group3 BSPh 2F1
-
Upload
ames-morales-torres -
Category
Documents
-
view
236 -
download
0
Transcript of group3 BSPh 2F1
-
8/2/2019 group3 BSPh 2F1
1/126
MAJOR INTRA EXTRACELLULARELECTROLYTES
-
8/2/2019 group3 BSPh 2F1
2/126
-
8/2/2019 group3 BSPh 2F1
3/126
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
-
8/2/2019 group3 BSPh 2F1
4/126
-
8/2/2019 group3 BSPh 2F1
5/126
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.
-
8/2/2019 group3 BSPh 2F1
6/126
-
8/2/2019 group3 BSPh 2F1
7/126
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.
-
8/2/2019 group3 BSPh 2F1
8/126
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
-
8/2/2019 group3 BSPh 2F1
9/126
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
-
8/2/2019 group3 BSPh 2F1
10/126
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
-
8/2/2019 group3 BSPh 2F1
11/126
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
-
8/2/2019 group3 BSPh 2F1
12/126
Chloride
Sodium
Potassium Phosphorus
Magnesium
Calcium
MAJOR PHYSIOLOGICAL IONS
-
8/2/2019 group3 BSPh 2F1
13/126
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)
-
8/2/2019 group3 BSPh 2F1
14/126
Principal Metabolic Functions
- Buffer constituent, acid-
base balance, water balance, C0 2
transport, osmotic pressure, cellmembrane permeability, muscle
irritability
Clinical Manifestation of
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.
-
8/2/2019 group3 BSPh 2F1
15/126
Principal Metabolic Functions
- Buffer constituent, acid-
base balance, water balance, C0 2
transport, osmotic pressure, cellmembrane permeability, muscle
irritability
Clinical Manifestation of
Deficiency- Dehydration, acidosis,
tissue atrophy, an excess lead to
edema and hypertension
ACIDOSIS
It is a condition in which
there is excessive acid in
the body fluids.
-
8/2/2019 group3 BSPh 2F1
16/126
Principal Metabolic Functions
- Buffer constituent, acid-
base balance, water balance, C0 2
transport, osmotic pressure, cellmembrane permeability, muscle
irritability
Clinical Manifestation of
Deficiency- Dehydration, acidosis,
tissue atrophy, an excess lead to
edema and hypertension
ATROPHY
It is the
general physiological pr
ocess of reabsorption
and breakdown
of tissues,involving apoptosis on
a cellular level.
-
8/2/2019 group3 BSPh 2F1
17/126
Principal Metabolic Functions
- Buffer constituent, acid-
base balance, water balance, C0 2
transport, osmotic pressure, cellmembrane permeability, muscle
irritability
Clinical Manifestation of
Deficiency- Dehydration, acidosis,
tissue atrophy, an excess lead to
edema and hypertension
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
-
8/2/2019 group3 BSPh 2F1
18/126
Principal Metabolic Functions
- Buffer constituent, acid-
base balance, water balance, C0 2
transport, osmotic pressure, cellmembrane permeability, muscle
irritability
Clinical Manifestation of
Deficiency- Dehydration, acidosis,
tissue atrophy, an excess lead to
edema and hypertension
-
8/2/2019 group3 BSPh 2F1
19/126
Principal Metabolic Functions
- Buffer constituent, acid-
base balance, water balance, C0 2
transport, osmotic pressure, cellmembrane permeability, muscle
irritability
Clinical Manifestation of
Deficiency- Dehydration, acidosis,
tissue atrophy, an excess lead to
edema and hypertension
HYPERTENSION
(Also known as high blood
pressure )
is a cardiac chronic medical
condition in which thesystemic arterial blood
pressure is elevated.
-
8/2/2019 group3 BSPh 2F1
20/126
Principal Metabolic Functions
- Buffer constituent, acid-base balance, CO 2 transport,
neuromuscular irritability
Clinical Manifestation of
Deficiency- Acidosis, renal damage
ACIDOSIS
It is a condition in which
there is excessive acid in
the body fluids.
-
8/2/2019 group3 BSPh 2F1
21/126
Principal Metabolic Functions
- Formation of apatite inbones and teeth, blood clotting
Clinical Manifestation of
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
-
8/2/2019 group3 BSPh 2F1
22/126
Principal Metabolic Functions
- Formation of apatite inbones and teeth, blood clotting
Clinical Manifestation of
Deficiency
- Rickets, poor growth,
osteoporosis
-
8/2/2019 group3 BSPh 2F1
23/126
Principal Metabolic Functions
- Formation of apatite inbones and teeth, blood clotting
Clinical Manifestation of
Deficiency
- Rickets, poor growth,
osteoporosis
OSTEOPOROSIS
It is the thinning of bone
tissue and loss of bone
density over time
-
8/2/2019 group3 BSPh 2F1
24/126
Principal Metabolic Functions
- Formation of apatite inbones and teeth, blood clotting
Clinical Manifestation of
Deficiency
- Rickets, poor growth,
osteoporosis
-
8/2/2019 group3 BSPh 2F1
25/126
Principal Metabolic Functions
- Cofactor for PO4
transferring enzymes; constituentof bones and teeth
Clinical Manifestation of
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.
-
8/2/2019 group3 BSPh 2F1
26/126
Principal Metabolic Functions
- Cofactor for PO4
transferring enzymes; constituentof bones and teeth
Clinical Manifestation of
Deficiency
- Muscular tremor,
reinform movement
-
8/2/2019 group3 BSPh 2F1
27/126
Principal Metabolic Functions
- Constituent of bones
and teeth; constituents of buffers;constituents(as HPO4)2 ofATP,
NAD, FAD
Clinical Manifestation of
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.
-
8/2/2019 group3 BSPh 2F1
28/126
Principal Metabolic Functions
- Constituent of bones
and teeth; constituents of buffers;constituents(as HPO4)2 of ATP,
NAD, FAD
Clinical Manifestation of
Deficiency
- Renal rickets, cardiac
arrhythmia, osteomalacia
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
-
8/2/2019 group3 BSPh 2F1
29/126
Principal Metabolic Functions
- Constituent of bones
and teeth; constituents of buffers;constituents(as HPO4)2 of ATP,
NAD, FAD
Clinical Manifestation of
Deficiency
- Renal rickets, cardiac
arrhythmia, osteomalacia
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.
-
8/2/2019 group3 BSPh 2F1
30/126
Principal Metabolic Functions
- Constituent of bones
and teeth; constituents of buffers;constituents(as HPO4)2 of ATP,
NAD, FAD
Clinical Manifestation of
Deficiency
- Renal rickets, cardiac
arrhythmia, osteomalacia
-
8/2/2019 group3 BSPh 2F1
31/126
Sodium Chloride USP XX
Calcium Chloride USP XX
Potassium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
32/126
(NaCl)
Mol. Wt. 58.44
S i C i S
-
8/2/2019 group3 BSPh 2F1
33/126
- Table Salt
- sea salt- sal
- Asin(tagalog)
Sodium Chloride USP XX
Synonyms:
S di Chl id USP XX
-
8/2/2019 group3 BSPh 2F1
34/126
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.
Sodium Chloride USP XX
Occurrence
S di Chl id USP XX
-
8/2/2019 group3 BSPh 2F1
35/126
In solutions it is found in the sea, some lakes, springs, and wells
Sodium Chloride USP XX
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
-
8/2/2019 group3 BSPh 2F1
36/126
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.
Sodium Chloride USP XX
Preparations
S di Chl id USP XX
-
8/2/2019 group3 BSPh 2F1
37/126
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.
Sodium Chloride USP XX
Preparations
S di Chl id USP XX
-
8/2/2019 group3 BSPh 2F1
38/126
Sodium Chloride USP XX
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
-
8/2/2019 group3 BSPh 2F1
39/126
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.
Sodium Chloride USP XX
Preparations
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
40/126
Sodium Chloride USP XX
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.
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.
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
41/126
Sodium Chloride USP XX
Preparations
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.
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
42/126
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
Sodium Chloride USP XX
Properties:
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
43/126
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.
Sodium Chloride USP XX
Uses
PULMONARY EDEMA
is fluid accumulation
in the lungs. It leads to
impaired gas exchange
and may cause
respiratory failure.
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
44/126
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.
Sodium Chloride USP XX
Uses
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
45/126
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.
Sodium Chloride USP XX
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.
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
46/126
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.
Sodium Chloride USP XX
Uses
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
47/126
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.
Sodium Chloride USP XX
Uses
Sodium Chloride USP XX
-
8/2/2019 group3 BSPh 2F1
48/126
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.
Sodium Chloride USP XX
Uses
-
8/2/2019 group3 BSPh 2F1
49/126
(KCl)
Mol. Wt. 74.56
POTASSIUM CHLORIDE USP
-
8/2/2019 group3 BSPh 2F1
50/126
Synonyms:
POTASSIUM CHLORIDE USP
Kalium Chloratum
Kali Chloridum
POTASSIUM CHLORIDE USP
-
8/2/2019 group3 BSPh 2F1
51/126
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)]
POTASSIUM CHLORIDE USP
SYLVITE
CARNALLITE
Occurrence:
POTASSIUM CHLORIDE USP
-
8/2/2019 group3 BSPh 2F1
52/126
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.
POTASSIUM CHLORIDE USP
Properties
POTASSIUM CHLORIDE USP
-
8/2/2019 group3 BSPh 2F1
53/126
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
POTASSIUM CHLORIDE USP
-
8/2/2019 group3 BSPh 2F1
54/126
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
POTASSIUM CHLORIDE USP
-
8/2/2019 group3 BSPh 2F1
55/126
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)
POTASSIUM CHLORIDE USP
-
8/2/2019 group3 BSPh 2F1
56/126
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
-
8/2/2019 group3 BSPh 2F1
57/126
(CaCl2.2H2O)
Mol. Wt. 147
CALCIUM CHLORIDE
-
8/2/2019 group3 BSPh 2F1
58/126
Synonyms
Cloruro de Calcio
Muriate of Lime
Fosforo de Homberg
CALCIUM CHLORIDE
-
8/2/2019 group3 BSPh 2F1
59/126
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
-
8/2/2019 group3 BSPh 2F1
60/126
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
-
8/2/2019 group3 BSPh 2F1
61/126
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.
-
8/2/2019 group3 BSPh 2F1
62/126
-
8/2/2019 group3 BSPh 2F1
63/126
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.
-
8/2/2019 group3 BSPh 2F1
64/126
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.
-
8/2/2019 group3 BSPh 2F1
65/126
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.
-
8/2/2019 group3 BSPh 2F1
66/126
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
67/126
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.
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
68/126
Conditions
(causes)
Buffer
System
Respiratory
Function
Renal
Function
Metabolic Acidosis-
Primary HCO3deficit
(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
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.
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
69/126
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,
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
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
70/126
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.
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
71/126
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.
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
72/126
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
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
73/126
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
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
74/126
C
(causes) System
p a y
Function
a
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.
HYSTERIA
Behavior exhibiting excessive or uncontrollable emotion, such as fear or
panic.
Conditions Buffer Respiratory Renal
-
8/2/2019 group3 BSPh 2F1
75/126
ANOXIA
means a total decrease in the level of oxygen, an extreme form of hypoxia or
"low oxygen".
(causes) System
p y
Function 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.
-
8/2/2019 group3 BSPh 2F1
76/126
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.
-
8/2/2019 group3 BSPh 2F1
77/126
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
-
8/2/2019 group3 BSPh 2F1
78/126
-
8/2/2019 group3 BSPh 2F1
79/126
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.
-
8/2/2019 group3 BSPh 2F1
80/126
(CH3COONa.3H20)Mol. Wt. 136
SODIUM ACETATE USP XX
SODIUM ACETATE
-
8/2/2019 group3 BSPh 2F1
81/126
Acetate of soda
Acetado de-Sosa
Synonyms
SODIUM ACETATE
-
8/2/2019 group3 BSPh 2F1
82/126
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
-
8/2/2019 group3 BSPh 2F1
83/126
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
-
8/2/2019 group3 BSPh 2F1
84/126
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
UREMIC ACIDOSIS
metabolic acidosis seen in
chronic renal disease when the
ability to excrete acid is
decreased.
SODIUM ACETATE
-
8/2/2019 group3 BSPh 2F1
85/126
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
DIURETIC
Anything that promotes the
formation of urine by the
kidney.
SODIUM ACETATE
-
8/2/2019 group3 BSPh 2F1
86/126
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
DIAPHORETIC
induce involuntary
perspiration that helps to
reduce fever
SODIUM ACETATE
-
8/2/2019 group3 BSPh 2F1
87/126
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
APERIENT
(laxative)
gently moving the bowels
SODIUM ACETATE
-
8/2/2019 group3 BSPh 2F1
88/126
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
ALKALIZER
an agent that counteracts or
neutralizes acidity
-
8/2/2019 group3 BSPh 2F1
89/126
(CH3COOK)Mol. Wt. 98.15
POTASSIUM ACETATE
-
8/2/2019 group3 BSPh 2F1
90/126
Diuretic salts
Synonyms
POTASSIUM ACETATE
-
8/2/2019 group3 BSPh 2F1
91/126
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
-
8/2/2019 group3 BSPh 2F1
92/126
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
-
8/2/2019 group3 BSPh 2F1
93/126
(NaHCO3)Mol. Wt. 84.01
SODIUM BICARBONATE
-
8/2/2019 group3 BSPh 2F1
94/126
Baking Soda
Soda Saleratus
Sal de Vichy
Soda Acid Carbonate
Sodium Hydrogen Carbonate
Bicarbonate of Soda
Synonyms
SODIUM BICARBONATE
-
8/2/2019 group3 BSPh 2F1
95/126
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
-
8/2/2019 group3 BSPh 2F1
96/126
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
-
8/2/2019 group3 BSPh 2F1
97/126
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
-
8/2/2019 group3 BSPh 2F1
98/126
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.
-
8/2/2019 group3 BSPh 2F1
99/126
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
-
8/2/2019 group3 BSPh 2F1
100/126
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
-
8/2/2019 group3 BSPh 2F1
101/126
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.
-
8/2/2019 group3 BSPh 2F1
102/126
-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.
-
8/2/2019 group3 BSPh 2F1
103/126
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
-
8/2/2019 group3 BSPh 2F1
104/126
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.
-
8/2/2019 group3 BSPh 2F1
105/126
(KHCO3)
Mol. Wt. 100.12
POTASSIUM BICARBONATE
-
8/2/2019 group3 BSPh 2F1
106/126
Synonyms
Potassium Acid Carbonate
Salaeratus
POTASSIUM BICARBONATE
-
8/2/2019 group3 BSPh 2F1
107/126
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
POTASSIUM BICARBONATE
-
8/2/2019 group3 BSPh 2F1
108/126
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.
-
8/2/2019 group3 BSPh 2F1
109/126
(C6H5Na3O7)
Mol. Wt. 258.07
SODIUM CITRATE
-
8/2/2019 group3 BSPh 2F1
110/126
Synonyms
1,2,3-Propanetricarboxylic acid
2-hydroxy-, trisodium salt.
SODIUM CITRATE
-
8/2/2019 group3 BSPh 2F1
111/126
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
-
8/2/2019 group3 BSPh 2F1
112/126
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
-
8/2/2019 group3 BSPh 2F1
113/126
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
-
8/2/2019 group3 BSPh 2F1
114/126
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
-
8/2/2019 group3 BSPh 2F1
115/126
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
-
8/2/2019 group3 BSPh 2F1
116/126
(C6H5K3O7.H20)
Mol. Wt. 342
P ti
POTASSIUM CITRATE
-
8/2/2019 group3 BSPh 2F1
117/126
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
-
8/2/2019 group3 BSPh 2F1
118/126
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
-
8/2/2019 group3 BSPh 2F1
119/126
-
8/2/2019 group3 BSPh 2F1
120/126
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
-
8/2/2019 group3 BSPh 2F1
121/126
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.
-
8/2/2019 group3 BSPh 2F1
122/126
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.
-
8/2/2019 group3 BSPh 2F1
123/126
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
-
8/2/2019 group3 BSPh 2F1
124/126
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
-
8/2/2019 group3 BSPh 2F1
125/126
-
8/2/2019 group3 BSPh 2F1
126/126
ATP- Adenosine Triphosphate
FAD- Flavin Adenine Dinucleotide
NAD- Nicotinamide Adenine Dinucleotide