Cellular dynamics+fluids+diabetes

What is the most common type of cellular injury?

hypoxic injury (oxygen deficiency)

What is hypoxic injury?

o   Occurs when cells receive insufficient oxygen due to reduced blood supply (ischemia)

loss of hemoglobin and decreased production of red blood cells

What cellular adaptation occurs to myocardial cells that are overworked by pumping against high afterload over a long period of time?

Myocardial hypertrophy!

what is myocardial hypertrophy?

o   Cells increase in size rather than number- can’t divide so they adapt by enlarging

What is a phenotype?

o   outward appearance of the genetics of an organism (observable traits)

What is a genotype?

the composition of genes at a given locus

What is a karotype?

o   visual picture of chromsomes (shows the number and structure)

What is the relationship beetween calcium and phosphate?

o   When phosphorus rises,calcium drops 

o   When calcium rises, phosphorus drops 

What other electrolytes does magnesium regulate?

potassium and calcium

how does low magnesium affect potassium?

low mangesium leads to potassium wasting

how does magnesium regulate calcium levels?

o   Magnesium is needed for proper parathyroid hormone (PTH)- leads to low calcium

what are some objective signs of hyperkalemia?

S/S: ECG has peaked T waves, widened QRS 

Risk: ventricular fibrillation, asystole 

 

What happens in hyperkalemia?

·       Renal failure, potassium-sparing diuretics 

·       ACE inhibitors, ARBs, cell lysis (releases the potassium inside the cell) 

Metabolic acidosis (shift out of cells) 

What happens in type 1 diabetes?

·       Autoimmune destruction of pancreatic B-cells (immune cells destroy beta cells in pancreas) now pancreas can’t produce insulin  

·       ABSOLUTE insulin deficiency  

·       Glucose can’t enter insulin-dependent tissues- now more glucose in the blood  

·       Cells experience energy starvation  

·       Body shifts to fat metabolism for fuel   

What happens in type 2 diabetes?

·                Peripheral insulin resistance in muscle and adipose tissue  

·                Insulin is PRESENT but ineffective  

·                Pancreas compensates with increased insulin secretion initially  

·                Progressive B-cell dysfunction leads to relative insulin deficiency  

what is the primary defect in type 1 and type 2 diabetes?

·                Type 1: autoimmune B cell destruction  

·                Type 2: insulin resistance  

what is the insulin level in type 1 and type 2 diabetes?

·                Type 1: absent  

·                Type 2: normal- decreased over time  

which diabetes type usually has ketone production?

type 1

what is the primary acute rusk for type 1 and type 2 diabetes?

type 1 is DKA

type 2 is HHS

What are Kussmaul respirations?

o   Deep, rapid, labored breathing seen in severe metabolic acidosis (body’s attempt to blow off CO2 to raise blood ph  

when do kussmaul respirations happen?

o   occur when the blood becomes acidic, associated with DKA: 

·                Absolute insulin deficiency  

·                Unopposed lipolysis  

·                Ketone accumulation (fat breakdown leads to ketone production) 

·                Metabolic acidosis (bc blood pH drops)- body compensates by hyperventilating 

what are kussmaul respirations associated with?

type 1 diabetes

Why do blood sugar levels rise when someone is sick or stressed?

o   Stress (infection, injury, etc.) → release of stress hormones, including:

• Cortisol

• Epinephrine (adrenaline)

• Glucagon

Increased glucose production in the liver- decreases insulin effectiveness, promotes release of stored energy into the bloodstream

what does increased glucose in the liver do?

hyperglycemia- trying to provide fule for vital organs especially the brain and muslces to handle the stressor- this is why sick patients often have elvated blood sugar during illness (stress hyperglycemia)