fluid and electrolytes
Rich in potassium, magnesium, proteins, organic and
inorganic, and phosphates
What is intracellular compartment?
Low in sodium and chloride
Insufficient iron for hemoglobin synthesis
• Most common nutritional deficiency in the world &
most common cause of anemia
• Low intake
• Increased demand (e.g., pregnancy)
• Diminished absorption (e.g., chronic disease)
• Hemorrhage
• Hemodialysis
Clinical manifestations: Pica, spoon shaped nails, blue sclerae, weakness, fatigue, dyspnea, palpitations, tachycardia
•Interstitial (between cells),•Vascular compartment (blood vessels)•Transcellular (e.g., synovial, cerebrospinal, and gastrointestinal fluids)
What are components of extracellular fluid?
I gain more salt than water or lose more water than salt.
What is hypernatremia?
•Thirst
•Oliguria
•Central nervous dysfunction
•Confusion
•Lethargy
•Seizures
•Coma
Increase secretion of metabolic acid via the kidneys
What is compensatory response for respiratory acidosis?
May take several days
Full compensation – increased CO2, increased bicarb, normal pH
Divided into vascular (rich in protein) and
interstitial (few proteins).
What is extracellular compartment.
Rich in sodium, chloride, and bicarbonate
Low in potassium, magnesium, and phosphate.
A stem cell disorder characterized by decreased
RBCs, WBCs, and platelets usually caused by toxic, radiant, or immunologic injury to the bone marrow stem cells .
What is Aplastic anemia?
Most common form is iatrogenic
• Chemotherapeutic agents
• Irradiation
• Infections such as HIV, hepatitis, mycobacterial
infections
• More common among teens, and young adults
• Can be fatal if not successfully managed
Clinical Manifestations
• Weakness, fatigue, and lethargy
• Dyspnea
• Palpitation and tachycardia
• Fever and chills
• Bacterial infections
• Bruising
• Petechiae
• Nosebleeds
I am Rich in potassium, magnesium, proteins, organic and inorganic, and phosphates but low in sodium and chloride.
What are components of the intracellular compartment?
•Neoplastic transformation of bone marrow stem cells
What is Polycythemia Vera – Not anemia – Too many RBCs?
Clinical manifestations: Headache, Backache, Weakness, Dizziness, Weight loss, Dyspnea, Joint complaints, Hypertension, Mucosal hemorrhage, Thrombosis
Deficit of any acid except carbonic acid
Excessive intake of bicarbonate
Antacids, baking soda
Citrated blood transfusion (massive)
Extracellular fluid volume deficit (diuretics)
Loss of acid – emesis, hyperaldosteronism, hypokalemia
What is metabolic alkalosis?
Clinical Manifestations:
Hypokalemia coexists, Postural hypotension,Numbness/Tingling, Tetany = seizures, Confusion, Lethargy, Coma
pH of 7.8 or above = death
Compensatory Response:
Hypoventilation à CO2 retention
Carbonic acid retention
Full compensation – increased bicarb, increased CO2, normal pH
Removal of a sodium-containing
fluid from the body
What is volume deficit?
Clinical Manifestations
Acute weight loss (most sensitive measure)
Furrows in the tongue
Postural blood pressure decrease (postural
hypotension)
Increased heart rate
Flat neck veins
Lightheaded
Dizziness or syncope
Oliguria
Poor skin turgor
Anemia due to lack of intrinsic factor
leading to vitamin B12 deficiency .
What is pernicious anemia?
Low RBC, WBC, and platelet counts with
increased MCV; megaloblastic dysplasia
• RBCs of 500,000 to 750,000 cells/mm3
• WBCs of 4,000 to 5000 cells/mm3
• Platelets of 50,000 cells/mm3
• Peripheral nerve degeneration
• Megaloblastic madness
• Paranoid ideation
• Cognitive dysfunction
• Delusions and hallucinations
• Paresthesia
• Memory impairment
• Depression
• Sleep deprivation
• Irritability
I am Divided into vascular (rich in protein) and interstitial (few proteins),Rich in sodium, chloride, and bicarbonate,Low in potassium, magnesium, and phosphate.
What are the components of extracellular compartment?
Excess of metabolic acids or removal of bicarb
What is Metabolic acidosis?
Patho:
Increase in acid:
Prolonged fasting – fats metabolized
Tissue anorexia – lactic acidosis
Ketoacidosis
Severe hyperthyroidism
Burns
Circulatory shock
End stage renal failure
Poisoning or overdose – salicylates, methanol, anti-freeze
Decrease in bicarbonate: Diarrhea due to bicarb removal
Clinical Manifestations:
Headache, Abdominal pain,Confusion,Lethargy, Stupor, coma, Tachycardia, Dehydration, Decreased cardiac contractility, pH < 6.9 = death from brainstem dysfunction
This condition may include Pathophysiology such as carbonic acid deficit, hyperventilation, pain, anxiety, prolonged crying, and alcohol withdrawal.
What is respiratory alkalosis?
Clinical Manifestations: Paresthesia, carpal and pedal spasm, Confusion, Cerebral vasoconstriction – decreased cerebral blood flow
Compensatory Response:
Carbonic acid retention
Slow down hyperventilation
Rebreathe expelled air (paper bag)
Full compensation – decreased CO2, decreased bicarb, normal pH
Addition or Retention of Sodium (increased
sodium in vascular system)
What is volume excess?
Excessive Infusion of Isotonic Solutions
Renal Retention (Caused by
Hyperaldosteronism, Chronic Heart Failure,
Cirrhosis, Cushing's Disease,
Glomerulonephritis, Renal Disease, Steroid
Therapy)
Clinical Manifestations
Weight Gain (most sensitive
indicator)
Edema
Bounding Pulses
Neck Vein Distention
Crackles, Dyspnea, Orthopnea
Severe-Pulmonary Edema
Increased RBC destruction (hemolysis) resulting in
decreased RBC survival rates (shorter lifespan)
What is Thalassemia (hemolytic) anemia?
• Associated with mutant genes
• Decreased hemoglobin synthesis
• Increased iron absorption in hemolytic anemia
(thalassemia)
Clinical manifestations:
Splenomegaly
Hepatomegaly
Symptoms of anemia in general
Leg ulcers
Bone deformities
Delayed development
Jaundice
Acute weight loss (most sensitive measure),Furrows in the tongue,Postural blood pressure decrease (postural hypotension),Increased heart rate,Flat neck veins,lightheaded,Dizziness or syncope,Oliguria,Poor skin turgor
What are the clinical manifestations of volume deficit?
Caused by removal of a sodium-containing fluid from the body.
GI Loss (Emesis, GI Suction, Fistulas, Diarrhea)
Renal Excretion (Adrenal Insufficiency, Diuretic Use, Bed Rest)
Other Causes (Paracentesis, hemorrhage, third spacing, burns, massive diaphoresis)
Excess of carbonic acid and Impaired gas exchange, inadequate neuromuscular function, impaired brainstem function
What is respiratory acidosis?
Pathophysiology:
COPD, Pneumothorax, Pneumonia, Severe asthma, Pulmonary edema, ARDS, Guillain-Barre, Open heart surgery, Respiratory depressants – opioids, barbiturates
Clinical Manifestations:
headache – due to CO2 increase, CO2 = potent vasodilator, Tachycardia, Cardiac dysrhythmias, Hypotension due to vasodilation, Blurred vision, Tremors, Vertigo, Lethargy, somnolence
antibodies that “remember” past exposure or infection
What are B lymphocytes?
I may be either dilutional or depletional in nature.
Dilutional causes: •Excessive ADH, •Excessive D5W Infusions, •Hypotonic Irrigations, •Excessive Water Intake
Depletional causes: •Diuretic Use, •Salt-wasting Renal Disease, •GI Loss (Nasogastric tube (NG) to suction, Emesis, diarrhea), •Burns
What is hyponatremia?
•Central Nervous system dysfunction:
•Malaise and weakness
•Anorexia, nausea, vomiting,
•Headache
•Confusion
•Lethargy
•Seizures
•Coma
•Cerebral herniation due to brain swelling or edema
•Sickled cells cause vascular occlusions of different shapes and sizes, recurrent painful episodes
What is sickle cell anemia?
Pathogenesis:
•RBC Genetically determined defect of hemoglobin synthesis resulting in hemoglobin instability and insolubility
•Almost exclusively in African American’s
Clinical Manifestations:
Recurrent painful episodes
Tachycardia
Jaundice
Splenomegaly and organ dysfunction
Priapism
Chest syndrome
Leg ulcers
Stroke
Infections
Weight Gain (most sensitive indicator), Edema,Bounding Pulses, Neck Vein Distention, Crackles, Dyspnea, Orthopnea, Severe-Pulmonary Edema
What are the clinical manifestations of fluid volume excess?
Pathogenesis
Addition or Retention of Sodium (increased sodium in vascular system)
Excessive Infusion of Isotonic Solutions
Renal Retention (Caused by Hyperaldosteronism, Chronic Heart Failure, Cirrhosis, Cushing's Disease, Glomerulonephritis, Renal Disease, Steroid Therapy)
Compensatory Response Hyperventilation
what is compensatory response metabolic acidosis?
Excretion of carbonic acid and water
Full compensation – decreased bicarb, decreased CO2 (from hyperventilation), normal pH
recognizes foreign invaders and directly kills them
What are T lymphocytes?
Helper T cells – stimulate B cells to make antibodies,
Shows B lymphocytes what infection to make antibodies from
Killer T cells – destroy infected cells directly
Foreign