group3 bsph 2f1

8/2/2019 group3 BSPh 2F1

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MAJOR INTRA EXTRACELLULARELECTROLYTES


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At the end of this discussion, the reporters

will be able to discuss:

-Electrolytes

-Fluids and Fluid Compartments

-Major Physiological Ions

-Electrolytes Used for Replacement Therapy-Physiological Acid-base Balance

-Compensatory Mechanism of the Body

-Electrolytes in Acid Base Therapy

-Electrolyte Combination Therapy


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Electrolytes DefinitionElectrolyte is any substance

containing free ions that make the

substance electrically conductive

Electrolytes are dissolved in

body fluids

Commonly, electrolytes are

solutions of acids, bases or salts.


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Fluids DefinitionThe body fluids are solutions of inorganic

and organic solutes

The concentration balances of the various

components are maintained in order for the

cells and tissues to have a constant

environment.

There are regulatory mechanisms which

control pH, ionic balances, osmotic

balances, etc.


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Fluids DefinitionThere are also large number of products under

the general heading of replacement therapy whichcan be used by the physicians when the body itself

is unable to correct an electrolyte imbalance due to

change in the composition of its fluids.

These products include electrolyte, acids and bases,

blood products, carbohydrates, amino acids and

proteins


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FLUID COMPARTMENTSThe concentration of electrolytes vary in different fluid compartments

which include:

1. Intracellular fluid- fluid inside cells [ICF]

2. Extracellular fluid- fluid outside cells and all other body fluidsa. Interstitial fluid- is interstitial fluid. Small amount is localized

as CSF, serous fluid, synovial fluid, humors of eye &

endo/perilymph of ears

b. Plasma and vascular fluid- is plasma [intravascular fluid]

*the term extracellular fluids include both interstitial and vascular fluids

- These 3 compartments are separated from each other by membranes

that are permeable to water and many organic and inorganic solutes


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Your body is 66% water

Not evenly distributedseparated into

compartments

Able to move back and forth thru the cell

membranes to maintain an equilibrium

FLUID COMPARTMENTS


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FLUID COMPARTMENTS

They are nearly impermeable to macromolecules such as proteins

and are selectively permeable to certain ions such as sodium,potassium, and magnesium.

The solution in each compartment is ionically balanced.

Thus,

sodium and chloride- are found in the plasma and interstitial fluid

potassium, magnesium, and phosphate- are found in the

intracellular fluid


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Chloride

Sodium

Potassium Phosphorus

Magnesium

Calcium

MAJOR PHYSIOLOGICAL IONS


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HYPOCHLOREMIC

ALKALOSIS

Is a metabolic disorder

resulting from a decrease in

blood bicarbonate level

secondary to loss of

chloride from the body.

Principal Metabolic Functions

- Maintaining normal

hydration, and osmotic pressure,gastric HCl, acid and base balance,

electrolyte balance

Clinical Manifestation of

Deficiency

- Hypochloremic

alkalosis(pernicious vomiting)


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- Buffer constituent, acid-

base balance, water balance, C0 2

transport, osmotic pressure, cellmembrane permeability, muscle

irritability


Deficiency- Dehydration, acidosis,

tissue atrophy, an excess lead to

edema and hypertension

DEHYDRATION

Dehydration means your

body does not have as

much water and fluids as

it should. Dehydration

can be caused by losingtoo much fluid, not

drinking enough water

or fluids, or both.


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irritability





ACIDOSIS

It is a condition in which

there is excessive acid in

the body fluids.


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irritability





ATROPHY

It is the

general physiological pr

ocess of reabsorption

and breakdown

of tissues,involving apoptosis on

a cellular level.


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irritability





EDEMA

Condition in which fluid

accumulates in the

interstitial compartment.

Sometimes due to blockage

of lymphatic vessels or by a

lack of plasma proteins or

sodium retention


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irritability






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irritability





HYPERTENSION

(Also known as high blood

pressure )

is a cardiac chronic medical

condition in which thesystemic arterial blood

pressure is elevated.


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- Buffer constituent, acid-base balance, CO 2 transport,

neuromuscular irritability


Deficiency- Acidosis, renal damage

ACIDOSIS

It is a condition in which

there is excessive acid in

the body fluids.


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- Formation of apatite inbones and teeth, blood clotting


Deficiency

- Rickets, poor growth,

osteoporosis

RICKETS

It is a disorder caused by a

lack of vitamin D, calcium,

or phosphate. It leads to

softening and weakening ofthe bones


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Deficiency


osteoporosis


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Deficiency


osteoporosis

OSTEOPOROSIS

It is the thinning of bone

tissue and loss of bone

density over time


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Deficiency


osteoporosis


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- Cofactor for PO4

transferring enzymes; constituentof bones and teeth


Deficiency

- Muscular tremor,

reinform movement

MUSCULAR TREMOR

It is a minute regularinvoluntary contraction of

individual muscle fasciculi.

If the tremors are mild and

occasional, the cause may

be physiologic. Profuse,

persistent, or recurrent

widespread muscular

twitching often indicates a

motor neuron disorder.


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- Cofactor for PO4

transferring enzymes; constituentof bones and teeth


Deficiency

- Muscular tremor,

reinform movement


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- Constituent of bones

and teeth; constituents of buffers;constituents(as HPO4)2 ofATP,

NAD, FAD


Deficiency

- Renal rickets, cardiac

arrhythmia, osteomalacia

RENAL RICKETS

A form of rickets occurring

in children in association

with, and apparently as a

result of renal disease with

hyperphosphatemia. Alsocalledpseudorickets.


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and teeth; constituents of buffers;constituents(as HPO4)2 of ATP,

NAD, FAD


Deficiency



CARDIACARRHYTHMIA

An irregular heart rate or

rhythm. a problem with the

rate or rhythm of the heartbeat.

During an arrhythmia, the

heart can beat too fast, tooslow, or with an irregular

rhythm


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NAD, FAD


Deficiency



OSTEOMALACIA

It is the softening of bone,particularly in the sense of

bone weakened by

demineralization (the loss of

mineral) and most notably by

the depletion of calcium from

bone. Osteomalacia in children

is known as rickets, andbecause of this, use of the

term osteomalacia is often

restricted to the milder, adult

form of the disease.


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NAD, FAD


Deficiency




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Sodium Chloride USP XX

Calcium Chloride USP XX

Potassium Chloride USP XX


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(NaCl)

Mol. Wt. 58.44

S i C i S


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- Table Salt

- sea salt- sal

- Asin(tagalog)


Synonyms:

S di Chl id USP XX


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Common salts exists in nature either in the solid or in a

solution.

In the solid state it is called rock salt, halite, fossil salt, and sal

gemmae. It is often found forming extensive beds and even

an entire mountains, from which it is extracted in blocks or

masses by mining operations.


Occurrence

S di Chl id USP XX


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In solutions it is found in the sea, some lakes, springs, and wells


Shatt Al-Jarid is a large saline lake

in southwestern Tunisia, occupying

a salt-flat basin of about 4,900

square km. The lake is covered

with water only in the lowest areas,

except after periods of heavy rains.

Occurrence

S di Chl id USP XX


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In the hot countries like here inthe Philippines, this salt isobtained in the sea water by

concentrating it in a very largeflat basins connected in seriescalled salt pans. The heatfrom the sun is sufficient toeffect the evaporation of the

water.


Preparations

S di Chl id USP XX


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Sodium chloride obtained natural sources always contain

impurities depending on the locality where it has been

extracted.

It must be purified before using for medicinal purposes which

required to contain n.l.t. 99.5% NaCl.


Preparations

S di Chl id USP XX


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Preparations

DECANTATION

is a process for theseparation of immiscible liquids.

This is achieved by carefully

pouring a solution froma container in order toleave the precipitate (sediments)

in the bottom of theoriginal container. Usually a

small amount of solution

must be left in the container,and care must be taken toprevent a small amount ofprecipitate from flowing

with the solution outof the container.

The process adopted in its purification dependson the nature of impurities, the common ones

being calcium and magnesium.

They are readily precipitated by addingconcentrated solution of sodium carbonate tobrine(sodium chloride solution), evaporating to

the saturation point, then saturating the cooledsolution with hydrogen chloride when puresodium chloride precipitates. The crystals arecollected by decantation or centrifugation anddried.

S di Chl id USP XX


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Preparations



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Preparations

CENTRIFUGATION

is a process that involves the

use of the centrifugal force for

the sedimentation of mixtureswith a centrifuge, used in

industry and in laboratory

settings. More-dense

components of the

mixture migrate away fromthe axis of the centrifuge,

while less-dense components

of the mixture migrate

towards the axis.







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Preparations







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Sodium chloride USP occurs as colorless,

cubic crystals or as white crystalline powder

having a saline taste.

It is freely soluble in water and slightly more

soluble in boiling water.

It is soluble in glycerin and slightly soluble in

alcohol


Properties:



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Isotonic solutions(0.9w/v) are used as wet

dressings for irrigating body cavities or

tissues and as injections when fluids and

electrolytes have been depleted inisotonic proportions.

Build-up of extensive extracellular fluid

due to administration of isotonic sodiumchloride may lead to both pulmonary

and peripheral edema.


Uses

PULMONARY EDEMA

is fluid accumulation

in the lungs. It leads to

impaired gas exchange

and may cause

respiratory failure.



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Uses



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Uses

PERIPHERAL EDEMA

is the swelling of tissues,

usually in the lower limbs,

due to the accumulation of

fluids. The condition iscommonly associated with

aging, but can be caused by

many other conditions,

including congestive heart

failure, trauma, alcoholism,

altitude sickness,

pregnancy, hypertension,

or merely long periods of

time sitting or standing

without moving.



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Uses



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Hypotonic solutions are administeredfor maintenance therapy when patientsare unable to take fluid and nutrientsorally for one to three days.

DEXTROSE(glucose) is usually thecaloric source.

Hypertonic injections are used when

there is a loss of sodium in an excessof water.


Uses



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In the form of Sodium Chloride Injection USP

XX(0.9% NaCl) and tablets. It is categorized as

fluid and electrolyte replenisher.

Orally it is given to individuals who perspire

profusely such as workers and athletes, to

prevent the development cramps. Large

amounts produce emesis, catharsis, anddiuresis.

It is an antidote to silver poisonings,

condiment, and preservative.


Uses


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(KCl)

Mol. Wt. 74.56

POTASSIUM CHLORIDE USP


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Synonyms:


Kalium Chloratum

Kali Chloridum



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Potassium chloride is found in large deposits in the form ofsylvite; often times in combination with sodium chlorideand in the form of carnallite, MgCl2.KCl.6H 2O----[ KMgCl36(H2O)]


SYLVITE

CARNALLITE

Occurrence:



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Potassium Chloride USP occurs as

colorless, elongated, prismatic or

cubical crystals as white, granular

powder. It is odorless, has a saline taste

and is stable in air. It is freely soluble

in water and even more so in boiling

water, giving solutions that are neutralto litmus. It is insoluble in alcohol.


Properties



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Potassium Chloride is the drug of choice for oral

replacement of potassium preferably as a solution.

It is irritating to the gastrointestinal tract and solution must

be well diluted.

The USP requires that the tablets be enteric coated, butseveral authorities do not recommend the use of the tablets

because they have produce intestinal ulcerations and because

the tablets absorption is undependable.

Properties



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Potassium Chloride is a component of the Official

Ringers Injections and Solution and Lactated

Ringers Injection. The injection form is used as

fluid and electrolyte replenisher while the solutionis for topical purposes.

Potassium Chloride injection is given to patients

with severe hypopotassemia or if the patient isunable to take potassium orally.

Uses



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Potassium Chloride is indicated in

the treatment of familial periodic

paralysis(a recurring, rapidly

progressive, flaccid paralysis).

Menieres syndrome (disease of theinner ear which includes dizziness

and noise in the ear) and as an

antidote to digitalis intoxication.

Uses

FLACCID PARALYSIS

a clinical manifestation characterized

by weakness or paralysis and reduced

muscle tone without other obvious

cause (e.g., trauma)



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The latter results form either large doses of

digitalis administered together with diuretics

or when maintenance doses are taken for a

long period of time.It is also given when adrenal steroids ACTH

or the diuretics chlorothiazide are

administered as these drugs tend to diminish

the potassium content of the bodyWhen given a dilute oral solution, potassium

chloride is mixed with fruit or vegetable juice

to mask saline taste

Uses


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(CaCl2.2H2O)

Mol. Wt. 147

CALCIUM CHLORIDE


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Synonyms

Cloruro de Calcio

Muriate of Lime

Fosforo de Homberg

CALCIUM CHLORIDE


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Calcium Chloride is a salt composed ofwhite, slightly translucent, hard fragments orgranules, odorless, with a sharp bitter, saline

taste and very deliquescent. One gramdissolves in 1.2 ml of water.

It is insoluble in ether, chloroform and fixedand volatile oils. Because of its great

solubility in water, the salt forms anexcellent freezing mixture with ice. Whenone part of the salt is mixed with two-thirdsof its weight of crushed ice, it gives atemperature of -45 degrees Celsius.

Properties

DELIQUESCENT

tending to undergo gradual

dissolution and

liquefaction by the

attraction and absorption

of moisture from the air

CALCIUM CHLORIDE


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Electrolyte replenisher as Ringers

Injection and Lactated Ringers Injection.

Calcium Chloride is used in Internal

hemorrhages, in certain bone disease,

nervous disorders and whenever there is

deficiency of calcium in the system.Usually it is dispensed in aqueous

solution, although it may be made non-

deliquescent by mixing with lactose.

Uses

HEMORRHAGES

the escape of blood from

the vessels

CALCIUM CHLORIDE


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Since Calcium Chloride is irritating

to the veins, calcium gluconate is

considered by many to be the

treatment of choice

for hypocalcemia because it is non-

irritating calcium salt of oralcalcium replacement therapy.

Uses

HYPOCALCEMIA

Is a low bood calcium level, occurs

when the concentration of free

calcium ions in the blood falls below

4.0 mg/dL (dL = one tenth of a liter).

The normal concentration of free

calcium ions in the blood serum is

4.0-6.0 mg/dL.


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Before discussing the electrolytes used in acid-base balance,

an overview of the means used by the body to maintain

physiological pH will be presented.

Acids (either carbonic from carbon dioxide and lactic acid

from anaerobic metabolism) are constantly being produced

during metabolism.


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Since most metabolic reactions occur within a very narrow pH

range, the body utilizes several efficient buffer systems whichare:

1. Bicarbonate/Carbonic Acid (HC03/H2CO3) found in the

plasma and kidneys.

2. Monohydrated phosphate ( HPO42/ H2PO4

-)found in the

cells and kidneys.

3. Hemoglobin and proteinsfound in the red blood cells

which are the most effective single systems for buffering thecarbonic acid produced during metabolic processes.


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Due to a variety causes, the bodys acid levels may increaseand/or alkali levels decrease below normal, causing acidosis or

the acid levels may decrease and/or alkali levels increase above

normal, causing alkalosis.

The term acidosis and alkalosis refer to the pH dropping slightly

below 7.38 or increasing slightly above 7.42, respectively.


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Conditions Buffer Respiratory Renal


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Conditions

(causes)

Buffer

System

Respiratory

Function

Renal

Function

Metabolic Acidosis-

Primary HCO3 deficit

(diabetic acidosis,

diarrhea, renal failure)

HCO3/H2CO3 Hyperventilation

causing increased

excretion ofH2CO3

as CO2

Increased acid

excretion by Na+(-

H)+ exchange

increased NH3

formation and HCO3

reabsorption

DIABETIC ACIDOSIS

[Diabetic ketoacidosis (DKA)]

is a potentially life-threatening complication in patients with diabetes

mellitus. It happens predominantly in those with type 1 diabetes, but it

can occur in those with type 2 diabetes under certain circumstances.



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Conditions

(causes)

Buffer

System

Respiratory

Function

Renal

Function

Metabolic Acidosis-

Primary HCO3deficit

(diabetic acidosis,



causing increased

excretion ofH2CO3

as CO2

Increased acid

excretion by Na+(-

H)+ exchange

increased NH3

formation and HCO3

reabsorption

DIARRHEA

also spelled diarrhoea, is the condition of having three or more loose or

liquid bowel movements per day. It is a common cause of death in developing

countries and the second most common cause of infant deaths worldwide. The

loss of fluids through diarrhea can

cause dehydration and electrolyte imbalances.



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RENAL FAILURE

or kidney failure (formerly called renal insufficiency)

describes a medical condition in which the kidneys fail to adequately filter

toxins and waste products from the blood. Problems frequently encountered in

kidney malfunction include abnormal fluid levels in the body, deranged acid

levels, abnormal levels of potassium, calcium, phosphate, and (in the longer

term) anemia as well as delayed healing in broken bones.

Conditions

(causes)

Buffer

System

Respiratory

Function

Renal

Function

Metabolic Acidosis-

Primary HCO3deficit

(diabetic acidosis,



causing increased

excretion ofH2CO3

as CO2

Increased acid

excretion by Na+(-

H)+ exchange

increased NH3

formation and HCO3

reabsorption



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Conditions

(causes)

Buffer

System

Respiratory

Function

Renal

Function

Metabolic Alkalosis

Primary HCI3 Excess

(administration of

excess alkali, vomiting)

HCO3/H2CO3 CO2 retention causing

increased H2CO3

concentration

Decreased rate of

Na+(-H)+ exchange,

decreased NH3

formation and

reabsorption of

HCO3

.

VOMITING

(known medically as emesis and informally as throwing up and by a number

of other terms) is the forceful expulsion of the contents of one's

stomach through the mouth and sometimes the nose.



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Conditions

(causes)

Buffer

System

Respiratory

Function

Renal

Function

Respiratory acidosis-

Primary H2CO3 (cardiac

disease, lung damage,

drowning)

Hemoglobin

and protein

Increased CO2

excretion through thelungs

Same as metabolic

acidosis(Increased acid

excretion by Na+(-

H)+ exchange

increased NH3

formation and HCO3

reabsorption)

CARDIAC DISEASE

Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety

of diseases affecting the heart.



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Conditions

(causes)

Buffer

System

Respiratory

Function

Renal

Function

Respiratory acidosis-

Primary H2CO3 (cardiac

disease, lung damage,

drowning)

Hemoglobin

and protein

Increased CO2

excretion through thelungs

Same as metabolic

acidosis(Increased acid

excretion by Na+(-

H)+ exchange

increased NH3

formation and HCO3

reabsorption)

DROWNING

to suffocate because of excess of body fluid that interferes with the passage of

oxygen from the lungs to the body tissues



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Conditions

(causes)

Buffer

System

Respiratory

Function

Renal

Function

Respiratory alkalosis-

Primary H2CO3 deficit(fever, hysteria, anoxia,

salicylate poisoning)

Same as

metabolicalkalosis for

buffer system

CO2 retention causing

increased H2CO3concentration

Decreased rate

of Na+(-H)+exchange,

decreased NH3

formation and

reabsorption of

HCO3.

FEVER

a rise of body temperature above the normal whether a natural response (as to

infection) or artificially induced for therapeutic reasons



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C

(causes) System

p a y

Function

a

Function




Same as


buffer system



Decreased rate


decreased NH3

formation and

reabsorption of

HCO3.

HYSTERIA

Behavior exhibiting excessive or uncontrollable emotion, such as fear or

panic.



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ANOXIA

means a total decrease in the level of oxygen, an extreme form of hypoxia or

"low oxygen".

(causes) System

p y

Function Function




Same as


buffer system



Decreased rate


decreased NH3

formation and

reabsorption of

HCO3.


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1.) Sodium salts of minerals and organic acids are removed from

the plasma by glomerular filtration.

2.) Sodium is preferably removed from the renal filtrates or

tubular fluid and in the tubule cells, reacts with carbonic acid

formed by the carbonic anhydrase-catalyzed reaction of carbon

dioxide and water. This is sometimes called the sodium hydrogen

exchange.

3.) The sodium bicarbonate returns to the plasma (and removed

from the lung as CO2) and the protons enter the tubular fluids,

forming acids of the anions of the sodium salts.


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The normal acid-base balance of the plasma is maintained by 3mechanisms working together

(a) the buffer of the body fluids and red blood cells,

(b) the pulmonary excretion of excess CO2 and

(c) the renal excretion of either acid or base, whichever is in

excess


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Metabolic acidosis is treated with the sodium salts ofbicarbonate, lactate, acetate, and citrate, administration of

bicarbonate deficit. Lactate, acetate and citrate ions are normal

components of metabolism and will be degraded to carbon

dioxide and water by the tricarboxylic acid cycle. The carbon

dioxide, by the action of carbonic anhydrase, will form

bicarbonate and therapy reduce the bicarbonate deficit.

Metabolic alkalosis has been treated with ammonium

salts, its action is in the kidneys where it retards the sodium-

hydrogen exchange.


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(CH3COONa.3H20)Mol. Wt. 136

SODIUM ACETATE USP XX

SODIUM ACETATE


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Acetate of soda

Acetado de-Sosa

Synonyms

SODIUM ACETATE


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Sodium Acetate USP occurs as

colorless, transparent crystals, as a

white granular crystalline powder or as

a white flake. It is odorless or has a

faint acetous odor.

It is efflorescent in warm, dry air. It is

very soluble in water and in alcohol.

Properties

SODIUM ACETATE


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Sodium Acetate is metabolized

to carbon dioxide then to

bicarbonate; hence it can beused as an effective buffer in

metabolic acidosis of acute

cholera. Uremic acidosis (acidic

urine) has been corrected by

infusion of sodium acetate. It is

used as diuretic, diaphoretic,

aperient (laxative) and systemic

alkalizer.

Uses

ACUTE CHOLERA

An acute infectious disease of

the small intestine, caused by

the bacterium Vibrio

cholerae and characterized by

profuse watery diarrhea,

vomiting, muscle cramps,severe dehydration, and

depletion of electrolytes.

SODIUM ACETATE


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alkalizer.

Uses

UREMIC ACIDOSIS

metabolic acidosis seen in

chronic renal disease when the

ability to excrete acid is

decreased.

SODIUM ACETATE


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alkalizer.

Uses

DIURETIC

Anything that promotes the

formation of urine by the

kidney.

SODIUM ACETATE


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alkalizer.

Uses

DIAPHORETIC

induce involuntary

perspiration that helps to

reduce fever

SODIUM ACETATE


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alkalizer.

Uses

APERIENT

(laxative)

gently moving the bowels

SODIUM ACETATE


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alkalizer.

Uses

ALKALIZER

an agent that counteracts or

neutralizes acidity


89/126

(CH3COOK)Mol. Wt. 98.15

POTASSIUM ACETATE


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Diuretic salts

Synonyms

POTASSIUM ACETATE


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Potassium Acetate occurs as colorless, monoclinic crystals or

as a white crystalline powder. It has a saline and alkaline

taste. It deliquesces on exposure to moist air. It is verysoluble in water and alcohol.

Properties

POTASSIUM ACETATE


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When given in doses of 1-4g, it is used a diaphoretic and

bicarbonate acid. In large(16-30g) it is used as a cathartic.

Dry use its deliquescent nature, it is never prescribed in the state,but always in solution. It is categorized as an alkalizer.

Along with potassium citrate and bicarbonate, it is found in

Potassium Triplex.

All the precautions mentioned for potassium chloride apply to

potassium acetate.

Uses


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(NaHCO3)Mol. Wt. 84.01

SODIUM BICARBONATE


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Baking Soda

Soda Saleratus

Sal de Vichy

Soda Acid Carbonate

Sodium Hydrogen Carbonate

Bicarbonate of Soda

Synonyms

SODIUM BICARBONATE


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Sodium bicarbonate USP occurs as a white, crystalline which is

dry air, but slowly decompose in moist air. In solutions, whenfreshly prepared with cold water without shaking are alkaline to

litmus. The alkalinity increases as the solutions stand, are

agitated or heated. It is soluble in water and insoluble in

alcohol.

Properties

SODIUM BICARBONATE


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When heated, the salt loses water and carbon dioxide and

is converted to normal carbonate.

It accounts for one of the major for one of the major

difficulties in attempting to sterilize either the dry salts or

its solutions, since the sodium carbonate which remains inmuch dangerous to use parenterally.

Properties


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Ways of Sterilizing Sodium

Bicarbonate

1. Bacteriological Filtration

2. Autoclaving- carbon dioxide is

passed though the solution for oneminute and then placing the solutionin gas- tight containers forautoclaving process

3. Heating bicarbonate solution in an

open vessel and then resaturatingthe cooled solution with sterilecarbon dioxide


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Another characteristic reaction of bicarbonate salts is that carbonate is

liberated when they are treated with acids. The liberated CO2 bubbling

thought the liquid is termed as effervescence tablets and salts may useof the reaction of sodium bicarbonate with acids because in the dry state

the bicarbonate and the acid do not react where as when introduced into

water a vigorous evolution of CO2 take place.


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However, it is well to remember that the reaction can take

place in moist air and may account for incompatibilitiesin dry prescription mixtures of sodium bicarbonate with

acetylsalicylic acid (aspirin) or other acidic substances.

SODIUM BICARBONATE


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Because sodium bicarbonate is the principal bicarbonateof drug use, a discussion of its action will serve as guide

to consideration of other bicarbonates.

Uses

S di bi b t b id d f th t d i t f


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Sodium bicarbonate maybe considered from the standpoint of

two relationships.

1. Its relationship to the body economy and buffer component.

- The bicarbonate/carbonic acid is by far the most important plasma

buffer.- This buffer system involves equilibrium between sodium

bicarbonate and carbonic acid.

- At given pH, the ratio of the concentrations of the two substances

is constant.- When an excess of acid is liberated to the body, it is neutralized by

some of the sodium bicarbonate.


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-The excess carbonic acid decomposes into water and carbondioxide and the letter is excreted through the lungs until the

normal bicarbonate/carbonic acid ratio is achieved.

-If an excess alkali occurs in the body, it combines with thecarbonic acid to form bicarbonate and more carbonic acid is

formed the carbon dioxide and water to restore the balance.

- Since carbon dioxide is the end product of metabolism thereis always abundant upon which to withdraw.


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2. Its therapeutic and miscellaneous uses

- Sodium bicarbonate is used in medicine principally for its acid-neutralizingproperties.

It is used to combat hyperacidity and to combat systemic acidosis.

-Oral administration of the drug causes a lessening of the acidity if the urine or

many even produce alkalinization. This effect has been used to lessen the

possibility of drug crystallizing and its related drug.

-Changing the pH of the reaction of the urine alternately from acid to alkaline

has been treatment of certain types of urinary tract infections

-Simultaneous administration of sodium bicarbonate with other drugs inhibits

activity of the administered drug.

-Example is sodium bicarbonate and sodium salicylate which


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p y

when administered simultaneously in equal amounts greatly

retards the rise in the serum salicylate level, in contrast to

sodium salicylate alone which rather quickly brings up to theirsalicylate level.

-Sodium bicarbonate is administered parenterally and orally as a

current drug if choice to combat systemic acidosis.

-It is also used in the treatment of methyl alcohol poisoning.

-It is widely uses in the manufacture of effervescent salts, baking

powders, fire extinguishers, carbonated drinks and cleaning

mixtures.


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(KHCO3)

Mol. Wt. 100.12

POTASSIUM BICARBONATE


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Synonyms

Potassium Acid Carbonate

Salaeratus



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Occurs as colorless, transparent, monoclinic

prisms or as white granular powder which is

odorless and is stable in air.

Its solutions are neutral or alkaline to litmus.It is freely soluble in water and practically

insoluble in alcohol

Deliquescence in indicative of the presence of

carbonate.DELIQUESCENCE

Is the process by which a substance absorbs moisture

from the atmosphere until it dissolves in the absorbed

water and forms a solution.

Properties



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Electrolytes replenisher.

Component along with potassium acetate and citrate of

Potassium Triplex and oral effervescent potassium replacement

solution (K-lyte).

Antacid for people who must restrict their sodium intake, but

there is a riskhyperpotassemia with prolonged use.

Uses

HYPERPOTASSEMIA

Abnormally high potassium concentration in the

blood, most often due to defective renal excretion.


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(C6H5Na3O7)

Mol. Wt. 258.07

SODIUM CITRATE


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Synonyms

1,2,3-Propanetricarboxylic acid

2-hydroxy-, trisodium salt.

SODIUM CITRATE


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Occurs as colorless crystals, or as a white

crystalline powder.

Anhydrous or contains two moles of

hydration.

Label must indicates the physical form.

As the hydrous salt, sodium citrate is freely

soluble in water and very soluble in boiling

water; soluble in alcohol.

Properties

SODIUM CITRATE


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as Anticoagulant for whole blood.

chelates serum calcium, thereby removing one of the component

of blood clotting.

Citrates are used for the chelation of other cations e.g , Benedicts

solution and Ferrous Sulfate Syrup., Citric acid and its salts as

buffering agents.

Uses

ANTICOAGULANT

stops blood from clotting

U

SODIUM CITRATE


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as Anticoagulant for whole blood.

chelates serum calcium, thereby removing one of the component

of blood clotting.

Citrates are used for the chelation of other cations e.g , Benedicts

solution and Ferrous Sulfate Syrup., Citric acid and its salts as

buffering agents.

Uses

CHELATION

administration of chelating agents to

remove heavy metals from the body

U

SODIUM CITRATE


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Because citrate, a componentof the tricarboxylic acid or Krebs

cycle is rapidly metabolized to carbon dioxide and then to

bicarbonate.

Used in chronic acidosis to restore bicarbonate reserve.

Has diuretic effects due to increased body salt concentration.

CHRONIC ACIDOSISwhich is also called latent acidosis

is much more commonly observed featuring a slight shift of blood pH in the acid

direction within the normal range (7.347.45). At the same time, blood buffering

capacity is diminished

Uses

U

SODIUM CITRATE


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Because citrate, a componentof the tricarboxylic acid or Krebs

cycle is rapidly metabolized to carbon dioxide and then to

bicarbonate.

Used in chronic acidosis to restore bicarbonate reserve.

Has diuretic effects due to increased body salt concentration.

DIURETIC

promotes the formation of urine by the kidney.

Uses


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(C6H5K3O7.H20)

Mol. Wt. 342

P ti

POTASSIUM CITRATE


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transparent crystals or as

white, granular powder.

Odorless, has cooling salinetaste and is deliquescent when

exposed to moist air

Freely soluble in water andalmost insoluble in alcohol.

Properties

U

POTASSIUM CITRATE


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Uses

being alkali salt of organic acid,

potassium citrate is used as systemic

alkalizer.

As diuretic, diaphoretic,expectorant, laxative, and gastric

antacid.

EXPECTORANT

agent which dissolves thick mucus and is

usually used to help relieve respiratory

difficulties.

LAXATIVEused to produce bowel movements

ANTACID

neutralizes stomach acidity

ALKALIZER

an agent that counteracts or

neutralizes acidity

DIAPHORETIC

induce involuntary perspiration that

helps to reduce fever

DIURETIC

Anything that promotes the formation

of urine by the kidney


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I n short term therapy, such as following surgery,

infusion of standard glucose and saline solution maybeadequate

however, when deficits are severe, solutions

containing additional electrolytes are usually required.

These combination products can

be divided into two groups.

FLUID MAINTENANCEELECTROLYTE

REPLACEMENT


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MAINTENANCE THERAPY with intravenous fluid is

intended to supply normal requirement for water ad electrolytes

to patients who cannot take them orally.

All maintenance solution should contain at least 5% dextrose.

This minimizes the build-up of those metabolited associated with

starvation urea, phosphate and ketone bodies.


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In addition to dextrose, the general electrolyte composition

of maintenance solutions are Na, Cl, HCO3 , Mg and P ions.

REPLACEMENT THERAPY is needed when there is

heavy loss of water and electrolyte, as in prolonged fever,

severe vomiting, and initial replacement more or less

resembles the electrolyte concentrations found in theextracellular fluids.


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Ringers Injection USP XXeach liter

contains 8.6g sodium chloride, 0.3g

potassium chloride and 0.33g calcium

chloride.

Lactated Ringers Injection USP XX

each 100mL contains 600mg sodium

chloride, 30mg potassium chloride and 20mg

calcium and 310mg sodium lactate

ORAL ELECTROLYTE SOLUTIONS are used to supply


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ORAL ELECTROLYTE SOLUTIONS are used to supply

water and electrolyte in amount needed for maintenance as soon

as intake of usual foods and liquids is discontinued and beforeserious fluid losses or deficits occurs.

They are also given to replace mild to moderate fluids losses due

to diarrhea and other conditions associated with excessive fluidloss or deficit fluid intake.

Example of these solutions are

PEDIALYTE manufactured by Abbott Laboratories

LYTREN


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ATP- Adenosine Triphosphate

FAD- Flavin Adenine Dinucleotide

NAD- Nicotinamide Adenine Dinucleotide

group3 bsph 2f1

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