A&P 2 Ch 26

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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


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