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Chapter 26
Fluid, Electrolyte & Acid Base Balance
| Question | Answer |
|---|---|
| Intracellular fluid (ICF) accounts for approx how much volume? | 2/3 |
| Extracellular fluid (ECF) accounts for approx how much volume? | 1/3 |
| The ECF compartment can be divided into what two subcompartments? | plasma, interstitial fluid (IF) |
| Interstitial fluid (IF) is found where? | tissue spaces |
| What are four other types of ECF? | lymph, CSF, synovial fluid, serous fluid |
| ____ is the universal solvent? | water |
| Solutes are classified into what two categories? | nonelctrolytes, electrolytes |
| ____- Do not dissociate in solution e.g. glucose, lipids, urea? | nonelectrolytes |
| ____- Dissociate into ions in solution e.g. inorganic salts, acids, bases? | electrolytes |
| (electrolytes/nonelectrolytes)have greater osmotic power and cause fluid shifts? | electrolytes |
| (electrolytes/nonelectrolytes)are expressed in millequivalents per liter (mEq/L)? | electrolytes |
| Water moves according to osmotic gradients: from (low/high) osmolality to (low/high) osmolality (from more water to less water)? | low; high |
| What is the primary cation in ECF? | Na+ |
| What is the primary anion in ECF? | Cl- |
| What is the primary cation in ICF? | K+ |
| What is the primary anion in ICF? | phosphate |
| In ICF there is ___ times more protein than plasma? | 3 |
| Sodium and potassium concentration within the cell and outside the cell is the same? | False-opposite |
| How is sodium and potassium concentration being opposite maintained? | Na+K+ATPase pump |
| (Electrolytes/nonelectrolytes) are the most abundant solutes in body fluids? | Electrolytes |
| (T/F) Electrolytes have no effect on physical & chemical reactions? | False - electrolytes determine physical & chemical reactions |
| (T/F) Proteins, phospholipids, cholesterol, and TG's account for only a small amount of dissolved solutes in body fluids? | False-They account for the bulk of dissolved solutes in body fluids |
| Where is intracellular fluid found? | Inside the cell |
| Where is interstitial fluid found? | Between the tissue spaces |
| Where is plasma found? | Blood capillaries |
| How does exchange take place between the capillary and the interstitial fluid? What happens to the fluid that leaks out? | At the arterial end hydrostatic pressure pushes the fluid out containing little or no plasma proteins; at the venous end osmotic pressure pulls the fluid back in. Almost 3L/day is picked up by the lymphatic system and returned to the blood. |
| Where do exchanges between IF & ICF occur? | Across the plasma membrane |
| Water flows from ____ osmolarity to ____ osmolarity? | low; high |
| What does the exchange between IF & ICF depend on? | permeability of the membrane |
| (T/F) Ion movements are selective? | true |
| What is the osmolarity of body fluids? | 300milliosmo/L |
| Fluid movement between ICF & IF: Osmolality of all body fluids is equal, why? | Because water moves freely between compartments |
| Fluid movement between ICF & IF: Changes in ECF solute concentrations are followed by volume changes in (IF/ICF)? | ICF |
| Fluid movement between ICF & IF: Increase in ECF osmolality causes water to move (into/out) of the cells? | out |
| Fluid movement between ICF & IF: Decrease in ECF osmolality causes water to move (into/out) of the cells? | into |
| (T/F) For the body to remain properly hydrated, water intake does not have to be equal to water output? | False- water intake must equal water output |
| (T/F) No water is formed in cellular respiration? | False - glucose + oxygen = ATP + water |
| Water output is mainly in the form of ____? What %? | urine; 60% |
| Aside from urine, what other four places is water lost? What %? | feces - 4% , (lungs, skin - 28%), sweating - 8% |
| Water loss in the lungs and sweating is considered ____ ____ of ____? | insensible loss of water |
| What two mechanisms are stimulated when there is a rise in body fluid osmolality? | thirst mechanism; ADH release |
| Where does ADH formed? Released? Where does it go and act? What does it do? | hypothalamus; posterior pituitary gland; kidney (collecting duct); create aquaporins to make it permeable to water |
| A (rise/fall) in osmolality will active the thirst mechanism and ADH release? | rise |
| Where is the thirst center located in the body? It contains special cells called _____? | hypothalamus; osmoreceptors |
| (Thirst mechanism) - When there is an increase in osmolality, the osmoreceptors with be ____? What will this do? | stimulated; it will shift fluid outside |
| What will a fall in blood pressure / blood volume do to the thirst mechanism? Example: a person going into shock | stimulate |
| The two mechanisms by which the thirst mechanism can be activated are: change is osmolality and decline in blood pressure or blood volume, which is more sensitive? | change in osmolality |
| (T/F) Thirst is always an effective indicator of need? | False - it is effective but not always reliable because thirst can be quenched before need is met |
| Water that vaporizes out of the lungs in expired air of diffuses directly through the skin is called ____ ____ ____? | insensible water loss |
| What is the minimum amount of water loss in urine? What is the normal amount? | 500ml; 1500ml/1.5L |
| Water reabsorption in the collecting ducts of the kidney is proportional to ____ release? | ADH |
| (High/low) ADH levels - water in CDs reabsorbed-produce a small volume of concentrated urine? | high |
| (High/low) ADH levels - water in CDs not reabsorbed-producing dilute urine? | low |
| What are five factors that reduce blood volume and trigger ADH? | 1.excessive sweating 2.vomiting 3.diarrhea 4.severe blood loss 5.burns |
| What are two disorders of water balance? | 1.dehydration 2.edema |
| _____ is when water output exceeds water intake and the body is in negative fluid balance? | dehydration |
| The following are causes of _____: hemorrhage, severe burns, prolonged vomiting or diarrhea, profuse sweating, water deprivation, diuretics? | dehydration |
| In dehydration water is lost from ECF, this cause osmotic movement of water from ____ to ____? | cells; ECF |
| Severe dehydration can cause ____ ____? | hypovolemic shock |
| ____ is the accumulation of fluid in the interstitial tissue spaces? | edema |
| The following are causes of _____: 1.increased capillary hydrostatic pressure (incompetent venous valves, localized blood vessel blockage) 2.increased capillary permeability (inflammation)? | edema |
| The following are causes of _____: 1.decrease in colloid osmotic pressure (low levels of plasma proteins-protein malnutrition, liver disease, kidney diseases in which proteins leak out) 4. lymphatic drainage blocked? | edema |
| What are the effect of edema on blood volume and BP? | fluid accumulation results in low blood volume and BP and impaired circulation |
| ____ include salts, acids, and bases, but the term ____ ____ usually refers to the salt balance in the body? | electrolytes; electrolyte balance |
| Colloidal osmotic pressure is due to what plasma protein? | albumin |
| Sodium account for ___-___% of all solutes in the ECF? This makes it the most abundant cation in the ECF. | 90-90% |
| ____mOsm of sodium is contributing to the daily 300mOsm/L ECF osmolality? | 280mOsm |
| What electrolyte controls ECF volume and water distribution in the body? | sodium |
| Regulation of sodium is controlled by what hormone? Which comes from? Where does it go and act? | aldosterone; andrenal cortex; DCT and collecting duct |
| 65% of sodium in filtrate is reabsorbed where? | PCT |
| When levels of _____ (what hormone) are high, all of the remaining Na+ not reabsorbed in the PCT can be reabsorbed where? | aldosterone; DCT,CD |
| What mechanism triggers aldosterone release? | Renin-angiotension mechanism |
| What will happen to sodium reabsorption if aldosterone is inhibited? | no more Na+ will be reabsorbed |
| What are two stimuli for renin from the JGA? | low blood pressure, low blood volume |
| What are the two effects of aldosterone? | Na+ reabsorption, K+ secretion |
| ANP (increases/reduces) BP and blood volume? | reduces |
| ANP is released in the heart from the ____ in response to _________? | atria; elevated BP |
| ANP acts on what part of the kidney and does what to Na+? What then will occur to Na+ and H2O? | CD; inhibit Na+ reabsorption; release Na= and H2O in urine |
| What is the chief intracellular cation? | K+ |
| Like Na+, K+ balance is also maintained by the _____ (what organ)? | kidney |
| Along with Na+, K+ is required for what two things? | nerve and muscle conduction; Na+K+ ATPase pump |
| Most of filtered K+ is reabsorbed by the (what part of the kidney)? | PCTs |
| After the PCTs, some K+ is reabsorbed by the (what part of the kidney)? | ascending loop of Henle |
| At the level of the collecting ducts, unlike Na+, K+ is....? | secreted |
| What will happen to K+ if the levels of K+ in the ECF is low? | less K+ will be secreted in urine |
| What will happen to K+ if the levels of K+ in the ECF is high? | more K+ will be secreted in urine |
| What is hyperkalemia? | elevated K+ |
| What is hypokalemia? | low K+ |
| What will happen with aldosterone if there is hyperkalemia? | aldosterone will be released |
| Both hyperkalemia and hypokalemia can be dangerous to what body system? | cardiovascular - it can disrupt electrical conduction in the heart |
| K+ is also part of the body's buffer system, which effects the body's ____ of body fluids? | pH |
| When K+ levels increase- release of aldosterone- resulting in (secretion/reabsorption) of K+ & (secretion/reabsorption) of Na+ | secretion; reabsorption |
| ___% of body calcium is found in bones | 99% |
| Ca++ in ECF is important for what two things? | blood clotting and neuromuscular transmission |
| What is the primary hormone regulator of blood calcium levels? | parathyroid hormone (PTH) |
| When plasma Ca+ levels are normal, PTH is (released/inhibited)? | inhibited |
| When plasma Ca+ levels are low, PTH is (released/inhibited)? | released |
| (T/F) Calcium conservation & phosphate excretion go hand in hand? | true |
| PTH promotes increase in Ca+ levels by having what effect on the: bones? | activates osteoclasts to break down bone, releasing Ca into blood |
| PTH promotes increase in Ca+ levels by having what effect on the: small intestines? | increases absorption of calcium |
| PTH promotes increase in Ca+ levels by having what effect on the: kidneys? | PTH increases calcium reabsorption and decreases phosphate reabsorption |
| ____ is the major anion accompanying Na+ in the ECF? | chloride |
| 99% of chloride is reabsorbed in the kidney passively as it follows _____? | Na+ |
| The normal pH of arterial blood is _____? | 7.40 |
| The normal pH of venous blood is _____? | 7.35 |
| (alkalosis/acidosis) arterial blood pH rises above 7.45? | alkalosis |
| (alkalosis/acidosis) arterial blood pH drops below 7.35? | acidosis |
| What is pH? | the concentration of hydrogen ions |
| Where do most of the H+ ions come from that are responsible for body fluid pH? | cellular respiration |
| Concentration of H+ ions in blood is regulated by what three mechanisms? | 1.chemincal buffer systems 2.brain stem respiratory center (lungs) 3.renal mechanisms |
| Concentration of H+ ions in blood by chemical buffer system acts within ____? | seconds |
| Concentration of H+ ions in blood by the brain stem respiratory center (lungs) acts within _____? | 1-3 minutes |
| Concentration of H+ ions in blood by renal mechanisms acts within _____? | hours to days |
| Concentration of H+ ions in blood by the lungs acts simply by changing _________________? | rate and depth of breathing |
| Of the three pH/H+ ion regulators which is the strongest/most important? | renal mechanism |
| What are acids? | proton donor (hydrogen ion donor) |
| What is a base? | proton acceptor |
| Acidity depends on the number of _____________? | free hydrogen ion |
| (strong/weak) acids - dissociate completely (release all their H+ in water)? | strong acids |
| (strong/weak) acids - dissociate partially in water (efficient at preventing pH changes), they act as buffers? | weak acids |
| (strong/weak) bases - dissociate easily in water and quickly tie up H+? | strong bases |
| (strong/weak) bases - accept H+ more slowly, they are as buffers? | weak bases |
| A ____ ____ is a system of compounds that act to resist pH changes when a strong acid or base is added? | chemical buffer |
| What will happen to the pH if a strong base is added and there is no buffer? | it will become highly alkaline |
| What will happen to the pH if a strong acid is added and there is no buffer? | it will become highly acidic |
| What are the three major chemical buffer systems? | 1.bicarbonate buffer system 2.phosphate buffer system 3. protein buffer system |
| Of the three major chemical buffer systems, which is the most important? | bicarbonate buffer system |
| Where does the bicarbonate buffer system act? | ECF |
| Where does the phosphate buffer system act? | urine, ICF |
| Where does the protein buffer system act? | proteins in plasma, cells, Hb |
| Chemical buffers bind to H+ when pH (drops/rises) and releases H+ when pH (drops/rises)? | drops; rises |
| Bicarbonate buffer system is a mixture of what two things? | carbonic acid (H2CO3) and sodium bicarbonate (NaHCO3) |
| What system regulates carbonic acid? | lungs - by changing the levels of CO2 |
| How does the bicarbonate buffer work? | Converting strong acids to weak acids and converting strong bases to weak bases. |
| How does the respiratory system regulate pH? | Changing the rate and depth of breathing and altering pCO2 |
| What will happen to pCO2 if breathing rate is high? | go down |
| What will happen to pCO2 if breathing rate is low? | go up |
| If acidosis (rise in plasma H+) occurs, peripheral chemoreceptors are (stimulated/depressed)? | stimulated |
| If Alkalosis (rise in pH) occurs- respiratory center (stimulated/depressed)? | depressed |
| More CO2 will cause what type of pH change? | acidosis |
| Less CO2 will cause what type of pH change? | alkalosis |
| (hyperventilation/hypoventilation) causes net CO2 retention & respiratory acidosis? | hypoventilation |
| (hyperventilation/hypoventilation) causes net elimination of CO2 & respiratory alkalosis? | hyperventilation |
| Why are renal mechanisms needed when there are chemical buffers? | Chemical buffers can tie up excess acids or bases, but they cannot eliminate them from the body |
| Info: The kidney regulates acid-base balance by reabsorption of bicarb ion (HCO3) and secretion of hydrogen ions (H+). | |
| The kidneys can control acid base balance by doing what to the urine? | excreting acidic or basic urine |
| What will the kidneys do if they bodies pH low? | kidney will excrete more H+ ions and excreting acidic urine |
| (Renal mechanism) - Reabsorption of HCO3 ̄ is linked to secretion of ____? | H+ |
| 80-90% of HCO3 ̄ reabsorption & secretion of H+ occurs in ____ (what part of the kidney)? | PCTs |
| 10% of HCO3 ̄ reabsorption & secretion of H+ occurs in _____(what part of the kidney)? | ascending limb of loop of Henle |
| Where does the remaining HC3 reabsorption & H+ secretion occur after the PCT and loop of Henle? | DCTs & CDs |
| For each H+ ion secreted, how much HCO3 is reabsorbed? | one for one; for each H+ion secreted one HCO3 is reabsorbed |
| By the time the DCTs and CDs are reached there isn't anymore HCO3, what happens to the H+ that remains? | it is secreted and makes the urine acidic |
| Respiratory acidosis is the (least/most) common cause of acid-base imbalance? It often occurs when a person breathes (deeply/shallowly) or when gas exchange is hampered by disease? | most; shallowly |
| What are three diseases that can cause respiratory acidosis? | pneumonia, cystic fibrosis, emphysema |
| Respiratory acidosis is characterized by (rising/falling) blood pH and (rising/falling) PCO2? | falling; rising |
| When talking about respiratory acidosis or alkalosis, it always has to do with abnormal levels of _____? | PCO2 |
| When talking about metabolic acidosis or alkalosis, it always has to do with abnormal levels of _____? | HCO3 |
| Respiratory (acidosis/alkalosis) results when CO2 is eliminated from the body faster than it is produced? | alkalosis |
| What is respiratory alkalosis called? | hyperventilation |
| Metabolic (acidosis/alkalosis) is low blood pH and HCO3? | acidosis |
| Metabolic (acidosis/alkalosis) is high blood pH and HCO3? | alkalosis |
| What are some common causes of metabolic acidosis? | diarrhea, accumulation of lactic acid, DKA, kidney failure |
Created by:
kmking