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BMD 420 Module 2 (Chapter 2)

front 1

Intracellular fluid (ICF)

back 1

Fluid inside cells

front 2

Extracellular fluid (ECF)

back 2

Fluid outside cells including intravascular and interstitial fluid

front 3

Hydrostatic pressure

back 3

Force that pushes fluid out of capillaries into tissues

front 4

Osmotic pressure

back 4

Force that pulls water toward higher solute concentration

front 5

Edema

back 5

Excess fluid accumulation in interstitial tissue causing swelling

front 6

Four causes of edema

back 6

Increased hydrostatic pressure; decreased plasma proteins; lymphatic obstruction; increased capillary permeability

front 7

Pitting edema

back 7

Indentation remains after pressing swollen tissue

front 8

Dehydration

back 8

Insufficient body fluid due to low intake or excessive loss

front 9

Isotonic dehydration

back 9

Equal loss of water and electrolytes

front 10

Hypotonic dehydration

back 10

Greater electrolyte loss than water causing diluted plasma

front 11

Hypertonic dehydration

back 11

Greater water loss than electrolytes causing concentrated plasma

front 12

Common dehydration causes

back 12

Vomiting, diarrhea, sweating, diabetic ketoacidosis, inadequate H2O intake

front 13

Signs of dehydration

back 13

Dry mucous membranes, decreased skin turgor, fatigue, low BP, increased hematocrit

front 14

Body compensation for dehydration

back 14

Increased thirst, increased heart rate, vasoconstriction, concentrated urine

front 15

Third-spacing

back 15

Fluid shift from bloodstream into tissues or cavities where it cannot be used for circulation

front 16

Third-spacing effect

back 16

Hypovolemia despite fluid present in body

front 17

Conditions causing third-spacing

back 17

Burns peritonitis severe inflammation

front 18

Sodium main role

back 18

Primary extracellular cation controlling fluid balance and nerve conduction

front 19

Hyponatremia definition

back 19

Low serum sodium levels below 135 mEq/L which causes fluid to shift into the cells.

front 20

What can cause Hyponatremia?

back 20

Excessive sweating, diarrhea, and vomiting. Low Na+ Diet. Diuretic drugs. Low aldosterone (Not reabsorbing Na+), excess ADH (Increases the amount of H2O retained and not excreted), and adrenal insufficiency (responsible for producing aldosterone). Renal failure and drinking too much H2O.

front 21

What are some effects of Hyponatremia?

back 21

Fatigue, cramps, impaired nerve conduction, fluid imbalances, low blood volume since the fluid shifted into the cells like brain cells.

front 22

Hyponatremia fluid movement.

back 22

1. Low Na+ in blood (Less pull of H2O from the vasculature). 2. Low osmotic pressure (pull) in the ECF. 3. H2O shifts out of the blood. 4. Cells in the ECF have a higher osmotic pressure (pull) due to the K+ inside which pulls H2O inside the cell. 5. Cell swells and ruptures

front 23

Hypernatremia definition

back 23

High serum sodium levels above 145 mEq/L which causes fluid to shift out of cells causing dehydration of tissues

front 24

What can cause Hypernatremia?

back 24

Ingesting too much Na+. High H2O loss. Low ADH (Excreting a lot of fluid and leaving high levels of Na+ behind). Loss of thirst mechanism (Not drinking enough water). Diarrhea.

front 25

What are some effects of Hypernatremia?

back 25

Weakness, agitation, Firm tissue, increased thirst with dry mucous membranes, and decreased urine output due to normal ADH secretion.

front 26

Potassium main role

back 26

Primary intracellular cation critical for cardiac and muscle function

front 27

Relationship of H+ and K+

back 27

1. High H+ [ ] in blood. 2. H+ shifts out of the capillary and into the ECF. 3. In a cell in the ECF, the H+ will enter and displace the K+ that was already in there. 4. K+ is now in the ECF after being kicked out and will travel into the blood. 5. High K+ [ ] in the blood

front 28

Hypokalemia definition

back 28

Low serum potassium levels below 3.5 mEq/L

front 29

What can cause Hypokalemia?

back 29

Diuretics, diarrhea, low intake of K+, excessive aldosterone (Promotes Na+ retention and K+ loss), insulin therapy (causes cells to uptake more K+=less K+ in the blood)

front 30

What are some effects of Hypokalemia?

back 30

Cardiac dysrhythmias, fatigue, muscle weakness, Paresthesia (abnormal touch sensations, feeling of "pins and needles", decreased GI motility, Impaired renal functions (Can't concentrate urine or increased urine output), and respiratory weakness

front 31

Electrocardiogram changes with K+ imbalances (Hypokalemia)

back 31

Prolonged PR interval, ST depression, shallow T wave, prominent U wave

front 32

Hyperkalemia definition

back 32

High serum potassium levels above 5 mEq/L

front 33

What can cause Hyperkalemia?

back 33

Renal failure (Not releasing enough K+=increased K+ amount in blood), tissue damage (leakage of intracellular K+ into ECF), acidosis (Displacement of K+ cells), potassium sparing diuretic drugs (Everything but K+ is getting excreted), Aldosterone deficit (body id not releasing enough K+)

front 34

What are some effects of Hyperkalemia?

back 34

Cardiac dysrhythmias, fatigue, muscle weakness, paresthesia, nausea

front 35

Electrocardiogram changes with K+ imbalances (Hyperkalemia)

back 35

Wide P wave, prolonged PR interval, decreased R wave height, widened QRS, Depressed ST segment, and tall peaked T wave

front 36

Calcium main role

back 36

Bone strength nerve stability muscle contraction clotting enzyme function. Balance maintained by: Parathyroid hormone (PTH) which increases Ca2+ absorption, and Calcitonin which lowers Ca2+.

front 37

What can cause Hypocalcemia?

back 37

Hypoparathyroidism (underproduction of PTH which increases Ca2+ absorption), Malabsorption syndrome, Deficit serum albumin (Ca2+ often bound to these proteins), Increased pH (alkalosis), and renal failure (increased phosphate retention and loss of Ca2+)

front 38

What are some effects of Hypocalcemia?

back 38

Muscle twitching, hyperactive reflexes, Chvostek sign (Spasm of the lip or face), Trousseau sign (carpopedal spasm when BP cuff blocks circulation to the hand), laryngospasm, arrhythmias (weak heart contractions)

front 39

What can cause Hypercalcemia?

back 39

Neoplasms (malignant bone tumors due to uncontrolled Ca2+ release), Hyperparathyroidism (overproduction of PTH which increases Ca2+ absorption), decreased stress to bone, increased Ca2+ intake, Milk-alkali syndrome (High milk and antacid intake)

front 40

What are some effects of Hypercalcemia?

back 40

Muscle weakness, lethargy, personality changes, kidney stones, dysrhythmias (increased strength of cardiac contractions), polyuria (high Ca2+ interferes with ADH),

front 41

Magnesium role

back 41

Intracellular cation affecting neuromuscular function and linked to calcium and potassium

front 42

What can cause Hypomagnesemia?

back 42

Due to malabsorption or malnutrition. Diuretics, diabetic ketoacidosis, hyperparathyroidism, and hyperaldosteronism

front 43

What are some effects of Hypomagnesemia?

back 43

Neuromuscular irritability, tremors, insomnia, personality changes, arrhythmias (Increased heart rate)

front 44

What can cause Hypermagnesemia?

back 44

Renal failure

front 45

What are some effects of Hypermagnesemia?

back 45

Depressed neuromuscular function, decreased reflexes, lethargy, cardiac arrhythmias

front 46

Phosphate role

back 46

Located in bone but circulates in ICF and ECF. Functions: Bone mineralization, ATP metabolism, buffer system, cell membranes

front 47

What can cause Hypophosphatemia? (Hypercalcemia)

back 47

Malabsorption, diarrhea, too many antacids, alkalosis, hyperthyroidism

front 48

What are some effects of Hypophosphatemia? (Hypercalcemia)

back 48

Tremors, weak reflexes, paresthesia, confusion, poor blood cell function, anorexia

front 49

What can cause Hyperphosphatemia?

back 49

Renal failure or tissue destruction releasing intracellular phosphate

front 50

What are some effects of Hyperphosphatemia? (Hypocalcemia)

back 50

Neuromuscular irritability, tremors, insomnia, personality changes, arrhythmias (Increased heart rate)

front 51

Chloride role

back 51

Major extracellular anion important for acid-base balance and follows sodium

front 52

What can cause Hypochloremia?

back 52

Early stages vomiting, alkalosis, excessive sweating

front 53

What are some effects of Hypochloremia?

back 53

Nausea, vomiting, diarrhea, muscle twitching, confusion, sleepiness

front 54

What can cause Hyperchloremia?

back 54

Excess sodium chloride intake or dehydration

front 55

What are some effects of Hyperchloremia?

back 55

Edema and weight gain

front 56

Hyperchloremic alkalosis steps

back 56

1. Vomiting (loses HCl). 2. Stomach has low HCl levels. 3. Cl- moves from ECF to gastric secretions (stomach). 4. Cl- shifts from plasma to ECF. 5. Bicarbonate ions (HCO3-) moves out of RBC to replace the lost Cl-. 5. Increased HCO3- in blood leads to alkalosis

front 57

Normal blood pH

back 57

7.35 to 7.45

front 58

Acidosis definition

back 58

Blood pH below normal range

front 59

Alkalosis definition

back 59

Blood pH above normal range

front 60

Main clinical buffer system

back 60

Sodium Bicarbonate carbonic acid buffer system

front 61

Required bicarbonate to carbonic acid ratio

back 61

20 to 1

front 62

Control of serum pH: Respiratory system in acidosis

back 62

Chemoreceptors (Peripheral/Carotid bodies and Central/Medulla oblongata) detect an increase in CO2 (decrease in pH) which stimulates increased respiration rate to drive off more CO2=raises pH

front 63

Control of serum pH: Respiratory system in alkalosis

back 63

Respiratory rate reduced and more CO2 retained=lowering blood pH

front 64

Respiratory acidosis

back 64

Increased CO2 retention from pneumonia, airway obstruction, opiates, chronic obstructive pulmonary disease

front 65

Metabolic acidosis causes

back 65

Decreased availability of bicarbonate ions. Diarrhea, renal failure, lactic acid ketoacidosis, bicarbonate loss

front 66

Respiratory alkalosis cause

back 66

Hyperventilation caused by anxiety, fever, aspirin overdose

front 67

Metabolic alkalosis causes

back 67

Vomiting, hypokalemia, excessive antacid intake

front 68

Metabolic acidosis compensation

back 68

Deep rapid breathing to remove CO2

front 69

Acid-base diagnostic test

back 69

Arterial blood gas analysis

front 70

Compensation in acid-base imbalance

back 70

Respiratory cause= change in CO2 levels. Metabolic cause= change in bicarbonate levels

front 71

Decompensation

back 71

Failure of lungs and kidneys to restore pH leading to life threatening imbalance

front 72

The balance of water and electrolytes maintained by Thirst Mechanism in Hypothalamus?

back 72

This mechanism responds to osmoreceptors that detect changes in blood plasma osmolality. As the high plasma osmolality increases that triggers the thirst mechanism which results in low available H2O meaning we need to increase the amount of H2O intake.

front 73

The balance of water and electrolytes maintained by Antidiuretic Hormone (ADH)?

back 73

This hormone is produced by the hypothalamus and released from the posterior pituitary gland in response to high plasma osmolality. It increases water reabsorption which reduces urine production.

front 74

The balance of water and electrolytes maintained by Aldosterone?

back 74

It is a hormone released by the adrenal cortex and increases Na+ and H2O reabsorption in the kidneys.

front 75

The balance of water and electrolytes maintained by Atrial natriuretic peptide (ANP)?

back 75

It is a hormone released by cardiac muscle fibers in the atria when it senses pressure/stretch in the chamber and in response to high blood volume/pressure by the kidneys increasing renal sodium excretion which brings blood volume and BP down.