins (albumin) aren't available, water will leak out into interstitial tissue.- happens in liver failure because liver produces albumin- increase in intravascular oncotic pressure leading water to leave vessels.

can be from increased capillary hydrostatic pressure- secondary to increased water retention or water intake- could be from back up of blood volume into pulmonary vasculature- pulmonary edema- increased volume in vessels- left ventricular hypertrophy leading to back up of blood volume increaseing capillary pressures. pulmonary edema

can be from increased capillary permeability- possibly from burns. fluid leaks out of capillaries.

can also be from lymphatic channel obstruction- leads to back up of lymph flow, increase of pressure and fluids leak out.

can be from high altitude difficulties. hypoxia leads to pulmonary artery vasoconstriction which increases pressure leading to fluid leakage

Front 26

how does sodium play a role in water regulation

Back 26

big component of extracellular fluid. regulates osmotic forces and water balance

normally in serum is 135-145 mEg/L

regulated by aldosterone hormone

Front 27

how is sodium manipulated

Back 27

through secreting or retaining. water follows sodium.

juxtaglomerular cells are in smooth muscles which secrete renin which goes into central circulation and activates angiotensinogen which cleaves into angiotensin 1 which is then metabolized by ACE into angiotensin 2 which then interacts with renal arterioles to cause them to constrict and initiates secretion of aldosterone causing kidneys to retain sodium which water will follow.

(look at cartoon on slide)

Front 28

hypokalemia

Back 28

low potassium level. potassium is important intracellular. important for resting membrane potential of cell. leads to change in resting membrane potential. vomiting, diarrhea, burns

restlessness and fatigue, cardiac arrhythmia, delayed repolarization of ventricles, strange EKG's

s/s lethargy, weakness, fatigue because muscles can't depolarize, dysrhythmia, susceptible to ventricle arrhythmias

Front 29

aldosterone

Back 29

controls sodium levels and therefore water levels

Front 30

renin-angiotensin system

Back 30

manipulates sodium through excreting or retaining. water follows sodium so if water or blood loss occurs, sodium is retained to increase water levels

juxtaglomerular cells harbor beta 1 receptors that secrete renin to and can form angiotensin 1 when in contact with angiotensinogen

aldosterone makes kidneys retain sodium to increase water