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ACIDS are proton (H+) donors BASES are proton (H+) acceptors Ionic substances dissociate in solutions STRONG ACIDS dissociate completely WEAK ACIDS dissociate incompletely pH is a measure of H+ in solution
Normal blood pH necessary for normal enzyme activity 7.35 - 7.45 Below 7.35 = acidosis Above 7.45 = alkalosis Changes in pH due to by-products or end products of metabolism.
[H+]= 35- 40meq/L or nmol/L Pco 2 [approximately 1.1 kPa (8 mmHg) higher in venous blood] and Po2 [approximately 7.5 kPa (56 mmHg) lower in venous blood].
PRODUCTION OF ACID
Volatile acid Carbonic acid Non-volatile acid phosphoric acid (nucleoproteins) lactic acid (anaerobic glycolysis) sulphuric acid (S-AA) ketones and fatty acids (fat metabolism Animal protein Acidic
PRODUCTION OF BASE
Normally negligible. HCO3 by metabolism of lactate and citrate. NH3 AA metabolism urea base Veg diet salts of organic acid (sodium lactate) + utilize H+. Alkalizing effect on the body. Urine excretion neutral or slight alkaline.
REGULATION OF BLOOD pH
Chemical Buffer Systems Intracellular Extracellular Bicarbonate buffer system Na HCO3/ H2CO3 Phosphate buffer system Na2 HPO4/ NaH2PO4 Protein buffer system Na+ Protein/ Protein RBC buffer KHb/ HHb
Respiratory System
Renal Mechanisms
H2CO3
H+ + HCO3
H2PO4-3
HPO4-2
Hb AS A BUFFER
Tissue level Hb binds to H+ & help to transport CO2 as HCO3 Lungs Hb combines with O2 H+ removal
2H + 2HCO3- 2H2CO3 2H2O + 2CO2 (Exhaled)
CO2
2H2CO3 2HCO3
-
2H+
HbO2
2H+ + 2HCO3-
4O2
Hb2H+
4O2
Henderson-Hasselbach Equation
Demonstrates interrelationship between
Carbonic acid Bicarbonate pH
Kassirer-Bleich equation
[H+] = 24 x PCO2/ [HCO3-] Can be used to calculate any component of buffer system provided other 2 components are known
RESPIRATORY ACIDOSIS
Low pH due to high pCO2 pH = 6.1 + log [HCO-3]
[PCO2] x 0.3
RESPIRATORY ACIDOSIS
Causes: in alveolar ventilation [Emphysema, pneumonia] COPD like Asthma Overdose of Respiratory depressant drugs Trauma to medulla oblongata Cystic fibrosis Compensation: - Kidney retains bicarbonate
RESPIRATORY ALKALOSIS
High pH due to low pCO2
pH = 6.1 + log
RESPIRATORY ALKALOSIS
Caused by Hyperventilation Hysterical over breathing incracranial pressure Brain stem lesions stimulate respiratory centre High altitude, Hypoxia stimulate Resp. centre Anxiety Drugs Salicylate overdos Compensation Kidney secrete bicarbonate
Results seen:
ACID-BASE DISORDER H+ PH Metabolic acidosis
HCO3
PCO2
Metabolic alkalosis
Respiratory acidosis Respiratory alkalosis
increased level; greatly increased level; decreased level; greatly decreased level
Electrolytes refers to a group of four tests: Na+ (sodium), K+ (potassium), Cl- (chloride) and bicarbonate (total CO2 content). An anion gap can be calculated from the electrolytes and provides a clue to the cause of the acid/base imbalance. Depending on the suspected cause, a number of other tests may be ordered: CMP (comprehensive metabolic panel), ketones in blood and ketones in urine, lactate, salicylates, ethylene glycol, and methanol, to name a few.
Anion Gap
AG= [Na+] ([HCO3] + [Cl-]) Normal anion gap is 7 +/- 4 Is the unmeasured anion concentration
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