Pharmacology Quiz on Electrolytes and pH Balance
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Questions and Answers

What is the pH range of Calcium Chloride injection?

  • 6.5 - 8.0
  • 4.5 - 6.0
  • 5.0 - 7.5 (correct)
  • 3.5 - 5.5
  • Which statement about Sodium Chloride and Dextrose injection is NOT true?

  • It contains not less than 95% of the stated amount.
  • It contains antimicrobial agents. (correct)
  • It is a clear colorless or faintly straw colored solution.
  • It has a pH range of 3.5 - 6.5.
  • What is the minimum percentage of calcium chloride required in Calcium Lactate?

  • 97% (correct)
  • 95%
  • 99%
  • 93%
  • In which condition is Potassium Chloride NOT typically used?

    <p>Acute dehydration (C)</p> Signup and view all the answers

    What describes acedemia?

    <p>Abnormal decrease in blood pH (A)</p> Signup and view all the answers

    Which of the following compounds is less soluble in water than sodium chloride?

    <p>Potassium chloride (D)</p> Signup and view all the answers

    What is the molecular weight of Potassium Chloride?

    <p>74.56 (A)</p> Signup and view all the answers

    What is NOT a typical use of Calcium Lactate?

    <p>Potassium deficiency treatment (C)</p> Signup and view all the answers

    What is the primary characteristic of metabolic alkalosis?

    <p>Inability to excrete alkali due to renal damage (B)</p> Signup and view all the answers

    What results from respiratory alkalosis?

    <p>Decrease in arterial pCO2 (C)</p> Signup and view all the answers

    Which drug interaction is caused by mixing with sodium bicarbonate?

    <p>Formation of insoluble precipitates (D)</p> Signup and view all the answers

    Which of the following is NOT a use of sodium bicarbonate?

    <p>As a laxative (C)</p> Signup and view all the answers

    Which factor does NOT contribute to respiratory alkalosis?

    <p>Excessive vomiting (D)</p> Signup and view all the answers

    Which solution is recommended for treating acute poisoning from acidic drugs?

    <p>Sodium bicarbonate (D)</p> Signup and view all the answers

    In which condition is contraction alkalosis seen?

    <p>Excessive Cl– and sodium loss due to diuretics (C)</p> Signup and view all the answers

    What happens to the solubility of sodium bicarbonate upon standing or heating?

    <p>Increases (A)</p> Signup and view all the answers

    What role does the bicarbonate-carbonic acid buffer system play in extracellular fluid?

    <p>It helps maintain the extracellular pH within a narrow range. (D)</p> Signup and view all the answers

    Why is the hemoglobin buffer system considered the most effective?

    <p>It removes more protons for each millimole of oxygen dissociated. (D)</p> Signup and view all the answers

    What process occurs during the chloride shift?

    <p>An exchange of bicarbonate for chloride ions. (D)</p> Signup and view all the answers

    What is the normal HCO3-/H2CO3 ratio corresponding to a pH of 7.4?

    <p>27/1.35 meq/lt (D)</p> Signup and view all the answers

    What happens to carbon dioxide when it enters the erythrocytes?

    <p>It reacts with water to form carbonic acid. (B)</p> Signup and view all the answers

    What physiological mechanism helps control the bicarbonate-carbonic acid ratio?

    <p>Breathing regulation influences the levels of carbon dioxide and bicarbonate. (D)</p> Signup and view all the answers

    Why is a continuous supply of carbon dioxide essential for the buffering system?

    <p>It provides a sufficient concentration to maintain buffering. (C)</p> Signup and view all the answers

    What triggers the dissociation of carbonic acid in the lungs?

    <p>An abundance of oxygen combining with deoxyhemoglobin. (D)</p> Signup and view all the answers

    What is the primary objective of replacement therapy?

    <p>To restore the volume and composition of body fluids to normal (C)</p> Signup and view all the answers

    In a severe volume depletion scenario, what is the recommended intravenous therapy rate for the first 1000 ml?

    <p>100 ml per minute (D)</p> Signup and view all the answers

    What is the common use of isotonic sodium chloride solutions?

    <p>Irrigating body cavities or tissues (C)</p> Signup and view all the answers

    What is the acceptable w/v percentage range for Sodium Chloride Injection?

    <p>0.85% to 0.95% (A)</p> Signup and view all the answers

    What distinguishes hypertonic sodium chloride injection from isotonic sodium chloride injection?

    <p>Higher sodium concentration (D)</p> Signup and view all the answers

    In which situation are hypotonic solutions typically administered?

    <p>During maintenance therapy when oral intake is not possible (C)</p> Signup and view all the answers

    What is the pH range for Sodium Chloride Hypertonic Injection?

    <p>5.0 to 7.5 (A)</p> Signup and view all the answers

    What is typically included in Compound Sodium Chloride Injection apart from sodium chloride?

    <p>Potassium chloride (C)</p> Signup and view all the answers

    What is the typical HPO4-2/H2PO4- ratio at physiological pH of 7.4?

    <p>4:1 (C)</p> Signup and view all the answers

    Which process involves the preferential removal of sodium in the kidneys?

    <p>Sodium hydrogen exchange (D)</p> Signup and view all the answers

    What characterizes metabolic acidosis?

    <p>Excess production of protons (C)</p> Signup and view all the answers

    Which treatment is used for metabolic acidosis due to bicarbonate deficit?

    <p>Administration of sodium salts of bicarbonate (C)</p> Signup and view all the answers

    Respiratory acidosis is primarily caused by which of the following?

    <p>Retention of carbon dioxide (D)</p> Signup and view all the answers

    Which condition is NOT a cause of renal acidosis?

    <p>Increased dietary bicarbonate (A)</p> Signup and view all the answers

    What may cause metabolic acidosis due to excessive loss of alkaline fluid?

    <p>Diarrhea (C)</p> Signup and view all the answers

    What ions are typically used to treat metabolic acidosis?

    <p>Lactate and acetate (B)</p> Signup and view all the answers

    What is the primary use of potassium acetate?

    <p>As a buffer in metabolic acidosis (B)</p> Signup and view all the answers

    What physical form does sodium citrate typically occur in?

    <p>Granular crystals (D)</p> Signup and view all the answers

    In which circumstance is sodium citrate particularly utilized?

    <p>Anticoagulation of blood (C)</p> Signup and view all the answers

    What is the solubility characteristic of potassium citrate in alcohol?

    <p>Practically insoluble (C)</p> Signup and view all the answers

    What kind of effect does ammonium chloride have on the body?

    <p>Diuretic effect (D)</p> Signup and view all the answers

    What is the pH range of a 5% potassium acetate solution in water?

    <p>7.5 to 9.2 (C)</p> Signup and view all the answers

    How should potassium acetate be stored?

    <p>In airtight containers (B)</p> Signup and view all the answers

    What is sodium citrate's solubility characteristic in ethanol?

    <p>Practically insoluble (A)</p> Signup and view all the answers

    Flashcards

    Replacement Therapy

    The process of restoring the volume and composition of body fluids to normal levels.

    Volume Contraction

    A condition that occurs when the body loses excessive fluid, affecting circulation, blood volume, and overall fluid balance.

    Isotonic Sodium Chloride Solution

    A solution used to replenish fluids and electrolytes, typically used in intravenous therapy.

    Sodium Chloride Injection

    A type of sodium chloride solution used in medical treatments, containing a specific concentration of sodium chloride.

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    Sodium Chloride Hypertonic Injection

    A type of sodium chloride solution used in medical treatments, containing a higher concentration of sodium chloride than isotonic solutions.

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    Compound Sodium Chloride Injection (Ringer Injection)

    A type of intravenous solution containing sodium chloride, potassium chloride and calcium chloride, often used for fluid and electrolyte replacement.

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    Isotonic, Hypotonic, and Hypertonic Solutions

    Solutions used in medical treatments to restore fluid balance, categorized by their concentration compared to the body's fluids.

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    Fluid and Electrolyte Replenishment

    The process of providing fluids and electrolytes to maintain normal bodily function, especially during times of illness or dehydration.

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    Calcium Chloride Injection

    A sterile solution containing calcium chloride in water for injection. Used for calcium replacement therapy. It is clear, colorless, and has a pH between 5 and 7.5. It does not contain any antimicrobial agents.

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    Sodium Chloride and Dextrose Injection

    A sterile solution of sodium chloride and dextrose in water for injection. Used for fluid and electrolyte replacement. It is clear, colorless or faintly straw-colored, with a pH between 3.5 and 6.5. It contains a specific concentration of sodium chloride and dextrose.

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    Potassium Chloride

    A white crystalline solid used to replenish potassium in the body. It is less soluble in water than sodium chloride, and more soluble in boiling water. It is also soluble in glycerine but insoluble in alcohol.

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    Calcium Lactate

    A white, odorless powder that is soluble in water. Used as an oral calcium supplement in cases of calcium deficiency.

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    Acedemia

    A decrease in the pH of the blood, making it more acidic.

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    Acidosis

    A clinical state that can lead to acedemia. This state can involve respiratory or metabolic disturbances.

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    Alkalemia

    An increase in the pH of the blood, making it more alkaline.

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    Alkalosis

    A clinical state that can lead to alkalemia. This can involve respiratory or metabolic issues.

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    Bicarbonate-Carbonic Acid Buffer System

    The chemical system in the body that helps maintain a stable pH level, primarily composed of bicarbonate (HCO3-) and carbonic acid (H2CO3).

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    pH Regulation

    The ability of the body to maintain a stable pH level within a narrow range, typically between 7.38 and 7.42.

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    Acid Production

    The process by which the body produces acids as a byproduct of normal metabolic reactions.

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    Blood pH Regulation

    The process of maintaining a stable pH level in the blood, within a narrow range of 7.38 to 7.42, using various buffer systems.

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    Bicarbonate-Carbonic Acid Buffer System in Blood

    The primary buffer system that controls blood pH, composed of bicarbonate and carbonic acid.

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    CO2 Formation and Carbonic Acid

    The process by which carbon dioxide (CO2) produced in cells diffuses into the blood and reacts with water to form carbonic acid (H2CO3).

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    Chloride Shift

    A process that occurs in red blood cells (RBCs) where bicarbonate ions (HCO3-) diffuse out of the RBCs and chloride ions (Cl-) diffuse into the RBCs to maintain electrical neutrality.

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    Hemoglobin Buffer System

    The ability of hemoglobin in red blood cells to bind with and release protons (H+), effectively buffering carbonic acid produced during metabolism.

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    Phosphate Buffer System

    The phosphate buffer system is a complex of HPO4-2 and H2PO4-, which acts as a buffer in the body fluids. It effectively maintains pH. At pH 7.4, the ratio of HPO4-2 to H2PO4- is approximately 4:1.

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    Metabolic Acidosis

    Metabolic acidosis occurs due to excess proton production in the body, often caused by accelerated metabolism, intake of acidic drugs, or loss of alkaline fluids.

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    Respiratory Acidosis

    Respiratory acidosis is caused by an accumulation of carbon dioxide (CO2) in the body, leading to increased carbonic acid content. It can be caused by chronic lung diseases, respiratory muscle paralysis, or drugs that interfere with breathing.

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    Treating Metabolic Acidosis

    Metabolic acidosis is treated by administering sodium salts like bicarbonate, lactate, acetate, or citrate. These substances help increase the HCO3-/H2CO3 ratio, restoring pH balance.

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    Renal Acidosis

    Renal acidosis occurs when the kidneys are unable to properly remove H+ from the body. It can be seen in tubular disorders, Addison's disease, or when certain drugs interfere with H+ secretion.

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    Sodium Hydrogen Exchange

    Sodium hydrogen exchange is a critical process in the kidney that removes H+ from the body. Sodium (Na+) in the tubular fluid is exchanged for hydrogen ions (H+), leading to the excretion of acidic urine.

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    Renal Role in Acid-Base Balance

    The kidneys play a vital role in maintaining acid-base balance by excreting H+ in the urine. They achieve this by filtering and reabsorbing substances, adjusting the concentration of H+ and bicarbonate to stabilize pH.

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    Compensated Alkalosis

    A state of alkalosis where the hydrogen ion concentration in the plasma remains normal, despite an overall reduction in body's hydrogen ion content.

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    Metabolic Alkalosis

    A type of alkalosis caused by the kidneys' inability to excrete alkali efficiently. It can occur due to alkali ingestion, excessive vomiting, or renal damage.

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    Contraction Alkalosis

    A type of alkalosis that develops following the administration of diuretics, leading to excessive loss of chloride and sodium ions.

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    Respiratory Alkalosis

    A type of alkalosis caused by hyperventilation, which removes excess carbon dioxide from the body, reducing the hydrogen ion concentration.

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    Sodium Bicarbonate

    A common medicine used in treating metabolic acidosis, diarrhea, acidic drug poisoning, and dyspepsia. It also has uses in ophthalmic and ear care.

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    Sodium Acetate

    A salt used in various medical applications, including as an alternative to sodium bicarbonate in some cases.

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    Potassium Acetate

    A colorless, transparent crystal or white granular powder that is soluble in water and alcohol. It acts as a buffer in metabolic acidosis and is used in peritoneal dialysis fluid.

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    Sodium Citrate

    A white, granular crystal or white crystalline powder that is soluble in water but practically insoluble in ethanol. It has various uses, including systemic alkalizing, anticoagulation, and desensitizing agent in dentifrices.

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    Potassium Citrate

    A transparent, odourless, hygroscopic crystal or a white granular powder, soluble in water and glycerol, but practically insoluble in alcohol. It is used as a systemic alkalizer and a gastric antacid.

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    Ammonium Chloride

    A sterile solution of ammonium chloride in water for injection. It contains not less than 99.5% and not more than 105% of ammonium chloride with reference to dried substance. It is used to adjust the acid-base equilibrium of the body and has a diuretic effect.

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    Study Notes

    Replacement Therapy

    • The main goal of replacement therapy is to restore the volume and composition of bodily fluids to normal levels.
    • Volume contraction is life-threatening because it hinders circulation, decreases blood volume, lowers cardiac output, and compromises microcirculation.
    • In cases of severe volume depletion, a rapid infusion of isotonic sodium chloride solution is necessary.
    • In critical situations, intravenous therapy at 100ml per minute for the first 1000ml is considered crucial for treating cholera.
    • A common guideline is to replace half of the estimated volume loss during the first 12-24 hours of treatment.

    Sodium Replacement

    • Sodium Chloride (NaCl) has a molecular weight (MW) of 58.44.
    • It exists as colorless cubic crystals or white crystalline powder, with a saline taste.
    • It's highly soluble in water and, to a lesser degree, in boiling water, glycerin, and alcohol.

    Sodium Chloride Uses

    • Used as a fluid and electrolyte replenisher.
    • Utilized in preparing isotonic solutions.
    • Provides flavor enhancement.
    • Used in wet dressings.
    • Used for irrigating cavities and tissues..

    Sodium Chloride Injection

    • A sterile isotonic sodium chloride solution in water for injection.
    • Contains a minimum of 0.85% and a maximum of 0.95% w/v sodium chloride.
    • Does not contain any antimicrobial agents.
    • The pH of the solution ranges between 4.5 and 7.0.

    Sodium Chloride Hypertonic Injection

    • A sterile sodium chloride solution for injection.
    • Contains a minimum of 1.52% and a maximum of 1.68% w/v sodium chloride.
    • Free of antimicrobial agents.
    • Has a pH between 5 and 7.5.
    • Meets pyrogen testing requirements.

    Compound Sodium Chloride Injection (Ringer Injection)

    • Contains:
      • Minimum 0.82%, maximum 0.9% w/v sodium chloride.
      • Minimum 0.0285%, maximum 0.0315% w/v potassium chloride.
      • Minimum 0.03%, maximum 0.036% w/v calcium chloride in water for injection.
    • Free of antimicrobial agents.
    • pH between 5 and 7.5.

    Sodium Chloride and Dextrose Injection

    • A sterile solution of sodium chloride and dextrose in water for injection.
    • It appears clear, colorless, or faintly straw-colored.
    • The pH ranges between 3.5 and 6.5.
    • Contains a specified percentage (95% to 105%) of sodium chloride and dextrose.

    Potassium Replacement (Potassium Chloride)

    • Potassium Chloride (KCl) has a molecular weight (MW) of 74.56.
    • Contains a minimum of 99% of dried substance.
    • Exists as a white crystalline solid, cubic crystals.
    • Less soluble in water than sodium chloride, slightly more soluble in boiling water; soluble in glycerin, and insoluble in alcohol.

    Potassium Chloride Injection (Ringer Injection) Uses

    • Replenishes electrolytes in potassium deficiency.
    • Treats familial periodic paralysis, Meniere's syndrome, and digitalis intoxication.
    • Treats myasthenia gravis.
    • Contraindicated in renal impairment and acute dehydration.

    Calcium Replacement (Calcium Lactate)

    • Calcium lactate has a molecular weight (MW) of 308.30.
    • Potassium chloride must be between 97% and 103% of Calcium Chloride dihydrate.
    • Occurs as a white odourless powder.
    • Soluble in water, virtually insoluble in alcohol.
    • Used for oral calcium deficiency treatment.

    Physiological Acid-Base Balance

    • Variations in blood pH are significant clinically.
    • Acidaemia and alkalaemia denote abnormal decreases or increases in blood pH, respectively.
    • Acidosis and alkalosis are clinical conditions that can result in acidaemia or alkalaemia.
    • The degree of pH change often depends on compensation mechanisms, which vary between conditions. A common technique to assess is through bicarbonate-carbonic acid (HCO3- - H2CO3) system.

    Extracellular Fluid Buffer System

    • Bicarbonate is the most abundant buffer component in extracellular fluid.
    • Carbon dioxide supply is unlimited.
    • Physiological processes maintain extracellular pH by controlling fluid.
    • The bicarbonate-carbonic acid buffer system coexists with hemoglobin.

    Acid Production and Buffering

    • Metabolisms produce acids continuously.
    • Most metabolic processes occur in a narrow pH range (7.38-7.42).
    • The body uses buffer systems (Bicarbonate/carbonic acid and monohydrogen phosphate/dihydrogen phosphate) in plasma, kidneys, and cells.
    • Red blood cells (RBCs) use hemoglobin's buffering system to neutralize carbonic acid.

    Carbon Dioxide Buffering in Blood

    • Carbon dioxide (CO2) produces carbonic acid in the cells which diffuses into the blood and reacts with water.
    • Increased carbonic acid is buffered by plasma proteins in blood.
    • CO2 enters RBCs where it reacts with water to form carbonic acid (H2CO3)via carbonic anhydrase; or it combines with hemoglobin (Hb).
    • To prevent a drop in blood pH, the bicarbonate anion leaves, and chloride enters red blood cell, a "chloride shift".
    • In the air, the reverse process happens, and CO2 is released in the lungs.

    Phosphate Buffer System

    • The phosphate buffer system is an important component in regulating physiological pH.
    • Buffer effectiveness peaks at pH 7.4.
    • It involves the HPO4-2/H2PO4- ratio; with a 4:1 ratio being ideal for pH 7.4
    • In the kidneys, the pH of urine can vary between 4.5-4.8, corresponding to a HPO4-2/H2PO4- ratio between 1:99 and 1:100

    Acid Excretion by Kidneys

    • Acids (mineral or organic) are excreted from the kidneys by removing their sodium salts during glomerular filtration.
    • Sodium is removed from the renal filtrate or tubular fluid in the tubular cells via sodium hydrogen exchange.
    • Bicarbonate is returned to plasma and removed by the lungs as CO2.
    • Protons enter the fluid, forming acids from original sodium salts.

    Acidosis

    • A rise in either potential and/or non-volatile hydrogen ion (H+) content in the body is called acidosis.
    • Increased H+ concentration in plasma is known as acidaemia, visible as a decrease in blood pH.
    • If the concentration of H+ stays constant despite acidosis, it's called a compensated acidosis.

    Metabolic Acidosis Types and Causes

    • Elevated proton production, such as an overactive metabolism (e.g., in fever)
    • Intake of substances that produce protons (e.g., salicylates and chlorides)
    • Excessive alkali loss from the intestines (e.g., diarrhea)
    • Introduction of high quantities of saline.

    Metabolic Acidosis Treatment

    • It's treated by providing sodium salts of bicarbonate, lactate, acetate, or citrate.
    • Sodium bicarbonate administration helps balance the HCO3-/H2CO3 ratio.
    • Lactate, acetate, and citrate are normal metabolic components; the TCA cycle degrades them into carbon dioxide and water.

    Renal Acidosis

    • Due to inadequate renal H+ excretion.
    • Seen in conditions like tubular disorders, Addison's disease.
    • This can occur due to drugs interfering with H+ tubular secretion, like carbonic anhydrase inhibitors

    Respiratory Acidosis

    • Develops from a buildup of carbon dioxide (CO2). This results in a buildup of carbonic acid.
    • Occurring in chronic lung disease, respiratory muscle paralysis, and respiratory depressant drugs.

    Alkalosis

    • It represents a decrease in the body's total hydrogen ion (H+) content.
    • Decrease in hydrogen ion plasma is known as alkalemia.
    • This leads to an increase in blood pH.
    • If no associated plasma H+ decrease, the state is compensated.

    Metabolic Alkalosis

    • Caused by renal inability to effectively excrete alkali.
    • Can occur due to excessive vomiting, leading to loss of H+ and Cl-.
    • Treated with ammonium salts which acts in the kidneys slowing down the Na+/H+ exchange.
    • Can occur due to excessive use of mercurial diuretics.

    Respiratory Alkalosis

    • Caused by hyperventilation, leading to a reduced amount of CO2 and thus carbonic acid in the blood.
    • Characterized by a fall in arterial pCO2 and a reduction in the bicarbonate-to-carbonic acid ratio.
    • Can result from high altitudes, fever, encephalitis, hypothalamic tumors, or salicylate intake, or a heated environment.

    Electrolytes in Acid-Base Balance

    • Sodium Bicarbonate

      • Contains at least 99% sodium bicarbonate.
      • Occurs as a white, crystalline powder or granules.
      • Soluble in water (1:12).
      • Partially soluble in alcohol.
      • Stored in air-tight containers (alkalinity increased by standing/heating). -Used in metabolic acidosis treatment, diarrhea, and poisoning from acidic drugs.
    • Sodium Bicarbonate with Other Compounds

      • Reacts with calcium or magnesium salts, cisplatin, dobutamine, and oxytetracycline to form insoluble precipitates.
      • Some drugs (adrenaline hydrochloride, benzyl penicillin potassium, carmustine, glycopyrronium bromide, isoprenaline hydrochloride, and suxamethonium chloride) lose their efficacy when mixed with sodium bicarbonate.
      • Used in medical applications (eye drops for crust removal in blepharitis, ear drops for softening ear wax, and as a lubricant for contact lenses).
    • Sodium acetate/ Potassium acetate/ Sodium citrate/ Potassium citrate characteristics. Uses and notes

    • Ammonium Chloride

      • A sterile ammonium chloride solution in water for injection.
      • Contains between 99.5% and 105% by weight of the dried substance.
      • Hydrochloric acid (HCl) may be added to adjust the pH.
      • Pharmacologically active as an acid-base equilibrium factor in the body.
      • It has diuretic and expectorant properties.
      • Contraindicated for patients with impaired renal or hepatic function.
      • Used in acid-base therapy, as a diuretic, and to correct hypochloremic alkalosis.

    Electrolyte Combination Therapy

    • Glucose and saline solutions are sufficient for short-term electrolyte restoration.
    • For significant electrolyte loss (severe blood loss or chronic diarrhea), additional electrolytes are needed.
    • Electrolyte combination therapy can fall into categories like fluid maintenance therapy and electrolyte replenishment therapy.
    • The electrolyte concentrations in the solutions used for quick replacement are similar to extracellular fluids. Maintenance solutions commonly include Sodium, Potassium, Chloride, Bicarbonate, Magnesium, and Phosphorus in specific concentration ranges. The notes state concentrations in mEq/l.

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    Description

    Test your knowledge on the pH ranges and uses of various electrolyte injections like Calcium Chloride, Sodium Chloride, and Potassium Chloride. This quiz covers metabolic and respiratory alkalosis, and the solubility of different compounds. Assess your understanding of drug interactions and conditions related to electrolyte imbalances.

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