Question

Conditions

• Metabolic acidosis and alkalosis
• Respiratory acidosis and alkalosis
• Hypernatremia and hyponatremia
• Hyperkalemia and hypokalemia
• Hypercalcemia and hypocalcemia
• Hyperchloremia and hypochloremia
• Edema

For all of the above conditions, answer each questions below.

CATEGORY	POSSIBLE POINTS	POINTS EARNED
Pathophysiology of each of these conditions.	20
What body systems are directly impacted by each of these conditions?	20
Describe the impact of the condition on the affected body system.	20
Identify the normal lab values for each of these conditions.	20
Identify the abnormal lab values for each of these conditions.	20
Points	100

Answer 1

1.

A. Pathophysiology of metabolic acidosis:-
Metabolic acidosis occurs when either an increase in the production of nonvolatile acids or a loss of bicarbonate from the body overwhelms the mechanisms of acid–base homeostasis or when renal acidification mechanisms are compromised.

Pathophysiology of metabolic alkalosis:-
As the extracellular potassium concentration decreases, potassium ions move out of the cells. To maintain neutrality, hydrogen ions move into the intracellular space. Administration of sodium bicarbonate in amounts that exceed the capacity of the kidneys to excrete this excess bicarbonate may cause metabolic alkalosis

B. Pathophysiology of respiratory alkalosis:-
Respiratory alkalosis is a pathology that is secondary to hyperventilation. Hyperventilation typically occurs in response to an insult such as hypoxia, metabolic acidosis, pain, anxiety, or increased metabolic demand. Respiratory alkalosis in itself is not life-threatening.

Pathophysiology of respiratory acidosis:-
A decreased pH level influences the mechanics of ventilation and maintains proper levels of carbon dioxide and oxygen. When ventilation is disrupted, arterial PCO2 increases and an acid-base disorder develop. Another pathophysiological mechanism may be due to ventilation/perfusion mismatch of dead space.

C. Pathophysiology of hypernatremia:-
When hypernatremia (of any etiology) occurs, cells become dehydrated. Either the osmotic load of the increased sodium acts to extract water from the cells or a portion of the burden of the body's free water deficit is borne by the cell.

Pathophysiology of hyponatremia:-
Hyponatremia results from the inability of the kidney to excrete a water load or excess water intake. Water intake depends upon thirst mechanism. Thirst is stimulated by increase in osmolality.

D. Pathophysiology of hyperkalemia:-
Hyperkalemia occurs when renal potassium excretion is limited by reductions in glomerular filtration rate, tubular flow, distal sodium delivery or the expression of aldosterone-sensitive ion transporters in the distal nephron.

Pathophysiology of hypokalemia:-
Hypokalemia is a potentially life-threatening imbalance that may be iatrogenically induced. Hypokalemia may result from inadequate potassium intake, increased potassium excretion, or a shift of potassium from the extracellular to the intracellular space. Increased excretion is the most common mechanism.

E. Pathophysiology of hypercalcemia:-
The principal pathophysiologic alteration in severe hypercalcemia accompanying hyperparathyroidism and malignancy is enhanced osteoclastic bone resorption. Hypercalcemia impairs renal mechanisms that lead to sodium and calcium excretion; PTH and PTHrP acting on renal tubules enhance further calcium reabsorption.

Pathophysiology of hypocalcemia:-
Hypocalcemia results whenever there is a net efflux of calcium from the extracellular fluid in greater quantities than the intestines or bones can replace. Symptoms are primarily neurological, with the inadequate calcium levels causing hyperexcitability of neuronal membranes.

F. Pathophysiology of hyperchloremia:-
hyperchloremia can occur when water losses exceed sodium and chloride losses, when the capacity to handle excessive chloride is overwhelmed, or when the serum bicarbonate is low with a concomitant rise in chloride as occurs with a normal anion gap metabolic acidosis or respiratory alkalosis.

Pathophysiology of hypochloremia:-
Hypochloremia occurs when there's a low level of chloride in your body. It can be caused by fluid loss through nausea or vomiting or by existing conditions, diseases, or medications. Your doctor may use a blood test to confirm hypochloremia. In mild cases, replenishing the chloride in your body can treat hypochloremia.

2. System affected by these conditions and impact on the body by these systems:-

A. Metabolic acidosis and alkalosis are due to a problem with the kidneys.
Acute metabolic acidosis may also cause an increased rate and depth of breathing, confusion, and headaches, and it can lead to seizures, coma, and in some cases death. Symptoms of alkalosis are often due to associated potassium (K+) loss and may include irritability, weakness, and muscle cramping.

B. Respiratory acidosis and alkalosis are due to a problem with the lungs.
Respiratory alkalosis occurs when you breathe too fast or too deep and carbon dioxide levels drop too low. This causes the pH of the blood to rise and become too alkaline. When the blood becomes too acidic, respiratory acidosis occurs.

C. Dietary sodium can adversely affect target organs, including the blood vessels, heart, kidneys and brain.
Nausea and vomiting Headache Confusion Loss of energy, drowsiness and fatigue Restlessness and irritability Muscle weakness, spasms or cramps Seizures Coma.

D. Potassium Helps Regulate Muscle and Heart Contractions.
weakness and fatigue, muscle cramps, muscle aches and stiffness, tingles and numbness, heart palpitations, breathing difficulties, digestive symptoms and mood changes.

E. Body needs calcium in order to circulate blood, move muscles, and release hormones. Calcium also helps carry messages from brain to other parts of body. Calcium is a major part of tooth and bone health as well. It makes bones strong and dense.

F. Chloride is one of the most important electrolytes in the blood. It helps keep the amount of fluid inside and outside of your cells in balance. It also helps maintain proper blood volume, blood pressure, and pH of your body fluids.

3. Normal values and abnormal values:-

Normal bicarbonate levels are: 23 to 30 mEq/L in adults.

Normal PCO2 ranges between 35 to 45 mmHg, or 4.7 to 6.0 kPa.

The normal range for blood sodium levels is 135 to 145 milliequivalents per liter (mEq/L)

Normal blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L).

Calcium (serum) is 8.6-10.3 mg/dL

The normal adult value for chloride is 97-107 mEq/L.


If bicarbonate <23= metabolic acidosis
bicarbonate > 30 = metabolic alkalosis

If pco2 < 35 = respiratory alkalosis
pco2 > 45 = respiratory acidosis

Na > 145 = hypernatremia
Na < 135 = hyponatremia

K > 5.2 hyperkalemia
K< 3.6 hypokalemia

Ca > 10.3 hypercalcemia
Ca < 8.6 hypocalcemia

Cl > 107 hyperchloremia
Cl < 97 hypochloremia