Patho ch6

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jwozniak814
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Patho ch6
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2011-06-21 13:01:51
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pathophysiology
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Chapter 6.
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  1. aldosterone
    a mineralocorticoid hormone that increases the reabsorption of sodium and water in the renal tubules
  2. anion
    a negatively charged ion such as chloride, Cl-
  3. anorexia
    loss of appetite
  4. antidiuretic hormone(ADH)
    increases absorption of water in the renal tubules
  5. ascites
    abnormal accumulation of fluid in the abdominal cavity
  6. atrial natriuretic factor (ANP)
    a peptide secreted by the atrial tissue of the heart in response to an increase in blood pressure. It influences blood pressure, blood volume, and cardiac output. it increases excretion of sodium and water in urine, thereby lowering blood volume and blood pressure and influencing cardiac output.
  7. capillary permeability
    allow solutes and water to move by two opposing processes: filtration and reabsorption. Involves the movement of substance from an area of high hydrostatic pressure to an area of low pressure. This forces fluid and solutes into the ICF. If unchecked would move fluid in only one direction, out of capillaries leading to hypovolemia and shock.
  8. carpopedal spasm
    a strong muscle contraction of the hand or foot.
  9. cation
    a positively charged ion such as sodium, Na+
  10. diffusion
    movement of particles along a concentration gradient with particles moving from an area of higher concentration to one of lower concentration. Referred to as moving down the concentration gradient
  11. diuretic
    increasing urine secretion. an agent that increases urine output. Used to treat hypertension, congestive heart failure, and edema. side effect- potassium depletion, low blood pressure, dehydration, and hyponatremia.
  12. dysrhythmia
    abnormal, disordered, or disturbed rhythm
  13. electrocardiogram (EKG)
    a record of conduction in the heart
  14. extracellular
    the extracellular compartment includes interstitial fluids and intravascular fluids.
  15. filtration
    the process of removing particles from a solution by allowing the liquid portion to pass through a membrane or there partial barrier. This contains hole or spaces that allow the liquid to pass but are too small to permit passage of the solid particles.
  16. hydrogen ion
    an element existing as a colorless, odorless, and tasteless gas, it is present in all acids.
  17. hydrostatic pressure
    pressure on and exerted by fluids when they are in equilibrium. may be viewed as the "push" force.
  18. hypertonic
    a solution with a greater concentration of solutes or higher osmotic pressure than that inside the cells present in the solution. Hypertonic IV Solutions-D5 NS, D5 LR, D5 33%NS, D5 1/2NS, 10% Dextrose in H2O.
  19. hypervolemia
    decreased blood volume, states: initial- blood volume decreases, 2. compensatory- maintain perfusion and blood pressure, no cell damage, 3. progressive- decompinsation, blood flow impaired, capillary permeability increased, blood flow sluggish to organs, enzyme changes and damage, 4. irreversible- VS changes, death, even if blood flow is restored- it's to late. Causes- lack of blood volume, dehydration, and vomiting. Manifestations- thirst (baroreceptors and chemoreceptors sense fluid changes, hypothalamus., increased HR (working hard to get oxygenated blood to tissues), cool clammy skin, decreased BP(lack of volume in area=less pressure), change in mentation (lack of), Oliguria (100-400mL in 24hours b/c of aldosterone RAS), Restless/apprehension. Treatment- O2, monitoring (cardiac), restore vascular volume, fluids (LR, artificial blood, plasma expanders, and blood.), CVP and PCWP (pressures in heart), Vasoactive drugs and dopamine (increased BP, increased perfusion.)
  20. interstitial fluid
    (between cells)
  21. intracellular
    within the cell
  22. isotonic
    relating to the maintenance of a constant amount of resistive force during muscular concentration, having equal pressure,, a solution with the same osmotic pressure as a reference solution. Isotonic IV solutions-.9%NaCl, 5% Dextrose in water, Lactated Ringers.
  23. laryngospasm
    closure of the larynx obstructing the airway
  24. milliequivalent
    one thousandth of a chemical equivalent. The concentration of electrolyes in a certain volume of solution is usually expressed as milliequivalent perliter (mEq/L). It is calculated by multiplying the milligrams per liter by the valence of the chemical and dividing by the molecular weight of the substance
  25. nonvolatile metabolic acids
    an acid produced from sources other than carbon dioxide and is not excreted by the lungs.
  26. osmoreceptors
    sensory nerve receptors stimulated by changes in fluid and electrolyte concentrations
  27. osmosis
    is the movement of water across a semipermeable membrane. As with particles water diffused down its concentration gradient moving from the side with a lesser number of particles to the side with a greater number of particles (attempts to "water down" a concentrate.)
  28. osmotic pressure
    (Na+, Cl-, and HCO3- account for 95% of the osmotic pressure. BUN and Glucose account for 5%.) The amount of hydrostatic pressure needed to draw a solvent across a membrane and develops as a result of a high concentration of particles colliding with one another.
  29. paresthesia
    abnormal sensations
  30. skin turgor
    the resistance of the skin to deformation, the state of hydration of the skin can determine which of these reactions occurs, but age is the most important factor. (indicates tension of the skin based on pressure within the cells; a measure of dehydration.)
  31. tetany
    repeated skeletal muscle concentrations or spasms, seen in the extremities and face, related to increased irritability of the nerves, often associated with hypocalcemia.
  32. trancellular
    passing through cells
  33. osmolarity
    number of particles in solution
  34. Slide
    Electrolytes
    are substances that dissociate in a solution to form charged particles or ions, as the name implies are associated with electricity in that they conduct current which is necessary for normal cell function, there are 6 major electrolytes Na,K,Ca,Cl, Phosphorous, and Mg.
  35. Slide
    Fluid compartments in the body
    intracellular compartment is fluid contained within the cells of the body and it contains 2/3rds of the total body fluid. the extracellular compartment includes interstitial fluids and intravascular fluids.
  36. Slide
    Electrolytes not distributed evenly
    major intracellular electrolytes K+ and Phosphorus, major extracellular electrolytes Na and Cl, the cell membranes separating the two compartments have selective permeability, electrolytes and water are in constant motion moving through diffusion and osmosis.
  37. Slide
    Capillary facts
    are the smallest blood vessels in the body being only an endothelial layer thick, carry blood between arteries and veins, carry oxygenated and deoxygenated blood, allows solutes and water to move by two opposing processes: filtration and reabsorption.
  38. Capillary filtration
    involves the movement of substance from an area of high hydrostatic pressure to an area of low hydrostatic pressure. This forces fluid and solutes into the ICF. If unchecked would move fluid in only one direction, out of capillaries leading to hypovolemia and shock.
  39. capillary reabsorption
    keeps filtration in check, during filtration albumin remains behind with the diminishing volume for water, as albumin concentration increase the albumin begins to draw water back in by osmosis and water is then reabsorbed by capillaries, this pulling force is called colloid osmotic pressure (oncotic pressure).
  40. Slide
    Mechanisms for water regulation
    water losses and gain, Renin Angiotensin Adlosterone System, hormones like ADH (vasopressin), Thirst.
  41. Slide
    general etiologies of imbalances in fluids and electrolytes
    excess or insufficient intake, decreased or increased output, diseases, adverse effects of medications, a look at some examples.
  42. Slide
    fluid volume excess etiology
    represents isotonic expansion of extracellular fluid compartment, occurs secondary to increased total body Na which leads to increase body water, represents an increase in interstitial and vascular volumes, most commonly caused by decreased Na and H2O elimination by the kidneys.
  43. Slide
    Fluid Loss Manifestations
    wt. gain, increased BP, bounding P not easily obliterated, JVD, increases RR, dyspnea, crackles, edema, puffy lids, full cheeks, periorbital edema, slow emptying of hand veins when raised, decreased hct, decreased BUN, reduced serum osmolarity.
  44. Slide
    Edema
    palpable swelling produced by expansion of interstitial volume, not evident till interstitial fluid volume increases by 2.5-3L, causes include increased vascular volume, decreased capillary colloidal osmotic pressure, increased capillary permeability, or obstructed lymph flow.
  45. Slide
    types of edema
    pitting vs. nonpitting, brawny edema (nonpitting, skin thickens and hardens), third space accumulation (fluid trapped in trancellular spaces), lymphadema (disrupted lymph flow).
  46. Slide
    edema etiology
    increased capillary filtration pressure, decreased capillary colloidal osmotic pressure, increased capillary permeability, obstructed lymphatic flow.
  47. Slide
    treatment of fluid volume excess
    complete history assessing for heart problems like HF, kidney or liver disease, infection or malnutrition, obtain diet history focusing on Na, protein, and water intake, assess VS (bounding P, elevated BP), S/S of hypervolemia (edema, SOB), look for decreased UO. assess for pulmonary status, monitor VS and daily wt. (a gain of 2.2 lbs is equivalent to 1 L of fluid), check for pitting edema and document, monitor IV fluids carefully, monitor diet, encourage those with liver disease to eat adequate protein ( increases colloid pressure pulling fluids from tissue spaces). diuretics of necessary and check electrolytes is used, potassium supplementation may be necessary, check skin and circulation, monitor and/or restrict fluids, be aware that a more acute situation can occur like pulmonary edema.
  48. slide
    fluid volume deficit
    characterized by a decrease in extracellular fluid including the circulating blood volume, with a severe ECF loss and an increase in serum osmolality there is an intracellular fluid loss, if loss of water and solutes are equal, then intracellular fluid loss is unlikely, dehydration means lack of water, this may be due to ECF loss, decrease in fluid.
  49. slide
    fluid deficit etiologies
    vomiting and/or diarrhea, inadequate fluid intake, increased solute intake (Na, G, protein), DKA, GI draining abscess or suctioning, fever with diaphoresis, hemorrhage, burns, ascites, intestinal obstruction. Manifestations- wt. loss, increased thready P, Decreased BP and ortho. BP, decreased CVP, sunken eyes, dry conjuctivae, decreased tearing, poor skin turgor, lack of moisture in groin and axillae, thirst, decreased salavation, dry cracked lips, furrows in tongue, difficulty forming words, mental status changes, weakness, decreased UO, increased Hct, increased serum electrolyte, increased BUN, increased serum osmolarity.
  50. slide
    treatment fluid deficit
    LR, 1500 to replace ECF losses, NS 500 mL, D5W 4700 mL to replace the water deficit and increase UO, K+ 40-80 meq may be divided into 3 liters to replace K+ loss, this must be closely monitored, bicarbonate if acidosis present<7.35
  51. Slide
    sodium excess, hypernatremia
    normal value is 135-145 mEq/L, is the principal cation found in the ECF, mainly responsible for H2O retention, hypernatremia is >145. Manifestations-thirst,flushed skin, oliguria, dry sticky membranes, SALT pneumonic- skin flushed, agitation, low grade fever, and thirst
  52. Slide
    hypernatremia etiologies
    increased Na intake, Decreased H2O intake, vomiting, diarrhea, decreased RF, perspiration, increased adrenocortical hormone production (oral or IV cortisone)
  53. Slide
    hyponatremia
    low sodium, <135, etiologies- low Na diet, excessive water intake, anorexia nervosa, prolonged use of IV D5W, vomiting diarrhea, GI suctioning, tap water enemas, GI surgery bulimia, loss of potassium salt wasting kidney disease, diuretics, ADH, SIADH, decreased ACTH secretion which is Addison's disease. Manifestations-muscle weakness, decreased skin turgor, headache, tremor seizures. Treatment-to restore Na balance due to a Na deficit, either NS or a 3% salt solution is recommended. Na should fall below 130 before giving NS and <115 before giving a concentration salt solution i.e. 3% saline, the cause of the problem should be identified and corrected.
  54. Slide
    Potassium
    is the most abundant cation in the body cells, 97% of the body's potassium is found in the ICF, normal 3.5-5.3, death can occur with >5.3 or <3.5
  55. Slide
    hyperkalemia, K+ excess
    >5.3, etiologies include K+ supplements, salt substitutes, nutritional supplements and herbal juices, IV K+, RF, metabolic acidosis (K+ moves out of cells), blood that is 1-3 weeks old, decreased secretion of ACTH (Addison's disease), K+ sparing diuretics, ACE inhibitors, beta blockers, hemolyis, false reading with tourniquet too tight. Manifestations-muscle weakness, nausea, diarrhea, oliguria, tachycardia, later bradycardia, and finally cardiac arrest (severe). Treatment- in mild cases (5.4-5.6) restricting K+ intake may correct the problem, IV bicarbonate solution (moves K+ back into cells), insulin and glucose infusion (moves K+ back into cells), and IV Ca salt (cardiac irritability) and correcting the cause of the problem. In severe cases (>6.7) Kayexalate and sorbitol administered orally or rectally. Magnesium sitrate causes diarrhea to lose K+.
  56. slide
    hypokalemia
    <3.5, etiologies include malnutrition, GI losses through vomiting, diarrhea suctioning, intestinal fistula, laxative abuse, bulimia, enemas, diuretics and dialysis, hormonal influences through steroid use, cushing's syndrome, stress, excess licorice, trauma,surgery burns, insulin alkalotic state, magnesium deficit and meds. Medications causing Hypokalemia- sympathomimetics (adrenergics), epinephrine, decongestants, bronchodilators, beta 2 adrenergic agonists, amphotericin B, aminoglycosides, and large doses of penicillin. Suction Pneumonic for hypokalemia-skeletal muscle weakness, U wave (EKG change), constipation (ileus), toxic effects of digoxin (from hypokalemia), irregular pulse, orthostatic hypotension, numbness (paresthsia). Treatment-oral or IV supplements, monitor patients status, monitor EKG changes: ST segment depressed or prolonged, T wave flat or inverted, U wave evident.
  57. Slide
    Calcium
    normal serum level is 8.9-10.1, major cation found in ECF of teeth and bones, responsible form normal nerve and muscle activity (heart), maintenance of normal cellular permeability (increases decrease cellular permeability), helps form strong bones and teeth.
  58. Slide
    hypercalcemia
    >10.1, etiologies include increased calcium supplements, diuretics thiazides (decrease excretion), cellular destruction of bone and immobility, increased PTH (promotes release of Ca form bone), decreased phosphorous, and steroids which mobilize Ca absorption form bone. Manifestations- lethargy, headache, muscle flaccidity, nausea, vomiting, anorexia, constipation, polydipsia, hypertension, polyuria, nerves and muscles are more difficult to excite. Treatment- correct the cause if possible, expanding the fluid volume is important to increase renal excretion, using NS as it increases volume decreasing Ca reabsorption, loop diuretic such as furosemide (Lasix) is prescribed to prevent fluid overload.
  59. slide
    hypocalcemia
    <8.9, etiologies include lack of Ca in diet, inadequate Vit D (need to absorb Ca), hypoalbuminemia, chronic diarrhea, renal failure, decreased PTH, increase serum phosphorous, increased serum mg., citrated blood transfusions, hypoparathyroidism, alkalosis (increases Ca protein binding). Manifestations- muscle tremor, muscle cramps, tetany, tonic-clonic seizures, parethesia, bleeding, arrhythmias, hypotension, positive Chvostek's and Trousseau's sign, (tapping over facial nerve, and BP cuff on arm blown up 20 mm causing flexive spasm in 1-5min.) Cardiac changes are lengthened ST segment and prolonged QT interval. Treatment- mild oral calcium salts with Vit D twice a day, moderate or severe 10% IV calcium gluconate, take care with patients on digitalis cause elevating the Ca enhances the action of the drug and can cause digitatis toxicity (a concern with hypercalcemia).
  60. Slide
    role of parathyroid and thyroid glands in Ca balance
    • 1. parathyroid gland--PTH--calcium leaves bone--increases serum Ca.
    • 2. thyroid gland--calcitonin--calcium returns to bone--decreases serum Ca.
  61. Slide
    magnesium
    normal serum level is 1.5-2.5 with 33% bound protein and remainder as free cations, one half if contained in the bone, 49% in the body cells an 1% in the ECF, the second most plentiful intracellular cation, and has similar functions, causes of imbalances and clinical manifestation, as K+.
  62. Slide
    magnesium functions
    transmits neuromuscular activity and is mediator of neural transmissions, contracts the heart muscle, activate may cellular enzymes for carb and protein metabolism
  63. slide
    hypermagnesemia
    >2.5, etiologies include excess administration of magnesium products (Mg Sulfate, antacids and laxatives with Mg), renal failure and insufficiency, severe dehydration and DKA. Manifestations- Renal Pneumonic- reflexes decreased (plus weakness and paralysis), electrocardiogram changes (bradycardia) and hypotension, Nausea and vomiting, Appearance flushed, Lethargy (plus drowsiness and coma). Treatment- IV NaCL and Ca salt may be prescribed, if hypermagnesemia from renal failure, dialysis may be necessary, Ventilator assistance may be needed with resp. distress.
  64. slide
    hypomagnesemia
    <1.5, common etiologies include inadequate intake, malnutrition, GI losses, TPN, chronic alcoholism, renal dysfunction (ARF in diuretic phase), MI (fifth day post), HF (prolonged diuretic therapy), hypokalemia, hypocalcemia, metabolic alkalosis, medics (aminoglycosides, K+ wasting diuretics, cortisone, amphotericin B, digitalis. Manifestations- Starved Pneumonic, seizures and muscle tremors, tetany, anorexia and arrhythmias, rapid heart rate, vomiting, emotional liability, deep tendon reflexes increased. Treatment- may be corrected by a diet of green vegetables, legumes, whole grain cereal, nuts, and fruit, oral of IV Mg salts may be prescribed when severe deficit.
  65. slide
    what is an acid-base balance
    an equalization between the acidity and alkalinity of body fluids, whether a solution is an acid or alkaline depends on its concentration of hydrogen and hydoxyl ions
  66. slide
    what is an acid
    any substance that releases hydrogen ions when placed in a solution, in the body we have nonvolatile fixed acids derived from catabolic breakdown of proteins and fats, these fixed acids are lactic and sulfuric acids and acetoacetic acid from fat metabolism.
  67. slide
    more acids in the body
    carbonic acid is a volatile or non fixed acid that is reciprocal with carbon dioxide and water in the body and dissociates into hydrogen and bicarbonate ions, a volatile acid can be vaporized or evaporated and is the means by with CO2 in the ECF is transformed in the lungs and removed during resp.
  68. slide
    what is a base?
    any substance that releases hydroxyl ions in a solution and is able to accept and combine with hydrogen ions, bases are derived from the metabolic breakdown of citrate, lactate, and isocitrate to CO2 an H2O, they are found in most foods but mostly in fruits and vegetables
  69. slide
    neutralization
    is the process whereby opposing forces balance each other so that neither force dominates, salt is made up of the negative ion of any acid and the positive ion of any base, it results from the chemical interaction within a solution where the acid and base neutralize each other.
  70. slide
    what is pH?
    the potential of hydrogen, or the chemical unit of measurement used to describe the degree of acidity of alkalinity of a substance, gauged on a scale of 0-14 with 7 indicating neutrality(neither acid or base). an inverse correlation between acid-base properties: as the hydrogen ion concentration increases, the pH decreases (acidity); as the concentration of hydrogen ions decreases, the pH rises (alkalinity), when below 7.0 it is acid, when above 7.0 it is alkaline.
  71. slide
    acidosis versus alkalosis
    acidosis is the accumulation of excess acids (hydrogen ions) or a deficiency of base (bicarbonate ions) resulting in a pH < 7.0, alkalosis is the reduction of acids (hydrogen ions) and an increase of base (bicarbonate ions), resulting in a pH > 7.0.
  72. slide
    what are buffer systems
    a buffer is a substance that maintains the body's acid-base balance by regulating hydrogen ion concentration, a buffer system is the combination of an acid and a base and is sometimes referred to as a buffer pair, for normal cellular activity to occur, the hydrogen ion concentration of the body's fluid must be sustained within a limited range.
  73. slide
    the carbonic acid-bicarbonate buffer system
    • this is the most important buffering system, and exists in the ESF compartment, it operates in the lungs and kidneys, under normal circumstances the body maintains a balanced ration of one part carbonic acid to twenty parts bicarbonate.
    • carbonic acid supply is regulated by the resp. system, CO2 becomes carbonic acid, when CO2 levels rise the resp. center in the brain is stimulated and then signals the lungs to increase rate and depth of resp. thereby blowing off CO2, when CO2 drops the resp. center is stimulating again to decrease RR, the kidneys also regulate pH, in the renal tubules nonvolatile acids are removed, in the formation of urine, acid and alkaline phosphates are altered to produce and acid urine, this mechanism conserves Na, K+, Mg, and Ca all which maintain the body's fixed base. Kidneys also help by; in the presence of acidosis they excrete hydrogen ions and retain bicarbonate ions (get rid of acid), they also manufacture bicarbonate from CO2 and H2O (Neurtalize), in alkalotic situations the kidneys retain hydrogen ions and excrete bicarbonate ions (create acid).
  74. slide
    acid-base imbalances
    occur whenever there is a change in hydrogen ion concentration of the blood, the imbalances related to carbonic acid (CO2 levels) levels are resp. disturbances and those that relate to bicarbonate ratios are metabolic disturbances (kidneys), they include: resp. acidosis or alkalosis (CO2 changes), and metabolic acidosis or alkalosis (bicarbonate changes).
  75. slide
    resp. acidosis
    presence of abnormally elevated hydrogen ion concentration and excess carbonic acid, is the most common acid-base disturbance, Hypercapnia (increased CO2) is the cause, the kidneys compensate by increasing the plasma bicarb concentration which helps return the pH to normal. Etiologies and contributing factors- altered pulmonary ventilation due to diseases like COPD, pneumonia, bronchiectasis, and cardiopulmonary arrest, also associated with extreme abd. pain, disorders that affect resp. muscles, pneumothorax, extreme obesity, and inadequate ventilation, can be compensated or uncompensated. Manifestations- weak, sluggish, and person experiences confusion and disorientation, signs of CNS depression, may be productive cough, dyspnea, and cyanosis, see blood gas levels-
  76. slide
    normal blood gas values
    partial pressure oxygen (PaO2)- 75-100mm Hg, partial pressure of carbon dioxide (PaCO2) -35-45 mm Hg, a pH of 7.35-7.45, oxygen saturation (SaO2)- 94%-100%, bicarbonate (HCO3)- 22-26 mEq/L
  77. slide
    blood gas values with resp. acidosis
    PaCO2>45mm Hg, pH<7.35, if kidney are compensating the plasma bicarb. will be >28 mEq/L. Treatment- is aimed at underlying lung disease- smoking cessation is extremely important, bronchodilator drugs may reverse some airway obstruction, oxygen may be necessary if the blood oxygen level is low, non-invasive positive-pressure ventilation or mechanical ventilation may be necessary is the resp. acidosis is severe.
  78. Slide
    resp. alkalosis
    a condition of excessive alkalinity of the body fluids, most often associated with resp. (breathing) disorders, the pH is high and carbon dioxide levels are low. the levels of plasma pH will be >7.45, and the PaCO2 will be<35, the HCO3 will be <21. (buffers are of no use in alkalosis). Etiologies- common causes include hyperventilation (increased rate of breathing), anxiety, and fever, the symptoms may include light-headedness, dizziness, and numbness of the hands and feet. Treatment- includes removal of the cause, breathing into a paper bag, or use of mask that causes re-breathing of carbon dioxide, helps reduce symptoms in some cases.
  79. slide
    metabolic acidosis
    disturbance of the body acid-base balance in which there is excessive acidity of the blood, metabolic acidosis can occur as a result of many different conditions, such as kidney failure, poisoning, diabetic ketoacidosis (DKA), and shock, many of these conditions are life-threatening, if severe, metabolic acidosis may lead to shock or death, in some situations, metabolic acidosis can be a mild, chronic condition. Manifestations- most symptoms are caused by the disease or condition that is causing the metabolic acidosis, usually causes rapid breathing, confusion or lethargy may also occur.
  80. slide
    metabolic acidosis blood gas results
    pH<7.35, HCO3=21mEq/L (buffer), depending on compensatory mechanisms the PCO2 is normal or low. Treatment- is aimed at the underlying condition, in certain circumstances, sodium bicarbonate (baking soda) may be given to improve the acidity of the blood, fluid volume deficits and electrolyte imbalances that coexist must be adjusted with IV fluids and electrolytes and monitored carefully.
  81. slide
    metabolic alkalosis
    describes all cases of alkalosis not caused by a chronic acid deficit, occurs when the level of base bicarbonate is abnormally high or there is a decrease in hydrogen ion concentration, is compensated for by the lungs and by the kidneys. Etiologies- occurs as a result of excess intake of alkalis, such as sodium bicarbonate, or loss of acid, which results in an increased bicarbonate level, vomiting and diarrhea can result in a loss of chloride and hydrogen ions, which causes an increase in blood bicarb. as well as a K+ deficit. Adrenal malfunction and renal failure as well as diuretics, tissue destruction, and hypercalcemia can be causes. Manifestations- breathing patterns are depressed both in rate and in depth, a resp. compensatory mechanism to raise the pCO2, CNS depression, hyperexcitability with hypertonicity of muscle activity and hyperactive reflexes, if severe, tetany and convulsions because of Ca loss.
  82. slide
    metabolic alkalosis blood gases
    HCO3>28mEq/L, pH>7.45 (first), plasma K+ and Cl are low! Treatment- correct the underlying cause, infusion therapy involves administering electrolytes (i.e. K+), fluid therapy with the administration of ammonium chloride an acidifying salt if severe.

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