Physiology 3 (pt 2)

  1. Two phases of breathing or pulmonary ventilation
    • Inspiration (inhalation): air into lungs
    • Expiration (exhalation): gases leaving lungs
  2. Ventillation
    • Defined as the exchange of air between the atmosphere and the alveoli
    • Actual movement of respiratory gasses at the terminal branches occurs due to diffusion
    • Air moves towards lower pressure
  3. Flow equation
    F= ∆P/R

    Flow is proportional to the pressure difference btwn two points and inversely proportional to the resistance
  4. Respiratory pressures
    • Described relative to atmospheric pressure (about 760mm Hg)
    • All pressures pushing on you comes from the air surrounding you
    • Also called alveolar pressure would like to be stabilized with or equal to atmospheric pressure
  5. Pressure difference determined by
    Difference in alveolar pressure and atmospheric pressure

    During ventilation, air moves into and out of the lungs bc alveolar pressure is alternately less than and greater than atmospheric pressure and is trying to stabilize itself
  6. Alveolar pressure
    • Intrapulmonary
    • Pressure within the alveoli of the lungs
    • Rises and falls with breathing; goes up and down so we take a breath
  7. Intrapleural pressure
    • PIP
    • Pressure within the pleural cavity which houses each lung
    • Also fluctuates with breathing
  8. Why is intrapleural pressure always negative pressure compared to atmosphere and intrapulmonary pressure?
    • Natural tendency of lungs to recoil (pulls lungs away from thorax wall)
    • Surface tension of alveolar fluid (pulls lungs away from thorax wall)
  9. Transpulmonary pressure
    • The difference between the intrapleural (pressure outside lungs) and alveolar (pressure inside lungs) keeps the airspaces of the lungs open and free from collapsing
    • Issue w/premature infants
  10. Rate during expiration of intrapulmonary pressure and intrapleural pressure?
    Increase at the same rate
  11. Boyles Ideal Gas Law
    When the temperature is constant, the pressure of a gas varies inversely with its volume

    • P1V1 = P2V2
    • Gases flow from higher pressure to lower pressure and volume and pressure are inverse of each other
  12. How to create inhalation
    • Contraction of the diaphragm by phrenic nerve
    • External intercostals contract to elevate the ribs (intercostal nerves); increase volume in thoracic cavity
    • Decrease in intrapleural pressure due to boyle's law (increase volume, decrease pressure)
    • Surface tension between parietal and visceral pleura (pulls lungs up and open)
    • Increase lung volume
    • Causes decrease in alveolar pressure (by about 4 mmHg)
    • Gases diffuse into alveoli to equalize the air pressure
  13. What does contraction of diaphragm by phrenic nerve do during inhalation
    • Dome of diaphragm flattens
    • Increases volume in thoracic cavity
  14. What happens when external intercostals contract to elevate ribs in inhalation?
    Increases volume in thoracic cavity
  15. How to create exhalation
    • Relaxation of the diaphragm and external intercostals
    • Elastic recoil; causes decrease in lung volume
    • Contraction of internal intercostals to bring rib cage down (decrease volume) for forced expiration, other rib cage just naturally falls when external intercostals not contracting
    • Increase in alveolar pressure and intrapleural due to decrease in thoracic volume (by about 4mmHg)
    • Air diffuses out of alveoli, again to equalize air pressure
  16. Elastic recoil
    • Tendency of an elastic structure to oppose stretching, lungs have a natural tendency to collapse
    • Lungs shrink down
  17. What happens during relaxation of the diaphragm and external intercostals
    Becomes dome-shaped again, rib cage falls due to gravity
  18. Deep or forced breathing
    • Can be due to vigorous exercise or some chronic obstructive pulmonary disease
    • Capacity of the thorax is further increased by activation of accessory muscles i.e scalenes, sternocleidomastoid, and pectoralis major which also function in quiet inspiration

    Contraction of the abdominal wall muscles, obliques, increase intra abdominal pressure which creates a pressure on the diaphragm and depresses the rib cage for forced exhalation
  19. Role of surfactant
    Surface tension draws liquid molecules closer together and water is a major component of the liquid film that coats the alveolar walls which has a very high surface tension

    Without surfactant, the lungs alveoli's cannot open up after a breath, they have collapsed. With this, surface tension is reduced and alveoli can open again
  20. Surfactant
    • Detergent-like lipoprotein produced by alveolar cells that interferes with cohesiveness of water
    • Makes it easier to expand lungs 
    • Secreted by type II alveolar cells
  21. Why do premature babies need a respirator?
    They do not produce surfactant so it is needed to open alveoli between breaths
  22. Respiratory compliance
    • Defined as the amount of change in lung volume produced by a change in pressure
    • Greater lung compliance, the easier it is to expand at any given pressure
    • Opposite of stiffness
  23. Respiratory distress syndrome
    • Leading cause of death in premature infants, in which surfactant synth cells may be too immature to function
    • Prior to birth, fetus does not require surfactant bc lungs are filled with amniotic fluid and fetus receives oxygen from mothers blood
    • Bc of this the affected infant can inspire only with the most strenous effort which lead to exhaustion, inability to breathe, lung collabse
    • Can use a ventilator and injected surfactant into trachea
  24. Factors that determine airway resistance
    • Tube length, tube radius and interactions between molecules (gas molecules in this case)
    • Physical, neural and chemical factors affect radius and therefore resistance
  25. How to keep airways open?
    • Transpulmonary pressure; keeps bronchiole tubes open as well as alveolar sacs
    • Cartilage rings along bronchi and trachea
    • Lateral traction
    • Epinephrine relaxes airway smooth muscle (bronchodilation
  26. Lateral traction
    Elastic connective tissue attached to the outside of smaller bronchioles (pulled open when lungs open) to keep airways open
  27. Chronic bronchitis
    • Long term inflammation of the airways leading to persistent cough with mucus production and chronic inflammation of smaller airways
    • Due to a combination of genetic propensity for respiratory infections and exposure to cigarette smoke or air pollution or respiratory illness in fancy
    • Combination of mucus, thickening of airway, bronchoconstriction interfere w/air flow
    • Persistant cough, production of mucus, dyspnea (difficulty breathing) and wheezing
    • Frequently, people develop emphysema
  28. Emphysema
    • The walls between the alveoli break down resulting in much larger but fewer number of alveoli which looks more like a big sac with decrease in surface tension
    • Less surface area=less gas exchange=working harder for each breath
    • Cigarette smoking correlates well with this
  29. Worst form of emphysema
    • The amount of destruction to the alveoli significantly decreases the surface area for gas exchange thereby decreasing the amount of oxygen in the blood leading to tissue hypoxia
    • Typically end up with barrel chest bc they are using peripheral muscles with every breath
  30. Asthma
    • Disease exhibiting decreased diameter of the airways due to allergies, irritants, stress, or unknown causes
    • Bronchoconstriction evokes the acute attack where leukotrienes contract airway smooth muscle especially during inflammation and allergen attack
  31. Respiratory volumes/capacities
    • Measure the amount of air that is flushed in or out depending on various conditions and act to measure a person's respiratory status
    • Usual values are given for young, healthy adult males (females are 80% of those values)
  32. Tidal volume
    • Normal quiet breathing
    • Approx. 500ml of air moves into and out of the lungs with each breath
    • ~12 quiet breaths per minute
  33. Inspiratory reserve volume
    • IRC
    • The amount of air that can be inspired forcibly beyond the tidal volume
    • 2100-3200 mls
  34. Expiratory reserve volume
    • ERC
    • The amount of air that can be evacuated from the lungs after tidal expiration
    • 1000-1200 mls
  35. Residual Volume
    • The air that remains in the lungs even after strenuous exercise
    • 1200 ml
    • Prevents lung collapse
  36. Inspiratory capacity
    • The total amount of air that can be inspired after tidal expiration
    • Tidal volume + inspiratory reserve volume
  37. Functional residual capacity
    • FRC
    • Combined residual and expiratory reserve volumes represent the amount of air remaining in lungs after tidal expiration 
    • Expiratory reserve volume + residual volume
    • Avg 2400 ml
  38. Vital Capacity**
    • Total amount of exchangeable air
    • Tidal volume + inspiratory reserve volume + expiratory reserve volume
  39. Total lung capacity
    • Sum of all lung volumes i.e inspiratory, functional residual, and vital capacity
    • Around 6000 ml
  40. Dead space
    • Some inspired air never reaches alveoli for exchange-- gets stopped at higher branches
    • About 150 ml (equal to weight in pounds)

    If tidal volume is equal to 500 ml, then only 350 ml is involved in alveolar ventilation
  41. Minute or total ventilation
    • Total amount of gas that flows into or out of respiratory tract in one minute 
    • About 6 liters/minute (500 ml x 12 breaths per minute)
    • About 200 liters during exercise
  42. Forced vital capacity
    • Measures the amount of gas expelled when a person takes a deep breath and then forcefully exhales
    • Poor vital capacity is found in restrictive lung diseases
    • Problems with lung tissue, the pleura, the chest wall or neuromuscular machinery
  43. Forced expiratory volume
    • Determines the amount of air expelled during specific time intervals of the forced vital capacity (1 sec, 3 sec)
    • Person takes a max inspiration and then exhales as fast as possible
    • FEV1 is about 80% of FVC
    • Poor in people w/obstructive lung diseases
    • Increased airway resistance
  44. External respiration
    Gas exchange between the blood and air-filled chambers of the lungs
  45. Internal respiration
    At systemic capillaries, gas exchange between capillaries and tissue cells
  46. Respiratory membrane
    • Respiratory gases move across this
    • The exchange of respiratory gases between the lungs and blood takes place by diffusion across the alveolar and capillary walls
  47. Make up of respiratory membrane
    • Consists of endothelium and basement membrane of capillary, connective tissue, basement membrane and epithelium (endothelium) of alveolus
    • Alveolar capillary membrane is usually only 0.4 microns in thickness for sufficient thickness
    • Immense surface aira (40x greater than skin)
    • Capillaries are so small, RBC's have to go through single file to give one maximum exposure to the available oxygen
  48. Factors that influence the movement of oxygen and CO2 across the respiratory membrane
    • Partial pressure gradients and gas solubilities
    • Structural characteristics of the respiratory membrane
    • Matching the alveolar ventilation with pulmonary blood perfusion (liquid diffusion)
  49. Pressure of gases
    • Each gas in a mixture has its own pressure (partial pressure; Dalton's Law)
    • Atmospheric pressure is a sum of atmosphere gasses (760 mmHg)
  50. Pulmonary respiration
    • The movement of O2 and CO2 between n the alveoli of lungs and the pulmonary capillaries across the respiratory membrane
    • Exchange converts deoxygenated blood into oxygenated blood
  51. Diffusion of gas
    • Occurs form the area where the gas's partial pressure is higher to the area where its partial pressure is lower
    • Each gas moves inidependently of the other
  52. If the pO2 of the alveolar air is about 100 mmHg and the pO2 of venous blood is about 40 mmHg, which way does the oxygen diffuse?
    • Towards the venous blood/capillaries to become oxygen rich
    • Much stronger rate of diffusion bc larger gradient
  53. If the pCO2 of the venous blood is about 46 mmHg and the pCO2 of alveolar air is about 40 mmHg, which way does the CO2 diffuse?
    • This will diffuse out to where there is less of it so towards the alveolar air
    • Gradient is smaller but enough to draw the CO2 out
  54. What happens where you have exposure to the unoxygenated blood to those RBC that need oxygen
    • The more you are able to saturate the cells
    • The partial pressure of oxygen increases the longer you spend time there
  55. Solubility of oxygen and carbon dioxide
    Fat soluble
  56. Where is the oxygen carried?
    • 3% soluble oxygen in plasma
    • 97% of oxygen is bound with hemoglobin
  57. How many iron atoms can heme hold?
    • 4
    • Each iron can bind one molecule of oxygen
    • If each hemoglobin had 4 oxygens bound, the hemoglobin is 100% saturated
  58. Oxyhemoglobin HbO
    Binding of oxygen to hemoglobin holds this
  59. What occurs when the first O2 binds?
    • Causes change in Hb shape and makes the next 3 oxygen molecules easier to attach
    • This causes an s-shaped curve for saturationImage Upload 1
  60. Arterial blood saturation under resting conditions
    • 98%
    • pO2 measures partial pressure of O2 in plasma only
  61. Venous blood saturation
    • 75% and reveals an O2 reserve (venous reserve)
    • In high altitudes and cardiopulmonary disease where pO2 is low, oxygen loading and delivery can still adequately occur
  62. Bohr effect
    • pCO2 and H+ concentration effect O2 bc they affect hemoglobin's saturation
    • Where O2 unloading is the goal, cells are metabolizing glucose and using O2
    • These cells then release CO2 which increases pCO2 and H+ content in the blood
    • Since pH decreases and pCO2, this weakens the Hb/oxygen bond
    • O2 unloading is accelerated
  63. What happens to blood pH when there is a build up of CO2?
    It decreases and becomes more acidic bc CO2 promotes H+ production
  64. What is the most important factor of saturation?
    • pO2
    • High p= high saturation
  65. pH effect on saturation
    • Acidic environment, oxygen breaks from hemoglobin more readily
    • Decreasing saturation
  66. Temperature effect on saturation
    • As temp increases, saturation decreases
    • When we burn sugar in presence of oxygen, CO2 and water is created
    • Heat is a waste product
  67. Carbon monoxide poisoning
    • Decreases the oxygen saturation of hemoglobin bc it binds to O2 and won't let go
    • CO is colorless and odorless; forms carboxyhemobglobin
    • Combines with hemoglobin, but 200x stronger than oxygen
    • Dangerously reduces the oxygen carrying capacity of hemoglobin bc it is taking oxygens place on the hemoglobin
    • Increased levels of CO lead to hypoxia
  68. Hypoxia
    • Deficiency of oxygen in the tissues
    • Can be caused by low pO2 in blood, high altitudes, anemia
    • Decreases hemoglobin saturation
  69. Carbon dioxide carriers
    • 7% is dissolved in plasma (soluble CO2)
    • 23% is bound to the globin part of hemoglobin (carbaminohemoglobin)
    • 70% is in the form of bicarbonate ions HCO3-
  70. Carbon dioxide formula
    • CO2 + H2O <-> H2CO3 <-> H+ + HCO3-
    • If CO2 goes up, H+ goes up and blood pH goes down (acidic)
  71. What happens when pCO2 is relatively high
    CO2 and globin combine in tissue capillaries
  72. What happens when pCO2 is low
    CO2 splits from hemoglobin in pulmonary capillaries
  73. Carbonic Acid (H2CO3)
    As CO2 diffuses into tissue capillaries, and enters RBC, it combines with water to form this
  74. What does carbonic acid break into
    • Hydrogen ions (acid) and bicarbonate ions
    • Bicarbonate ions diffuse into plasma
  75. Carbonic anhydrase
    What catalyzes the formation of carbonic acid
  76. Hyperventilation
    • Causes the body to expel more CO2
    • Increased breathing which pushes rxn to the left to become more basic
  77. Hypoventilation
    • Slow rate of breathing, allowing CO2 levels to rise
    • Rxn pushes to the right and becomes more acidic
  78. Respiratory centers
    Basic controls of breathing involve neurons in the medulla and pons
  79. Medulla
    • Promotes inspiration and controls the basic rhythm of breathing
    • Expiration is a passive process
    • Normal breathing rate is 12-15 breaths per minute
  80. What happens when medulla is suppressed
    Respiration stops
  81. Pons
    • Smooths out the transition from inspiration to expiration
    • Turns off medulla
    • Apneustic area extends your expiration even longer

    • Without it, inspirations become very long; turns off breathing in 
    • Normal lasts about 2 seconds
  82. Most important factors in setting respiration rate is changing levels of:
    • Carbon dioxide
    • Oxygen
    • Hydrogen ions
    • In arterial bloods
  83. Central chemoreceptors
    • Closely controls CO2 content
    • pCO2 is partial pressure which is an indicatory of percentage of gas involved 
    • Maintained by homeostatic mechanisms mediated through sensing of oxygen levels in the brain stem through the cerebrospinal fluid
    • CSF pH: 7.35-7.45
  84. Normal level of pCO2
    • 40 mmHg
    • Range: 35-45
  85. What happens if pH of CSF decreases
    • Chemoreceptors send signals to increase the depth and rate of breathing to flush CO2 out of the blood
    • Any small change in CO2, creates change in pH and so respiratory center reacts suddenly even with plenty of oxygen
  86. Peripheral chemoreceptors
    • O2 sensors
    • Normal is 80-100 mmHg, but needs to drop below 60 to stimulate a response 
    • So levels can drop dramatically before body is even aware
  87. Hering- Breuer Reflex
    • Visceral pleurae and conducting passages in the lungs contain numerous stretch receptors that are stimulated when lungs are inflated
    • Send inhibitory impulses to terminate respiration, allowing expiration
    • Protective response to overfilling
  88. Pulmonary irritant reflexes
    • Longs contain receptors that respond to an enormous variety of irritating factors
    • When activated, these receptors communicate w/respiratory centers to promote reflex constriction of bronchioles
    • Examples: dust, lint, mucus, cigarette smoke
  89. Emotions (hypothalamic controls)
    • Strong emotions and pain acting through the limbic system activate sympathetic centers in the hypothalamus
    • Modulates the respiration rate and depth by sending signals to the respiratory centers
  90. Cortical control
    Exert conscious control over the rate and depth of our breathing by direct signals from the cerebral motor cortex to motor neurons which excite the respiratory muscles
  91. Electrolytes
    • Acids and bases are these
    • Ionize or dissociate in water and conduct an electrical current
  92. Acids
    • React with metals and is a proton donor (releases H+)
    • HCl is a strong acid bc it has a strong tendency to dissociate or release H+ into the environment
    • More H+ ions = more acidic
  93. Bases
    • Proton acceptors; hydroxides
    • Dissociate in water to hydroxyl ions (OH-)
    • Higher concentrations = more alkaline
    • OH- is strong base bc it will rapidly capture free H+
  94. pH scale
    • Runs from 0 to 14 and is mesured logarithmically (1 pH unit change is a tenfold change in H+ ion
    • <7 means acidic
    • >7 means basic
  95. pH of arterial blood and urine
    • Arterial blood: 7.35-7.4
    • Urine: 4.5-8.0
  96. Buffers
    • Help maintain homeostasis of acid-base balance 
    • Resist abrupt and large swings of pH by releasing H+ and binding to it.
    • Acidity of a soln reflects only the free hydrogen ions
    • Does not eliminate hydrogen ions; just "locks" them until balance is restored
  97. Strong acid
    • Acids that dissociate freely and completely in solution
    • Release a lot of free H+ ions
    • Dramatically change the pH
    • HCl and sulfuric acid are strong acids
  98. Weak acids
    • Don't dissociate completely
    • Carbonic acid, acetic acid
    • Un-dissociated acids do not affect the pH
    • Dynamic equilibrium is reached
  99. Strong base
    • Easily dissociates
    • Ties up H ions
  100. Weak base
    Accepts very few H+
  101. lower pH is
    higer H+ concentration
  102. Buffer system
    • Kidneys are ultimately responsible for balancing hydrogen ions to maintain a relatively constant plasma hydrogen ion concentration
    • Respiratory system is the first buffering system to activate (hypo- and hyper- ventilation)
    • If H+ ion imbalances are caused by non-respiratory cause, then ventilation can be altered to compensate for imbalance
  103. Bicarbonate
    • Primary buffer for blood
    • Carbonic acid: bicarbonate is the predominate form in which CO2 is carried in the blood to be released from the lungs
  104. Other physiological buffers
    • Protein: primary buffer inside cells
    • Hemoglobin: primary buffer inside RBC
    • Phosphate: primary buffer in urine
  105. Respiratory system
    Eliminates CO2 from the blood while replenishing its stores of oxygen
  106. CO2 exhalation
    • Rxn shifts to the left
    • H+ generated is reincorporated into H2O which can lower pH
    • Compensate for metabolic acidosis (breathe faster to get rid of acid)
    • No overall change in pH
  107. CO2 retention
    • Rxn shifts to the right
    • Excites respiratory center to stimulate deeper and more rapid respiration rate (which can raise pH) 
    • As ventilation increases, the reaction is pushed to the left; more CO2 is released, more H+ is bound to H2O reducing the pH and H+ concentration
    • Compensation for metabolic alkalosis
    • Breathe slower to retain more acid
  108. Carbonic Anhydrase
    Enzyme found in RBCs that speeds up the reaction so that balance can occur within one minute
  109. Respiratory acidosis
    • CO2 retention leads to this
    • Holding your breath or have COPD, like asthma
  110. Respiratory alkalosis
    • Hyperventilation can lead to this
    • Panic attacks causes you to breathe faster, loose too much CO2 and pass out
  111. Renal system
    • Buffers that can tie up excess acids or bases temporarily but cannot eliminate them from the body
    • Only kidneys can rid the body of excess acids
  112. Most important renal mechanism for regulating acid-base balance of the blood involves:
    • Excreting bicarbonate ions (to increase hydrogen ion concentration)
    • Conserving (reabsorbing) new bicarbonate ions (to decrease hydrogen ion concentration)
  113. Bicarbonate buffer process
    • In order to reabsorb bicarbonate, H+ has to be secreted for balance
    • Renal tubule and collecting duct cells respond directly to pH
    • H+ secretion rises and falls with CO2 levels; increased CO2 = increased H+ secretion
  114. What happens to any secreted H ions once almost all the bicarb has been reabsorbed and is no longer available in the lumen?
    • Nonbicarbonate buffer 
    • Ammonia (NH3) is an example of common waste product in protein breakdown, can act as weak base, accepts proton and becomes NH4 and is excreted from the urine
  115. Acidosis
    Any situation in which the H concentration of arterial plasma is elevated
  116. Alkalosis
    Denotes a reduction of H concentration in arterial plasma
  117. Most common hallmark of respiratory acidosis is
    An elevation in both arterial pCO2 and hydrogen ion concentration
  118. Metabolic acidosis
    • Any decrease in the ration of HCO3- to H2CO3 (bicarbonate base to carbonic acid) not due to changes in carbon dioxide
    • Normal ration is 20:1
    • There is too little bicarbonate to your acid but this is not due to breathing
    • Accumulation of acids in the renal system
  119. Causes of metabolic acidosis
    • Either excess acid production or excessive loss of bicarbonate ions
    • Severe diarrhea can cause excessive loss of bicarbonate
    • Renal failure can cause excessive retention of acid
  120. Ketoacidosis
    Metabolic acidosis due to diabetes mellitus and excess lactic acid production due to excess anaerobic metabolism are common causes due to excess acid production
  121. Characteristics of metabolic acidosis
    • Stimulates the respiration center to increase pulmonary ventilation resulting in hyperventilation 
    • Other effects are shifting of potassium out of cells, anorexia, nausea, stupor

    Increase in H+ results in decrease of HCO3- -> decrease in pH -> increase in breathing to compensate
  122. Metabolic alkalosis
    Any increase in the bicarbonate/carbonic acid ratio not due to changes in carbon dioxide (pH goes up)
  123. Causes of metabolic alkalosis
    Excessive loss of Hydrogen ions (H+) such as in excessive vomiting (bulimia) or by excessive intake of bicarbonate such as excessive intake of antacids
  124. Characteristics of metabolic alkalosis
    • Inhibits the respiratory center resulting in hypoventilation 
    • Acid can then build back up
    • Also leads to hyper irritability, spasms and convulsions
  125. Low pH, high carbon dioxide, and low oxygen will all increases ventilation. Increasing blood carbon dioxide will decrease pH. All of these relationships are reversible.

    How will ventilation, carbon dioxide, and oxygen change if an excessive vomiting stomach acid leads to an increase in blood pH?
    • Decreased ventilation, increased blood carbon dioxide, decreased oxygen
    • Image Upload 2
  126. Low pH, high carbon dioxide, and low oxygen will all increases ventilation. Increasing blood carbon dioxide will decrease pH. All of these relationships are reversible.

    If barbiturates suppress ventilation, how will carbon dioxide, oxygen and pH levels change?
    • Increased carbon dioxide, decreased oxygen, decreased pH
    • Image Upload 3
  127. Respiratory system of acidosis
    • Shortness of breath
    • Coughing
  128. Heart symptoms of acidosis
    • Arrhythmia
    • Increased HR
  129. Digestive system symptoms of acidosis and alkalosis
    • Nausea 
    • Vomiting
    • Diarrhea

    Alkalosis is just the first two
  130. CNS symptoms of alkalosis and acidosis
    • Confusion
    • Light-headedness
    • Stupor
    • Coma

    • Acidosis:
    • Headache
    • Sleeplessness
    • Loss of consciousness 
    • Confusion
  131. Peripheral Nervous System symptom of alkalosis
    • Hand tremor
    • Numbness or tingling in the face, hands, or feet
  132. Muscular system symptoms of alkalosis vs acidosis
    • Alkalosis
    • Twitching
    • Prolonged spasms

    • Acidosis:
    • Seizures
    • Weakness
Author
Zaqxz
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347870
Card Set
Physiology 3 (pt 2)
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Updated