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Page 1 — Regulation (Pg 749)
(3) BMR in children is higher than in adults
Alveoli, Bronchi, Lungs
Regulation of Dorsal Respiration
- Dorsal Respiratory Group — Controls Normal Inspiration
- Inspiration is controlled by Diaphragm and External Intercostal muscles (MS)
Ventral Respiratory Group
- Controls forced breathing
- It causes contraction of Inspiratory muscles & prolonged inspiration
- Stimulation of excitatory neurons causes prolonged expiration
Pontine
(1) Apneustic Centre:
- Stimulation of Apneustic centre causes Apneusis — prolonged inspiration followed by short inefficient expiration
- It increases depth of inspiration by acting directly on the dorsal group neurons
(2) Pneumotaxic Centre:
- Switching between inspiration & expiration by inhibiting inspiration and apneustic centre
- Controls the activity of DRG (inspiration)
- Increases rate of respiration by reducing duration of respiration
Formula to Calculate BMR
BMR — Men:
= 88.362 + (13.397 × wt. in kg) + (4.799 × ht. in cm) − 5.677 × age yrs
(Diagram: Pons → Medulla → Intercostal Nerves / Phrenic N. → Diaphragm; Afferent Vagus & Glossopharyngeal)
Page 2 — Chemical Mechanism
Mediated by Chemoreceptors.
These receptors are most sensitive to changes in O₂ and CO₂ in the blood & CSF.
Located centrally & peripherally.
Central Chemoreceptors | Peripheral Chemoreceptors
| Central Chemoreceptors | Peripheral Chemoreceptors |
|---|---|
| Located on the surface of Medulla Oblongata & are bathed in CSF | Situated in the Arch of Aorta & Carotid Bodies |
| When conc. of CO₂ in arterial blood is raised, these receptors are stimulated | Sensitive even to a small rise in conc. of CO₂ in arterial blood & low conc. of O₂ |
| The afferent impulses stimulate the Respiratory centres — ventilation is increased & CO₂ is relieved from the blood | Afferent impulses are conveyed by 9th (glossopharyngeal) & 10th (vagus) nerve to respiratory centre — respiratory centre is stimulated — rate & depth of respiration are increased |
| When O₂ is reduced the same mechanism occurs |
Hering-Breuer Inflation Reflex
- The receptors are stretch receptors located in the lungs — mainly the bronchi & bronchioles.
- During inspiration, when the lungs become stretched, these receptors are stimulated.
- Afferent impulses travel through Vagus N. & reach the respiratory centre — exert an inspiration-inhibiting effect on inspiration & it is cut off & expiration commences.
Page 3 — Lung Pressures
Lung / Intrapulmonary or Intra-alveolar pressure (can be +ve or −ve)
- Intrathoracic pressure / Intrathoracic p. — always negative
- Intrapleural pressure / Transmural diff. between IP — always positive
- Transpulmonary pressure — always positive
Intrapleural p. = Transpulmonary p. but with a negative sign
T.P = +6 I.P = −6 (same magnitude)
Intra-alveolar Pressure
According to Boyle's Law: Volume ∝ 1/P
During Inspiration:
- Increased lung volume → Decreased pressure
- P↓ → (−1) → atm p = 0 → Inspiration sucks the air in
At end of Expiration:
- Decreased lung volume → Increased pressure
- (+1) → It pushes the air out
At the end of inspiration & at the end of expiration, the pressure is atmospheric pressure.
During mid-inspiration — lungs expand so pressure decreases (creating a suction force to pull the air in), then air enters the lungs to fill the void; when air enters to fill the void it raises pressure. At the end of inspiration the pressure is atmospheric.
Rewrite which is mentioned on the pages
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Page 1 — Mid Expiration & Intrapleural Pressure
During mid expiration lungs recoil:
- Decreased lung volume
- Increased pressure → then air exits
- (+1 → 0) as (increased pressure forces the air out) as the air exits, the pressure decreases till it reaches zero at the end of expiration.
(Diagram: two lung shapes labeled "+1 inspi" and "-1 insp")
Intrapleural Pressure
- Negative pressure between the 2 pleural layers.
Why is intrapleural pressure always negative?
Because the pressure inside the pleura is balanced on the dynamic harmonious antagonism between the chest wall (which wants to expand) & the elastic lung (which wants to recoil).
When 2 surfaces come close to each other, they create positive pressure. However, when 2 surfaces move away from each other, they create a negative pressure.
Example: Bring 2 glass slides & put a drop of water between them, try to pull them apart — you can't, because when you try to pull, a negative pressure is created between them, which prevents you from pulling them apart.
Lungs tend to recoil — Why?
- Surface tension (Surfactant prevents this)
- Elasticity
Page 2 — Chest Wall & Intrapleural Pressure (continued)
The chest wall wants to expand — Why?
-
Elasticity (like a spiral spring)
-
If the chest wall expands → lungs will collapse (Pneumothorax)
-
Without the negative (intrapleural) pressure, lungs tend to recoil until it reaches its relaxation volume.
-
Transmural pressure = +5, +7 / volume ≈ 5 litres
Intrapleural p. is −ve because the oesophagus is in the chest.
- The −ve pressure in the pleura will pull the oesophagus open, increasing its volume → decreasing its pressure, until it becomes negative.
- If the pressure in oesophagus > than that of pleura → oesophagus would expand.
- If pressure in oesophagus < than that of pleura → oesophagus would collapse.
- Therefore, the pressure in oesophagus must equal the intrapleural pressure, i.e. negative pressure.
- That's why we call intrapleural pressure as Intrathoracic pressure.
- Tension Pneumothorax
Measure the intra-oesophageal pressure by intra-oesophageal balloon. (16:35)
During Inspiration — As the Diaphragm:
As the diaphragm descends & external intercostal muscles contract, chest wall expands creating a −ve pressure, pulls air in → lungs expand → the more the lungs expand, the more it acquires a recoil tendency (pressure stored as potential energy) → more the recoil tendency increases → more −ve intrapleural pressure is going to be created.
Page 3 — In Lungs / Vocal Cord (Anatomy)
Vocal Cord (Anatomy)
How the larynx produces sound? — Vocal Cords
External Respiration (Diagram values):
Alveolar Air:
- PO₂ = 104 mmHg
- PCO₂ = 40 mmHg
↓ O₂ / ↑ CO₂ exchange
Pulmonary Vein → LA → LV → Aorta:
- PO₂ = 40 mmHg (deoxygenated)
- PCO₂ = 46 mm
Artery:
- PO₂ = 96 mmHg
- PCO₂ = 40 mmHg
Internal Respiration — Tissues:
- PO₂ = 20 mmHg
- PCO₂ = 58 mmHg
Veins:
- O₂ ↓
- O₂ is delivered to tissues
- CO₂ from tissues
- Surfactant opens the lung
- Surface tension collapses the lungs
Rewrite which is mentioned on the pages
Here is a clean rewrite of everything written on the pages:
Page 1 — Definition of Fluid & Electrolytes
Electrolytes are ions that are found in body fluids. They help to conduct electricity, energy.
- Total body water = 60 – 70%
- Help control body fluids & maintain homeostasis
- Electrolytes are found in fluids
- Help to send message from cell to cell
- Nerve to Nerve / Organ to Organ
Therapeutic Range | HOMEOSTASIS
| Therapeutic Range | Homeostasis |
|---|---|
| The range of concentrations at which a drug is most effective with least toxic effect. | The state of equilibrium or balance that is maintained by self-regulating process in the body. |
For e.g.: When a nurse gives K⁺ or K riders — technically to bring the body to the normal range.
- Electrolyte imbalance — Pg. 618
- Fluid imbalance — Pg. 15 AK Jain
Page 2 — Mnemonics for Electrolytes
Check in & Check out.
- Calcium is obtained through sunlight.
POT
- Profuse sweating (Diaphoresis) causes loss of Na⁺
- Burns — (loss of fluid)
- Electrolytes reside in fluid.
- Massive diarrhoea
- Electrolyte depletion
| Haemodilution | Haemoconcentration |
|---|---|
| Decreased conc. of cells & solids in blood resulting from gain of fluid | ↓ |
Page 3 — VI. Electrolyte: Chloride (Cl⁻)
4-EYED CHLORIDE (Cl⁻) — 98–106 mEq/L
(Found with Salt & Salt Substitutes)
- → Na⁺ — Super Salty
- → Cl⁻
Obtained through same sources as salt:
- Table salt
- Sea salt
- Seaweed
- Tomatoes
- Olives & others
Absorbed through small intestine &
Excreted by body in kidneys.
Functions:
- → Same function as Sodium
- → Maintains Blood Volume
- → Maintains Blood Pressure
- → Maintains pH of body fluids
Hyperchloraemia ↔ Hypochloraemia
Page 4 — PHOSPHATE (Friendly Fat Boy)
(Worst enemy of Calcium)
- Dairy, Meats & Beans
- 3.0 – 4.5 mEq/litre
Calcium's worst enemy:
- Opp. to Ca (Ca²⁺ / Phosphate)
- Ca²⁺ → PO₄³⁻ → see
Absorbed in small intestine &
Excreted in ___
Obtained from: Meats, Poultry, Fish, Nuts, Beans & Dairy Products
Function:
- Bone & Teeth formation
- → Repairs Cell Tissues
Regulated by:
- Parathyroid hormone (it regulates Calcium too) — ↓ serum PO₄³⁻ in blood
Hyperphosphataemia | Hypophosphataemia
② TROUSSEAU'S Sign:
- Trousseau's Sign → latent tetany identified by inflating a BP cuff above systolic pressure for 2–3 mins causing carpal spasm (wrist / carpopedal flexion spasm)
Chvostek's Sign:
-
Twitching of ipsilateral facial muscles when the facial nerve is tapped below the zygomatic arch
-
Dizziness
-
Moans & Groans
-
Bleeding
+1 more
Rewrite which is mentioned on page
Here is a clean rewrite of everything written on the pages:
Page 1 — Calcium: Sources & Regulation
SOURCES — "3B's (makes strong)"
- → Bones
- → Blood (Clotting factors)
- → Beats (Heart Beats)
- Best Friends (Ca + Mg) — Calcium moves same as Magnesium
- Ca → Mg
Calcium Regulated by 3 Hormones:
① Parathyroid Hormone
- Increases Calcium concentration in the blood.
② CALCITONIN HORMONE
- Puts a ton of Calcium in the bones.
③ CALCITRIOL
- Controls blood Calcium by stopping (Calcitonin reverses in blood)
Hypocalcaemia | Hypercalcaemia
| Hypocalcaemia | Hypercalcaemia |
|---|---|
| Trousseau's sign | Swollen & Slow + Hyp |
| Chvostek's / Bleeding | Moans, Groans & Groans |
| ② Stones | Bone Pain |
| ⑥ ↓ DTR | Constipation |
Page 2 — Magnesium & Calcium (continued)
Excreted by the Kidneys once again.
- → Keeps Law & Order in the Muscles
Functions of Magnesium:
- → Protein Synthesis
- → Nerve function
- → Blood sugar control
- Stimulates Parathyroid Hormone
- Regulates Calcium levels inside the cell
- BFF = Calcium
- → Required for Calcium & Vitamin D absorption (Buckwheat)
- → Binds Ca to teeth
IV. CALCIUM
- Normal value: 9.0 – 10.5 mg/dl
- 99% found in bones
Obtained from:
- → Fruits, veggies, almonds, oranges
- Dairy products, green leafy vegetables, milk
Absorbed in small intestine.
Excreted in kidneys.
Hypercalcaemia:
- Calming / Calm
- Heartblood
- Diarrhoea →
- Hypocalcaemia →
Page 3 — Na Functions & Magnesium
Na Functions:
- Maintains Blood volume
- Maintains Blood pressure
- Sodium is regulated by:
- → ADH (Antidiuretic Hormone) — Add the (da) H₂O — It adds water in the body.
- → Aldosterone ④ — (Holds sodium in the body)
- → Na⁺/K⁺ pump ⑤ — Na⁺ energises each cell
- → Buffers out ⑥ — Maintains Acid/Base Balance
Mnemonic:
When Na⁺ moves in → K⁺ moves out
| HyperNatraemia | HypoNatraemia |
|---|---|
| 1.5 g↑ Bloated | ↓ K⁺ Depressed / Deflated |
| Red & Rosy | Seizures & Coma |
| Ill waterlogged skin | Neurological deficits |
Magnesium — "Magnum"
- Normal values → 1.3 – 2.1 mg/dl
- → Maintains "LAW & ORDER" in the muscle & body
- → Contains Magnesium
Obtained through:
- → Spinach
- → Almonds
- → Yogurt
(TSCES / MS loss)
Page 4 — K⁺ (King) Potassium & Sodium
K⁺ (King) Potassium
- Normal value: 3.5 – 5.0 mEq/litre
- In skeletal muscles
- Maintains Na⁺/K⁺ pump
| K⁺ | King of Action |
|---|---|
| I | ② |
| N | CONTRACTION |
| Ce | ← |
- → Especially in heart & skeletal muscles
- Keeps each muscle cell charged or polarised ←
- → Maintains Na⁺/K⁺ pump ↑
Sources: Banana, Avocado
- → Obtained through diet (fruits & green leafy vegetables) → Spinach
- Absorbed in intestine
- Excreted out of the body & into bile, bowel & kidney
| Hyperkalaemia | Hypokalaemia |
|---|---|
| Tight & Contract | Slow / Low & decreased motility |
II. Na⁺ (Sodium)
- Normal value: 135 – 145 mEq/L
- → Na⁺ (wherever water goes Na⁺ moves)
- → H₂O — so maintains the body fluid level
- Major cation in Extracellular fluid
Obtained in diet through:
- → Canned foods, processed meats & cheeses; fast food (packaged)
Page 5 — Definition of Fluid & Electrolytes (sideways page — same content as previously rewritten)
Def. of Fluid & Electrolytes
Electrolytes are ions that are found in body fluids. They help to conduct electricity, energy.
- Total body water = 60 – 70%
- Help control body fluids & maintain homeostasis
- Electrolytes are found in fluids
- Help to send message from cell to cell
- Nerve to Nerve / Organ to Organ
Therapeutic Range | HOMEOSTASIS
| Therapeutic Range | Homeostasis |
|---|---|
| The range of concentrations at which a drug is most effective with least toxic effect. | The state of equilibrium or balance that is maintained by self-regulating process in the body. |
For e.g.: When nurse gives K⁺ or K riders — technically to bring the body to the normal range.
- Electrolyte imbalance — Pg. 618
- Fluid imbalance — Pg. 15 AK Jain
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