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ACID – BASE BALANCE HOMEOSTASIS Relative [ ] of hydrogen ions
pH – potential hydrogen Normal pH: – 7.45 <7.35 is acidosis >7.45 is alkalosis
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Deviation of 0.4 in either direction can be fatal
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ACIDOSIS Metabolic Acidosis Excessive blood acidity or loss of bicarbonate Causes ingestion of something that is or can be metabolized to an acid such as…..
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Wood alcohol Antifreeze Large doses of ASA Abnormal metabolism Advanced stages of shock Poorly controlled IDDM Normal levels of acid if kidneys aren’t functioning normally
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Symptoms Mild metabolic acidosis may have no sx. Usually experiences nausea vomiting fatigue Breathing becomes deeper and slightly faster As acidosis worsens:
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Extremely weak and drowsy
May feel confused Increasingly nauseated Eventually b/p can fall leading to shock, coma, or death Treatment: Depends primarily on the cause insulin removing toxic substances
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RESPIRATORY ACIDOSIS Build up of CO2 in the blood from poor lung function or slow breathing Blood becomes acidic -> pH drops respiratory center in the brain stimulates faster and deeper breathing Develops when…….
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Develops when the lungs do not expel CO2 adequately….such as
Emphysema Chronic bronchitis Severe pneumonia Pulmonary edema Asthma
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Diseases of the nerves or muscles of the chest
If overly sedated from narcotics and strong sleeping medications that slow respirations Symptoms:
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First symptom may be headache and drowsiness
Drowsiness may progress to stupor or coma ABGs Treatment…..
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Aims at improving function of the lungs
i.e. drugs to improve breathing If acidosis is mild, IV fluid may be all that is needed If severe; HCO3- (provides only temporary relief and may cause harm by overloading the body with Na+ and H2O
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Treatment Slow down rate Pain relief Other facts to ponder………….
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J:\Class Presentations\BA Acid Base Disturbances.doc
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Life essential functions like K+ and Na+ channels are inactivated by acidosis
A habitually acid pH can directly cause immediate weight gain Fasting and dieting are known acid producing conditions One way the body compensates is to deposit excess acid into tissues and joints
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Acid producing foods create excess mucus, which congests the system and block oxygen from entering
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ALKALOSIS Overabundance of bicarbonate in the blood
Loss of acid from the blood
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Respiratory Alkalosis
Low levels of CO2 in the blood that results from rapid or deep breathing Hyperventilation anxiety cirrhosis low levels of oxygen in the blood fever ASA overdose
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METABOLIC ACIDOSIS Body looses too much acids Gain too much base stomach acid is lost during periods of prolonged vomiting excessive loss of Na+ or K+ affects the kidney’s ability to control the blood’s acid-base balance loss of K+ - use of diuretics or corticosteroids
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Corticosteroids Steroid hormones Synthesized from cholesterol Involved in stress response, immune response, regulation of inflammation, carbohydrate metabolism, protein catabolises blood electrolyte level and behavior
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Catabolism: breaks down molecules into smaller units and releases energy
Alkalosis may cause: Irritability Muscle twitching Muscle cramps If severe, prolonged contraction and spasms of muscle (tetnaory)
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Treatment Metabolic Replacing H2O, Na+, and K+ while treating underlying cause Next: …………..
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FLUIDS AND ELECTROLYTYES
Water 60% total body weight Distributed into various compartments, separated by cell membranes Largest compartment is intracellular environment ICF All the fluid found inside body cells 75% of all water is found within this compartment
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Extracellular compartment
2 divisions Intravascular fluid Outside the cells and within the circulatory system. Essentially the same as the blood plasma
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Interstitial fluid Outside the cell membranes, not within the circulatory system TBW Infants – 75-80% Infants have less fat. Fat does not absorb water. Less fat, more water
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Water is essential for high rates of metabolism necessary to promote growth
With age Loss of muscle mass inc. % of fat Body’s decreasing ability to regulate fluid levels lower TBW to 45-55% Elderly and very young are at high risk for dehydration and disorders related to to electrolyte imbalances
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ELECTROLYTES Dissociate in electronically charged particles when placed into water ions Cations + charge Anions - charge
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Cations Na+ Most prevalent in extracellular fluid Plays major role in distribution of water Important in the transmission of nervous impulses
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K+ Intracellular fluid Transmission of electrical impulses Ca++ Major role in muscle contraction Nervous impulse transmission
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Mg++ Necessary for several biochemical processes (over 300) Prevents over excitability of muscles ½ found in bone ½ found predominantly inside cells of tissues and organs Helps maintain normal nerve and muscle function
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Regulates heart rhythm
Supports healthy immune system Keeps bones strong Helps regulate blood sugar levels Promotes normal blood pressure Known to be involved in protein synthesis and metabolism
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ANIONS Cl- Plays a major role in fluid balance and renal function HCO3- Principal buffer
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Phosphate HPO4- Body energy stores Closely associated with Mg++ in renal function Acts as a buffer primarily in the intracellular space
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OSMOSIS AND DIFFUSION Isotonic When solutions on opposite sides of a semipermiable membrane are equal in [ ] > on one side – hypertonic < on one side – hypotonic Difference in [ ] – osmotic gradient
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Homeostasis The tendency to keep the balance of water electrolytes are = on both sides of the membrane. Diffusion Movement from an area of higher [ ] to lower [ ] and does not require energy
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Osmosis The passage of any solvent usually water through a membrane Active Transport Movement of a substance across the cell membrane against the osmotic gradient or toward the side that already has more of the substance; requires an expenditure of energy
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Facilitated diffusion
Diffusion of a substance such as glucose that requires the assistance of a helper or carrier protein
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FLUIDS COLLOIDS Contain large proteins Cannot pass through a capillary membrane Remains in the circulatory system Increases volume of blood and fluid contained within the blood vessels
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CRYSTALLOID Contain electrolytes and water Tonicity: number of particles per unit volume Isotonic Tonicity equal to blood plasma Will not cause a significant fluid or electrolyte shift
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HYPERTONIC Higher solute [ ] that the cells Causes fluid shift out of intracellular compartment into extracellualar compartment
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HYPOTONIC Lower solute [ ] than the cells Movement extracellular intracellular
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ABGs Determine pH but also to differentiate respiratory / metabolic acidosis / alkalosis Norms pH PaCO PaO2 greater than 80 HCO
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PaCO2 Amount of CO2 dissolved in arterial blood PaO2 amount of oxygen dissolved in arterial blood HCO3 amount of bicarbonate
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Interpretation (R)espirtory (O)pposite, (M)etabolic (E)qual If the pH is opposite the PaCO2 (high or low) then it’s respiratory if the pH is equal to the HCO3, it is metabolic
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Problem #1 pH 7.30 PaCO2 50 HCO3 26 PaO2 60 Acidosis or Alkalosis? Metabolic or Respiratory? Answer………
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Respiratory Acidosis Why? pH is high indicating Acidosis pH is low; PaCO2 is high {opposite} indicating this is respiratory Problem #2
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pH 7.50 PaCO2 43 HCO3 45 PaO2 80 Acidosis or Alkalosis? Metabolic or Respiratory? Answer………
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Metabolic Alkalosis Why? pH is high indicating alkalosis pH high; HCO3- high {equal} Indicating this is metabolic METABOLIC ACIDOSIS
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