Fluis and electrolytes in body
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| Primary function of H2O | Medium for transport
Facilitate metabolism and celular functioning
Maintain body temp (thru respirations)
Tissue lubricant
Body secretions
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| Solvent | Liquid that holds substances in solution
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| Solute | Substance that dissolves in solution for electrolytes
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| Fluid departments | Intracelular (IFC)
Extra celular (ECF)
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| ICF | Fluid inside cell
K+, Mg+, PO4- other electrolytes
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| ECF | Fluid outside cell
Na+, Cl-, HCO3-
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| ECF (special) | Interstitial = Edema, fluid between body cells
Intravascular = Main func transport blood (plasma)
Transcellular = Cerebrospinal fluid, pleural fluid, peritoneal fluid, Synovial fluid, Digestive Fluid
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| Careful when administering meds that... | affect ICF
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| 40% of body weight is.. | ICF
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| 20% of body weight is.. | ECF
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| increase fat will decrease | fluids
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| Women have less..... and more..... | fluids, fat
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| Muscular man have | increase fluids due to increase muscle
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| I & O should be | EQUAL
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| LArgest compartment? | ICF
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| Osmosis | Primary mode of movement, H2O moves from less concentrated to higher concentrated area across cell membrane
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| Isotonic | Same make up , same ph. What's inside cell is equal to outside.
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| Hypertonic | Maintains balance w/in compartments. Fluid contains higher concentration than blood. H20 will move from cell to ECF (Cell shrinks)
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| Hypotonic | Fewer soluble concentration. Push fluid into cell from ECF (Cell expands)
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| Osmolarity | Measure of concentration of luid to push/pull from/to cell
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| Osmotic Potential | Ability to pull H2O into fluid compartment EX. Na+ holds to H2O
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| Diffusion | Intermingling of molecules. MOLECULES move from HIGH concentration to LOW concentration until both sides are equal
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| ATP | ENERGY is used to move MOLECULES from LOW concentration to HIGH concentration
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| Na+ & K+ Pump | Na+ concentrations is higher in ECF -> enters cell by diffusion -> Pulls K+ out from ICF
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| Filtration | Movement of H2O and PARTICLES from HIGH CONCENTRATION to LOW CONCENTRATION
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| Movement between vascular compartment and Interstitial fluid | Filtration
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| Hydrostatic pressure | Pushing force created by fluid w/in closed normal circulatory system
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| Increased pressure at... than... | arterial capillaries, venous system
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| Osmotic Pressure | Solution pulling force to draw H2O
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| Hydrostatic stronger than osmotic at... | Arteries
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| Osmotic stronger than hydrostatic at... | Veins
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| Normal intake in a day? Normal output in a day? | 2,500 ml in
1,500 ml out
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| Higher fat foods produce more | WATER
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| Protein makes less | WATER
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| Sentible output (measurable) | Urine, feces
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| Insentible Output | Skin, Lungs
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| Mayor regulation of blood in body? | KIDNEYS
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| Thirst | Primary regulator supported by hypothalamus
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| Kidneys | Main organ of excretion, output from kidneys is around 1,500 ml. 175 L of plasma daily
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| Hormones that regulate fluid balance | Antidiuretic hormone (ADH)
Renin-Angiotensin System
Aldosterone
Thyroid Hormone
Natriuretic Peptid
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| ADH | Causes kidney to retain fluid.
Fluid decreases, BP decreases, More ADH is release
Fluid increases, BP increases, Less ADH released
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| Renin-Angiotensin System | Fluid decreases -> Rening angiotensin system kicks in and hangs to Na+ and H2O -> Aldosterone is released -> Kidneys stimulate H2O and Na+ into cell and kick out K+
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| Natriuretic Peptid | Atrial (ANP) Brain (BNP) C-Type (CNP)
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| ANP | Right Atrium, Most important indicator of heart failure
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| Fluid Volume Deficit (FVD) | Hypo, Hyper
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| Hypovolemia | Low fluid volume. Occur due to trauma, rupture
Proportional loss of fluid/electrolyte from ECF
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| Dehydration | Negative fluid balance. Loss of fluid from ICF and ECF
Insufficient intake of fluids
Excessive fluid loss EX. bleeding, vomiting, diarrhea
Fluids shift (Leaking into body tissues)
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| Sources of fluid loss | Diarrhea/Vomiting, Draining wounds, NG suctioning, Paracentesis/Thoraceentesis, Infection, fever, Diuretics Extensive burns
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| Fluid Loss Assessment | Heart Rate ↑, BP↑, Rapid weak pulses, Skin and mucous membranes ↓, ↓ Skin Turgor, Urine output ↓, Neck veins flat, Muscle Weakness, Temp ↑, HCT lab ↑, SP gravity ↑
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| At risk for Fluid Loss | Older Adults
Infants (cant tell you)
Toddlers (rather play)
Pt's w Diabetes, vomiting, diarrhea
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| Fluid Volume Excess (FVE) | Hypervolemia
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| Hypervolemia | Excess of blood volume
Retention of Na+ and H2O
Excessive salt intake
Disease of liver, kidney, heart <-(Can't bring fluid back from lower body)
↑ Osmotic pressure and ECF (Fluid from cell to ECF)
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| Dependent Edema | Heart not strong enough to pull fluids back from lower body
May be up 5-10 lbs weight gain
Relieve by elevation
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| Pitting Edema | Pit or depression after finger pressure
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| Fluid Excess Assessment | BP ↑, Pulse strong bounding, Respirations shallow and ↑, Neck veins distended, Skin pale/cool, Urine output ↑/dilute, Weight ↑ (If severe crackles in lungs). BUN ↓, HCT ↓, SP gravity ↓
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| Acitasis | Build up fluid in peritoneum
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| IONS | Atom or molecule carrying an electric charge
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| ELECTROLYTE | Substance capable of braking into electrically charged ions hen dissolved in solution
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| CATION | + charge ion (NA, K, Mg, Ca)
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| ANION | - charge ion (CL, PO4, HCO3)
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| Functions of electrolytes | Regulate water distribution
Transmit nerve impulses
Clotting blood
Regulate Acid Base balances
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| Na+ | Major cation in ECF
Normal 135-145
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| Na+ Function | Regulate fluid Volume
Helps maintain blood volume
Interacts with Ca+ and maintain muscle contraction
Stimulates conduction of nerve impulses
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| Na+ Regulation | Moves by ATP
Regulated by ADH and aldosterone
Reabsorbed and excreted by Kidneys
Minimal loss thru feces and perspiration
↓ Na+ = ↑ H2O intake
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| Na+ Source | Salt, Soy sauce, Pork, Cheese, Milk, Canned Products
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| Hyponatremia | ↓ Na+ levels <135
Due to: Diuretics, Adrenal insufficiency, Excessive intake of hypotonic solutions
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| Hyponatremia Sx | Lethargy, Confusion, Muscle cramps, Seizures, Anorexia, Vomiting
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| Hyponatremia Tx | Monitor I & O, Monitor Na+ levels, ↑ Na+intake, seizure precautions if severe.
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| Hypernatremia | ↑ Na+ levels >145
Due to: Excesive Na+ intake, H2O deprivation, ↑ H2O loss, Diabetes
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| Hypernatremia Sx | Thirst, ↑ temp, hallucinations, irritability, lethargy, seizures
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| Hypernatremia Tx | Monitor I&O, VS, ↓ Na+ intake, Watch for hidden Na+, IV solutions that dont contain Na+
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| K+ | Major Cation in ICF
Normal 3.5-5
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| K+ Function | Maintain ICF osmolality
Regulate conduction of cardiac rhythm
Transmit electrical impulses in multiple body systems
Assists with acid-base balance
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| K+ Regulations | Regulated by aldosterone
Excreted n conserve thru kidneys
Loss thru vomiting and diarrhea
Loss triggered by many diuretics (↓ Ka+ = ↑ Urine output)
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| K+ sources | Bananas, green lefty veggies, Oranges, Apricots, figs, carrots, potatoes, tomatoes, Dairy products, meats
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| Hypokalemia | Low K+ <3.5
Due to: Steroid administrations, Hyperaldosteronism, anorexia/bulimia
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| Hypokalemia Sx | Fatigue, Muscle weakness, Disrhythmias, ECG changes, sensitive to digitalis
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| Hypokalemia Tx | Monitor I&O, K+ levels, pulse if on Digoxin, K+ supplement pills
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| Hyperkalemia | ↑ K+ levels > 5.0
Due to: inability to excrete K+, Renal failure, K+ sparing siuretics, Hypoaldosteronism, High K+ intake with renal insufficiency, acidosis, major trauma
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| Hyperkalemia Sx | Muscle weakness, dysrhythmias, ECG changes
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| Hyperkalemia Tx | Monitor I&O and K+ levels
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| Ca+ | Most abundant electrolyte in body
Normal 8.9-10.1
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| Ca+ Function | Promotes transmision of nerve impulses
Major componennt of bone n teeth
Regulates muscle contractions (with Na+)
Maintain Cardiac automaticity
Essential factor in the formation of blood clots
Catalyst for many cellular activities
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| Ca+ Regulations | combines with PO4- to form mineral salts of teeth and bones
Na+ and PO4- levels inversely proportional
PTH stimulates release of Ca+ from bones and reabsorption from kidneys and intestines
Absortion stimulated by VIT D
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| Calcitonin | Blocks bone breakdown and lower calcium levels
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| Ca+ Source | Milk, cheeses, Dark green veggies, Salmon, Breads, Cereals
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| Hypocalcemia | ↓ Na+ levels <8.9
due to: Hypoparathyroidism, Pancreatitis, Alakalosis
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| Hypocalcemia Sx | Numbness/tingling of extremities, tetany, Cardia irritability, Trousseau's and Chvostek's
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| Trousseaus | Hand/finger twitching when BP cuff inflated
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| Chvostek's | Twitching of mouth or nose when cheek is tapped
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| Hypocalcemia Tx | Encourage ↑ of Ca+, administer Ca+ supplements, Airway, Seizure and safety precautions
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| Hypercalcemia Sx | Muscle weakness, constipation, Kidney stones, Bizarre behavior, bradycardia
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| Hypercalcemia | ↑ Na+ Levels > 10.5
Due to: Hyperparathyroidism, malignant bone disease, prolonged immobilization, thiazide diuretics, Excessive intake
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| Hypercalcemia Tx | Encourage fluid intake to prevent stone formations. Fiber intake to prevent constipation, Limit Ca+ intake
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| Mg+ | Present in skeleton and ICF
Second most abundant in ICF
Normal 1.5 -2.5
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| Mg+ Function | Protein and carbohydrate metabolism
Necessary for protein and DNA synthesis w/in the cell
Maintain normal Intracellular levels of K+
Involved in electrical activity in nerve and muscle. Including heart
Influence release n activity of insulin
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| Mg+ Regulation | Ingested in the diet and absorbed thru small intestines
Excreted by kidneys
Loss due to diuretics, poorly controlled diabetes and excessive alcohol intake
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| Mg+ Source | Green veggies, Cereal, Grains, Nuts
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| Hypomagnesemia | ↓ Mg+, <1.5
Due to: Chronic alcoholism, prolonged gastric suction, diabetes
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| Hypomagnesemia Sx | Neuromuscular irritability, disorientation, disrhythmias,
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| Hypomagnesemia Tx | Avoid alcohol intake, encourage ↑ food with Mg+
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| Hypermagnesemia | Too high Mg+ > 2.5
Due to: Renal failure, adrenal insufficiency, excess replacement
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| Hypermagnesemia Sx | Flushing and warmth of skin, hypotension, lethargy, hypoactive reflexes, depressed respirations, bradycardia
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| Hypermagnesemia Tx | Monitor VS, airway, reflexes, avoid Mg+ supplements and food rich in Mg+
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| PO4- | Major anion in ICF
Normal 2.5-4.5
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| PO4- Function | Serves as catalyst for many intracellular activities
Promotes muscle and nerve action
Assists with Acid bace balance
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| PO4- Regulation | combines with Ca+ to form mineral salts for teeth and bones
Ca+ and PO4- levels inversely proportional
Regulated by PTH, inverse respond to Ca+
Excreted and reabsorbed by Kidneys
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| PO4- source | Meat, Fish, Poultry, Milk products, Carbonated Beverages, Legumes
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| Hypophosphatemia | ↓ PO4- Levels < 2.5
Due to: refeeding after starvation, alcohol withdrawal, diabetic ketoacidosis, respiratori acidosis
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| Hypophosphatemia Sx | Joint Stiffness, Seizures, impaired tissue oxygenation
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| Hypophosphatemia Tx | Monito PO4- levels, calcium levels
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| Hyperphosphatemia | ↑ levels of PO4- >4.5
Due to: Renal Failure, Hyperthyroidism, Phosphate based laxatives
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| Hyperphosphatemia Sx | Tetany Sx, tingling of extremities and craping, calcification of soft tissue
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| Hyperphosphatemia Tx | Monitor PO4- levels, monitor for tetany, administer milk of magnesia with meals to bind to PO4-
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| Cl- | Major anion in ECF
Normal 96-106
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| Cl- Function | Works with Na+ to maintain osmotic pressure between fluid compartments
Essential for production for HCL for gastric secretions
Functions as buffer in O2-carbon dioxide exchange in RBCs
Assist with acid base balance
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| Cl- Regulation | Reabsorbed and excreted through kidneys along w Na+
Regulated by Aldosterone and ADH
Deficit will lead to K+ deficit and vise versa
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| Cl- Source | Foods high in Na+
Cheese
Processed foods
Meats
Seafood
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| HCO3- | Major buffer in both ICF and ECF
Normal 22-28
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| HCO3- Function | Maintain acid base balance by functioning as the primary buffer in body
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| HCO3- Regulation | Loss thru diarrhea, diuretics, renal insufficiency
Excess possible if person ingests quantities of acid neutralizers
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| HCO3- Sources | Acid neutralizers (Sodium bicarbonate)
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| Acid | A substance that donates hydrogen ions
Ph 1-6.9
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| Base | A substance that accepts hydrogen ions
Ph 7.1 - 14
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