Physio Q

[MudPhud20XX]

A 75-year-old woman in a nursing home has a fever of 40°C (105°F) from a lobar pneumonia. She has had very little fluid intake. Exam reveals normal skin turgor and a normal blood pressure. Which of the following figures best represents the changes that are occurring in plasma osmolality (POsm) and volume in the extracellular fluid (ECF) and intracellular fluid (ICF) compartment?

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[Instatewaiter]

E

Shes febrile meaning she's losing water in sweat. P0sm will thus go up and yo you lose it from ICF> ECF

 

[MudPhud20XX]

E

Shes febrile meaning she's losing water in sweat. P0sm will thus go up and yo you lose it from ICF> ECF

excellent... E it is.

Patients with a high fever lose significant amounts of water via evaporation from the skin surface and mucous membranes. This is called insensible water loss. Since water does not contribute to skin turgor and most of the total body water is normally in the ICF compartment, the amount of water lost in the ECF compartment is not significant enough to alter skin turgor or maintenance of the normal blood pressure. Na+ is the most important electrolyte that maintains skin turgor and blood pressure. A loss of pure water causes hypernatremia, which correlates with an increase in POsm (Figure E). An osmotic gradient is established that favors the movement of water out of the ICF into the ECF compartment. This contracts the ICF compartment. Water does not remain in the ECF because of loss by evaporation.

 

[MudPhud20XX]

A 60-year-old woman complains of persistent breathing difficulties. Her laboratory studies show:
pH = 7.39
[H+] = 44 nmol/L
PaCO2 = 55 mm Hg
[HCO3-] = 32 mmol/L
Which of the following is the most likely diagnosis?

 

[lunalight]

A 60-year-old woman complains of persistent breathing difficulties. Her laboratory studies show:
pH = 7.39
[H+] = 44 nmol/L
PaCO2 = 55 mm Hg
[HCO3-] = 32 mmol/L
Which of the following is the most likely diagnosis?

Compensated respiratory acidosis

 

[MudPhud20XX]

A 35-year-old man in poor physical condition went for a run on a hot afternoon. Forty minutes into the run, he collapsed and was taken to the emergency room. On arrival, the patient was conscious, but he reported feeling lightheaded and nauseous. He was sweating profusely. The blood pressure of the supine patient was 140/100 mm Hg, heart rate was 135 beats per minute, respiratory rate was 16 breaths per minute, and body temperature was 37°C (99°F). Comparing the patient’s current state with his state before exercise, what changes in extracellular fluid volume (ECFV), intracellular fluid volume (ICFV), and body fluid osmolarity will be apparent?

 

[MudPhud20XX]

Compensated respiratory acidosis

Compensated respiratory acidosis

it's actually primary resp acidosis and prim metabolic alkalosis...

The acid and base components are both higher than normal (normal PaCO2 = 35–45 mm Hg; normal HCO3– = 22–28 mmol/L); thus, an acid-base imbalance must exist. The pH is within normal limits (7.35–7.45). Full compensation rarely, if ever, occurs with a single acid-base disorder. Therefore, the patient most likely has a primary respiratory acidosis (PCO2 55 mm Hg) and primary metabolic alkalosis (HCO3–32 mEq/L) causing the pH to be in the normal range. A common example of this type of blood gas is a patient with chronic bronchitis (respiratory acidosis) who is taking a loop diuretic (metabolic alkalosis) for congestive heart failure.

 

[lunalight]

it's actually primary resp acidosis and prim metabolic alkalosis...

The acid and base components are both higher than normal (normal PaCO2 = 35–45 mm Hg; normal HCO3– = 22–28 mmol/L); thus, an acid-base imbalance must exist. The pH is within normal limits (7.35–7.45). Full compensation rarely, if ever, occurs with a single acid-base disorder. Therefore, the patient most likely has a primary respiratory acidosis (PCO2 55 mm Hg) and primary metabolic alkalosis (HCO3–32 mEq/L) causing the pH to be in the normal range. A common example of this type of blood gas is a patient with chronic bronchitis (respiratory acidosis) who is taking a loop diuretic (metabolic alkalosis) for congestive heart failure.

Ughhh...I always forget that you can have them together!