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WATER BALANCEWATER BALANCE
NORMAL WATER CONTENT OF NORMAL WATER CONTENT OF BODYBODY
75% AT BIRTH75% AT BIRTH 55-60% YOUNG ADULTS55-60% YOUNG ADULTS
MEN SLIGHTLY HIGHER THAN WOMENMEN SLIGHTLY HIGHER THAN WOMEN (MORE FAT, LESS WATER)(MORE FAT, LESS WATER)
45% IN ELDERLY, OBESE45% IN ELDERLY, OBESE
WATER BALANCEWATER BALANCE
TOTAL BODY WATERTOTAL BODY WATER ~40 LITERS~40 LITERS SEVERAL FLUID COMPARTMENTSSEVERAL FLUID COMPARTMENTS
65% INTRACELLULAR FLUID (ICF)65% INTRACELLULAR FLUID (ICF) 35% EXTRACELLULAR FLUID (ECF)35% EXTRACELLULAR FLUID (ECF)
25% INTERSTITIAL FLUID (TISSUE FLUID)25% INTERSTITIAL FLUID (TISSUE FLUID) 8% BLOOD PLASMA AND LYMPH8% BLOOD PLASMA AND LYMPH 2% TRANSCELLULAR FLUID2% TRANSCELLULAR FLUID
SYNOVIAL, PLEURAL, PERICARDIAL, ETC.SYNOVIAL, PLEURAL, PERICARDIAL, ETC.
WATER BALANCEWATER BALANCE
TOTAL BODY WATERTOTAL BODY WATER ENTERS BODYENTERS BODY
OSMOSIS FROM DIGESTIVE TRACTOSMOSIS FROM DIGESTIVE TRACT ALSO PRODUCED BY AEROBIC RESPIRATIONALSO PRODUCED BY AEROBIC RESPIRATION ALSO PRODUCED BY CONDENSATION ALSO PRODUCED BY CONDENSATION
REACTIONSREACTIONS
EXITS BODYEXITS BODY URINARY, DIGESTIVE, RESPIRATORY, & URINARY, DIGESTIVE, RESPIRATORY, &
INTEGUMENTARY SYSTEMSINTEGUMENTARY SYSTEMS
WATER BALANCEWATER BALANCE
TOTAL BODY WATERTOTAL BODY WATER FLUID EXCHANGED BETWEEN FLUID EXCHANGED BETWEEN
COMPARTMENTSCOMPARTMENTS CAPILLARY WALLS, PLASMA MEMBRANES CAPILLARY WALLS, PLASMA MEMBRANES DRIVEN BY TRANSIENT OSMOTIC GRADIENTSDRIVEN BY TRANSIENT OSMOTIC GRADIENTS OSMOTIC GRADIENTS DEPENDENT ON SOLUTE OSMOTIC GRADIENTS DEPENDENT ON SOLUTE
MOLECULESMOLECULES MOST ABUNDANT SOLUTES ARE ELECTROLYTESMOST ABUNDANT SOLUTES ARE ELECTROLYTES WATER BALANCE AND ELECTROLYTE BALANCE WATER BALANCE AND ELECTROLYTE BALANCE
ARE CLOSELY RELATEDARE CLOSELY RELATED
WATER BALANCEWATER BALANCE
WATER BALANCEWATER BALANCE FLUID GAIN = FLUID LOSSFLUID GAIN = FLUID LOSS BOTH TYPICALLY ~2500 ML / DAYBOTH TYPICALLY ~2500 ML / DAY
WATER BALANCEWATER BALANCE
WATER GAINWATER GAIN TYPICALLY ~2500 ML / DAYTYPICALLY ~2500 ML / DAY 1600 ML FROM DRINK1600 ML FROM DRINK 700 ML FROM FOOD700 ML FROM FOOD 200 ML FROM METABOLISM200 ML FROM METABOLISM
AEROBIC RESPIRATIONAEROBIC RESPIRATION CONDENSATION REACTIONSCONDENSATION REACTIONS
A.K.A. DEHYDRATION REACTIONSA.K.A. DEHYDRATION REACTIONS
WATER BALANCEWATER BALANCE
WATER LOSSWATER LOSS TYPICALLY ~2500 ML / DAYTYPICALLY ~2500 ML / DAY 1500 ML EXCRETED AS URINE1500 ML EXCRETED AS URINE 200 ML ELIMINATED IN FECES200 ML ELIMINATED IN FECES 300 ML EXPIRED IN BREATH300 ML EXPIRED IN BREATH 100 ML SECRETED AS SWEAT100 ML SECRETED AS SWEAT 400 ML LOST AS CUTANEOUS 400 ML LOST AS CUTANEOUS
TRANSPIRATIONTRANSPIRATION DIFFUSES THROUGH EPIDERMIS, EVAPORATESDIFFUSES THROUGH EPIDERMIS, EVAPORATES
WATER BALANCEWATER BALANCE
WATER LOSSWATER LOSS CAN VARY GREATLYCAN VARY GREATLY
INCREASED RESPIRATORY LOSS IN COLD INCREASED RESPIRATORY LOSS IN COLD WEATHERWEATHER
INCREASED SWEAT LOSS IN WARM INCREASED SWEAT LOSS IN WARM WEATHERWEATHER
INCREASED RESPIRATORY AND SWEAT INCREASED RESPIRATORY AND SWEAT LOSS, DECREASED URINE OUTPUT LOSS, DECREASED URINE OUTPUT DURING PHYSICAL EXERTIONDURING PHYSICAL EXERTION
WATER BALANCEWATER BALANCE
WATER LOSSWATER LOSS OBLIGATORY WATER LOSSOBLIGATORY WATER LOSS
RELATIVELY UNAVOIDABLERELATIVELY UNAVOIDABLE EXPIRED AIR, CUTANEOUS EXPIRED AIR, CUTANEOUS
TRANSPIRATION, SWEAT, FECAL TRANSPIRATION, SWEAT, FECAL MOISTURE, MINIMUM URINE OUTPUT MOISTURE, MINIMUM URINE OUTPUT (~400 ML/DAY)(~400 ML/DAY)
WATER BALANCEWATER BALANCE
REGULATION OF WATER INTAKEREGULATION OF WATER INTAKE GOVERNED BY THIRSTGOVERNED BY THIRST
PROVOKED BY INCREASED PLASMA OSMOLARITYPROVOKED BY INCREASED PLASMA OSMOLARITY PROVOKED BY BLOOD LOSSPROVOKED BY BLOOD LOSS
THIRST CENTER IN HYPOTHALAMUSTHIRST CENTER IN HYPOTHALAMUS RESPONDS TO SIGNS OF DEHYDRATIONRESPONDS TO SIGNS OF DEHYDRATION
ANGIOTENSIN IIANGIOTENSIN II ANTIDIURETIC HORMONE (ADH)ANTIDIURETIC HORMONE (ADH) SIGNALS FROM OSMOCENTERSSIGNALS FROM OSMOCENTERS
INHIBITS SALIVATIONINHIBITS SALIVATION
WATER BALANCEWATER BALANCE
REGULATION OF WATER INTAKEREGULATION OF WATER INTAKE INHIBITED SALIVATIONINHIBITED SALIVATION
DRY MOUTHDRY MOUTH SENSE OF THIRSTSENSE OF THIRST INGESTION OF WATERINGESTION OF WATER
COOLS AND MOISTENS MOUTHCOOLS AND MOISTENS MOUTH DISTENDS STOMACH AND INTESTINESDISTENDS STOMACH AND INTESTINES REHYDRATES BLOODREHYDRATES BLOOD
THIRST INHIBITEDTHIRST INHIBITED
WATER BALANCEWATER BALANCE
REGULATION OF WATER OUTPUTREGULATION OF WATER OUTPUT CONTROLLED VIA ALTERATIONS IN URINE CONTROLLED VIA ALTERATIONS IN URINE
VOLUMEVOLUME URINE VOLUME AFFECTED BYURINE VOLUME AFFECTED BY
SODIUM REABSORPTIONSODIUM REABSORPTION WATER FOLLOWS SODIUM REABSORPTIONWATER FOLLOWS SODIUM REABSORPTION MORE LATERMORE LATER
ANTIDIURETIC HORMONE (ADH)ANTIDIURETIC HORMONE (ADH) BLOOD VOLUME BLOOD VOLUME , [Na+] , [Na+] , OSMORECEPTORS , OSMORECEPTORS
STIMULATED, PITUITARY RELEASES ADHSTIMULATED, PITUITARY RELEASES ADH AQUAPORINS PRODUCED IN KIDNEY’S COLLECTING AQUAPORINS PRODUCED IN KIDNEY’S COLLECTING
DUCTSDUCTS FACILITATE REABSORPTIONFACILITATE REABSORPTION ALSO WORKS IN REVERSEALSO WORKS IN REVERSE
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID DEFICIENCYFLUID DEFICIENCY
VOLUME DEPLETION (HYOVOLEMIA)VOLUME DEPLETION (HYOVOLEMIA) DEHYDRATIONDEHYDRATION
FLUID EXCESSFLUID EXCESS VOLUME EXCESSVOLUME EXCESS HYPOTONIC HYDRATIONHYPOTONIC HYDRATION
FLUID SEQUESTRATIONFLUID SEQUESTRATION
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID DEFICIENCY: HYPOVOLEMIAFLUID DEFICIENCY: HYPOVOLEMIA CAUSED BY PROPORTIONATE LOSS OF CAUSED BY PROPORTIONATE LOSS OF
WATER AND SODIUM WITHOUT WATER AND SODIUM WITHOUT REPLACEMENTREPLACEMENT
TOTAL BODY WATER DECREASEDTOTAL BODY WATER DECREASED OSMOLARITY UNCHANGEDOSMOLARITY UNCHANGED CAUSESCAUSES
HEMORRHAGEHEMORRHAGE SEVERE BURNSSEVERE BURNS CHRONIC VOMITING OR DIARRHEACHRONIC VOMITING OR DIARRHEA
MAJOR CAUSE OF INFANT MORTALITYMAJOR CAUSE OF INFANT MORTALITY
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID DEFICIENCY: DEHYDRATIONFLUID DEFICIENCY: DEHYDRATION CAUSED BY LOSS OF MORE WATER THAN CAUSED BY LOSS OF MORE WATER THAN
NaNa++
TOTAL BODY WATER DECREASEDTOTAL BODY WATER DECREASED ECF OSMOLARITY INCREASESECF OSMOLARITY INCREASES CAUSESCAUSES
LACK OF DRINKING WATERLACK OF DRINKING WATER DIABETES MELLITUSDIABETES MELLITUS ADH HYPOSECRETIONADH HYPOSECRETION PROFUSE SWEATINGPROFUSE SWEATING OVERUSE OF DIURETICSOVERUSE OF DIURETICS
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS
FLUID DEFICIENCY: DEHYDRATIONFLUID DEFICIENCY: DEHYDRATION AFFECTS ALL FLUID COMPARTMENTS AFFECTS ALL FLUID COMPARTMENTS INFANTS MORE VULNERABLE THAN ADULTSINFANTS MORE VULNERABLE THAN ADULTS
HIGHER METABOLISM HIGHER METABOLISM MORE WASTES MORE WASTES MORE WASTES MORE WASTES MORE URINE VOLUME MORE URINE VOLUME
IMMATURE KIDNEYSIMMATURE KIDNEYS URINE LESS CONCENTRATEDURINE LESS CONCENTRATED
GREATER SURFACE AREA-TO-VOLUME RATIOGREATER SURFACE AREA-TO-VOLUME RATIO GREATER WATER LOSS BY EVAPORATIONGREATER WATER LOSS BY EVAPORATION
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS
EFFECTS OF FLUID DEFICIENCYEFFECTS OF FLUID DEFICIENCY CIRCULATORY SHOCK CIRCULATORY SHOCK
DUE TO LOSS OF BLOOD VOLUMEDUE TO LOSS OF BLOOD VOLUME NEUROLOGICAL DYSFUNCTION NEUROLOGICAL DYSFUNCTION
DUE TO DEHYDRATION OF BRAIN CELLSDUE TO DEHYDRATION OF BRAIN CELLS
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS
FLUID EXCESSFLUID EXCESS LESS COMMON THAN FLUID LESS COMMON THAN FLUID
DEFICIENCY DEFICIENCY KIDNEYS ARE TYPICALLY ABLE TO KIDNEYS ARE TYPICALLY ABLE TO
EXCRETE MORE URINEEXCRETE MORE URINE
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS
FLUID EXCESS: VOLUME EXCESSFLUID EXCESS: VOLUME EXCESS CAUSED BY PROPORTIONATE RETENTION CAUSED BY PROPORTIONATE RETENTION
OF EXCESS WATER AND SODIUMOF EXCESS WATER AND SODIUM TOTAL BODY WATER INCREASEDTOTAL BODY WATER INCREASED OSMOLARITY UNCHANGEDOSMOLARITY UNCHANGED CAUSESCAUSES
ALDOSTERONE HYPERSECRETIONALDOSTERONE HYPERSECRETION RENAL FAILURERENAL FAILURE
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID EXCESS: HYPOTONIC HYDRATIONFLUID EXCESS: HYPOTONIC HYDRATION ““WATER INTOXICATION”, “POS HWATER INTOXICATION”, “POS H220 BALANCE”0 BALANCE” CAUSED BY RETENTION OF MORE WATER CAUSED BY RETENTION OF MORE WATER
THAN SODIUMTHAN SODIUM TOTAL BODY WATER INCREASED TOTAL BODY WATER INCREASED ECF OSMOLARITY DECREASESECF OSMOLARITY DECREASES CAUSESCAUSES
REPLACEMENT OF WATER AND SALT WITH WATERREPLACEMENT OF WATER AND SALT WITH WATER LACK OF PROPORTIONATE INTAKE OF ELECTROLYTESLACK OF PROPORTIONATE INTAKE OF ELECTROLYTES
ADH HYERSECRETIONADH HYERSECRETION
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS
EFFECTS OF FLUID EXCESSEFFECTS OF FLUID EXCESS PULMONARY EDEMA PULMONARY EDEMA CEREBRAL EDEMA CEREBRAL EDEMA
WATER BALANCEWATER BALANCE
WATER BALANCE DISORDERS WATER BALANCE DISORDERS FLUID SEQUESTRATIONFLUID SEQUESTRATION EXCESS FLUID ACCUMULATES IN A EXCESS FLUID ACCUMULATES IN A
PARTICULAR LOCATIONPARTICULAR LOCATION TOTAL BODY WATER MAY BE NORMALTOTAL BODY WATER MAY BE NORMAL CIRCULATING VOLUME MAY DROPCIRCULATING VOLUME MAY DROP EXAMPLESEXAMPLES
EDEMA (IN INTERSTITIAL SPACES)EDEMA (IN INTERSTITIAL SPACES) HEMORRHAGE (LOST TO CIRCULATION)HEMORRHAGE (LOST TO CIRCULATION) PLEURAL EFFUSION (IN PLEURAL CAVITY)PLEURAL EFFUSION (IN PLEURAL CAVITY)
ELECTROLYTE BALANCEELECTROLYTE BALANCE
IMPORTANCE OF ELECTROLYTESIMPORTANCE OF ELECTROLYTES SALTSSALTS
E.G. NaCl, CaE.G. NaCl, Ca33(PO(PO44))22, ETC., ETC. INCLUDE IONS IN DEFINITIONINCLUDE IONS IN DEFINITION
MANY ROLESMANY ROLES INVOLVED IN METABOLISMINVOLVED IN METABOLISM DETERMINE ELECTRICAL MEMBRANE DETERMINE ELECTRICAL MEMBRANE
POTENTIALSPOTENTIALS AFFECT OSMOLARITY OF BODY FLUIDSAFFECT OSMOLARITY OF BODY FLUIDS AFFECT WATER CONTENT AND DISTRIBUTIONAFFECT WATER CONTENT AND DISTRIBUTION ETC.ETC.
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUMSODIUM PRINCIPAL EXTRACELLULAR CATIONPRINCIPAL EXTRACELLULAR CATION
90 – 95% OF OSMOLARITY FROM SODIUM SALTS90 – 95% OF OSMOLARITY FROM SODIUM SALTS ROLESROLES
DEPOLARIZATIONDEPOLARIZATION MUSCLES, NERVESMUSCLES, NERVES
AFFECT TOTAL BODY WATERAFFECT TOTAL BODY WATER AFFECT WATER DISTRIBUTIONAFFECT WATER DISTRIBUTION COTRANSPORTCOTRANSPORT
GLUCOSE, AMINO ACIDS, CALCIUM, ETC.GLUCOSE, AMINO ACIDS, CALCIUM, ETC. ETC.ETC.
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASISSODIUM HOMEOSTASIS 0.5 G / DAY DIETARY REQUIREMENT0.5 G / DAY DIETARY REQUIREMENT RECEIVE 3 – 7 G / DAY FROM OUR DIETRECEIVE 3 – 7 G / DAY FROM OUR DIET KIDNEYS EXCRETE EXCESS (~5 G / DAY)KIDNEYS EXCRETE EXCESS (~5 G / DAY) EXCRETION REGULATED BY 3 EXCRETION REGULATED BY 3
HORMONESHORMONES ALDOSTERONEALDOSTERONE ANTIDIURETIC HORMONE (ADH)ANTIDIURETIC HORMONE (ADH) ATRIAL NATRIURETIC FACTOR (ANF)ATRIAL NATRIURETIC FACTOR (ANF)
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE ““SALT-RETAINING HORMONE”SALT-RETAINING HORMONE” STEROID HORMONESTEROID HORMONE ALDOSTERONE SECRETION ALDOSTERONE SECRETION
STIMULATED BY:STIMULATED BY: HYPONATREMIAHYPONATREMIA HYPERKALEMIAHYPERKALEMIA HYPOTENSIONHYPOTENSION
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE TARGET CELLSTARGET CELLS
DISTAL CONVOLUTED TUBULEDISTAL CONVOLUTED TUBULE COLLECTING DUCTCOLLECTING DUCT
TRANSCRIBE GENE FOR NaTRANSCRIBE GENE FOR Na++-K-K++ PUMP PUMP SODIUM REABSORPTION INCREASESSODIUM REABSORPTION INCREASES HH++ AND K AND K ++ SECRETION INCREASES SECRETION INCREASES URINE pH DROPSURINE pH DROPS
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE AVERAGE NaAVERAGE Na++ EXCRETION 5 G / DAY EXCRETION 5 G / DAY ALDOSTERONE REDUCES TO ~0ALDOSTERONE REDUCES TO ~0 WATER REABSRBED WATER REABSRBED
PROPORTIONALLYPROPORTIONALLY SODIUM CONCENTRATION IN BODY SODIUM CONCENTRATION IN BODY
UNCHANGEDUNCHANGED
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE INHIBITED BY HYPERTENSIONINHIBITED BY HYPERTENSION KIDNEYS THEN REABSORB LITTLE KIDNEYS THEN REABSORB LITTLE
NaNa++
EXCRETION INCREASED TO ~30 G / EXCRETION INCREASED TO ~30 G / DAYDAY
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ADHREGULATION BY ADH INDEPENDENTLY MODIFIES SODIUM AND INDEPENDENTLY MODIFIES SODIUM AND
WATER EXCRETIONWATER EXCRETION CAN CHANGE SODIUM CONCENTRATIONCAN CHANGE SODIUM CONCENTRATION
HIGH BLOOD [NaHIGH BLOOD [Na++] ] ADH SECRETION ADH SECRETION INCREASES WATER REABSORPTIONINCREASES WATER REABSORPTION
SODIUM CONCENTRATION DECREASEDSODIUM CONCENTRATION DECREASED ADH ALSO STIMULATES THIRSTADH ALSO STIMULATES THIRST
ALSO HAPPENS IN REVERSEALSO HAPPENS IN REVERSE
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY ANFREGULATION BY ANF HYPERTENSION HYPERTENSION ANF SECRETION ANF SECRETION
INHIBITS ADH AND RENIN SECRETIONINHIBITS ADH AND RENIN SECRETION INHIBITS SODIUM & WATER INHIBITS SODIUM & WATER
REABSORPTIONREABSORPTION MORE SODIUM AND WATER EXCRETEDMORE SODIUM AND WATER EXCRETED BLOOD PRESSURE DECREASEDBLOOD PRESSURE DECREASED
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASISSODIUM HOMEOSTASIS REGULATION BY OTHER HORMONESREGULATION BY OTHER HORMONES ESTROGENS MIMIC ALDOSTERONEESTROGENS MIMIC ALDOSTERONE
WATER RETENTION DURING PREGNANCYWATER RETENTION DURING PREGNANCY MENSTRUAL WATER RETENTIONMENSTRUAL WATER RETENTION
PROGESTERONEPROGESTERONE REDUCES SODIUM REABSORPTIONREDUCES SODIUM REABSORPTION DIURETIC AEFFECTDIURETIC AEFFECT
GLUCOCORTICOIDSGLUCOCORTICOIDS PROMOTE SODIUM REABSORPTION, EDEMAPROMOTE SODIUM REABSORPTION, EDEMA
ELECTROLYTE BALANCEELECTROLYTE BALANCE
SODIUM HOMEOSTASIS: IMBALANCESSODIUM HOMEOSTASIS: IMBALANCES RELATIVELY RARERELATIVELY RARE HYPERNATREMIAHYPERNATREMIA
CAN RESULT FROM IV SALINECAN RESULT FROM IV SALINE CAUSES WATER RETENTION, HYPERTENSION, CAUSES WATER RETENTION, HYPERTENSION,
EDEMAEDEMA HYPONATREMIAHYPONATREMIA
GENERALLY FROM WATER EXCESSGENERALLY FROM WATER EXCESS HYPOTONIC HYDRATIONHYPOTONIC HYDRATION CORRECTED BY EXCRETION OF EXCESS WATERCORRECTED BY EXCRETION OF EXCESS WATER
ELECTROLYTE BALANCEELECTROLYTE BALANCE
POTASSIUMPOTASSIUM PRINCIPAL INTRACELLULAR CATIONPRINCIPAL INTRACELLULAR CATION AFFECTS INTRACELLULAR OSMOLARITYAFFECTS INTRACELLULAR OSMOLARITY AFFECTS CELL VOLUMEAFFECTS CELL VOLUME ROLESROLES
PRODUCES RESTING & ACTION POTENTIALSPRODUCES RESTING & ACTION POTENTIALS COTRANSPORTCOTRANSPORT THERMOGENESISTHERMOGENESIS COFACTOR FOR PROTEIN SYNTHESISCOFACTOR FOR PROTEIN SYNTHESIS
ELECTROLYTE BALANCEELECTROLYTE BALANCE
POTASSIUM HOMEOSTASISPOTASSIUM HOMEOSTASIS HOMEOSTASIS LINKED TO THAT OF NaHOMEOSTASIS LINKED TO THAT OF Na++
KK++ AND Na AND Na++ COREGULATED BY ALDOSTERONE COREGULATED BY ALDOSTERONE 90% OF K90% OF K++ REABSORBED IN PCT REABSORBED IN PCT
REMAINDER EXCRETED IN URINEREMAINDER EXCRETED IN URINE CONTROL IMPARTED IN DCT & CONTROL IMPARTED IN DCT &
COLLECTING DUCT (CD)COLLECTING DUCT (CD) HIGH [KHIGH [K++] ] SECRETE MORE INTO FILTRATE SECRETE MORE INTO FILTRATE LOW [KLOW [K++] ] SECRETE LESS INTO FILTRATE SECRETE LESS INTO FILTRATE EXCHANGED FOR NaEXCHANGED FOR Na++
ELECTROLYTE BALANCEELECTROLYTE BALANCE
POTASSIUM HOMEOSTASISPOTASSIUM HOMEOSTASIS REGULATION BY ALDOSTERONEREGULATION BY ALDOSTERONE HIGH [KHIGH [K++] ] ALDOSTERONE ALDOSTERONE
PRODUCTIONPRODUCTION NaNa++-K-K++ PUMP PRODUCED PUMP PRODUCED NaNa++ AND K AND K++ COREGULATED COREGULATED INCREASE KINCREASE K++ SECRETION SECRETION DECREASE NaDECREASE Na++ SECRETION SECRETION
ELECTROLYTE BALANCEELECTROLYTE BALANCE
POTASSIUM HOMEOSTASIS: IMBALANCESPOTASSIUM HOMEOSTASIS: IMBALANCES MOST DANGEROUS ELECTROLYTE IMBALANCESMOST DANGEROUS ELECTROLYTE IMBALANCES HYPERKALEMIAHYPERKALEMIA
EFFECTS DEPEND ON SPEED OF CONC RISEEFFECTS DEPEND ON SPEED OF CONC RISE QUICK RISE QUICK RISE NERVE/MUSCLE CELLS VERY EXCITABLE NERVE/MUSCLE CELLS VERY EXCITABLE CARDIAC ARRESTCARDIAC ARREST
E.G., K+ RELEASED FROM INJURED CELLSE.G., K+ RELEASED FROM INJURED CELLS E.G., TRANSFUSION WITH OLD BLOODE.G., TRANSFUSION WITH OLD BLOOD E.G., EUTHANASIA, CAPITAL PUNISHMENT LETHAL INJECTIONE.G., EUTHANASIA, CAPITAL PUNISHMENT LETHAL INJECTION
K+ HAS LEAKED FROM ERYTHROCYTESK+ HAS LEAKED FROM ERYTHROCYTES SLOW RISE SLOW RISE NERVE/MUSCLE CELLS LESS EXCITABLE NERVE/MUSCLE CELLS LESS EXCITABLE (Na+ CHANNELS INACTIVATED)(Na+ CHANNELS INACTIVATED)
E.G., ALDOSTERONE HYPOSECRETION, RENAL FAILURE, E.G., ALDOSTERONE HYPOSECRETION, RENAL FAILURE, ACIDOSISACIDOSIS
E.G., SUPPLEMENTAL K+ TO RELIEVE MUSCLE CRAMPSE.G., SUPPLEMENTAL K+ TO RELIEVE MUSCLE CRAMPS
ELECTROLYTE BALANCEELECTROLYTE BALANCE
POTASSIUM HOMEOSTASIS: IMBALANCESPOTASSIUM HOMEOSTASIS: IMBALANCES HYPOKALEMIAHYPOKALEMIA
NERVE/MUSCLE CELLS LESS EXCITABLENERVE/MUSCLE CELLS LESS EXCITABLE MUSCLE WEAKNESS, LOSS OF MUSCLE TONE, MUSCLE WEAKNESS, LOSS OF MUSCLE TONE,
DEPRESSED REFLEXES, IRREGULAR HEART DEPRESSED REFLEXES, IRREGULAR HEART ACTIVITYACTIVITY
E.G., HEAVY SWEATING, CHRONIC VOMITING OR E.G., HEAVY SWEATING, CHRONIC VOMITING OR DIARRHEA, EXCESSIVE LAXATIVES, DIARRHEA, EXCESSIVE LAXATIVES, ALDOSTERONE HYPERSECRETION, ALKALOSISALDOSTERONE HYPERSECRETION, ALKALOSIS
E.G., DEPRESSED APPETITE, BUT RARELY FROM E.G., DEPRESSED APPETITE, BUT RARELY FROM DIETARY INSUFFICIENCYDIETARY INSUFFICIENCY
ELECTROLYTE BALANCEELECTROLYTE BALANCE
CHLORIDECHLORIDE MOST ABUNDANT ANION IN ECFMOST ABUNDANT ANION IN ECF
MAJOR CONTRIBUTION TO OSMOLARITYMAJOR CONTRIBUTION TO OSMOLARITY ROLESROLES
FORMATION OF HClFORMATION OF HCl CHLORIDE SHIFTCHLORIDE SHIFT
COCO22 LOADING/UNLOADING LOADING/UNLOADING
REGULATION OF BODY pHREGULATION OF BODY pH
ELECTROLYTE BALANCEELECTROLYTE BALANCE
CHLORIDE HOMEOSTASISCHLORIDE HOMEOSTASIS ClCl-- STRONGLY ATTRACTED TO SOME STRONGLY ATTRACTED TO SOME
CATIONS (E.G., NaCATIONS (E.G., Na++, K, K++, Ca, Ca2+2+)) CANNOT KEEP THEM APARTCANNOT KEEP THEM APART
HOMEOSTASIS ACHIEVED AS AN HOMEOSTASIS ACHIEVED AS AN EFFECT OF NaEFFECT OF Na++ HOMEOSTASIS HOMEOSTASIS ClCl-- PASSIVELY FOLLOWS Na PASSIVELY FOLLOWS Na++
ELECTROLYTE BALANCEELECTROLYTE BALANCE
CHLORIDE IMBALANCESCHLORIDE IMBALANCES HYPERCHLOREMIAHYPERCHLOREMIA
RESULTS FROM DIETARY EXCESSRESULTS FROM DIETARY EXCESS RESULTS FROM INTERVENOUS SALINE RESULTS FROM INTERVENOUS SALINE
ADMINISTRATIONADMINISTRATION HYPOCHLOREMIAHYPOCHLOREMIA
SIDE EFFECT OF HYPONATREMIASIDE EFFECT OF HYPONATREMIA SIDE EFFECT OF HYPOKALEMIASIDE EFFECT OF HYPOKALEMIA
KIDNEYS RETAIN K+ BY SECRETING Na+, Cl- KIDNEYS RETAIN K+ BY SECRETING Na+, Cl- FOLLOWSFOLLOWS
EFFECTSEFFECTS ALTERED ACID-BASE BALANCEALTERED ACID-BASE BALANCE
ELECTROLYTE BALANCEELECTROLYTE BALANCE
CALCIUMCALCIUM ROLESROLES
STRENGTHENS BONESTRENGTHENS BONE MUSCLE CONTRACTIONMUSCLE CONTRACTION SECOND MESSENGER FOR HORMONESSECOND MESSENGER FOR HORMONES ACTIVATES EXOCYTOSISACTIVATES EXOCYTOSIS BLOOD CLOTTINGBLOOD CLOTTING
ELECTROLYTE BALANCEELECTROLYTE BALANCE
CALCIUMCALCIUM BINDS TO PHOSPHATE IONBINDS TO PHOSPHATE ION
CAN FORM CaCAN FORM Ca33(PO(PO44))22
HIGH CONCENTRATIONS OF BOTH IONS HIGH CONCENTRATIONS OF BOTH IONS WILL FORM PRECIPITATE CRYSTALSWILL FORM PRECIPITATE CRYSTALS
INTRACELLULAR [CaINTRACELLULAR [Ca2+2+] MUST BE KEPT ] MUST BE KEPT LOWLOW
CaCa2+2+ PUMPED OUT & INTO E.R. PUMPED OUT & INTO E.R.
ELECTROLYTE BALANCEELECTROLYTE BALANCE
CALCIUM HOMEOSTASISCALCIUM HOMEOSTASIS REGULATED BY PTH & CALCITROLREGULATED BY PTH & CALCITROL
ALSO BY CALCITONIN IN CHILDRENALSO BY CALCITONIN IN CHILDREN BLOOD [CaBLOOD [Ca2+2+] REGULATED VIA] REGULATED VIA
BONE DEPOSITION & REABSORPTIONBONE DEPOSITION & REABSORPTION INTESTINAL ABSORPTIONINTESTINAL ABSORPTION URINARY EXCRETIONURINARY EXCRETION
ELECTROLYTE BALANCEELECTROLYTE BALANCE
CALCIUM IMBALANCESCALCIUM IMBALANCES HYPERCALCEMIAHYPERCALCEMIA
REDUCES EMBRANE PERMEABILITY TO Na+ REDUCES EMBRANE PERMEABILITY TO Na+ INHIBITS DEPOLARIZATION OF INHIBITS DEPOLARIZATION OF
NERVES/MUSCLESNERVES/MUSCLES MUSCULAR WEAKNESS, CARDIAC MUSCULAR WEAKNESS, CARDIAC
ARRHYTHMI, ETC.ARRHYTHMI, ETC. RESULTS FROMRESULTS FROM
ALKALOSISALKALOSIS HYPERPARATHYROIDISMHYPERPARATHYROIDISM HYPOTHYROIDISMHYPOTHYROIDISM
ELECTROLYTE BALANCEELECTROLYTE BALANCE
CALCIUM IMBALANCESCALCIUM IMBALANCES HYPOCALCEMIAHYPOCALCEMIA
INCREASES EMBRANE PERMEABILITY TO Na+INCREASES EMBRANE PERMEABILITY TO Na+ NERVES/MUSCLES OVERLY EXCITABLENERVES/MUSCLES OVERLY EXCITABLE TETANUS IF CONCENTRATION DROPS TO TETANUS IF CONCENTRATION DROPS TO
LOWLOW RESULTS FROMRESULTS FROM
ACIDOSISACIDOSIS VITAMIN D DEFICIECYVITAMIN D DEFICIECY DIARRHEADIARRHEA PREGNANCY OR LACTATIONPREGNANCY OR LACTATION HYPOPARATHYROIDISMHYPOPARATHYROIDISM HYPERTHYROIDISMHYPERTHYROIDISM
ELECTROLYTE BALANCEELECTROLYTE BALANCE
PHOSPHATESPHOSPHATES RELATIVELY CONCENTRATED IN ICFRELATIVELY CONCENTRATED IN ICF ROLESROLES
COMPONENTS OF BONESCOMPONENTS OF BONES COMPONENTS OF DNA & RNACOMPONENTS OF DNA & RNA COMPONENTS OF PHOSPHOLIPIDSCOMPONENTS OF PHOSPHOLIPIDS ACTIVATE / DEACTIVATE ENZYMESACTIVATE / DEACTIVATE ENZYMES BUFFER pH OF BODY FLUIDSBUFFER pH OF BODY FLUIDS
ELECTROLYTE BALANCEELECTROLYTE BALANCE
PHOSPHATESPHOSPHATES COMPONENTS OFCOMPONENTS OF
NUCLEIC ACIDS (DNA, RNA)NUCLEIC ACIDS (DNA, RNA) NTPs AND dNTPs (ATP, dATP, GTP, dGTP, etc)NTPs AND dNTPs (ATP, dATP, GTP, dGTP, etc) cAMPcAMP PHOSPHOLIPIDSPHOSPHOLIPIDS VARIOUS OTHER PHOSPHORYLATED MOLECULESVARIOUS OTHER PHOSPHORYLATED MOLECULES
GENERATED VIA ATP HYDROLYSIS, ETC.GENERATED VIA ATP HYDROLYSIS, ETC. EXIST AS MIXTURE OF THREE FORMSEXIST AS MIXTURE OF THREE FORMS
POPO443-3- (PHOSPHATE ION)(PHOSPHATE ION)
HPOHPO442-2- (MONOHYDROGEN PHOSPHATE ION)(MONOHYDROGEN PHOSPHATE ION)
HH22POPO44-- (DIHYDROGEN PHOSPHATE ION)(DIHYDROGEN PHOSPHATE ION)
ELECTROLYTE BALANCEELECTROLYTE BALANCE
PHOSPHATE HOMEOSTASISPHOSPHATE HOMEOSTASIS DIET PROVIDES AMPLE PHOSPHATEDIET PROVIDES AMPLE PHOSPHATE READILY ABSORBED BY SMALL READILY ABSORBED BY SMALL
INTESTINEINTESTINE REGULATIONREGULATION
RENAL TUBULES SITE OF REGULATIONRENAL TUBULES SITE OF REGULATION PTH INCREASES PHOSPHATE EXCRETIONPTH INCREASES PHOSPHATE EXCRETION EXCRETION RATE AFFECTED BY URINE pHEXCRETION RATE AFFECTED BY URINE pH
ELECTROLYTE BALANCEELECTROLYTE BALANCE
PHOSPHATE IMBALANCESPHOSPHATE IMBALANCES PHOSPHATE HOMEOSTASIS NOT PHOSPHATE HOMEOSTASIS NOT
VERY CRITICALVERY CRITICAL BODY CAN TOLERATE WIDE BODY CAN TOLERATE WIDE
VARIATIONS OF PHOSPHATEE VARIATIONS OF PHOSPHATEE CONCENTRATION WITH LITTLE CONCENTRATION WITH LITTLE EFFECTEFFECT
ACID-BASE BALANCEACID-BASE BALANCE
ACIDS, BASES, AND pHACIDS, BASES, AND pH ACIDACID
ANY SUBSTANCE RELEASING HANY SUBSTANCE RELEASING H++
[H+] INCREASES (pH DECREASES)[H+] INCREASES (pH DECREASES) BASEBASE
ANY SUBSTANCE ACCEPTING HANY SUBSTANCE ACCEPTING H++
[H+] DECREASES (pH INCREASES)[H+] DECREASES (pH INCREASES) pHpH
A MEASURE OF [HA MEASURE OF [H++]] -LOG [H-LOG [H++]] SCALE 0 – 14, 7 IS NEUTRALSCALE 0 – 14, 7 IS NEUTRAL
ACID-BASE BALANCEACID-BASE BALANCE
WHY IS ACID-BASE BALANCE WHY IS ACID-BASE BALANCE IMPORTANT?IMPORTANT?
METABOLISM REQUIRES NUMEROUS METABOLISM REQUIRES NUMEROUS ENZYMESENZYMES
ENZYMES ARE PROTEINSENZYMES ARE PROTEINS pH AFFECTS PROTEIN STRUCTUREpH AFFECTS PROTEIN STRUCTURE PROTEIN STRUCTURE AFFECTS FUNCTIONPROTEIN STRUCTURE AFFECTS FUNCTION DEVIATIONS FROM NORMAL pH CAN DEVIATIONS FROM NORMAL pH CAN
INACTIVATE ENZYMES AND SHUT DOWN INACTIVATE ENZYMES AND SHUT DOWN METABOLIC PATHWAYSMETABOLIC PATHWAYS
ACID-BASE BALANCEACID-BASE BALANCE
BLOOD pHBLOOD pH BLOOD AND TISSUE pH 7.35 – 7.45BLOOD AND TISSUE pH 7.35 – 7.45
ENZYMES FUNCTION WELL WITHIN THIS ENZYMES FUNCTION WELL WITHIN THIS RANGERANGE
ENZYMES FUNCTION POORLY (OR NOT ENZYMES FUNCTION POORLY (OR NOT AT ALL) WHEN SIGNIFICANTLY OUTSIDE AT ALL) WHEN SIGNIFICANTLY OUTSIDE OF THIS RANGEOF THIS RANGE
THIS RANGE MUST BE MAINTAINEDTHIS RANGE MUST BE MAINTAINED ACID-BASE BALANCEACID-BASE BALANCE
ACID-BASE BALANCEACID-BASE BALANCE
BUFFERSBUFFERS ANY MECHANISM OF RESISTING ANY MECHANISM OF RESISTING
SIGNIFICANT CHANGES IN pH SIGNIFICANT CHANGES IN pH ACCOMPLISHED BY CONVERTING:ACCOMPLISHED BY CONVERTING:
STRONG ACID STRONG ACID WEAK ACID WEAK ACID STRONG BASE STRONG BASE WEAK BASE WEAK BASE
ACID-BASE BALANCEACID-BASE BALANCE
BUFFERSBUFFERS PHYSIOLOGICAL BUFFER PHYSIOLOGICAL BUFFER
SYSTEM STABILIZING pH BY CONTROLLING SYSTEM STABILIZING pH BY CONTROLLING BODY’S OUTPUT OF ACIDS, BASES, OR COBODY’S OUTPUT OF ACIDS, BASES, OR CO22
URINARY SYSTEMURINARY SYSTEM BUFFERS GREATEST QUANTITYBUFFERS GREATEST QUANTITY REQUIRES HOURS OR DAYS TO EXERT EFFECTREQUIRES HOURS OR DAYS TO EXERT EFFECT
RESPIRATORY SYSTEMRESPIRATORY SYSTEM SMALLER EFFECTSMALLER EFFECT EXERTS EFFECT WITHIN MINUTESEXERTS EFFECT WITHIN MINUTES
ACID-BASE BALANCEACID-BASE BALANCE
BUFFERSBUFFERS CHEMICAL BUFFER SYSTEMCHEMICAL BUFFER SYSTEM
COMBINATION OF WEAK ACID AND WEAK BASECOMBINATION OF WEAK ACID AND WEAK BASE BINDS TO HBINDS TO H++ AS [H AS [H++] RISES, AND] RISES, AND RELEASES HRELEASES H++ AS [H AS [H++] FALLS] FALLS CAN RESTORE NORMAL pH ALMOST CAN RESTORE NORMAL pH ALMOST
IMMEDIATELYIMMEDIATELY THREE MAJOR CHEMICAL BUFFER SYSTEMSTHREE MAJOR CHEMICAL BUFFER SYSTEMS
BICARBONATE SYSTEMBICARBONATE SYSTEM PHOSPHATE SYSTEMPHOSPHATE SYSTEM PROTEIN SYSTEMPROTEIN SYSTEM
ACID-BASE BALANCEACID-BASE BALANCE
BICARBONATE BUFFER SYSTEMBICARBONATE BUFFER SYSTEM CARBONIC ACID (HCARBONIC ACID (H22COCO33))
WEAK ACIDWEAK ACID BICARBONATE ION (HCOBICARBONATE ION (HCO33
--)) WEAK BASEWEAK BASE
COCO22 + H + H220 0 H H22COCO33 H H++ + HCO + HCO33--
WORKS IN CONCERT WITH WORKS IN CONCERT WITH RESPIRATORY AND URINARY SYSTEMRESPIRATORY AND URINARY SYSTEM THESE SYSTEMS REMOVE COTHESE SYSTEMS REMOVE CO22 OR HCO OR HCO33
--
ACID-BASE BALANCEACID-BASE BALANCE
PHOSPHATE BUFFER SYSTEMPHOSPHATE BUFFER SYSTEM DIHYDROGEN PHOSPHATE ION(HDIHYDROGEN PHOSPHATE ION(H22POPO44
--)) WEAK ACIDWEAK ACID
MONOHYDROGEN PHOSPHATE ION (HPOMONOHYDROGEN PHOSPHATE ION (HPO442-2-))
WEAK BASEWEAK BASE HH22POPO44
-- H H++ + HPO + HPO442-2-
STRONGER THAN BICARBONATE STRONGER THAN BICARBONATE BUFFERING SYSTEMBUFFERING SYSTEM
MORE IMPARTANT IN BUFFERING ICF AND MORE IMPARTANT IN BUFFERING ICF AND RENAL TUBULES THAN IN ECFRENAL TUBULES THAN IN ECF
ACID-BASE BALANCEACID-BASE BALANCE
PROTEIN BUFFER SYSTEMPROTEIN BUFFER SYSTEM PROTEINS ARE MORE CONCENTRATED THAN PROTEINS ARE MORE CONCENTRATED THAN
BICARBONATE AND PHOSPHATE BUFFERSBICARBONATE AND PHOSPHATE BUFFERS ACCOUNTS FOR ~75% OF ALL CHEMICAL ACCOUNTS FOR ~75% OF ALL CHEMICAL
BUFFERING OF BODY FLUIDSBUFFERING OF BODY FLUIDS BUFFERING ABILITY DUE TO CERTAIN BUFFERING ABILITY DUE TO CERTAIN
FUNCTIONAL GROUPS OF AMINO ACID FUNCTIONAL GROUPS OF AMINO ACID RESIDUESRESIDUES CARBOXYL GROUPSCARBOXYL GROUPS
--COOH --COOH -COO -COO-- + H + H++
AMINO GROUPSAMINO GROUPS --NH--NH33
++ -NH -NH22 + H + H++
ACID-BASE BALANCEACID-BASE BALANCE
RESPIRATORY CONTROL OF pHRESPIRATORY CONTROL OF pH COCO22 + H + H220 0 H H22COCO33 H H++ + HCO + HCO33
--
ADDITION OF COADDITION OF CO22 INCREASES [H INCREASES [H++]] REMOVAL OF COREMOVAL OF CO22 DECREASES [H DECREASES [H++]] CAN NEUTRALIZE 2-3 X MORE ACID CAN NEUTRALIZE 2-3 X MORE ACID
AS CHEMICAL BUFFERSAS CHEMICAL BUFFERS
ACID-BASE BALANCEACID-BASE BALANCE
RENAL CONTROL OF pHRENAL CONTROL OF pH CAN NEUTRALIZE MORE ACID OR CAN NEUTRALIZE MORE ACID OR
BASE THAN BOTH RESPIRATORY BASE THAN BOTH RESPIRATORY SYSTEM AND CHEMICAL BUFFERSSYSTEM AND CHEMICAL BUFFERS
RENAL TUBULES SECRETE HRENAL TUBULES SECRETE H++
HH++ EXCRETED IN URINE EXCRETED IN URINE EXCHANGED FOR SODIUM ION (NaEXCHANGED FOR SODIUM ION (Na++)) ONLY POSSIBLE WHEN [HONLY POSSIBLE WHEN [H++] INSIDE ] INSIDE
TUBULE CELLS IS > [HTUBULE CELLS IS > [H++] IN TUBULAR ] IN TUBULAR FLUIDFLUID
ACID-BASE BALANCEACID-BASE BALANCE
ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS AT pH 7.4, 20:1 HCOAT pH 7.4, 20:1 HCO33
--:H:H22COCO33 RATIO RATIO IF [HIF [H22COCO33] INCREASES, pH DROPS] INCREASES, pH DROPS
pH BELOW 7.35 = pH BELOW 7.35 = ACIDOSISACIDOSIS IF [HCOIF [HCO33
--] INCREASES, pH INCREASES] INCREASES, pH INCREASES pH ABOVE 7.45 = pH ABOVE 7.45 = ALKALOSISALKALOSIS
ACID-BASE BALANCEACID-BASE BALANCE
ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS RESPIRATORY ACIDOSISRESPIRATORY ACIDOSIS
COCO22 PRODUCTION EXCEEDS RESPIRATORY CO PRODUCTION EXCEEDS RESPIRATORY CO22 ELIMINATIONELIMINATION
COCO22 ACCUMULATES IN ECF ACCUMULATES IN ECF pH DROPSpH DROPS
RESPIRATORY ALKALOSISRESPIRATORY ALKALOSIS RESPIRATORY CORESPIRATORY CO2 2 ELIMINATION EXCEEDS COELIMINATION EXCEEDS CO22
PRODUCTIONPRODUCTION EXCESSIVE VENTILATION (HYPERVENTILATION)EXCESSIVE VENTILATION (HYPERVENTILATION) pH RISESpH RISES
ACID-BASE BALANCEACID-BASE BALANCE
ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS METABOLIC ACIDOSISMETABOLIC ACIDOSIS
INCREASED PRODUCTION OF ORGANIC ACIDSINCREASED PRODUCTION OF ORGANIC ACIDS E.G., FERMENTATION E.G., FERMENTATION LACTIC ACID LACTIC ACID E.G., ALCOHOLISM, DIABETES MELLITUS E.G., ALCOHOLISM, DIABETES MELLITUS KETONE BODIES KETONE BODIES
INGESTION OF ACIDIC DRUGSINGESTION OF ACIDIC DRUGS E.G., ASPIRINE.G., ASPIRIN
LOSS OF BASELOSS OF BASE E.G., CHRONIC DIARRHEA, OVERUSE OF LAXITIVESE.G., CHRONIC DIARRHEA, OVERUSE OF LAXITIVES
METABOLIC ALKALOSISMETABOLIC ALKALOSIS RARERARE OVERUSE OF BICARBONATESOVERUSE OF BICARBONATES
E.G., ANTACIDSE.G., ANTACIDS LOSS OF STOMACH ACID FROM CHRONIC VOMITINGLOSS OF STOMACH ACID FROM CHRONIC VOMITING
ACID-BASE BALANCEACID-BASE BALANCE
ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS ACIDOSISACIDOSIS HH++ PASSIVELY DIFFUSES INTO CELLS PASSIVELY DIFFUSES INTO CELLS KK++ DIFFUSES OUT DIFFUSES OUT
ELECTRICAL BALANCE MAINTAINEDELECTRICAL BALANCE MAINTAINED HH++ BUFFERED BY INTRACELLULAR PROTEINS BUFFERED BY INTRACELLULAR PROTEINS NET LOSS OF CATIONS FROM CELLNET LOSS OF CATIONS FROM CELL MEMBRANE IS NOW HYPERPOLARIZEDMEMBRANE IS NOW HYPERPOLARIZED NERVE & MUSCLE CELLS DIFFICULT TO NERVE & MUSCLE CELLS DIFFICULT TO
STIMULATESTIMULATE CENTRAL NERVOUS SYSTEM DEPRESSEDCENTRAL NERVOUS SYSTEM DEPRESSED
CONFUSION, DISORIENTATION, COMACONFUSION, DISORIENTATION, COMA
ACID-BASE BALANCEACID-BASE BALANCE
ACID-BASE BALANCE DISORDERSACID-BASE BALANCE DISORDERS ALKALOSISALKALOSIS HH++ PASSIVELY DIFFUSES OUT OF CELLS PASSIVELY DIFFUSES OUT OF CELLS KK++ DIFFUSES INTO CELLS DIFFUSES INTO CELLS
GAIN IN POSITIVE INTRACELLULAR CHARGEGAIN IN POSITIVE INTRACELLULAR CHARGE MEMBRANE POTENTIAL SHIFTEDMEMBRANE POTENTIAL SHIFTED NERVOUS SYSTEM HYPEREXCITABLENERVOUS SYSTEM HYPEREXCITABLE
NEURONS FIRE SPONTANEOUSLYNEURONS FIRE SPONTANEOUSLY SKELETAL MUSCLES OVERSTIMULATEDSKELETAL MUSCLES OVERSTIMULATED
MUSCLE SPASMS, TETANY, CONVULSIONS, MUSCLE SPASMS, TETANY, CONVULSIONS, RESPIRATORY PARALYSISRESPIRATORY PARALYSIS
ACID-BASE BALANCEACID-BASE BALANCE
ACID-BASE IMBALANCE COMPENSATIONACID-BASE IMBALANCE COMPENSATION RESPIRATORY SYSTEM COMPENSATIONRESPIRATORY SYSTEM COMPENSATION ADJUSTS PADJUSTS PCOCO2 2 IN ECFIN ECF
COCO22 EXCESS EXCESS INCREASED VENTILATION INCREASED VENTILATION COCO22 DEFICIENCY DEFICIENCY DECREASED VENTILATION DECREASED VENTILATION
EFFECTIVE VS EFFECTIVE VS RESPIRATORYRESPIRATORY ACIDOSIS AND ACIDOSIS AND ALKALOSISALKALOSIS
NOTNOT VERY EFFECTIVE VS VERY EFFECTIVE VS METABOLICMETABOLIC ACIDOSIS ACIDOSIS AND ALKALOSISAND ALKALOSIS I.E., CANNOT RID BODY OF KETONE BODIESI.E., CANNOT RID BODY OF KETONE BODIES
CAN CORRECT pH 7.0 TO 7.2 OR 7.3CAN CORRECT pH 7.0 TO 7.2 OR 7.3 NOT ALL THE WAY TO 7.4NOT ALL THE WAY TO 7.4
ACID-BASE BALANCEACID-BASE BALANCE
ACID-BASE IMBALANCE COMPENSATIONACID-BASE IMBALANCE COMPENSATION RENAL SYSTEM COMPENSATIONRENAL SYSTEM COMPENSATION SLOWER TO RESPONDSLOWER TO RESPOND CAN FULLY RESTORE NORMAL pHCAN FULLY RESTORE NORMAL pH URINE pH NORMALLY 5 – 6URINE pH NORMALLY 5 – 6
MAY DROP TO 4.5 WITH EXCESS HMAY DROP TO 4.5 WITH EXCESS H++
RESPONSE TO ACIDOSISRESPONSE TO ACIDOSIS RENAL TUBULES INCREASE HRENAL TUBULES INCREASE H++ SECRETION SECRETION HH++ IN URINE IS BUFFERED IN URINE IS BUFFERED
MAY RISE TO 8.2 WITH EXCESS HCOMAY RISE TO 8.2 WITH EXCESS HCO33--
RESPONSE TO ALKALOSISRESPONSE TO ALKALOSIS HCOHCO33
-- CONCENTRATION IN URINE ELEVATED CONCENTRATION IN URINE ELEVATED
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