A&P 2 Ch 26
ICF electrolytes
-Low Na+ and Cl- -Major cation: K+ -Major anion HPO42- increased soluble proteins vs plasma
ECF electrolytes
-Major cation: Na+ -Major anion: Cl- except for inc protein & reduced Cl- content of plasma
What is the minimum amount of urine that can be excreted per day in a healthy person?
500ml
What hormone can "water down" the ECF is its concentration is too high?
ADH
Decreases blood pressure and blood volume Inhibits ADH, renin, and aldosterone productionIncreases excretion of Na+ and water Promotes vasodilation directly and also by decreasing production of angiotensin II
ANP
If the walls of the atrium are stretch beyond homeostasis, what hormones secretion is increased?
ANP
What hormone inhibits RAAS hormones and causes vasodilation
ANP
What hormone has the most direct and significant effect on blood potassium?
Aldosterone
The text erroneously says alkalemia and alkalosis are the same thing. What is the difference?
Alkalemia is the plasma pH value being above 7.45 and alkalosis is the process of the blood pH shifting toward basicity.
If a molecule donates a hydrogen ion to a solution, what would it be considered?
An Acid
What is true about sensible water loss?
Any fluid loss a patient could actually sense is a component of sensible water loss.
What is sodium CONTENT import for regulating?
Blood volume and blood pressure.
Which of the following ions has a higher concentration in the ECF than the ICF? Figure 26.2
Ca2+ Na+ HCO3 Cl-
What ion are blood phosphate levels tied directly to?
Calcium
What are the ways the body regulates and controls pH described in the text?
Chemical buffers Respiratory centers Renal mechanisms
What ECF ion balances sodium ion's positive charge in ECF?
Chloride
-Increasing or decreasing resp rate and depth
Co2 conservation/loss
What are buffers in general?
Compounds that resist pH changes when acids or bases are added
What function can decrease blood pressure?
Decreased Aldosterone Secretion
If excessive water is lost through exercise, which of the following would happen?
ECF osmotic pressure rises
Why are electrolytes better at controlling fluid levels than a nonelectrolytes like glucose?
Greater osmotic power than nonelectrolytes due to ability to dissociate into two or more ions causing fluid shifts
What are some common ways that ionic concentrations are imbalanced?
Hormone imbalances, dehydration, renal issues, and mineral deficiencies/excesses.
What ion imbalance can lead to kidney stones and (more seriously) decreased neuromuscular excitability?
Hypercalcemia
A patient shows up to the ER with a fracture of the tibial after skipping a step on the stairs. Upon taking a health history it is found they have been experiencing frequent muscle cramps and tingling in the fingers. What ionic imbalance might be suspected?
Hypocalcemia
What ion imbalance could diuretic therapy or Cushing's syndrome most likely lead to?
Hypokalemia
Where are most of the body's fluids contained?
ICF
accounts for 2/3 of body fluids
ICF
If no other factors change, if overall H2O content drops in the body what happens to overall ECF ion concentration?
Increase Concentration
What do the lungs do to compensate for metabolic acidosis?
Increase Respiratory Rate and Depth
What do the kidneys do to compensate for respiratory acidosis?
Increase overall bicarb production, reabsorption, and hydrogen secretion.
What fluid compartment is implicated in edema? Why is this not as much of a problem as if the cells were swelling?
Interstitial fluid causing the swelling and my inhibit mobility and some nutrient exchange. This is very different then cells swelling where ECF and ICF concentrations would be way out of whack. If cells swell too much they would burst.
Why might a person's brain compel them to eat coins, nuts, and bolts?
Iron deficiency
What occurs when ECF osmolarity (concentration) increases? What happens when blood plasma decreases?
Osmotic and hydrostatic pressures regulate continuous exchange and mixing of fluids All body fluid osmolality is almost always equal. Change in solute concentration of any compartment leads to net water flow ↑ ECF osmolality → water leaves cell ↓ ECF osmolality → water enters cell
What 2 hormones play the biggest role in [calcium]?
PTH & Vit D (calcitriol)
What ion's excretion is tied to calciums conservation?
Phosphate
Elevated respiratory rate and a blood pH of 7.36.
Primary metabolic acidosis with fully compensated respiratory alkalosis
Which of the following is a cause of hypercalcemia?
Prolonged immobilization
What is the most important buffer in intracellular fluid?
Protein
When the fluid or sodium level falls, juxatolomerluar cells secrete renin. Renin>angotensinogen (liver)=AG1 > ACE (lungs, endothelium)=AG2 *AG2 >vasconstriction, thirst, stimulates aldosterone, & ADH production.
RAAS
What is obligatory water loss
Required to remove solutes and wastes from the body.
What type of food do bars like to give their patrons to increase their thirst?
Salty
What is more important for maintaining nervous function?
Sodium concentration
How would the body respond to a drop in plasma volume of 10%?
Stimulate RAAS
If ECF concentration is way too high, what will the cells do? (Shrink or Swell) How does the body prevent this?
The fluid in cells will leave toward the hypertonic ECF causing the cells to shrink. This is prevented with thirst and ADH.
What makes electrolytes different from nonelectrolytes?
Their ability to dissociate.
Hypoaldosteronism/do not produce aldosterone. Lose large amounts of NaCl and water to urine. At risk for hypovolemia
addison's
If blood volume is too low, what hormone can manipulate salt levels to retain H2O?
aldosterone
What hormones stimulus includes increased blood [potassium]?
aldosterone
biggest role in regulation of Na+ by kidneys. Also triggered by elevated K+ levels in ECF High concentration: Na+ is actively reabsorbed in DCT and CT and water follows, so ECF volume increases Low concentration: Na+ is not actively reabsorbed and is lost to urine, along with increased loss of water.
aldosterone
what are extracellular fluids
all non intracellular fluids
Triggers aldosterone release from adrenal cortex Results in increasedNa+ reabsorption by kidney tubules
angiotensin II
What hormone increases thirst, vasoconstriction, ADH & Aldosterone secretion?
angiotensin II
Acidosis or acidemia
arterial pH <7.35
Alkalosis or alkalemia
arterial pH >7.45
-Dissociation of carbonic acid liberates HCO3 directly from the filtrate, generated within them into the peritubular capillary blood. -HCO3 leaves the tubule cell either accompanied by Na+ or in exchange for Cl− -H+ is actively secreted, mostly by a Na+H+ antiporter, but also by a H+ ATPase. In the filtrate, H+ combines with filtered HCO3. For this reason, reabsorption of HCO3 4 , active secretion of H+. For each filtered HCO3 the filtrate, a HCO3 − depends on the secretion of H+
bicarb conserved
-Secretion of H+ occurs mainly in the PCT and in type A intercalated cells of the collecting duct. -The H+ secreted comes from the dissociation of carbonic acid. This is created when CO2 and water combine within the tubule cells in a reaction catalyzed by carbonic anhydrase -H+ is secreted into the lumen of the PCT, Na+ is reabsorbed from the filtrate, maintaining the electrical balance. The rate of H+ secretion rises and falls with CO2 levels in the ECF. The more CO2 in the peritubular capillary blood, the faster the rate of H+ secretion. -Secreted H+ can combine with HCO3 − in the filtrate, generating CO2 and water. The rising concentration of CO2 in the filtrate creates a steep diffusion gradient for its entry into the tubule cell, and it promotes more H+ secretion.
bicarb lost
Buffers both ICF and ECF. Only important buffer ECF. -Mixture of H2CO3 (weak acid) and salts of HCO3- -If strong acid added: HCO3- ties up H+ and forms H2CO3. pH decreases only slightly, unless all available HCO3- (alkaline reserve) is used up -If strong base added: H2CO3 to dissociate and donate H+. H+ ties up the base and pH rises only slightly. H2CO3 supply is from CO2 released by respiration and subject to respiratory controls
bicarbonate
Which electrolyte is high in ICF and uniquely blood plasma with a negative charge?
bicarbonate
depression of CNS. Coma and death
blood pH < 6.8
overexcitation of nervous system. Resp arrest, muscle tetany, extreme nervousness, convulsions, and death
blood pH >7.8:
hypothalamus center controlling C02 levels
brain stem buffers
Which electrolyte is high in ECF with a +2 charge and is essential for clotting?
calcium
Bicarb, proteins, Phosphate
chemical buffers
Which electrolyte is high in ECF and is the primary buffer of ECF?
chloride
Which electrolyte is high in ECF with a -1 charge and balances sodium?
chloride
Increase Na+ reabsorption and promote edema
cortisol
What is a glucocorticoid that causes edema?
cortisol
From excessive exposure to cortisol, either from steroid use or over production. Overproduction of aldosterone and can cause hypokalemia
cushing's
ECF water loss -Excessive loss of H20 from ECF leads to ECF osmotic pressure rising -Cells lose H20 to ECF via osmosis. Cells shrink
dehydration
Atypical accumulation of IF. Results in tissue swelling, not cell swelling. Only the volume of IF is increased, not of other compartments.
edema
What female hormone is like aldosterone?
estrogen
increase NaCl reabsorption (like aldosterone). Leads to H2O retention during menstrual cycles and pregnancy
estrogens
Electrolytes do not participate in chemical reactions.
false
Electrolytes take up more space than non-electrolyte solutes.
false
Which electrolyte is high in ICF with a -2 charge and is a urine buffer?
hydrogen phosphate
A bed-ridden cancer patient with a salmon addiction went in to get labs drawn for some confusion. It is found out the tumor metastasized to the parathyroid leading to hypersecretion of PTH. The patient also complained of dysuria. Physicians performed an ultrasound on the kidneys and detected nephrolithiasis. While the patient was waiting for the results of the ultrasound, the weak patient developed a cardiac arrythmia that resulted in his eventual death.
hypercalcemia
The novice nurse administered the corrective solution for scenario 4 too rapidly. The patient immediately developed bradycardia and flaccid paralysis. Eventually the patient developed asystole
hyperkalemia
A poor dehydrated baby was given an excessive intravenous high concentration saline solution in attempt to correct the situation. Unfortunately, the infant started twitching and having convulsions. The infant was unresponsive (lethargic) and eventually went into a coma.
hypernatremia
A night owl burn patient with late stage renal failure started to develop a tingling in his fingers with skeletal muscle cramps. Upon getting up to go to the restroom the patient fractured his ankle. Upon examination his heart rate was depressed. The situation was corrected in time to save the patient's life.
hypocalcemia
A patient with Cushing's syndrome on diuretic therapy for hypertension shows up to the ER with an arrhythmia and muscular weakness. Laboratory findings included a flattened T-wave on the EKG and the ABG showed metabolic alkalosis.
hypokalemia
What would be a worry with hypersecretion of aldosterone?
hypokalemia
A person developed gastroenteritis with excessive vomiting and diarrhea. Water loss and ____ ions were both lost causing to circulatory/hypovolemic shock due to low blood volume and pressure.
hyponatremia
A person with Addison's disease decided to participate in a water chugging contest. Unfortunately, she accidentally bought distilled water. Her symptoms manifested rapidly with muscular twitching, irritability, and convulsions.
hyponatremia
Which of the following would most likely occur due to hypotonic hydration?
hyponatremia
What part of the brain most directly regulates thirst?
hypothalamus thirst center
Cellular overhydration, or water intoxication Excessive H20 enters ECF and osmotic pressure falls Cells gain/swell with excessive H20. Cells burst
hypotonic hydration
Total body water decreases with age, homeostatic mechanisms slow. Become unresponsive to thirst clues. Suffer more from CHF, DM
importance of hydration in elderly
Proportionately more ECF than adults until 2 years First months of life at risk for dehydration and acidosis d/t: low residual lung volume, high rate of fluid intake and output, high metabolic rate
importance of hydration in infants
ECF compartments
interstitial, intravascular, synovial, intestinal, biliary, hepatic, pancreatic & cerebrospinal fluids, sweat, urine, pleural, synovial, peritoneal, pericardial, & intraocular
ICF
intracellular fluid
Which electrolyte is high in ICF with a +2 charge is a enzymatic co-factor?
magnesium
A-B imbalance in this pathology: excess alcohol
metabolic acidosis
A-B imbalance in this pathology: excess aldosterone
metabolic acidosis
A-B imbalance in this pathology: renal failure
metabolic acidosis
A-B imbalance in this pathology: severe diarrhea
metabolic acidosis
A-B imbalance in this pathology: starvation
metabolic acidosis
A-B imbalance in this pathology: untreated DM II
metabolic acidosis
A-B imbalance in this pathology: excessive tums
metabolic alkalosis
A-B imbalance in this pathology: excessive vomiting
metabolic alkalosis
A-B imbalance in this pathology: selected diuretics
metabolic alkalosis
What function of calcium is the most important reason to maintain calcium homeostasis?
neuromuscular excitability
22-26
normal HCO3 range
35-45
normal PaCO2 range
7.35-7.45
normal blood pH range
What pH is considered alkalemia?
pH >7.45
Buffer in urine and ICF, unimportant in buffering plasma Mixture: -dihydrogen phosphate (H2PO4-), a weak acid and - monohydrogen phosphate (HPO42-), a weak base H+ released by strong acids is tied up with a weak acid Strong bases are converted to weak bases
phosphate
What is the name for the condition where people with electrolyte deficiencies develop an abnormal appetite for strange substances?
pica
accounts for 1/3 of body fluids
plasma and IF
H+ shifts in and out of cells in opposite direction of K+ to maintain cation balance ECF K+ levels rise with acidosis ECF K+ levels fall with alkalosis
potassium
Which electrolyte is high in ICF with a +1 charge and is essential for repolarization?
potassium
What female hormone inhibits aldosterone?
progesterone
decreases Na+ reabsorption (blocks aldosterone). Promotes Na+ and H2O loss
progesterone
Buffer in ICF and plasma. Are amphoteric; function as both weak acid and weak base -pH rises: organic acid or carboxyl (COOH) groups can release H+ -pH falls: NH2 groups can bind H+ Hemoglobin functions as intracellular buffer
protein
Secrete H+, Secrete or generate Bicarb
renal
What hormone is secreted by the kidneys in response to decreased filtrate NaCl levels and decreased stretch in afferent arterioles of the nephron?
renin
A-B imbalance in this pathology: chest injury
respiratory acidosis
A-B imbalance in this pathology: cystic fibrosis
respiratory acidosis
A-B imbalance in this pathology: emphysema
respiratory acidosis
A-B imbalance in this pathology: narcotic OD
respiratory acidosis
A-B imbalance in this pathology: brain stem injury
respiratory alkalosis
A-B imbalance in this pathology: hypoxemia
respiratory alkalosis
A-B imbalance in this pathology: panic attack
respiratory alkalosis
Which electrolyte is high in ECF with a +1 charge and is essential for depolarization?
sodium
Determines osmolality of ECF. Influences excitability of neurons and muscles. Remains stable because of water shifts out of or into ICF. Primarily regulated by ADH and thirst. Sensed by osmoreceptors.
sodium concentration
Total body content determines ECF volume. Regulates BP and blood volume Regulated by RAAS and ANP. Sensed by baroreceptors
sodium content
Which electrolyte has sulfur and 4 oxygen atoms with a -2 charge?
sulfate
Electrolytes drive most physical reactions of fluid in the body
true
Electrolytes have a charge and dissociate
true
how much fluid is lost via sensible water loss?
urine (60%), visible sweat (8%), feces (4%)
What is an example of insensible water loss?
vaporization in the lungs
What contributes to average water intake per day?
water, food, metabolic activity
After reviewing question 37, does it make sense that a patient with compensatory metabolic alkalosis has a blood plasma pH reading of 7.32 meaning the patient has acidemia?
yes