What pH does thenlow volume state have?
Alkalotic (except diarrhea, RTA Type II and DKA) b/c Aldo dumps H+
What electrolytes does the low volume state have?
HIGH total Na, LOW serum Na (dilutional affect), LOW Cl, LOW K
What pH does vomiters have?
Alkalotic b/c you vomit out H+
What pH does diarrhea have?
Acidosis b/c stool has bicarb
What happened if pulse increased more than 10 on standing?
Hypovolemic shock
What happened if pulse decreases to less than 5 on standing?
Autonomic dysfunction
What are the symptoms of a low energy state?
CNS: mental retardation
CV: heart failure, pericardial effusion
Muscle: weakness, SOB, vasodilation, impotence, urinary retention, constipation
Rapidly dividing cells:
- skin: dry
- cuticles: brittle
- hair:alopecia
- bone marrow: suppressed
- vascular endothelium: breaks down
- lungs: infection, SOB
- kidney: PCT will feel the effect first
- GI: nausea, vomit, diarrhea
- bladder: oliguria
- sperm: decreased
- germ cells: predisposed to cancer
- breasts: atrophic
- endometrium: amenorrhea
What are the most common signs of the low energy state?
Tachypnea and dyspnea
What are the most common symptoms of the low energy state?
Weakness and SOB
What are the most common infections of the low energy state?
UTI and respiratory infections
What is the most common cause of death in the low energy state?
Heart failure
Explain all restrictive lung diseases:
Restrictive: intersticial problem (non bacterial)
- small stiff lungs (low VC)
- trouble breathing in => FEV1/FVC : >0.8
- ABG: low pO2 => increases RR, low pCO2, high pH
- CXR: reticulo-nodular pattern, ground glass apperance
- Die of cor pulmonale
- Ex: NM diseases (breathing out is passive), drugs, autoimmune dz
- Tx: Pressure support on ventilator, ^ O2 ^RR, ^inspiratory time
Explain all obstructive lung diseases:
Obstructive: airway problem (bacterial)
- Big mucus-filled lungs (^RV, ^Reid index = ^airway thickness/airway lumen)
- Trouble breathing out => FEV1/FVC: ^RR, v pH
- Die of bronchhiectasis
- Ex: COPD
- Tx: Manipulate rate on ventilator, ^RR, ^ expiratory time, ^O2 only if needed
What symptoms does a “more likely to depolarize” state have?
Brain: psychosis, seizures, jitteriness
Skeletal Muscle: muscle spasm, tetany
SM: diarrhea, then constipation
Cardiac: tachycardia, arrhytmias
What symptoms does a “less likely to depolarize” state have?
Brain: lethargy, mental status changes, depression
Skeletal Muscle: weakness, SOB
SM: constipation, then diarrhea
Cardiac: hypotension, bradycardia
What is humoral immune response?
B cells and PMNs patrol the blood looking bacteria
What is the cell-mediated immune response?
T cells and macrophages patrol the tissues looking for non-bacteria
What are macrophages called in each area of the body?
Blood:Monocytes Brain: microglia Lung: T1 pneumocytes Liver: Kupffer cells Spleen: RES cells Lymph: Dendritic cells kidney: Mesangial cells Payers patches: M cells Skin: Langerhans Bone: Osteoclasts
CT:
-Histiocytes
-Giant cells
Epitheloid cells
What is the CBC for every vasculitis?
v RBC, v platelets, ^WBC, ^T cells, ^ MP and schistocytes, ^ESR
What is the time course of the inflammatory response?
1 hr: swelling day 1: PMNs show up day 3: PMNs peak day 4: MP/T cells show up day 7: MP/T cells peak, fibroblast arrive day 30: fibroblast peak Month 3-6: Fibroblast leave
What state does estrogen mimic?
The neuromuscular disease state (estrogen is a muscle relaxant)
What does high GABA levels lead to?
Bradycardia, lethargy, constipation, impotence and memory loss
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