Term
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Definition
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Term
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Definition
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Term
| Decreases in pH denote . . . |
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Definition
| higher concentrations of H+ ions, or higher levels of acidity. |
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Term
| _____ is continuously produced during cellular metabolism |
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Definition
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Term
| Total body _____ is a combination of volatile acids (those that contain CO2 and its variants) and nonvolatile acids (i.e. amino acids, lactic acid) |
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Definition
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Term
| ______ can build up in the blood during intense exercise, but only becomes pathologic when increased production can not be corrected by the kidneys. |
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Definition
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Term
| Causes of build up of acid |
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Definition
| Ingestion, hypoventilation, diarrhea |
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Term
| Products of fat metabolism during periods of inadequate glucose availablility; i.e., starvation ketosis and metabolic acidosis. |
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Definition
| Ketone bodies, or ketoacids |
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Term
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Definition
Volatile acid
Dissociates into H2O and CO2
Excreted by lungs |
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Term
| 5 Non-volatile (fixed) acids, excreted by kidneys |
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Definition
Sulfuric Acid
Phosphoric Acid
Lactic Acid
Ammonium ions
Ketone Bodies:
Acetoacetic Acid
b-Hydroxybutyric Acid |
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Term
| pH homeostasis constantly regulated by |
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Definition
Buffers
Bicarbonate buffer system (ECF)
Phosphate, hemoglobin, & protein
Respiratory System
Renal System |
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Term
| Buffering systems consist of a weak acid + base. Prevent large changes in pH by taking up/releasing H+ to maintain normal pH. |
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Definition
| work to maintain pH within normal levels. |
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Term
| Bicarbonate buffering system ratio |
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Definition
Maintained at constant ratio of
20 HCO3 : 1 H2CO3 |
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Term
| Bicarbonate ions (HCO-3) regulated by |
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Definition
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Term
| Carbonic Acid (H2CO3) regulated by |
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Definition
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Term
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Definition
During periods of excess acid accumulation in the blood, bicarbonate is released into extracellular fluid where it can take up the extra H+ ions released by the acid and becomes carbonic acid. Carbonic acid is a weak acid and easily gives up H+. Thus, through enzymatic conversion by carbonic anhydrase, H2CO3 cans be dissociated into CO2 and H2O, which can be excreted by the lungs during respiration. |
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Term
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Definition
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Term
| Respiratory regulation of acid base balance |
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Definition
During exhalation, lungs continually excreting carbonic acid-effectively maintaining pH @ 7.4.
High levels of CO2 result from hypoventilation (slow, shallow respirations).
Low levels of CO2 result from hyperventilation (rapid, deep respirations)
Correction of alterations in CO2 is accomplished by changes in respiratory rate and depth. |
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Term
| Typical level of CO2 in blood |
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Definition
PaCO2: level of CO2 in blood
35 – 45 mm Hg |
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Term
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Definition
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Term
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Definition
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Term
| Poor respiratory function means acid base balance |
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Definition
| Cannot be properly regulated by respiration |
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Term
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Definition
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Term
| Renal regulation of acid base balance |
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Definition
Metabolic acid excretion
1. Filtered HCO3 reabsorbed-@ 80%
2. H+ or HCO3 secreted to maintain balance, |
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Term
| Renal compensation to excess or decrease in carbonic acid takes _____ to be effective |
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Definition
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Term
| ______ is the only acid not excreted by kidneys. Can only be excreted from lungs. Decreased HCO3 reflects an excess of metabolic acids in the blood. |
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Definition
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Term
| Bicarbonate is freely filtered at _________. |
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Definition
renal corpuscles
Usual plasma concentration is 24 mmol/L. The average daily glomerular filtration rate is 180 L/day, so huge amounts of bicarb (@4320 mmol/day would be excreted! That would be like adding huge amounts of acids to the body. Most-if not all-the filtered bicarbonate must be reabsorbed to balance acid! |
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Term
| ______ occurs when the absolute values of HCO3- and PaCO2 return to normal. |
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Definition
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Term
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Definition
| regulation of acid base balance through adaptive mechanisms, NOT correction of the primary imbalance |
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Term
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Definition
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Term
| 4 Key acid-base disturbances |
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Definition
Respiratory alkalosis
Respiratory acidosis
Metabolic alkalosis
Metabolic acidosis |
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Term
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Definition
| : Decreased CO2. Carbonic acid deficit. Caused by hyperventilation due to anxiety. |
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Term
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Definition
| Hypoventilation and accumulation of CO2 in body. Caused by airway obstruction, chronic obstructive lung diseases (emphysema), neuromuscular disorders. |
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Term
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Definition
| : Increase of blood pH by ingestion of excess alkali (sodium bicarbonate) or abnormal loss of acid (prolonged vomiting). |
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Term
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Definition
| : Decreased blood pH caused by disorders that increase lactic acid, ketone bodies (acetoacetic acid and b-hydroxybutyrate) or by ingestion of salicylates, ethylene glycol, methyl alcohol. Example: Diabetic ketoacidosis. |
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Term
| Respiratory alkalosis causes |
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Definition
hyperventilation
Anxiety, excessive sobbing
Brainstem stimulation-head trauma, meningitis |
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Term
| Respiratory alkalosis compensatory response |
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Definition
| decreased renal excretion of metabolic acids |
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Term
| Treatment of respiratory alkalosis |
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Definition
| Rebreathe CO2-laden breath, sedative |
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Term
| Respiratory acidosis causes |
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Definition
Retention of CO2
Pulmonary diseases: COPD, pneumonia, pulmonary edema, OSA
Impaired neuromuscular function |
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Term
| Respiratory acidosis compensation |
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Definition
| increased renal excretion of metabolic acids |
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Term
| Respiratory acidosis treatment |
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Definition
Correct respiratory impairment
Infusion of sodium bicarbonate if severe |
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Term
| 4 causes of metabolic acidosis |
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Definition
1. Chronic renal failure
2. Loss of bicarbonate during severe diarrhea
3. Ketoacidosis (ex: type 1 diabetes, starvation)
4. Methanol and certain medication poisoning |
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Term
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Definition
| headache, abdominal pain (unique--cause unknown), CNS depression |
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Term
| Metabolic Alkalosis causes |
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Definition
Excessive loss of gastric acid (vomiting, suctioning)
Overuse of bicarbonate products |
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Term
| Metabolic alkalosis compensatory response |
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Definition
| hypoventilation: losing acid--hang on to carbonic acid by decreasing exhalation of CO2 |
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Term
| Metabolic alkalosis treatment |
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Definition
Solution of sodium chloride plus potassium chloride
Facilitates renal excretion of bicarbonate |
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Term
| Metabolic Acidosis compensatory response |
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Definition
Respiratory: hyperventilation
Decreases H2CO3 in attempt to normalize pH when HCO3 is low |
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Term
| Metabolic acidosis treatment |
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Definition
Correct the underlying cause of acidosis
Occasionally Alkalinizing salt (sodium bicarbonate) if severe
Given oral or IV |
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Term
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Definition
pH: 7.35-7.45
PaCO2: 35 – 45 mm Hg
HCO3-: 22 – 26 mEq/L |
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Term
| Normal Values: PaO2 and SaO2 |
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Definition
Partial pressure of arterial oxygen (PaO2): 80-100 mm HG (varies with age)
Oxygen saturation (SaO2): % of Hgb carrying O2: 95%-100% |
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Term
CS3: 78 year old male, lifetime smoker, history of emphysema x 4 years
pH: 7.35
PaCO2: 60 mm Hg
HCO3: 38 mEq/L |
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Definition
| Impaired lung function, can't get rid of excess acid. High bicarb is compensatory. Fully compensated respiratory acidosis. |
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Term
CS1: Man brought to ED for OD of tricyclic antidepressant. Unconscious, with resp. rate of 5-8 BPM.
pH: 7.25
PaCO2: 61 mm Hg
PaO2: 76 mm Hg
HCO3: 26 mm Hg
SaO2: 89% |
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Definition
| Ph is low, so Uncompensated resp acidosis |
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Term
CS2: 13 year old female brought to ED with stomach pain, nausea and vomiting. She is lethargic and slightly confused. Resp. rate: 34.
pH: 7.2
PaCO2: 28 mm Hg
HCO3: 10 mm Hg
SaO2: 90% |
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Definition
| Metabolic acidosis, somewhat compensated thanks to hyperventilation. Acid and base are both low. Losing metabolic acids quickly. Prebicarb is binding to excessive acid load, so we're losing all this to urine. In ketoacidosis. Kidneys have been releasing more bicarb. Can't keep up--trying to breathe it out. Low bicarb-->metabolic |
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Term
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Definition
| a measure of the number of dissolved particles per unit of water in serum. concentration of the number of particles |
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Term
| TBW as a percentage of BW varies |
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Definition
| males (60%); females (50%);infants (70%) |
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Term
| Half of _____ is in the ICF & ECF of muscle |
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Definition
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Term
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Definition
Push
Created by fluid
Capillaries: the pumping of the heart
Tissue: interstitial fluid |
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Term
| Osmotic = oncotic = colloidal pressure |
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Definition
Pull
Created by proteins
Capillaries: plasma proteins
Tissue: interstitial proteins |
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Term
| 1. The ____consists of fluid contained within all the billions of cells in the body. |
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Definition
| intracelluar fluid compartment |
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Term
| 2. The ____ contains all the fluids outside the cell, including those in the interstitial or tissue spaces and blood vessels. |
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Definition
| extracellular_fluid compartment |
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Term
| 3. ___ is the movement of charged or uncharged particles along a concentration gradient. |
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Definition
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Term
| 4. _is the movement of water across a semi-permeable membrane. |
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Definition
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Term
| 5. __refers to the osmolar concentration 1 L of solution and ___ to the osmolar concentration in 1 kg of water. |
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Definition
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Term
| 6. _ and other organic compounds cannot pass through the membrane. |
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Definition
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Term
| 7. The ___ membrane pump continuously removes three Na+ ions from the cell for every two K+ ions that are back into the cell. |
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Definition
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Term
| 8. __refers to the movement of water through the capillary pores because of a mechanical, rather than osmotic force. |
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Definition
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Term
| 1. The ___represents an accessory route whereby fluid from interstitial spaces can return to the circulation. |
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Definition
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Term
| 10. ___is a palpable swelling produced by expansion of the interstitial fluid volume. |
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Definition
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Term
| 11. Edema due to decreased capillary colloidal osmotic pressure is the result of inadequate production of abnormal loss of _____. |
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Definition
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Term
| 12. __edema occurs at times when the accumulation of interstitial fluid exceeds the absorptive capacity of tissue gel. |
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Definition
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Term
| 13. __ represent an accumulation or trapping of body fluids that contribute to body weight but not to fluid reserve or function. |
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Definition
| Third-space fluids or third spacing |
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Term
| 14. Most sodium losses occur through the __or _. |
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Definition
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Term
| 15. The major regulator of sodium and water balance is the maintenance of the ___. |
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Definition
| effective circulating volume |
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Term
| 16. When the effective circulating blood volume is compromised, the condition is often referred to as ___. |
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Definition
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Term
| 17. __ cause sequestering of ECF in the serous cavities, extracellular space in injured tissues, or lumen of the gut. |
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Definition
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Term
| 18. Fluid volume excess represents an ____expansion of the ECF compartment with increases in both interstitial and vascular volumes. |
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Definition
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Term
| 19. A plasma sodium concentration below 135 mEg/L is called _. |
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Definition
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Term
| 20. Hypernatremia represents a deficit of ____in relation to the body’s sodium stores. |
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Definition
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Term
| 21. Chronic hyperkalemia is usually associated with _____________ |
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Definition
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Term
| 22. ___acts to sustain normal plasma levels of calcium and phosphate by increasing their absorption from the intestine. It is also is necessary for normal bone formation. |
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Definition
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Term
| 23. One liter of water weighs __ kg or __ lb. |
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Definition
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Term
| 24. ____ pressure pushes water out of the capillary and into the interstitial space. |
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Definition
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Term
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Definition
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Term
| pressure by which water is dawn into a solution through a semi-permeable membrane |
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Definition
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Term
| osmotic pressure generated by the plasma proteins impermeable to the capillary wall |
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Definition
Capillary colloidal
osmotic pressure |
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Term
| effect that the effective osmotic pressure of a solution on cell size because of water movement across the cell membrane |
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Definition
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Term
| result of increased vascular volume |
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Definition
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Term
| increased permeability of glomerular to proteins |
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Definition
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Term
| effective osmolality same as the ICF |
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Definition
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Term
| urine output that is required to eliminate waste |
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Definition
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Term
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Definition
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Term
| edema due to impaired lymph drainage |
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Definition
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Term
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Definition
Total Body Water = 60% of body weight
Intracellular fluid = 40% of body weight
Extracellular fluid = 20% of body weight |
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Term
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Definition
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Term
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Definition
1/3
Plasma: 1/4-influenced by kidney
Interstitial: 3/4-pathological states |
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Term
| – occurs at the glomerulus; non selective process |
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Definition
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Term
| - 99% of water, electrolytes, and nutrients undergo reabsorption by active transport; occurs all along the nephron |
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Definition
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Term
| - proximal convoluted tubule |
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Definition
| Active tubular secretion (not excretion!) |
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Term
| Most diuretics share the same MOA- |
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Definition
block Na and Cl reabsorption
(stays in the nephron) |
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Term
| Three basic functions of diuretics: |
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Definition
1. Cleansing and maintenance of extracellular fluid (ECF) (volume and composition)
2. Maintenance of acid-base balance
3. Excretion of metabolic wastes and foreign substances |
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Term
| Classification of Diuretics |
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Definition
üHigh-ceiling (loop) diuretics
•Thiazides and related diuretics
•Potassium-sparing diuretics
–Aldosterone antagonists
–Nonaldosterone antagonists
•Osmotic diuretics
•Carbonic anhydrase inhibitors (not covered) |
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Term
| ___ produces greatest diuresis |
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Definition
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Term
| Adverse effects of diuretics |
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Definition
Hypovolemia
Acid-base imbalance
Electrolyte imbalances (K) |
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Term
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Definition
Mannitol
proximal convoluted tubule
65% Na reabsorbed |
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Term
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Definition
Furosemide
thick segment ascending limb of Henle's loop
20% Na reabsorbed |
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Term
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Definition
Thiazides
early distal convoluted tubule
10% Na reabsorbed |
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Term
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Definition
Spironolactone, Triamterene
late distal convoluted tuble, collecting duct
1 - 5% Na reabsorbed |
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Term
| Potassium-sparing: two subdivisions |
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Definition
Aldosterone antagonists (spironolactone)
Nonaldosterone antagonists (triamterene) |
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Term
| Factors Influencing Edema Formation |
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Definition
↑ Hydrostatic pressure (e.g. Heart failure)
Oncotic pressure (low protein states)
↑ capillary permeability (inflammation)
Lymphatic obstruction
Na and H2O retention by the kidneys |
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Term
| A major side effect of ___ and ___ diuretics is hypokalemia. |
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Definition
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Term
| Amount of Na + Cl reabsorption inhibited |
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Definition
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