Term
| Intracellular Fluid: (ICF)- |
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Definition
Fluid within our cells
2/3 of total fluid in the body
Enclosed by plasma membrane
Allows passage of some, but Not All substance's
Has more:
Cations- K+, Mg2+ = intracellular cations
Anions- PO = intracellular anion and
Negatively charged proteins |
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Term
| Extracellular Fluid: (ECF)- |
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Definition
Fluid outside our cells (1/3 TBW)
Has more:
Cations- Na+, Ca2+ = extracellular
Anions: Cl-, HCO = extracellular
Proteins are abundant in plasma but little in interstitial fluid.
-reflects capillary permeability for ions but not proteins. |
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Term
| Interstitial Fluid: (IF)- |
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Definition
extracellular fluid that surrounds & "bathes" cells
-78% of extracelluar fluid |
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Term
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Definition
fluid within blood vessels
Separated from interstitial fluid by capillary wall (more permeable than plasma membrane)
20% of ECF |
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Term
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Definition
2% of ECF
CSF, synovial,
Serious fluid (in Pleural, Pericardial, Peritoneal Spaces) |
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Term
| Percentage of Body Fluid: |
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Definition
45-75% by weight, Average of 60-65%
Depends on Age, Relative Amounts of Adipose and Skeletal Muscle Tissue,
& Sex |
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Term
Percentage of Body Fluids:
Age-
Relative Amounts of Adipose and Skeletal Muscle Tissue-
Sex- |
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Definition
-generally decreases with age
infants with the highest percentage of fluid (about 70%)
Elderly with the lowest percentage
Children, young and middle-aged adults in between.
-Adipose tissue carries about 20% water; Skeletal muscle with 75% water; Generally males have more skeletal muscle & slightly higher percentage
Relative percentage decreases with increased body fat
- Generally males have higher% of TBW than Females |
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Term
Percentage of Body Fluids:
Age-
Relative Amounts of Adipose and Skeletal Muscle Tissue-
Sex- |
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Definition
-generally decreases with age
infants with the highest percentage of fluid (about 70%)
Elderly with the lowest percentage
Children, young and middle-aged adults in between.
-Adipose tissue carries about 20% water; Skeletal muscle with 75% water; Generally males have more skeletal muscle & slightly higher percentage
Relative percentage decreases with increased body fat
- Generally males have higher% of TBW than Females |
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Term
| Regulation of Fluid Intake: |
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Definition
Behavioral Modification
Stimulation (+) or inhibition (x) of Thirst
+ of thirst = increase of fluid intake = increase of BP & decrease of Osmolality (hypo-osmotor, watery blood, hypotonic)
(x) of thirst = decrease fluid intake = decrease in BP & increase of Blood Osmolality (hypertonic) blood becomes viscus
AI- promotes thirst, increase production of Aldosterone Na+ |
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Term
| Regulation of Fluid Output: |
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Definition
Mostly by Kidneys
Hormones:
directly by ADH- (Antidiarect Hormone- posterior Pituitary & Hypothalamus) decreases fluid output
increases reabsorption of H20 in CT (collecting tubules & duct)
Indirectly by-
ANP, Aldosterone, Angiotensin-II
Atreal Naturetic Peptide- Aldosterone increases Na+ secretion from blood to out the body H20 follows
Antagonist Adrenal Cortex absorb Na+ |
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Term
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Definition
Liquids- 1200mL
Solid Foods- 1000mL
Cell Metabol- 300mL
Total: 2500mL |
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Term
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Definition
Sensible:
Urine- 1400mL
Feces- 200mL
Insensible:
Lungs- 400mL
exhale
Skin- 500mL
sweat, evaporation & perspiration
Total: 2500mL
volume in must = volume out |
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Term
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Definition
"swelling", Generalized edemia- systemic="Anasarca"
Accumulation of fluid in the Abdominal Cavity = "Ascites" hydroperitaneum, in the interstitial space |
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Term
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Definition
Increased capillary hydrostatic pressure (BP):
hypervolemia (excessive vol. of blood), prolonged vasoconstriction or stenosis, pregnancy blocking veins (cankles), reduced venous return to the heart (systemic veins)
Loss of Plasma Proteins (Albumin):
malnutrition, in the urine, burn (loss of solutes hypotonic blood, hypertonic interstitial space)
Excessive Na+ in the Bloodstream
Lymphatic Vessel Obstruction (leads to Local Edema) Obstruction by a Tumor, Blockage by a Parasite, Postoperative- removing lymphnodes
Increased capillary permeability: Allergy, Bacterial Toxins, etc.
Increased rate of filtration, Elephantisus, Hydrothorax- between pleural in lungs, Hydropericardium- space in cardium |
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Term
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Definition
| local swelling, pitting edema- serious edema, body weight increase, functional impairment- swollen organs start malfunctinoning, Pain, Arterial Circulation Impairment- Diluted Concentration of Electrolytes, Death (in case of Cerebral Edema) Pulmonary Edema, Distorted shape of an organ or an extremity (CNS swelling- brain). |
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Term
| Excessive Fluid Loss= Loss>Gain: |
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Definition
Water & Solute Loss (iso-osmolar loss):
Hypervolemia- Hemorrhage, Severe Burns, Chronic Diarrhea, vomiting, Deficiency of Aldosterone
Water Loss More than Solute Loss (Hypo-osmolar loss):
Dehydration-
Excessive sweating, Insufficient water intake, decrease ADH secretion, Diabetes, Overexposure to cold |
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Term
| Excessive Fluid Gain= Gain>Loss: |
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Definition
Water & Solutes gain (iso-osmolar gain): Hypervolemia-
Hypersecretion of Aldosterone; Renal Failure
Water Gain is More than Solutes Gain (Hypo-osmolar gain):
Hypotonic Hydration (water intoxication)-
Hypersecretion of ADH, Large Volume of PLAIN water |
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Term
| Abnormal Fluid Distribution: |
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Definition
Accumulation of Fluid in One Compartment more than in other-
Edema: Accumulation of water in interstitial compartment; increases blood hydrostatic pressure; decreases blood osmotic pressure; Abstraction of Lymph vessels
Third Spacing: Ascitis, Pleural Effusion, Peritonitis |
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Term
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Definition
Fluid shifts from intravascular compartment to a body cavity- irritated= hyperproduced serous fluid, peritoneal space
No longer in the blood (circulating fluid)-
stabilize the patient
Examples: peritonitis- then to surgery, burns, pleuritis, hydrothorax, etc. (fluid from the blood)
Hypovolemia & Edema at the Same Time |
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Term
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Definition
Is the insufficient body fluid (Hypovolemia)- low blood volume
Grading Dehydration:
-mild: 2% of the body mass loss (of extracellular water)
-moderate: 5% body weight loss
-severe: 8% body weight loss
Loss of water is Accompanied by: loss of Electrolytes
Causes of Dehydration:
vomiting, diarrhea, or a combination of the two; excessive perspiration; Diabetes (DKA) Diabetic KetoAcidosis; Insufficient water intake |
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Term
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Definition
Dry skin and mucous membranes, dry eyes, dry mouth; Decreased skin turgor- elasticity of the skin; Low BP- hypovolemia, hypotension
Weak Pulse- insufficient amount of blood to pump
Fatigue, dizziness, LOC, confusion, impaired mental status- in both edema & dehyration.
Increased Ht (Cells/Plasma)- hematocrit: ratio between the number of erythrocyte to the volumes of plasma
Compensatory Mechanisms Include:
increased thirst- Angiotensin II, increased HR- hypotension reflex tachycardia, Dermal Vasoconstriction- increased Ht: increased number of RBC, vol. of Plasma blood; polysithemia disease of the blood;
Decrease in urine output (reabsorption water from urine)
Increased secretion of ADH and Aldosterone- from infected water vibreo cholera profuse vomiting & diarrhea
Normal Ht: 45%
Dehydration increased Ht: # of RBC / decreased volume of Plasma
due to loss of water out of plasma
Ht: # of cells / blood volume
decrease Ht: # of RBC / Increased volume of Plasma |
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Term
Electrolute Balance:
Major Cations & Anions: |
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Definition
Electrolytes:
dissociate in solution to form cations (+) and anions (-)
include salts, acids, and bases
the name refers to ability of substances to conduct el. current when dissolved;
e.g., NaCl dissociating into Na+ & Cl-
each ahs a unique function as well as osmotic functions
Major Cations:
Na+, K+, Ca2+, H+
Major Anions: Cl-, HCO3-, PO-
Electrolyte & Osmotic Pressure:
osmotic pressure (& osmolality) is dependent on the number of solute particles;
e.g. NaCl with twice the osmotic pressure of glucose - from one compartment to another freely. |
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Term
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Definition
predominantly extracellular
10mEq/L Intracellular (higher in blood)
135 to 145mEq/L in the blood |
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Term
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Definition
intracellular
room Eq/L intracellular
3.5 to 5mEq/L in the blood |
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Term
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Definition
Variable Intracellular
3.8 to 5mEq/L in the Blood
2.2 to 2.5mmol/L ionized Ca (free Ca) |
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Term
| Bicarbonate Normal Values: |
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Definition
extracellular
8mEq/L intracellular
27mEq/L in the Blood |
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Term
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Definition
Fall of the Sodium Level below 135mEq/L
Causes of Hyponatriemia:
Either direct Na, Loss, or Dilution of Na:
excessive perspiration, projectile vomiting and profuse diarrhea (eliminates H20 = loss of Na+ too).
low-salt diet
use of diuretics
low aldosterone level- low Na+ reabsorption
Hypersecretion of ADH: high H2O reabsorption diluted
Renal Failure
Excessive Water Intake: water poisoning |
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Term
Anions:
Chloride Ion (Cl-):
Phosphate Ion (PO-): |
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Definition
Cl-:
Common anion normally associated with Na+:
follows Na+ by electrostatic interactions, regulated by the same mechanisms
The most abundant anion in ECF
Found in Lumen of Stomach as HCl
Participates in Chloride shift within erythrocytes
Lost in sweat, gastric secretions, and urine
Phosphate Ion:
the most abundant anion in ICF
85% stored in bone and teeth as calcium phospate
Component of DNA, RNA, and ATP, a pH buffer
Intracellular buffer and urine buffer
Regulated by PTH |
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Term
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Definition
Excessive Na+ levels- above 145mEq/L
Causes of Hypernatriema:
Either a large Na+ intake, Or loss of water, Or excessive Na+ retention
ADH hyposecretion (Diabetes Insipidus)
Loss of the Thirst Mechanism
Watery Diarrhea
H20 loss= loss of Na+ too
Chronic Hyperventilation (tachypnea) exhalation
Chronic salt-rich diet
Aldosterone Hypersecretion: promotes Na+ reabsorption
loss H20 = increased Na+ concentration |
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Term
Electrolytes & Action Potential:
Influx- |
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Definition
flows out of the cell
Polarization- resting state of semipermeable membrane
Depolarization: stimulus opens Na+ channels, Na+ moves into cells
Repolarization: As impulse moves along membrane Na+ channels close and K+ channels open allowing K+ to move outward
Return to Resting State:
Channels close, Sodium-Potassium pump returns Na+ outside cell and K+ inside cell |
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Term
| Effects of Hypernatremia: |
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Definition
Na+ attracts water!
Osmotic Pressure (tonicity) of the extracellular compartment increases
Water shifts from intracellular compartment to the extracellular (interstitial and blood): Edema- systemic, lungs & brain too
weakness, agitation;
firm subcutaneous tissue (skin on palpation)
dry mouth and mucosae, dry eyes
increased thirst (osmoreceptors)
low or high urine volume (output)
includes CNS signs & symptoms; low hypoxia, & edema |
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Term
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Definition
99% in ECF and 1% in ICF
The principal cation in the ECF, exerts the greatest osmotic pressure
Functions in a number of physiological processes: nervous system: potentials
NaHCo3 has major role in buffering pH!
Hyponatremia (decreases blood Na+ <135)
Gain-from the diet
Lost through urine, feces, and sweat
Amount lost in urine regulated by Aldosterone, and ANP; [Na+] in blood regulated by ADH
Rule: water follows salt (NaCl)!
-H2O follows Na+
Hypernatremia- (increases blood Na+ >145) vs. Na+ Bicarbonate buffer treats acidosis |
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Term
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Definition
Anorexia, nausea, cramps
Fatigue, lethargy, muscle weakness
Headaches, confusion, seizures (neurons dehydrated, depolarized)
Decreased BP |
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Term
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Definition
Thirst, dry mouth, mucosae
General weakness, lethargy, agitation
Edema- neurons
Elevated CNS
Opposite to Hyponatremia |
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Term
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Definition
Intracellular
Normal blood level is 3.5-5mEq/L; in the cell ~ 160mEq/L
In with the diet, out with the urine (elimination)
Aldosterone stimulates K+ excretion
Insulin helps K+ into the cell (as a glucose companion!) accompanied by K+
Concentration ion Must be Checked!
Acidosis moves K+ from the cell (H+ displaces K+ in the cell): Hyperkaliemia
Acidosis promotes K+ retention and H+ excretion by the Kidneys
Alkalosis moves K+ into the cell, and does opposite to acidosis (hypokalemia)
Important in nerve conduction!
Important in Muscle Contraction!
EKG!
interferes with depolarization |
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Term
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Definition
serum K+ level is Below 3.5mEq/L
Causes of Hypokalemia:
Diarrhea, use or abuse of diuretics,
Hypersecretion of Aldosterone or Glucocorticoids (Cushing's Syndrome)
Malnutrition (alcoholism or starvation)
Insulin treatment of DKA Diabetic KetoAcidosis
K+ Concentration Check |
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Term
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Definition
98% in ICF
Required for neuromuscular activities & controlling heart rhythm
Intake with diet
Most K+ lost in the urine:
amount fluctuates
Increased loss when plasma K+ high, Increased aldosterone secretion, & decreased blood pH
Total body potassium is regulated by
Aldosterone
Distribution between ECF & ICF depends on, K+ level, H+ level, and insulin
Hyperkalemia-vs-Hypokalemia
The most lethal of electrolyte imbalances- can lead to cardiac &/or respiratory arrest |
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Term
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Definition
Cardiac dysrhythmias (arrhythmias) with prolonged repolarization (tachyarrhythmia)
Cardiac arrest (in severe cases)
Decreases response of a muscle to neural stimulation
Muscular fatigue & weakness
Paresthesia (additional, usually unpleasant, feelings) tingling false sensation
Decreased functions of the digestive system
Decreased GI peristalsis
Shallow breathing (superficial ventilation) muscle weakness of diaphragm
Impaired countercurrent mechanism in renal tubules
Urine Concentration fails
Polyuria
K+ slows down heart rate & increases activity of GI tract normally |
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Term
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Definition
Rise of serum K+ level above 5mEq/L
Caused by:
Renal failure
Hyposecretion of Aldosterone less K+ eliminated
Extensive tissue damage: severe and wide burns or crush injury (cell rupture)
Prolonged or severe Acidosis
Hyperkalemia hemolytic anemia: out of the RBC, in the Plasma |
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Term
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Definition
EKG: cardiac arrhythmia leading to cardiac arrest
Impairs NMJ activity
Muscle weakness, fatigue, & paralysis
Nausea and paresthesia |
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Term
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Definition
Cardiac arrhythmias, cardiac arrest (tachyarrhythmia)
Anorexia, nausea, constipation (GI inhibition)
Fatigue, muscle twitch, leg cramps ("Charlie horse")
Shallow respirations, paresthesias
Orthostatic Hypotension, polyuria, nocturia
Serum pH is OVER! 7.45 = Alkalosis |
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Term
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Definition
Cardiac arrhythmias, cardiac arrest (bradyarrhythmias)
Nausea, diarrhea, increased peristalsis (GI stimulation)
Muscle weakness, paralysis from the legs- moving up
Paresthesia: fingers, toes, face, tongue
Oliguria: a few very low volume of Urine
Serum pH is BELOW! 7.35 = Acidosis! |
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Term
Cation-
Calcium Ion (Ca2+): |
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Definition
The most abundant electrolyte in bone and teeth:
-99% stored here
More abundant in ECF
Needed for muscle contraction, neurotransmitter release, as a second messenger, participates in blood clotting, blocks neuron Na+ channels
In taken with the diet, lost in urine, feces, & sweat
Regulated by PTH, Calcitriol, & Calcitonin
Hypercalcemia-vs.-Hypocalcemia |
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Term
Cation-
Magnesium Ion (Mg2+): |
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Definition
Primarily within bone or within cells
Second most abundant cation in ICF
Participates in Hundreds of Enzymatic Reactions
Assists in Na+/K+ pump
Important in muscle relaxation:
-ATP Hydrolysis
In plasma: either free or bound to protein
Lost through sweat and urine
Blood plasma concentration is Regulated through the Kidney |
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Term
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Definition
Extracellular
Gets in with the diet, stored in bones, excreted with urine or feces
Calcitonin, PTH, Vit.D, & Phosphate level in the blood
Vit.D promotes Ca2+ movement from the intestine into the blood
Normally, Ca high + PO4 is low, and vice versa!
Alkalosis causes hypocalcemia!
Calcium:
is part of strong teeth and bones,
maintains permeability & excitability of the neuronal plasma membranes, promoting conduction
Required for muscle contractions
is a Co-Factor for Reactions (Blood Clotting) |
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Term
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Definition
Is caused by:
hypoparathyroidism
malabsorption
malnutrition
elevated serum phosphate level
low serum albumin
alkalosis
Renal Failure: PO4 rentention = Ca2+ is lost and Vit.D is Not Activated = intestinal absorption for Ca+ is Low. |
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Term
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Definition
Permeability of the neurilemma increases, excitability of nerve membranes goes up
Spontaneous Stimulation of the skeletal muscles:
carpopedal spasm
Chvostek's sign
Trousseau's sign
Tetany (skeletal muscle spasm)
Laryngospasm
Cardiac Contractions are Weak + arrhythmias
Hypotension |
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Term
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Definition
Serium ionized Ca+ level is Above 2.5mmol/L
Caused By:
Extensive bone resorption (bone tumors or metastatic breast, cervical or prostate CA, or bronchogenic carcinoma secreting PTH)
Hyperparathyroidism
High Vit.D level (sarcoidosis)
Prolonged immobility = bone resorption
Increased intake of Ca (dietary of a high Vit.D)
"Milk-Alkali" syndrome (milk and antacid intake) = high serum Ca |
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Term
| Effects of Hypercalcemia: |
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Definition
Neuromuscular Activity Depression:
muscle weakness
loss of muscle tone (tonus)
Interference with Nervous System Activity:
lethargy, stupor, changes in personality, anorexia and nausea
ADH in the kidney is blocked = Water reabsorption is low = Polyuria = Hypovolemia = Renal function decreases more = Nitrogen wastes accumulate = Cardiac Arrest
Cardiac contractility increases = arrhythmias |
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Term
Effects of Hypercalcemia on Bone:
Other Effects of Hypercalcemia: |
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Definition
IF Hyperparathyroidism = Ca+ comes to blood from bone! = Osteoporosis = Spontaneous (pathologic) fractures and pain
If High Ca+ intake = PTH is low (Calcitonin-high) = increased Ca+ deposition into the bone = bones are stronger
Ca+ depositions into organs and tissues (calcification)!
Renal stones!
Gallstones! |
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Term
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Definition
Tetany, carpopedal and laryngospasm
Tingling fingers (paresthesia)
Mental confusion, irritability
Arrhythmias, decreased cardiac contractility
Hormone's control Ca+ concentration
Calcitonin and PTH- Parathyroid Hormone |
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Term
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Definition
Hypermagnesiemia depresses NMJ functioning causing:
decreased reflexes
lethargy
arrhythmias
It results from:
renal failure
Hypomagnesiemia results from:
malabsorption
malnutrition
chronic alcoholism
Use (abuse) of diuretics
DKA
Hyperparathyroidism
Hyperaldosteronism |
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Term
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Definition
HPO4- or H2PO4-
Stored in bone
Circulates everywhere
Normal level in the blood is 0.85-1.45mEq/L (mmol/L)
FUnctions:
bone and tooth mineralization
in ATP!
in a Phosphate buffer system (pH, etc.)
in the Plasma Membrane!
Reciprocally related with serum Ca |
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Term
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Definition
Causes impaired neurological functions:
tremor
hyporeflexia
paresthesias
confusion & stupor
impaired deglutition (Dysphagia)
impaired erythrocyte functions (oxygen transport and blood clotting)
impaired leukocyte functions (phagocytosis)
Caused by:
Malabsorption, diarrhea, excessive use of Antacids
Alkalosis, Hyperparathyroidism |
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Term
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Definition
High phosphate level in blood
Results from:
renal failure
excessive tissue damage
chemotherapy
Results in the same S&S as Hypocalciemia |
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Term
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Definition
extracellular!
Normal level 98-106 mEq/L (mmol/L)
Follows Na!
Can replace Bicarbonate ion (HCO3-)
Helps maintain Acid/Base balance
Chloride shift: low blood Cl- leads to high HCO3- (alkalosis) |
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Term
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Definition
Hypochloremia:
is a result of vomiting (Alkalosis)
is a result of excessive perspiration (hard labour or fever)
Hyperchloremia:
is a result of high intake of NaCl (iv or orally)
is a result of Hypernatriemia |
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Term
Acid/Base Balance:
3 Compensatory Mechanisms for pH control: |
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Definition
1. Buffers
2. Changes in Respiratory Rate
3. Changes in the rate of Renal Excretion of Acids; reabsorption of Bicarbonate |
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Term
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Definition
Is an Acid AND a Base
-reacts and neutralizes acids AND bases thus maintaining pH
4 Major Buffer Systems:
1. Na Bicarbonate- carbonic acid system (most important one) Acidosis Reversed
2. The Phosphate System
3. The Hb system
4. The Protein System
Bicarbonate is the Major Buffer |
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Term
Bicarbonate-Carbonic Acid Buffer System:
Respiratory System: |
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Definition
The normal ratio of HCO3-/H2CO3 = 20/1 to have pH=7.4
In the lungs, H2CO3-> CO2 + H2O. CO2 is excreted via expiration
In the Kidneys, H2CO3-> H+ + HCO3-. H+ is excreted with the urine. Carbonic Anhydrase!
Respiratory Sytem:
Serum CO2 increase => Respiratory (chemo) receptors increase RR => more CO2 is expired per unit of time |
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Term
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Definition
AG = [Na+] = ([Cl-] + [HCO3-])
130-140 100 26
130 - (100 + 26)= 4
Normal AG= ranges from 7-14 mEq/L |
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Term
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Definition
GI: diarrhea & vomiting, through stoma (additional opening into the GI tract)
Renal: renal loss (through the kidneys) renal tubule acidosis
abuse of carbonic anhydrase inhibitors
Hypoaldosteronism- weaken the process of H+ breaking, causing Acidosis
(Spironolactone opposites) |
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Term
| Urinary System (kidneys): |
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Definition
Carbonic Anhydrase
Excretes most of the H+
H+ is exchanged for Na+ while being excreted
In the process, kidneys produce Bicarbonate to serve as a buffer in the bloodstream. |
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Term
Acid/Base Imbalance:
Stages: |
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Definition
Acidosis (pH is low) -vs.- Alkalosis (pH is high)
Stages:
1. Compensation:
pH is 7.35-7.45
2. Decompensation: (pH is "off homeostasis")-
pH <7.35-7.45> |
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Term
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Definition
Causes:
bradypnea, shallow breathing, others
Decompensation: pH <7.33
Effect: pH is decreased; Increased PCO2 normal bicarbonate
Compensation: Kidneys excrete more H+ and reabsorb more Bicarbonate.
pH=N; increase PCO2; increases [HCO3-] |
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Term
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Definition
Tachypnea:
(hyperventilation), others
Decompensation: pH>7.47
Effect: pH increase, decreased PCO2, normal Bicarbonate
Compensation: Kidneys excrete less H+ and reabsorb less Bicarbonate
pH=N; decreases PCO2; Decreases [HCO3-] |
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Term
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Definition
Causes: shock, DKA, renal failure, diarrhea, prolonged deep vomiting, others
Decompensation: pH<7.35
Effect: decreased pH, decreased blood bicarbonate, PCO2=N
Compensation: Tachypnea (Hyperventilation)
pH=N; decreases [HCO3-]; decreases PCO2 |
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Term
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Definition
Causes: short-term vomiting, Antacid abuse, others
Decompensation: pH>7.45
Effect: Increased serum Bicarbonate, PCO2=N
Compensation: Bradypnea, (Hypoventilation, slow shallow breathing).
pH=N; increases [HCO3-]; increases PCO2 |
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Term
| Signs & Symptoms of Acidosis: |
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Definition
| CNS depression, Muscle weakness, Headache, Lethargy, Confusion, Coma & Death |
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Term
| Signs & Symptoms of Alkalosis: |
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Definition
| CNS irritability, Restlessness, Muscle hyperactivity, Tetany, Seizures, Coma & Death |
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Term
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Definition
stimulates Na+ reabsorption and H+ secretion,
Activates Na+/H+ pump
Promotes K+ secretion (& excretion)
Treated with K+ Sparing Diuretic Spironolactone is Exact opposite to Aldosterone |
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Term
| Signs & Symptoms of Alkalosis: |
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Definition
| CNS irritability, Restlessness, Muscle hyperactivity, Tetany, Seizures, Coma & Death |
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