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Fluid, Electrolyte andAcid-Base Dynamics
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DefinitionsOsmoles:The concentration of an osmotic
solution.
A milliequivalentis equal to 0.001
equivalent weight.
An equivalent weight is equal to 1 mole
divided by the valenceof the substance.
A MOLEis the molecular weight in gramsper litre.
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Concentration of
Solutions Percent Salt
0.9% NaCl (Normal Saline)
Milliosmoles
300 milliosmoles/Liter
Milliequivalents
325 milliequivalents/Liter
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The passage of a liquid from a weak solution to a more
concentrated solution across a semipermeable membrane that
allows passage of the solvent (water) but not the dissolved
solids.
Osmosis
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Osmosis
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Hypertonic Solution
0.9%
NaCl
3% NaCl
Red Cell
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Cells Crenate in a
Hypertonic Solution
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Isotonic Solution
0.9%
NaCl
0.9% NaCl
No movement of liquid will occur as the concentration of Sodium
Chloride in the Red Cell and surrounding fluid are of equal strength.
Normal
Saline
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310 mosm
300 mosm
Which Way Will Fluid Move?
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Problem 1
A patient has recently started working
outdoors in the hot weather.
After a few days he experienced headaches,low blood pressure and a rapid heart rate.
His blood sodium was down to 125 meq/L.
The normal is 144 meq/L. How do you
explain this?
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Answer to Problem 1
The patient lost sodium by perspiration.
The low sodium in his blood allowed fluid
to move into cells by osmosis.Lack of fluid lowered his blood pressure to
give him a headache.
The increased heart rate was his bodiesway of trying to increase blood pressure.
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Problem 2
A patient has hypertension.
His doctor has advised her eat a lowsalt diet. She consumed a lot of salt
the day before her last checkup.
Her blood pressure was up. Why?
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Answer to Problem 2
The extra salt she consumed
made her blood hypertonic.Hypertonic blood will attract
fluids from body cells by
osmosis.
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Electrolyte vs..
Non electrolyte
NaCl Na++ Cl-
Glucose Glucose
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Aldosterone
Hormone secreted
from the adrenal
cortex Stimulates kidneys
Retain sodium
Retain water
Secrete potassiumKidney
Adrenal Gland
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Estrogen
Female hormone from the
ovaries
Similar to aldosterone
Stimulates the kidneys to retain
sodium Increases fluid retention
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Cortisol
Hormone from the adrenal cortex
Converts lipids and protein to glucose
Depress inflammation
Stimulates the kidneys to retain sodium
Increases fluid retentionElevated levels cause edema
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Antidiuretic Hormone
ADH
ADH
Hypertonic
Interstitial Fluid
Collecting
Duct
H2O
Urine
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Estrogen
CalciumBLOOD
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Parathormone
CalciumBLOOD
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Blood pH = 7.4
(7.35-7.45)
Blood pH regulated by
1. Kidneys
2. Lungs
3. Buffers in blood
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H+ Secreted
HCO3-
Rebsorbed
Blood
Kidney
NephronHCO3
-
H
+
Urine
H+= Hydrogen Ions
HCO3-= Bicarbonate Ions
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Kidneys Regulate pH
by
Excreting excess hydrogen ions &
retaining bicarbonate
if pH is too low Retaining hydrogen ions &
excreting bicarbonate
if pH is too high
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Lungs Regulate pH
Breathe faster to get rid of excess
carbon dioxide if pH is too low.
Carbon dioxide dissolves in
blood to forms carbonic acid.
Breathe slower to retain carbondioxide if pH is too high.
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Carbon Dioxide and Acid
CO2
+H2
O H2
CO3
H++ HCO3
-Carbonic Acid Bicarbonate
The enzyme, Carbonic anhydraseaccelerates the reaction
The reaction is reversable
LUNGS
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More Carbon Dioxide = More Acid
= Lower pH
Breathing slower will retain CO2
pH will decrease(more acid)
Breathing faster will eliminate more CO2
pH will increase(less acid)
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Blood pH Drops to 7.3
How does the body
compensate?
Breathe faster to getrid of carbon dioxide
eliminates acid
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Blood pH Increases to 7.45
How does the body
compensate?
Breathe slower to retain
more carbon dioxide
retains more acid
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A patient is taking Narcotics for Pain.
The narcotics have depressed his breathing
rate. What will happen to his blood pH?
pH will decreasebecause he willretain excess carbon dioxide which
will increase the amount of acid in
the blood
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Buffers Regulate pH
Chemicals that resist changes in pH.
Prevent large pH changes when an
acid or base is added.
Strong AcidAcid that releases many hydrogen ions
e.g. HCl
Weak AcidAcid that releases only a few hydrogen ions
e.g. Carbonic Acid
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Buffers Change Strong Acids
to Weak Acids
HCl +NaOHStrong
Acid
BaseH2CO3+ NaClWeak Acid Salt
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Bicarbonate : Carbonic Acid
Ratio 20:1 = pH 7.4
21:1 = pH more than7.4 19:1 = pH less than7.4
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Acidosis
pH below 7.35
Depresses the nervous system
coma
Alkalosis
pH above 7.45Overexcites the nervous system
convulsions - Tetany
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Respiratory Acidosis.
Respiratory Alkalosis.
Metabolic Acidosis.
Metabolic Alkalosis.
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Respiratory Acidosis
Any condition that impairs breathing
Carbon dioxide increases in blood
Excess carbon dioxide lowers pH
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Respiratory Alkalosis
Hyperventilation
Carbon dioxide decreases in blood
Low carbon dioxide raises pH
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Metabolic Acidosis
Not caused by breathing or carbondioxide imbalance.
Excess acid in blood
Renal disease, Diabetes or
Starvation.
Deficiency of bicarbonate in blood.Diarrhea
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Metabolic Alkalosis
Not caused by breathing or carbon
dioxide imbalance.
Deficiency of acid in the blood. Vomiting, Diuretics.
Excess bicarbonate in the blood.
Ingesting sodium bicarbonate.
S di
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Sodium Attracts water into the ECF.
(Extra Cellular Fluid) Nerve impulse.
Muscle contractions.
HypernatremiaExcess sodium in the blood.
Hypertension.Muscle twitching.
Mental confusion.
Coma.
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HyponatremiaDeficiency of sodium in the blood
Hypotension (Low blood pressure)
Tachycardia (Fast heart beat above 100BPM)
Muscle weakness
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Potassium
Attracts water into the ICF(Intracellular Fluid)
Nerve impulse
Muscle contractions
HyperkalemiaExcess potassium in the blood
Cardiac arrhythmias and cardiac arrest
Elevated T wave in ECG
Muscle weakness
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HypokalemiaDeficiency of potassium in the blood
Cardiac arrhythmias and cardiac arrest
Flattened T wave in ECG
Muscle weakness
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Calcium
Mostly in bones and teeth
Blood clotting
Nerve impulse
Muscle contraction
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HypercalcemiaExcess calcium in the blood
Kidney stones Bone pain
Cardiac arrhythmias Cancer
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HypocalcemiaDeficiency of calcium in the blood
Tetany
(uncontrolled muscle contraction)
Weak heart muscle
Increased clotting time
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Aldosteronism
Excess production of aldosterone
Elevated sodium levels
Depressed potassium levels
Hypertension
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Addisons Disease
Hyposecretion of the Adrenal Cortex Hyposecretion of Aldosterone
Hyposecretion of Glucocorticoids Hormones that convert protein sugar
Hypotension Sodium deficiency
Low blood sugar Not enough glucocorticoids
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Cushings Syndrome
Excess glucocorticoids
Tumor of adrenal gland
Side effect of steroid drugscortisone
Hyperglycemia
Fat accumulationAbdomen
Back of neck (buffalo hump)
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Insulin
Glucose
Cell
Blood
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Antidiuretic Hormone
ADH
ADH
Hypertonic
Interstitial Fluid
CollectingDuct
H2O
Urine
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Diabetes Insipidus
Hyposecretion of ADH
Increased urine volume Diabetes insipidus is caused by a
problem with your pituitary gland
or your kidneys.
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