Patho chapter 3

Distribution of Body Fluids

Total body water 60%, ICF 40%, ECF 20%

Which age group has the most amount of body water?

Newborns

T/F men and women have an equal amount of body water

False, men have a greater percentage of body water than women

T/F People that are obese have a lower percentage of body water

True

Is sodium in ECF or ICF?

ECF

Is potassium in ECF or ICF?

ICF

What are aquaporins?

A family of water channel proteins that provide permeability to water at the capillary membrane.

What is osmosis?

How water moves between ECF and ICF compartments

Water will move from one compartment to another until \___ \____ is reestablished

osmotic equilibrium

Starling Hypothesis

Net filtration is equal to the forces favoring filtration minus the forces opposing filtration

Forces favoring filtration

Move H2O out - capillary hydrostatic pressure and interstitial oncotic pressure

Forces opposing filtration

Keeps H2O in - capillary oncotic pressure and interstitial hydrostatic pressure

Edema

Accumulation of fluid in intersititial paces

Edema causes

Increased capillary hydrostatic pressure, decreased plasma oncotic pressure, increased capillary permeability, lymphatic obstruction

Clinical manifestations of edema

Trauma, gravity, pitting edema, Anasarca, Swelling and piffiness, tight-fitting clothes and shoes, weight gain

Edema treatment

Elevate edematous limbs, use compression stockings or devices, avoid prolonged standing, reduce salt intake, take diuretic agents

T/F Edema causes wounds to heal quickly

False

Are electrolytes in ECF are ICF?

Both

What is the intracellular cation

Potassium

What are the intracellular anions?

Phosphate and organic ions

What is the extracellular cation?

Sodium

What are the extracellular anions?

chloride and bicarbonate

What regulates sodium?

Aldosterone, from the adrenal cortex and natriuretic peptides

What regulates water balance?

ADH from the posterior pituitary

T/F chloride follows sodium

True

T/F Chloride is counted in labs

False

What system regulates Na and Cl levels?

Renin- Angiotensin- Aldosterone system

The Renin-Angiotensin-Aldosterone system stimulates the formation of angiotensin II due to decreases \____ which \_______

blood volume, blood pressure

T/F Angiotensin II is a vasoconstrictor, which causes the secretion of aldosterone

True

What does aldosterone regulate?

Sodium

What are natriuretic peptides?

Hormones produced by the heart, brain, and kidney that decrease blood pressure and Na and H2O retention

T/F Natriuretic peptides decrease tubular resorption and promote urinary excretion of sodium

True

What are natural antagonists to the Renin-Angiotensin-Aldosterone System

Atrial natriuretic peptide, brain natriuretic peptide, urodilatin

T/F ADH leads to a decrease in water volume and increase in urination

false

What regulates thirst perception?

Osmolarity receptors and baroreceptors

Isotonic fluid loss (Dehydration and hypovolemia) leads to

Contraction of ECF resulting in weight loss, dry skin, membranes, decreased UOP, and Sx of hypovolemia, hemoconcentration

Isotonic fluid excess (hypervolmeia) leads to

cortisol, high aldosterone, weight gain, decreased hematocrit

Hypernatremia, water moves from \__ to \___

ICF, ECF

Manifestations of hypernatremia

Intracellular dehydration, sezuires, muscle twitching, hyperreflexia

Treatment of hypernatermia

Isotonic salt free fluids

Water deficit manifestations

low blood pressure, weak pulse, postural hypotension, elavated hematocrit and serum sodium levels, headache, dry skin, dry mucus membranes

water deficit treatment

oral fluids, hypotonic saline solution

hyperchloremia occurs with

hypernatremia or a bicarbonate deficit

T/F Chlorine is antagonistic of bicarb

True

hypotonic alterations

Water excess

Hyponatremia treatment

Depends on underlying disorder, restrict water intake

Hypochloremia causes

Hyponatermia or elevated bicarbonate concentration

T/F Potassium adaption allows the body to accommodate slowly to increased levels of K intake

True

Hypokalemia causes

Reduced potassium intake, increased potassium entry into cell, increased potassium loss

Hypokalemia treatment

replace potassium orally and/or intravenously

Hypokalemia membrane manifestations

Decreased neuromuscular excitability, skeletal muscle weakness, smooth muscle atony, cardiac dysrhytmias, U wave on ECG

T/F Hyperkalemia is common

False

Hyperkalemia causes

Increased intake, Shift of K from ICF to ECF, decreased renal excretion, hypoxia, acidosis, insulin deficiency, cell trauma, digital overdose

Hyperkalemia mild attacks

tingling of lips and fingers, restlessness, intestinal cramping, diarrhea, T waves of ECG

Hyperkalemia severe attacks

Muscle weakness, loss of muscle tone, paralysis

Hyperkalemia treatment

Calcium gluconate, insulin and/or glucose, buffered solutions, dialysis

T/F Calcium and phosphate ate antagonistic

True

What hormones regulate calcium and phosphate

PTH, Vitamin D, calcitonin

Hypocalcemia causes

Inadequate intake or absorption, decrease in PTH and vitamin D, blood transfusions

hypocalcemia manifestations

increased neuromuscular excitability, muscle spasms, Chvostek and Trousseau signs, convulsions, tetany

hypocalcemia treatment

Calcium gluconate, calcium replacement, decrease phosphate intake

Chvostek sign

spasm of facial muscles causing smile

Trousseau sign

Spasm of hands and fingers after bp cuff inflation

Hypercalcemia causes

Hyperparathyroidism, bone metastasis, excess vitamin D, immobilization, acidosis, sarcoidosis

Hypercalcemia manifestations

decreased neuromuscular excitability, muscle weakness, kidney stones, constipation, heart block

Hypercalcemia treatment

oral phosphate, IV normal saline, bispohosphonates, calcitonin, denosumab

Hypophosphatemia leads to the inability to produce \___

ATP

Hypophosphatemia causes

Intestinal malabsorption and renal excretion, Vitamin D deficiency, antacid use, alcohol abuse, malabsorption syndromes

Manifestations of hypophosphatemia

Diminshed release of O2, osteomalacia, muscle weakness, bleeding disorders, leukocyte alterations, rickets

hypophosphatemia treatment

Treat underlying condition such as respiratory alkalosis and hyperparathyroidism

Hyperphosphatemia causes

Exogenous or endogenous addition of phosphate to ECF, long-term use of phosphate enemas or laxatives, renal failure

Hyperphosphatemia manifestations

same as hypocalcemia + possible calcification of soft tissue

Hyperphosphatemia treatment

Treat underlying condition, aluminum hydroxide, and dialysis

T/F Magnesium is an extracellular anion

False, its a intracellular anion

Hypomagesemia is from __

malabsorption

hypomagnesia manifestations

neuromuscular irritability, tetany, convulsions, increased reflexes

hypomagnesia treatment

Magnesium sulfate

Hypermagnesemia cause

renal failure

Hypermagnesmia manifestations

Skeletal muscle depression, skeletal muscle depression, muscle weakness, hypotension, respiratory depression, bradycardia

Hypermagnesmia treatment

avoid magnesium, dialysis

pH below 6.8

death

pH above 7.8

death

which organs are involved in the regulation of acid/base balance?

Bones, lungs, kidneys

Most important plasma membrane buffering system

carbonic acid- bicarbonate system and hemoglobin

Most important ICF buffers

Phosphate and protein

Is CO2 more acidic or basic?

acidic

Carbonic Acid- bicarbonate buffering operates in the \___ and \___

lung, kidney

T/F kidneys can quickly affect acid/base levels

false

Normal arterial blood pH

7.35-7.45

Acidosis

pH is less than 7.35

Alkalosis

pH is greater than 7.45

Respiratory acidosis

Elevation of CO2 as result of ventilation depression

Respiratory alkalosis

depression of Co2 as a result of Hyperventilation

Metabolic acidosis

Depression of HCO3 or an increase in noncarbonic acid

Metabolic alkalosis

elevation of HCO3, usually as a result of an excessive loss of metabolic acids

Metabolic acidosis causes

Lactic acidosis, renal failure, DKA, diarrhea, starvation

Metabolic acidosis manifestations

Headache, lethargy, Kussmal respirations

Metabolic acidosis treatment

buffering solution administration, treat the underlying cause, base administration, correct sodium and water deficits

T/F Anions should not equal cations

False

Normal anion gap

Characteristic of conditions related to bicarbonate loss with retention of chloride to maintain an ionic balance