logging in or signing up patho Chapt 03 Belly Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 637 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: January 05, 2008 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: arevil (8 month(s) ago) blessed day! can i ask a copy of your nice presentation?.its me arevil_07@yahoo.com..thanks!God bless! Saving..... Post Reply Close Saving..... Edit Comment Close By: mahilum (20 month(s) ago) wow!!amazing topic..nice one. could you please send me a copy in my email? chrisael_26@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close By: stanf (25 month(s) ago) Congratulations on a job well done. I would be very grateful if you would please send me a copy to my email: stanf@mail.com kind regards Stan Fry Saving..... Post Reply Close Saving..... Edit Comment Close By: maxinea (27 month(s) ago) this is a great presentation to help me study for my pathophysiology test coming up. could you please send me a copy to my email address? it's amneal3r@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close By: angelgretchel2000 (30 month(s) ago) hi...ur presentation is very comprehensive..can i ask for a copy? my email add is angelgretchel2000@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript The Cellular Environment: Fluids and Electrolytes, Acids and Bases: The Cellular Environment: Fluids and Electrolytes, Acids and Bases Chapter 3Distribution of Body Fluids: Distribution of Body Fluids Total body water (TBW) 60% of total body weight Intracellular fluid – inside the cells Extracellular fluid – not encased in cells Interstitial fluid – found in between cells and tissues Intravascular fluid- plasma found in circulatory system Lymph, synovial, intestinal, biliary, hepatic, pancreatic, CSF, sweat, urine, pleural, peritoneal, pericardial, and intraocular fluids are extracellular Water Movement Between the ICF and ECF: Water Movement Between the ICF and ECF Osmolality – the concentrations of solutes in water Osmotic forces – solutes will influence the movement of water across membranes Aquaporins- water channel proteins in membranes Starling hypothesis Net filtration = forces favoring filtration – forces opposing filtration As fluid flows through capillary it looses water and create greater osmotic return of water as it flows toward veinule end of capillary Water Movement Between the ICF and ECF: Water Movement Between the ICF and ECFNet Filtration: Net Filtration Forces favoring filtration Capillary hydrostatic pressure (blood pressure) Interstitial oncotic pressure (water-pulling) Forces favoring reabsorption Plasma oncotic pressure (water-pulling) Interstitial hydrostatic pressureOsmotic Equilibrium: Osmotic EquilibriumEdema: Edema Accumulation of fluid within the interstitial spaces Causes: Increase in hydrostatic pressure Losses or diminished production of plasma albumin Increases in capillary permeability Lymph obstruction – elephantitus, flibitusEdema: Edema Water Balance: Water Balance Thirst perception Osmolality receptors in medula respond to osmotic pressue of ECF Hyperosmolality and plasma volume depletion ADH secretion from posterior pituitary – conserves water in kidney to maintain water balance Sodium and Chloride Balance: Sodium and Chloride Balance Sodium Primary ECF cation Regulates osmotic forces Roles Neuromuscular irritability, acid-base balance, and cellular reactions Chloride Primary ECF anion Provides electroneutrality Sodium and Chloride Balance: Sodium and Chloride Balance Renin-angiotensin system – substanced produced in both liver and kidney Angiotensin produced by liver and coverted by enzymes activated by renin from Kidney Juxta Glomerular Aparatus to a powerful vasoconstrictor. Aldosterone – hormone from adrenal gland to regulate Na and K Natriuretic peptides Atrial natriuretic peptide - hormone from heart Brain natriuretic peptide – hormone from brain Urodilantin (kidney) – Kidney hormone Alterations in Na+, Cl–, and Water Balance: Alterations in Na+, Cl–, and Water Balance Isotonic alterations Total body water change with proportional electrolyte and water change Isotonic volume depletion Isotonic volume excess Hypertonic Alterations: Hypertonic Alterations Hypernatremia Serum sodium >147 mEq/L Related to sodium gain or water loss Water movement from the ICF to the ECF Intracellular dehydration Manifestations Intracellular dehydration, convulsions, pulmonary edema, hypotension, tachycardia, etc. Water Deficit: Water Deficit Dehydration Pure water deficits Renal free water clearance Manifestations Tachycardia, weak pulses, and postural hypotension Elevated hematocrit and serum sodium level Hypochloremia: Hypochloremia Occurs with hypernatremia or a bicarbonate deficit Usually secondary to pathophysiologic processes Managed by treating underlying disorders Hypotonic Alterations: Hypotonic Alterations Decreased osmolality Hyponatremia or free water excess Hyponatremia decreases the ECF osmotic pressure, and water moves into the cell Water movement causes symptoms related to hypovolemia Hyponatremia: Hyponatremia Serum sodium level <135 mEq/L Sodium deficits cause plasma hypoosmolality and cellular swelling Pure sodium deficits Low intake Dilutional hyponatremia Hypoosmolar hyponatremia Hypertonic hyponatremiaWater Excess: Water Excess Compulsive water drinking Decreased urine formation Syndrome of inappropriate ADH (SIADH) ADH secretion in the absence of hypovolemia or hyperosmolality Hyponatremia with hypervolemia Manifestations: cerebral edema, muscle twitching, headache, and weight gainHypochloremia: Hypochloremia Usually the result of hyponatremia or elevated bicarbonate concentration Develops due to vomiting and the loss of HCl Occurs in cystic fibrosisPotassium: Potassium Major intracellular cation Concentration maintained by the Na+/K+ pump Regulates intracellular electrical neutrality in relation to Na+ and H+ Essential for transmission and conduction of nerve impulses, normal cardiac rhythms, and skeletal and smooth muscle contractionPotassium Levels: Potassium Levels Changes in pH affect K+ balance Hydrogen ions accumulate in the ICF during states of acidosis. K+ shifts out to maintain a balance of cations across the membrane. Aldosterone, insulin, and catecholamines influence serum potassium levelsHypokalemia: Hypokalemia Potassium level <3.5 mEq/L Potassium balance is described by changes in plasma potassium levels Causes can be reduced intake of potassium, increased entry of potassium, and increased loss of potassium Manifestations Membrane hyperpolarization causes a decrease in neuromuscular excitability, skeletal muscle weakness, smooth muscle atony, and cardiac dysrhythmias Hyperkalemia: Hyperkalemia Potassium level >5.5 mEq/L Hyperkalemia is rare due to efficient renal excretion Caused by increased intake, shift of K+ from ICF, decreased renal excretion, insulin deficiency, or cell traumaHyperkalemia: Hyperkalemia Mild attacks Hypopolarized membrane, causing neuromuscular irritability Tingling of lips and fingers, restlessness, intestinal cramping, and diarrhea Severe attacks The cell is not able to repolarize, resulting in muscle weakness, loss or muscle tone, and flaccid paralysisCalcium: Calcium Most calcium is located in the bone as hydroxyapatite Necessary for structure of bones and teeth, blood clotting, hormone secretion, and cell receptor function Phosphate: Phosphate Like calcium, most phosphate (85%) is also located in the bone Necessary for high-energy bonds located in creatine phosphate and ATP and acts as an anion buffer Calcium and phosphate concentrations are rigidly controlled Ca++ x HPO4– – = K+ (constant) If the concentration of one increases, that of the other decreasesCalcium and Phosphate: Calcium and Phosphate Regulated by three hormones Parathyroid hormone (PTH) Increases plasma calcium levels Vitamin D Fat-soluble steroid; increases calcium absorption from the GI tract Calcitonin Decreases plasma calcium levels Hypocalcemia and Hypercalcemia: Hypocalcemia and Hypercalcemia Hypocalcemia Decreases the block of Na+ into the cell Increased neuromuscular excitability (partial depolarization) Muscle cramps Hypercalcemia Increases the block of Na+ into the cell Decreased neuromuscular excitability Muscle weakness Increased bone fractures Kidney stones ConstipationHypophosphatemia and Hyperphosphatemia: Hypophosphatemia and Hyperphosphatemia Hypophosphatemia Osteomalacia (soft bones) Muscle weakness Bleeding disorders (platelet impairment) Anemia Leukocyte alterations Antacids bind phosphate Hyperphosphatemia See Hypocalcemia High phosphate levels are related to the low calcium levelsMagnesium: Magnesium Intracellular cation Plasma concentration is 1.8 to 2.4 mEq/L Acts as a cofactor in protein and nucleic acid synthesis reactions Required for ATPase activity Decreases acetylcholine release at the neuromuscular junctionHypomagnesemia and Hypermagnesemia: Hypomagnesemia and Hypermagnesemia Hypomagnesemia Associated with hypocalcemia and hypokalemia Neuromuscular irritability Tetany Convulsions Hyperactive reflexes Hypermagnesemia Skeletal muscle depression Muscle weakness Hypotension Respiratory depression Lethargy, drowsiness BradycardiapH: pH Inverse logarithm of the H+ concentration If the H+ are high in number, the pH is low (acidic). If the H+ are low in number, the pH is high (alkaline). The pH scale ranges from 0 to 14: 0 is very acidic, 14 is very alkaline. Each number represents a factor of 10. If a solution moves from a pH of 6 to a pH of 5, the H+ have increased 10 times.pH: pH Acids are formed as end products of protein, carbohydrate, and fat metabolism To maintain the body’s normal pH (7.35-7.45) the H+ must be neutralized or excreted The bones, lungs, and kidneys are the major organs involved in the regulation of acid and base balancepH: pH Body acids exist in two forms Volatile H2CO3 (can be eliminated as CO2 gas) Nonvolatile Sulfuric, phosphoric, and other organic acids Eliminated by the renal tubules with the regulation of HCO3–Buffering Systems: Buffering Systems A buffer is a chemical that can bind excessive H+ or OH– without a significant change in pH A buffering pair consists of a weak acid and its conjugate base The most important plasma buffering systems are the carbonic acid–bicarbonate system and hemoglobinCarbonic Acid–Bicarbonate Pair: Carbonic Acid–Bicarbonate Pair Operates in both the lung and the kidney The greater the partial pressure of carbon dioxide, the more carbonic acid is formed At a pH of 7.4, the ratio of bicarbonate to carbonic acid is 20:1 Bicarbonate and carbonic acid can increase or decrease, but the ratio must be maintained Carbonic Acid–Bicarbonate Pair: Carbonic Acid–Bicarbonate Pair If the amount of bicarbonate decreases, the pH decreases, causing a state of acidosis The pH can be returned to normal if the amount of carbonic acid also decreases This type of pH adjustment is referred to as compensation The respiratory system compensates by increasing or decreasing ventilation The renal system compensates by producing acidic or alkaline urineCarbonic Acid–Bicarbonate Pair: Carbonic Acid–Bicarbonate PairOther Buffering Systems: Other Buffering Systems Protein buffering Proteins have negative charges, so they can serve as buffers for H+ Renal buffering Secretion of H+ in the urine and reabsorption of HCO3– Cellular ion exchange Exchange of K+ for H+ in acidosis and alkalosisBuffering Systems: Buffering SystemsAcid-Base Imbalances: Acid-Base Imbalances Normal arterial blood pH 7.35 to 7.45 Obtained by arterial blood gas (ABG) sampling Acidosis Systemic increase in H+ concentration Alkalosis Systemic decrease in H+ concentration Acidosis and Alkalosis: Acidosis and Alkalosis Four categories of acid-base imbalances: Respiratory acidosis—elevation of pCO2 due to ventilation depression Respiratory alkalosis—depression of pCO2 due to alveolar hyperventilation Metabolic acidosis—depression of HCO3– or an increase in non-carbonic acids Metabolic alkalosis—elevation of HCO3– usually due to an excessive loss of metabolic acidsMetabolic Acidosis: Metabolic AcidosisAnion Gap: Anion Gap Used cautiously to distinguish different types of metabolic acidosis By rule, the concentration of anions (–) should equal the concentration of cations (+). Not all normal anions are routinely measured. Normal anion gap = Na+ + K+ = Cl– + HCO3– + 10 to 12 mEq/L (other misc. anions [the ones we don’t measure]—phosphates, sulfates, organic acids, etc.)Anion Gap: Anion Gap An abnormal anion gap occurs due to an increased level of an abnormal unmeasured anion Examples: DKA—ketones, salicylate poisoning, lactic acidosis—increased lactic acid, renal failure, etc. As these abnormal anions accumulate, the measured anions have to decrease to maintain electroneutralityMetabolic Alkalosis: Metabolic AlkalosisRespiratory Acidosis: Respiratory AcidosisRespiratory Alkalosis: Respiratory Alkalosis You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
patho Chapt 03 Belly Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINTLite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 637 Category: Education License: All Rights Reserved Like it (1) Dislike it (0) Added: January 05, 2008 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... By: arevil (8 month(s) ago) blessed day! can i ask a copy of your nice presentation?.its me arevil_07@yahoo.com..thanks!God bless! Saving..... Post Reply Close Saving..... Edit Comment Close By: mahilum (20 month(s) ago) wow!!amazing topic..nice one. could you please send me a copy in my email? chrisael_26@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close By: stanf (25 month(s) ago) Congratulations on a job well done. I would be very grateful if you would please send me a copy to my email: stanf@mail.com kind regards Stan Fry Saving..... Post Reply Close Saving..... Edit Comment Close By: maxinea (27 month(s) ago) this is a great presentation to help me study for my pathophysiology test coming up. could you please send me a copy to my email address? it's amneal3r@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close By: angelgretchel2000 (30 month(s) ago) hi...ur presentation is very comprehensive..can i ask for a copy? my email add is angelgretchel2000@yahoo.com Saving..... Post Reply Close Saving..... Edit Comment Close loading.... See all Premium member Presentation Transcript The Cellular Environment: Fluids and Electrolytes, Acids and Bases: The Cellular Environment: Fluids and Electrolytes, Acids and Bases Chapter 3Distribution of Body Fluids: Distribution of Body Fluids Total body water (TBW) 60% of total body weight Intracellular fluid – inside the cells Extracellular fluid – not encased in cells Interstitial fluid – found in between cells and tissues Intravascular fluid- plasma found in circulatory system Lymph, synovial, intestinal, biliary, hepatic, pancreatic, CSF, sweat, urine, pleural, peritoneal, pericardial, and intraocular fluids are extracellular Water Movement Between the ICF and ECF: Water Movement Between the ICF and ECF Osmolality – the concentrations of solutes in water Osmotic forces – solutes will influence the movement of water across membranes Aquaporins- water channel proteins in membranes Starling hypothesis Net filtration = forces favoring filtration – forces opposing filtration As fluid flows through capillary it looses water and create greater osmotic return of water as it flows toward veinule end of capillary Water Movement Between the ICF and ECF: Water Movement Between the ICF and ECFNet Filtration: Net Filtration Forces favoring filtration Capillary hydrostatic pressure (blood pressure) Interstitial oncotic pressure (water-pulling) Forces favoring reabsorption Plasma oncotic pressure (water-pulling) Interstitial hydrostatic pressureOsmotic Equilibrium: Osmotic EquilibriumEdema: Edema Accumulation of fluid within the interstitial spaces Causes: Increase in hydrostatic pressure Losses or diminished production of plasma albumin Increases in capillary permeability Lymph obstruction – elephantitus, flibitusEdema: Edema Water Balance: Water Balance Thirst perception Osmolality receptors in medula respond to osmotic pressue of ECF Hyperosmolality and plasma volume depletion ADH secretion from posterior pituitary – conserves water in kidney to maintain water balance Sodium and Chloride Balance: Sodium and Chloride Balance Sodium Primary ECF cation Regulates osmotic forces Roles Neuromuscular irritability, acid-base balance, and cellular reactions Chloride Primary ECF anion Provides electroneutrality Sodium and Chloride Balance: Sodium and Chloride Balance Renin-angiotensin system – substanced produced in both liver and kidney Angiotensin produced by liver and coverted by enzymes activated by renin from Kidney Juxta Glomerular Aparatus to a powerful vasoconstrictor. Aldosterone – hormone from adrenal gland to regulate Na and K Natriuretic peptides Atrial natriuretic peptide - hormone from heart Brain natriuretic peptide – hormone from brain Urodilantin (kidney) – Kidney hormone Alterations in Na+, Cl–, and Water Balance: Alterations in Na+, Cl–, and Water Balance Isotonic alterations Total body water change with proportional electrolyte and water change Isotonic volume depletion Isotonic volume excess Hypertonic Alterations: Hypertonic Alterations Hypernatremia Serum sodium >147 mEq/L Related to sodium gain or water loss Water movement from the ICF to the ECF Intracellular dehydration Manifestations Intracellular dehydration, convulsions, pulmonary edema, hypotension, tachycardia, etc. Water Deficit: Water Deficit Dehydration Pure water deficits Renal free water clearance Manifestations Tachycardia, weak pulses, and postural hypotension Elevated hematocrit and serum sodium level Hypochloremia: Hypochloremia Occurs with hypernatremia or a bicarbonate deficit Usually secondary to pathophysiologic processes Managed by treating underlying disorders Hypotonic Alterations: Hypotonic Alterations Decreased osmolality Hyponatremia or free water excess Hyponatremia decreases the ECF osmotic pressure, and water moves into the cell Water movement causes symptoms related to hypovolemia Hyponatremia: Hyponatremia Serum sodium level <135 mEq/L Sodium deficits cause plasma hypoosmolality and cellular swelling Pure sodium deficits Low intake Dilutional hyponatremia Hypoosmolar hyponatremia Hypertonic hyponatremiaWater Excess: Water Excess Compulsive water drinking Decreased urine formation Syndrome of inappropriate ADH (SIADH) ADH secretion in the absence of hypovolemia or hyperosmolality Hyponatremia with hypervolemia Manifestations: cerebral edema, muscle twitching, headache, and weight gainHypochloremia: Hypochloremia Usually the result of hyponatremia or elevated bicarbonate concentration Develops due to vomiting and the loss of HCl Occurs in cystic fibrosisPotassium: Potassium Major intracellular cation Concentration maintained by the Na+/K+ pump Regulates intracellular electrical neutrality in relation to Na+ and H+ Essential for transmission and conduction of nerve impulses, normal cardiac rhythms, and skeletal and smooth muscle contractionPotassium Levels: Potassium Levels Changes in pH affect K+ balance Hydrogen ions accumulate in the ICF during states of acidosis. K+ shifts out to maintain a balance of cations across the membrane. Aldosterone, insulin, and catecholamines influence serum potassium levelsHypokalemia: Hypokalemia Potassium level <3.5 mEq/L Potassium balance is described by changes in plasma potassium levels Causes can be reduced intake of potassium, increased entry of potassium, and increased loss of potassium Manifestations Membrane hyperpolarization causes a decrease in neuromuscular excitability, skeletal muscle weakness, smooth muscle atony, and cardiac dysrhythmias Hyperkalemia: Hyperkalemia Potassium level >5.5 mEq/L Hyperkalemia is rare due to efficient renal excretion Caused by increased intake, shift of K+ from ICF, decreased renal excretion, insulin deficiency, or cell traumaHyperkalemia: Hyperkalemia Mild attacks Hypopolarized membrane, causing neuromuscular irritability Tingling of lips and fingers, restlessness, intestinal cramping, and diarrhea Severe attacks The cell is not able to repolarize, resulting in muscle weakness, loss or muscle tone, and flaccid paralysisCalcium: Calcium Most calcium is located in the bone as hydroxyapatite Necessary for structure of bones and teeth, blood clotting, hormone secretion, and cell receptor function Phosphate: Phosphate Like calcium, most phosphate (85%) is also located in the bone Necessary for high-energy bonds located in creatine phosphate and ATP and acts as an anion buffer Calcium and phosphate concentrations are rigidly controlled Ca++ x HPO4– – = K+ (constant) If the concentration of one increases, that of the other decreasesCalcium and Phosphate: Calcium and Phosphate Regulated by three hormones Parathyroid hormone (PTH) Increases plasma calcium levels Vitamin D Fat-soluble steroid; increases calcium absorption from the GI tract Calcitonin Decreases plasma calcium levels Hypocalcemia and Hypercalcemia: Hypocalcemia and Hypercalcemia Hypocalcemia Decreases the block of Na+ into the cell Increased neuromuscular excitability (partial depolarization) Muscle cramps Hypercalcemia Increases the block of Na+ into the cell Decreased neuromuscular excitability Muscle weakness Increased bone fractures Kidney stones ConstipationHypophosphatemia and Hyperphosphatemia: Hypophosphatemia and Hyperphosphatemia Hypophosphatemia Osteomalacia (soft bones) Muscle weakness Bleeding disorders (platelet impairment) Anemia Leukocyte alterations Antacids bind phosphate Hyperphosphatemia See Hypocalcemia High phosphate levels are related to the low calcium levelsMagnesium: Magnesium Intracellular cation Plasma concentration is 1.8 to 2.4 mEq/L Acts as a cofactor in protein and nucleic acid synthesis reactions Required for ATPase activity Decreases acetylcholine release at the neuromuscular junctionHypomagnesemia and Hypermagnesemia: Hypomagnesemia and Hypermagnesemia Hypomagnesemia Associated with hypocalcemia and hypokalemia Neuromuscular irritability Tetany Convulsions Hyperactive reflexes Hypermagnesemia Skeletal muscle depression Muscle weakness Hypotension Respiratory depression Lethargy, drowsiness BradycardiapH: pH Inverse logarithm of the H+ concentration If the H+ are high in number, the pH is low (acidic). If the H+ are low in number, the pH is high (alkaline). The pH scale ranges from 0 to 14: 0 is very acidic, 14 is very alkaline. Each number represents a factor of 10. If a solution moves from a pH of 6 to a pH of 5, the H+ have increased 10 times.pH: pH Acids are formed as end products of protein, carbohydrate, and fat metabolism To maintain the body’s normal pH (7.35-7.45) the H+ must be neutralized or excreted The bones, lungs, and kidneys are the major organs involved in the regulation of acid and base balancepH: pH Body acids exist in two forms Volatile H2CO3 (can be eliminated as CO2 gas) Nonvolatile Sulfuric, phosphoric, and other organic acids Eliminated by the renal tubules with the regulation of HCO3–Buffering Systems: Buffering Systems A buffer is a chemical that can bind excessive H+ or OH– without a significant change in pH A buffering pair consists of a weak acid and its conjugate base The most important plasma buffering systems are the carbonic acid–bicarbonate system and hemoglobinCarbonic Acid–Bicarbonate Pair: Carbonic Acid–Bicarbonate Pair Operates in both the lung and the kidney The greater the partial pressure of carbon dioxide, the more carbonic acid is formed At a pH of 7.4, the ratio of bicarbonate to carbonic acid is 20:1 Bicarbonate and carbonic acid can increase or decrease, but the ratio must be maintained Carbonic Acid–Bicarbonate Pair: Carbonic Acid–Bicarbonate Pair If the amount of bicarbonate decreases, the pH decreases, causing a state of acidosis The pH can be returned to normal if the amount of carbonic acid also decreases This type of pH adjustment is referred to as compensation The respiratory system compensates by increasing or decreasing ventilation The renal system compensates by producing acidic or alkaline urineCarbonic Acid–Bicarbonate Pair: Carbonic Acid–Bicarbonate PairOther Buffering Systems: Other Buffering Systems Protein buffering Proteins have negative charges, so they can serve as buffers for H+ Renal buffering Secretion of H+ in the urine and reabsorption of HCO3– Cellular ion exchange Exchange of K+ for H+ in acidosis and alkalosisBuffering Systems: Buffering SystemsAcid-Base Imbalances: Acid-Base Imbalances Normal arterial blood pH 7.35 to 7.45 Obtained by arterial blood gas (ABG) sampling Acidosis Systemic increase in H+ concentration Alkalosis Systemic decrease in H+ concentration Acidosis and Alkalosis: Acidosis and Alkalosis Four categories of acid-base imbalances: Respiratory acidosis—elevation of pCO2 due to ventilation depression Respiratory alkalosis—depression of pCO2 due to alveolar hyperventilation Metabolic acidosis—depression of HCO3– or an increase in non-carbonic acids Metabolic alkalosis—elevation of HCO3– usually due to an excessive loss of metabolic acidsMetabolic Acidosis: Metabolic AcidosisAnion Gap: Anion Gap Used cautiously to distinguish different types of metabolic acidosis By rule, the concentration of anions (–) should equal the concentration of cations (+). Not all normal anions are routinely measured. Normal anion gap = Na+ + K+ = Cl– + HCO3– + 10 to 12 mEq/L (other misc. anions [the ones we don’t measure]—phosphates, sulfates, organic acids, etc.)Anion Gap: Anion Gap An abnormal anion gap occurs due to an increased level of an abnormal unmeasured anion Examples: DKA—ketones, salicylate poisoning, lactic acidosis—increased lactic acid, renal failure, etc. As these abnormal anions accumulate, the measured anions have to decrease to maintain electroneutralityMetabolic Alkalosis: Metabolic AlkalosisRespiratory Acidosis: Respiratory AcidosisRespiratory Alkalosis: Respiratory Alkalosis