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Definitions
ACID
a substance that can yield a hydrogen ion (H+) or hydronium ion (H3O+) when dissolved in water
BASE
a substance that can yield a hydroxyl ion (OH-) when dissolved in water
INTRODUCTION
Definitions
BUFFER
the combination of a weak acid or weak base and its salt; a system that resists changes in pH
pH
the negative (or inverse) log of the hydrogen ion concentration; -log[H+] or log 1/[H+]
INTRODUCTION
Definitions
ACIDOSIS
a pH below the reference range
ALKALOSIS
a pH above the reference range
INTRODUCTION
Definitions
PARTIAL PRESSURE
the pressure exerted by an individual gas in the atmosphere; equal to the barometric pressure times the percentage for the gas
pO2
the partial pressure of oxygen
pCO2
the partial pressure of carbon dioxide
INTRODUCTION
Maintenance of H+
The arterial pH is controlled by systems that regulate the production and retention of acids and bases, including
buffers the respiratory center and lungs the kidneys
PHYSIOLOGIC THEORY
Buffer Systems
The bicarbonate-carbonic acid system; HCO3- and H2CO3
when acid is added to the bicarbonate-carbonic acid system, HCO3- will combine with the H+ from the acid to form H2CO3 when a base is added, the H2CO3 will combine with the OHgroup to form H2O and HCO3-
PHYSIOLOGIC THEORY
Buffer Systems
The bicarbonate-carbonic acid system is important for three reasons
1. 2. 3. H2CO3 dissociates into CO2 and H2O, allowing H+ to be eliminated as CO2 by the lungs changes in pCO2 modify the ventilation rate HCO3- concentration can be altered by the kidneys
PHYSIOLOGIC THEORY
Buffer Systems
Other buffer systems
the phosphate buffer system; HPO4-- and H2PO4 the plasma proteins
PHYSIOLOGIC THEORY
Respiratory System
Plasma
the end product of most aerobic metabolic processes is CO2 in the plasma, small amounts of CO2 remain as dCO2 or combine with proteins to form carbamino compounds; most of the CO2 combines with H2O to form H2CO3, which quickly dissociates into H+ and HCO3-
PHYSIOLOGIC THEORY
Respiratory System
Lungs
inspired O2 diffuses from the alveoli into the blood and is bound to hemoglobin, forming oxyhemo-globin;
o the H+ that was carried on the (reduced) hemoglobin in the venous blood is released to recombine with HCO3- to form H2CO3, which dissociates into H2O and CO2
the CO2 diffuses into the alveoli and is eliminated through ventilation
PHYSIOLOGIC THEORY
Renal System
Kidneys
the kidneys main role in maintaining acid-base homeostasis is to reclaim HCO3- from the glomerular filtrate and add it to the blood
PHYSIOLOGIC THEORY
PHYSIOLOGIC THEORY
Daltons law
in a gas mixture, the total barometric pressure equals the sum of the individual components
for example, in atmospheric air pAtm = pO2 + pCO2 + pN2 + pH2O
PHYSIOLOGIC THEORY
Source
Venous blood
if pulmonary function or O2 transport is not being assessed
Arterial blood
radial, brachial, femoral
Arterial lines
SPECIMEN
Handling
dry heparin ice water slurry immediate transport to lab
SPECIMEN
pH electrode system
Measuring electrode
a glass membrane sensitive to H+ is placed around an internal Ag-AgCl electrode
Reference electrode
calomel (Hg-HgCl) or Ag-AgCl
Voltmeter (potentiometry)
millivoltmeter
METHODS OF ASSAY
METHODS OF ASSAY
METHODS OF ASSAY
CLINICAL CORRELATIONS
CLINICAL CORRELATIONS
Panic Values
pH: < 7.2 or > 7.6 pO2: < 40 mm Hg pCO2: < 20 mm Hg or > 70 mm Hg
CLINICAL CORRELATIONS
Metabolic Acidosis
Etiology
excessive formation of organic acids
CLINICAL CORRELATIONS
Metabolic Acidosis
Etiology (continued)
direct administration of an acid-producing substance
CLINICAL CORRELATIONS
Metabolic Acidosis
Compensation
respiratory: hyperventilation; an increase in alveolar ventilation
o
CLINICAL CORRELATIONS
Respiratory Acidosis
Etiology
hypoventilation; a decrease in alveolar ventilation:
o emphysema; bronchopneumonia; asphyxiation (strangulation or aspiration) o congestive heart failure, with decreased cardiac output o effects of drugs--barbiturates, morphine, or alcohol
CLINICAL CORRELATIONS
Respiratory Acidosis
Compensation
metabolic (renal): the kidneys increase the excretion of H+ and increase the reabsorption of HCO3-
CLINICAL CORRELATIONS
Metabolic Alkalosis
Etiology
A gain in HCO3-
excess administration of sodium bicarbonate; ingestion of bicarbonate-producing salts such as sodium lactate, citrate, or acetate
Excessive loss of acid
vomiting; nasogastric suctioning prolonged use of diuretics that augment renal excretion of H+
CLINICAL CORRELATIONS
Metabolic Alkalosis
Compensation
respiratory: hypoventilation, increasing the retention of CO2
CLINICAL CORRELATIONS
Respiratory Alkalosis
Etiology
hyperventilation; an increased rate of alveolar ventilation; causing excessive elimination of CO2 by the lungs
o stimulation of the respiratory center by drugs, such as salicylates o an increase in environmental temperature; fever o hysteria o pulmonary emboli; pulmonary fibrosis
CLINICAL CORRELATIONS
Respiratory Alkalosis
Compensation
metabolic (renal): the kidneys compensate by excreting HCO3and retaining H+
CLINICAL CORRELATIONS
Oxygen saturation
the ratio of O2 that is bound to hemoglobin, compared with the total amount the hemoglobin could bind
NOTES
NOTES
Co-Oximetry
Principle
spectrophotometric, based on the fact that each type of hemoglobin has a characteristic absorbance curve
Application
measurement of oxyhemoglobin, O2Hb; deoxyhemoglobin, HHb; carboxyhemoglobin, COHb; and methemoglobin, MetHb
NOTES
Hemoglobin-Oxygen Dissociation
Oxygen dissociates from hemoglobin in a characteristic fashion
if this dissociation is graphed with the pO2 on the x-axis and percent SO2 on the y-axis, the resulting curve is sigmoid, or slightly S-shaped
NOTES
Oxygenation
Adequate tissue oxygenation requires:
available atmospheric oxygen adequate ventilation gas exchange between the lungs and arterial blood loading of O2 onto hemoglobin adequate hemoglobin adequate transport (cardiac output) release of O2 to the tissues
NOTES
Oxygenation
Factors that influence tissue oxygenation:
destruction of the alveoli (e.g. emphysema) pulmonary edema airway blockage (e.g. asthma, bronchitis) inadequate blood supply (e.g. pulmonary embolism or congestive heart failure)
NOTES
Oxygenation
Factors that influence tissue oxygenation
the concentration and type(s) of hemoglobin the presence of nonoxygen substances, such as carbon monoxide (CO) the pH the temperature of the blood the levels of pO2 the level of 2,3-DPG
NOTES
NOTES