BUFFERING OF HYDROGEN LOAD

Size: px
Start display at page:

Download "BUFFERING OF HYDROGEN LOAD"

Transcription

1

2 BUFFERING OF HYDROGEN LOAD 1. Extracellular space minutes 2. Intracellular space minutes to hours 3. Respiratory compensation 6 to 12 hours 4. Renal compensation hours, up to 2-3 days

3 RENAL HYDROGEN SECRETION

4 HYDROGEN SECRETION (>99 %) (<1%) BICARBONATE REABSORPTION HYDROGEN EXCRETION NH 4+ ( mmol/day) acidemia (+) hypokalemia (+) TITRATABLE ACID ( mmol/day) Filtered phosphate (+) Unreabsorbable anions (+) FREE HYDROGEN ( urine ph )

5 HYDROGEN SECRETION STIMULATION FACTOR Decrease in plasma [HCO 3- ] Increase in plasma pco 2 SITE OF ACTION Entire nephron Entire nephron Increased filtered load of [HCO 3- ] Proximal tubule Decrease in ECF volume Hypokalemia Aldosterone Nonreabsorbable anions Proximal and collecting tubule Proximal and collecting tubule Collecting tubule Entire nephron

6 TYPES OF ACID-BASE DISORDERS Alkalosis and Acidosis Metabolic and Respiratory Acute and Chronic Simple and Complex

7 ANALYSIS OF ACID-BASE BALANCE 1. BLOOD GASOMETRY 2. SERUM ANION GAP [Na] { [Cl] + [HCO 3 ] } 3. URINE ANION GAP { [Na] + [K] } [Cl] = - [NH 4 ]

8 RESPIRATORY ACIDOSIS [H + ] nmol/l [HCO 3- ] mmol/l pco 2 40 mm Hg Diagnosis NormaL

9 RESPIRATORY ACIDOSIS [H + ] nmol/l [HCO 3- ] mmol/l pco 2 40 mm Hg Diagnosis NormaL Acute Respiratory Acidosis

10 RESPIRATORY ACIDOSIS [H + ] nmol/l [HCO 3- ] mmol/l pco 2 40 mm Hg Diagnosis NormaL Acute Respiratory Acidosis Compensated Respiratory Acidosis

11 RESPIRATORY ACIDOSIS [H + ] nmol/l [HCO 3- ] mmol/l pco 2 40 mm Hg Diagnosis NormaL Acute Respiratory Acidosis Compensated Respiratory Acidosis Respiratory Acidosis and Metabolic Acidosis

12 RESPIRATORY ACIDOSIS [H + ] nmol/l [HCO 3- ] mmol/l pco 2 40 mm Hg Diagnosis NormaL Acute Respiratory Acidosis Compensated Respiratory Acidosis Respiratory Acidosis and Metabolic Acidosis Respiratory Acidosis and Metabolic Alkalosis

13 ANALYSIS OF ACID-BASE BALANCE 1. BLOOD GASOMETRY 2. SERUM ANION GAP [Na] { [Cl] + [HCO 3 ] } 3. URINE ANION GAP { [Na] + [K] } [Cl] = - [NH 4 ]

14 METABOLIC ACIDOSIS LACTIC ACIDOSIS -type A - caused by hypoxia - total anoxia ( 60 mmol of lactic acid/min) - type B - inadequate metabolism of lactate - liver failure - Lactic acidosis in presence of tumors: - production of LA in ischemic tumor cells - metabolites released from necrotic cells inhibit hepatic gluconeogenesis

15 METABOLIC ACIDOSIS 2. Ketoacidosis - accumulation of acetoacetate, β- hydroxybutyrate A. with normal β-cell function - hypoglycemia due to starvation - inhibition of insulin release (α-adrenergics) B. with abnormal β-cell function - decompensated diabetes mellitus

16 HYPERCHLOREMIC METABOLIC ACIDOSIS 1. Excessive loss of bicarbonates via GI tract - diarrhea ( activation of Na + /H + and Cl - /HCO 3- antiporters) 2. Excessive loss of bicarbonates via kidneys - inhibition of carbonic anhydrase - renal tubular acidosis

17 PROXIMAL RENAL TUBULAR ACIDOSIS (TYPE II) defective bicarbonate reabsorption due to decreased secretion of H + defect in basolateral Na + /HCO 3- cotransporter deficiency of carbonic anhydrase defect of Na + - K + ATPase the defect may coexist with: defective Na+ reabsorption defective reabsorption of other solutes (glucose, aminoacids) defective reabsorption of albumin Such disorder is called Fanconi Syndrome Fractional excretion of bicarbonates > 15%

18 DISTAL RENAL TUBULAR ACIDOSIS (TYPE I) defect in H + secretion from the α-intercalated cells dysfunction of HCO 3- /Cl - basolateral antiporter back-leakage of H + via hyperpermeable luminal membrane urine ph > 5.5 simultaneous increased secretion of potassium from principal cells

19 SYSTEMIC EFFECTS OF ACIDOSIS Cardiovascular dilatation of arteries constriction of veins negative inotropic effect release of catecholamines enhanced vagal stimulation Renal potassium wastage Central Nervous System inhibition of activity, depression Bones demineralisation

20 METABOLIC ALKALOSIS Patomechanisms adminstration of alkaline substances gastrointestinal H + loss contraction alkalosis metabolic alkalosis due to potassium deficiency Buffering of metabolic alkalosis ECF (about 65%) and ICF (about 35%) respiratory compensation renal compensation depends on ECF volume depends on potassium balance

21 SYSTEMIC EFFECTS OF ALKALOSIS Cardiovascular decreased cardiac output arrhytmias Respiratory decrease in respiratory drive increased affinity of oxygen to hemoglobin Renal decreased reabsorption of bicarbonates Central Nervous System lethargy, confusion, paresthesias

22 RESPIRATORY ACIDOSIS Excessive synthesis of CO 2 in the body Deficient elimination of CO 2 from the organism Patomechanisms of hypercapnia Excessive production of CO2 exercise hyperthyroidism increased body temperature carbohydrate diet all these factors do not cause hypercapnia if ventilation is adequate

23 RESPIRATORY ACIDOSIS - PATOMECHANISMS CENTRAL Inhibition of the medullary respiratory center ischemia barbiturates, opiates PERIPHERAL Disorders of the respiratory muscles or chest wall polimyositis myasthenia gravis hypokalemia kyphoscoliosis obesity Upper airway obstruction Impaired gas exchange in lungs obstructive lung disease adult respiratory distress syndrome pulmonary edema Mechanical hypoventilation

24 SYSTEMIC EFFECTS OF RESPIRATORY ACIDOSIS Acidification of cytosol => inhibition of glycolysis => inhibition of Krebs cyle => deficit of energy Cardiovascular effects negative inotropic effect vasodilatation increased blood flow in brain => brain edema (CO 2 narcosis) increased coronary blood flow ( stealing of blood from ischemic regions) intracellular acidification + increased catecholamines => arrhytmia Endocrine effects increased release of catecholamines from adrenal medulla increased release of cortisol increased release of aldosterone increased release of ACTH increased release of ADH

25 SYSTEMIC EFFECTS OF RESPIRATORY ACIDOSIS Gastrointestinal effects increased secretion of gastric juice Respiratory effects (if chronic) decreased sensitivity of respiratory center to CO 2 Renal increased secretion of hydrogen increased reabsorption of bicarbonates increased synthesis of NH 3 increased excretion of titratable acid

26 RESPIRATORY ALKALOSIS - PATOMECHANISMS Hypoxemia stimulation of the peripheral chemoreceptors => hyperventilation Pulmonary diseases hypoxemia stimulates ventilation pulmonary juxtacapillary receptors activated during edema =>n.vagus => hyper ventilation irritant receptors in bronchi => n.vagus => hyperventilation Direct stimulation of the respiratory center psychogenic or voluntary hyperventilation amines in liver failure endotoxins progesteron salicylates Mechanical hyperventilation

27 SYSTEMIC EFFECTS OF RESPIRATORY ALKALOSIS Alkalisation of the cells stimulation of anaerobic glycolysis leftward shift of hemoglobin curve => impaired O 2 supply to tissues Cardiovascular effects increased myocardial contractility => increased oxygen demand increased systemic vascular resistance => increased afterload arrhytmias increased platelet count & aggregation => thrombosis Respiratory effects increased airway resistance increased pulmonary capillary permeability depletion of lamellar bodies in pneumocytes => decreased compliance hypocapnia attenuates hypoxic pulmonary vasoconstriction => increased blood shunt in lungs Central Nervous System constriction of blood vessesl => decreased blood flow

D fini n tion: p = = -log [H+] ph=7 me m an s 10-7 Mol M H+ + (100 nmol m /l); ) p ; H=8 me m an s 10-8 Mol M H+ + (10 (10 n nmol m /l) Nor

D fini n tion: p = = -log [H+] ph=7 me m an s 10-7 Mol M H+ + (100 nmol m /l); ) p ; H=8 me m an s 10-8 Mol M H+ + (10 (10 n nmol m /l) Nor Definition: ph regulation ph = -log [H + ] ph=7 means 10-7 Mol H + (100 nmol/l); ph=8 means 10 Normal plasma value: 7.35-7.45; 7.45; (H Acidosis: ph7.45 Intracellular ph = 7.1-7.3

More information

Acid-Base Imbalance-2 Lecture 9 (12/4/2015) Yanal A. Shafagoj MD. PhD

Acid-Base Imbalance-2 Lecture 9 (12/4/2015) Yanal A. Shafagoj MD. PhD AcidBase Imbalance2 Lecture 9 (12/4/2015) Yanal A. Shafagoj MD. PhD Introduction Disturbance in acidbase balance are common clinical problem that range in severity from mild to life threatening, the acute

More information

ACID-BASE BALANCE URINE BLOOD AIR

ACID-BASE BALANCE URINE BLOOD AIR ACIDBASE BALANCE URINE BLOOD AIR H 2 PO 4 NH 4 HCO 3 KIDNEY H H HCO 3 CELLS Hb H LUNG H 2 CO 3 HHb CO 2 H 2 O ph = 7.4 [HCO 3 ] = 24 meq/l PCO 2 = 40 mm Hg CO 2 PRIMARY RENAL MECHANISMS INVOLVED IN ACIDBASE

More information

Acid and Base Balance

Acid and Base Balance Acid and Base Balance 1 2 The Body and ph Homeostasis of ph is tightly controlled Extracellular fluid = 7.4 Blood = 7.35 7.45 < 7.35: Acidosis (acidemia) > 7.45: Alkalosis (alkalemia) < 6.8 or > 8.0: death

More information

Metabolic Alkalosis: Vomiting

Metabolic Alkalosis: Vomiting RENAL ANL) ACID-BASE PHYSIOLOGY 213 Case 37 Metabolic Alkalosis: Vomiting Maria Cuervo is a 20-year-old philosophy major at a state university. When the "24-hour" stomach flu went around campus during

More information

Acids and Bases their definitions and meanings

Acids and Bases their definitions and meanings Acids and Bases their definitions and meanings Molecules containing hydrogen atoms that can release hydrogen ions in solutions are referred to as acids. (HCl H + Cl ) (H 2 CO 3 H + HCO 3 ) A base is an

More information

Acid Base Balance. Chapter 26 Balance. ph Imbalances. Acid Base Balance. CO 2 and ph. Carbonic Acid. Part 2. Acid/Base Balance

Acid Base Balance. Chapter 26 Balance. ph Imbalances. Acid Base Balance. CO 2 and ph. Carbonic Acid. Part 2. Acid/Base Balance Acid Base Balance Chapter 26 Balance Part 2. Acid/Base Balance Precisely balances production and loss of hydrogen ions (ph) The body generates acids during normal metabolism, tends to reduce ph Kidneys:

More information

Acid Base Balance. Professor Dr. Raid M. H. Al-Salih. Clinical Chemistry Professor Dr. Raid M. H. Al-Salih

Acid Base Balance. Professor Dr. Raid M. H. Al-Salih. Clinical Chemistry Professor Dr. Raid M. H. Al-Salih Acid Base Balance 1 HYDROGEN ION CONCENTRATION and CONCEPT OF ph Blood hydrogen ion concentration (abbreviated [H + ]) is maintained within tight limits in health, with the normal concentration being between

More information

Answers and Explanations

Answers and Explanations Answers and Explanations 1. The answer is D [V B 4 b]. Distal K + secretion is decreased by factors that decrease the driving force for passive diffusion of K + across the luminal membrane. Because spironolactone

More information

UNIT VI: ACID BASE IMBALANCE

UNIT VI: ACID BASE IMBALANCE UNIT VI: ACID BASE IMBALANCE 1 Objectives: Review the physiological mechanism responsible to regulate acid base balance in the body i.e.: Buffers (phosphate, hemoglobin, carbonate) Renal mechanism Respiratory

More information

Fluid and Electrolytes P A R T 4

Fluid and Electrolytes P A R T 4 Fluid and Electrolytes P A R T 4 Mechanisms that control acid-base homeostasis Acids and bases continually enter and leave body Hydrogen ions also result from metabolic activity Acids Hydrogen ion donors

More information

Renal physiology V. Regulation of acid-base balance. Dr Alida Koorts BMS

Renal physiology V. Regulation of acid-base balance. Dr Alida Koorts BMS Renal physiology V Regulation of acidbase balance Dr Alida Koorts BMS 712 012 319 2921 akoorts@medic.up.ac.za Hydrogen ions (H + ): Concentration and origin Concentration in arterial blood, resting: [H

More information

Renal Physiology. April, J. Mohan, PhD. Lecturer, Physiology Unit, Faculty of Medical Sciences, U.W.I., St Augustine.

Renal Physiology. April, J. Mohan, PhD. Lecturer, Physiology Unit, Faculty of Medical Sciences, U.W.I., St Augustine. Renal Physiology April, 2011 J. Mohan, PhD. Lecturer, Physiology Unit, Faculty of Medical Sciences, U.W.I., St Augustine. Office : Room 105, Physiology Unit. References: Koeppen B.E. & Stanton B.A. (2010).

More information

Acid-Base Tutorial 2/10/2014. Overview. Physiology (2) Physiology (1)

Acid-Base Tutorial 2/10/2014. Overview. Physiology (2) Physiology (1) Overview Acid-Base Tutorial Nicola Barlow Physiology Buffering systems Control mechanisms Laboratory assessment of acid-base Disorders of H + ion homeostasis Respiratory acidosis Metabolic acidosis Respiratory

More information

Chapter 15 Fluid and Acid-Base Balance

Chapter 15 Fluid and Acid-Base Balance Chapter 15 Fluid and Acid-Base Balance by Dr. Jay M. Templin Brooks/Cole - Thomson Learning Fluid Balance Water constitutes ~60% of body weight. All cells and tissues are surrounded by an aqueous environment.

More information

Chapter 19 The Urinary System Fluid and Electrolyte Balance

Chapter 19 The Urinary System Fluid and Electrolyte Balance Chapter 19 The Urinary System Fluid and Electrolyte Balance Chapter Outline The Concept of Balance Water Balance Sodium Balance Potassium Balance Calcium Balance Interactions between Fluid and Electrolyte

More information

Physiological Causes of Abnormal ABG s

Physiological Causes of Abnormal ABG s Physiological Causes of Abnormal ABG s Major Student Performance Objective 1 1. The student will be able to discuss causes for various types of blood gas results. 2. They will also be required to discuss

More information

Acid-Base Balance 11/18/2011. Regulation of Potassium Balance. Regulation of Potassium Balance. Regulatory Site: Cortical Collecting Ducts.

Acid-Base Balance 11/18/2011. Regulation of Potassium Balance. Regulation of Potassium Balance. Regulatory Site: Cortical Collecting Ducts. Influence of Other Hormones on Sodium Balance Acid-Base Balance Estrogens: Enhance NaCl reabsorption by renal tubules May cause water retention during menstrual cycles Are responsible for edema during

More information

NORMAL POTASSIUM DISTRIBUTION AND BALANCE

NORMAL POTASSIUM DISTRIBUTION AND BALANCE NORMAL POTASSIUM DISTRIBUTION AND BALANCE 98% of body potassium is contained within cells, principally muscle cells, and is readily exchangeable. Only 2% is in ECF. Daily intake exceeds the amount in ECF.

More information

There are number of parameters which are measured: ph Oxygen (O 2 ) Carbon Dioxide (CO 2 ) Bicarbonate (HCO 3 -) AaDO 2 O 2 Content O 2 Saturation

There are number of parameters which are measured: ph Oxygen (O 2 ) Carbon Dioxide (CO 2 ) Bicarbonate (HCO 3 -) AaDO 2 O 2 Content O 2 Saturation Arterial Blood Gases (ABG) A blood gas is exactly that...it measures the dissolved gases in your bloodstream. This provides one of the best measurements of what is known as the acid-base balance. The body

More information

Chapter 27: WATER, ELECTROLYTES, AND ACID-BASE BALANCE

Chapter 27: WATER, ELECTROLYTES, AND ACID-BASE BALANCE Chapter 27: WATER, ELECTROLYTES, AND ACID-BASE BALANCE I. RELATED TOPICS Integumentary system Cerebrospinal fluid Aqueous humor Digestive juices Feces Capillary dynamics Lymph circulation Edema Osmosis

More information

Carbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water

Carbon Dioxide Transport. Carbon Dioxide. Carbon Dioxide Transport. Carbon Dioxide Transport - Plasma. Hydrolysis of Water Module H: Carbon Dioxide Transport Beachey Ch 9 & 10 Egan pp. 244-246, 281-284 Carbon Dioxide Transport At the end of today s session you will be able to : Describe the relationship free hydrogen ions

More information

Blood Gases, ph, Acid- Base Balance

Blood Gases, ph, Acid- Base Balance Blood Gases, ph, Acid- Base Balance Blood Gases Acid-Base Physiology Clinical Acid-Base Disturbances Blood Gases Respiratory Gas Exchange Chemical Control of Respiration Dyshemoglobins Oxygen Transport

More information

3/19/2009. The task of the kidney in acid-base balance Excretion of the daily acid load. Buffering of an acid load. A o B - + H + B - A o +OH - C +

3/19/2009. The task of the kidney in acid-base balance Excretion of the daily acid load. Buffering of an acid load. A o B - + H + B - A o +OH - C + The task of the kidney in acid-base balance Excretion of the daily acid load Buffering of an acid load Oxidation of amino acids, fats and carbohydrates often lead to acid production. On an average American

More information

mmol.l -1 H+ Ca++ K+ Na+

mmol.l -1 H+ Ca++ K+ Na+ Disorders of acid-base equilibrium Pathobiochemistry and diagnostics of acid-base and mineral metabolism Physiologic ph Plasma and most extracellular fluids ph = 7.40 ± 0.02 Significance of constant ph

More information

CHAPTER 27 LECTURE OUTLINE

CHAPTER 27 LECTURE OUTLINE CHAPTER 27 LECTURE OUTLINE I. INTRODUCTION A. Body fluid refers to body water and its dissolved substances. B. Regulatory mechanisms insure homeostasis of body fluids since their malfunction may seriously

More information

RENAL TUBULAR ACIDOSIS An Overview

RENAL TUBULAR ACIDOSIS An Overview RENAL TUBULAR ACIDOSIS An Overview UNIVERSITY OF PNG SCHOOL OF MEDICINE AND HEALTH SCIENCES DISCIPLINE OF BIOCHEMISTRY & MOLECULAR BIOLOGY CLINICAL BIOCHEMISTRY PBL MBBS IV VJ. Temple 1 What is Renal Tubular

More information

Slide 1. Slide 2. Slide 3. Learning Outcomes. Acid base terminology ARTERIAL BLOOD GAS INTERPRETATION

Slide 1. Slide 2. Slide 3. Learning Outcomes. Acid base terminology ARTERIAL BLOOD GAS INTERPRETATION Slide 1 ARTERIAL BLOOD GAS INTERPRETATION David O Neill MSc BSc RN NMP FHEA Associate Lecturer (Non Medical Prescribing) Cardiff University Advanced Nurse Practitioner Respiratory Medicine Slide 2 Learning

More information

Physio 12 -Summer 02 - Renal Physiology - Page 1

Physio 12 -Summer 02 - Renal Physiology - Page 1 Physiology 12 Kidney and Fluid regulation Guyton Ch 20, 21,22,23 Roles of the Kidney Regulation of body fluid osmolarity and electrolytes Regulation of acid-base balance (ph) Excretion of natural wastes

More information

Acids, Bases, and Salts

Acids, Bases, and Salts Acid / Base Balance Objectives Define an acid, a base, and the measure of ph. Discuss acid/base balance, the effects of acidosis or alkalosis on the body, and the mechanisms in place to maintain balance

More information

ANATOMY & PHYSIOLOGY - CLUTCH CH ACID-BASE BALANCE-- CONTROLLING BLOOD PH

ANATOMY & PHYSIOLOGY - CLUTCH CH ACID-BASE BALANCE-- CONTROLLING BLOOD PH !! www.clutchprep.com ANATOMY & PHYSIOLOGY - CLUTCH CONCEPT: INTRO. TO DISTURBING AND MAINTAINING BLOOD ph Physiological Sources of Acid (and Base): Acids are molecules/substances that H+ to a solution.

More information

Kidneys in regulation of homeostasis

Kidneys in regulation of homeostasis Kidneys in regulation of homeostasis Assoc. Prof. MUDr. Markéta Bébarová, Ph.D. Department of Physiology Faculty of Medicine, Masaryk University This presentation includes only the most important terms

More information

Acid-base balance is one of the most important of the body s homeostatic mechanisms Acid-base balance refers to regulation of hydrogen ion (H + )

Acid-base balance is one of the most important of the body s homeostatic mechanisms Acid-base balance refers to regulation of hydrogen ion (H + ) Acid-base balance is one of the most important of the body s homeostatic mechanisms Acid-base balance refers to regulation of hydrogen ion (H + ) concentration in body fluids Precise regulation of ph at

More information

Dr. Suzana Voiculescu

Dr. Suzana Voiculescu Dr. Suzana Voiculescu AB balance parameters Extracellular ph (plasmatic ph)= 7.35-7.45 < 7.35= acidosis >7.45= alkalosis Kassirer-Bleich equation [H+] = 24 PCO2/ [HCO3-] predicts that the ratio of dissolved

More information

Arterial Blood Gas Interpretation: The Basics

Arterial Blood Gas Interpretation: The Basics http://www.medicine-on-line.com ABG Basics: Page 1/10 Arterial Blood Gas Interpretation: The Basics Author: David C Chung MD, FRCPC Affiliation: The Chinese University of Hong Kong Sampling of arterial

More information

UNIT 9 INVESTIGATION OF ACID-BASE DISTURBANCES

UNIT 9 INVESTIGATION OF ACID-BASE DISTURBANCES UNIT 9 INVESTIGATION OF ACIDBASE DISTURBANCES LEARNING OBJECTIVES At the end of this chapter, students must be able to: 1. Describe the main parametres that define the acidbase equilibrium 2. Identify

More information

Basic facts repetition Regulation of A-B balance. Pathophysiology of clinically important disorders

Basic facts repetition Regulation of A-B balance. Pathophysiology of clinically important disorders In The name of God Acid base balance Basic facts repetition Regulation of A-B balance Pathophysiology of clinically important disorders Acid-Base Balance Physiology - The ph of ECF is tightly regulated

More information

/ABG. It covers acid-base disturbance, respiratory failure, and a small summary for some other derangements. Causes of disturbance

/ABG. It covers acid-base disturbance, respiratory failure, and a small summary for some other derangements. Causes of disturbance /ABG This page focuses on providing some possible causes for the various disturbances that may be seen on an ABG. Although not an exhaustive list, it attempts to outline the main headings for possible

More information

Water, Electrolytes, and Acid-Base Balance

Water, Electrolytes, and Acid-Base Balance Chapter 27 Water, Electrolytes, and Acid-Base Balance 1 Body Fluids Intracellular fluid compartment All fluids inside cells of body About 40% of total body weight Extracellular fluid compartment All fluids

More information

Acid-Base Balance Dr. Gary Mumaugh

Acid-Base Balance Dr. Gary Mumaugh Acid-Base Balance Dr. Gary Mumaugh Introduction Acid-base balance is one of the most important of the body s homeostatic mechanisms Acid-base balance refers to regulation of hydrogen ion (H + ) concentration

More information

CASE 27. What is the response of the kidney to metabolic acidosis? What is the response of the kidney to a respiratory alkalosis?

CASE 27. What is the response of the kidney to metabolic acidosis? What is the response of the kidney to a respiratory alkalosis? CASE 27 A 21-year-old man with insulin-dependent diabetes presents to the emergency center with mental status changes, nausea, vomiting, abdominal pain, and rapid respirations. On examination, the patient

More information

Acid-base balance (ABB)

Acid-base balance (ABB) Acid-base balance (ABB) Overview of the lecture ph, relationships between metabolism and changes of ph: Definition of ph, ph values in the different body compartments Production of acids and bases in the

More information

There are many buffers in the kidney, but the main one is the phosphate buffer.

There are many buffers in the kidney, but the main one is the phosphate buffer. 9 Yanal Obada Zalat Renal Control of AcidBase Balance The kidneys play three major roles in the maintenance of normal acidbase balance: 1excretion of H+ (fixed _non volatile H+) 2Reabsorption of filtrated

More information

Physiology questions review

Physiology questions review Physiology questions review 1- The consumption of O2 by the kidney: a- decrease as blood flow increases b- regulated by erythropoiten c- remains constant as blood flow increase d- direct reflects the level

More information

Acid-Base Balance * OpenStax

Acid-Base Balance * OpenStax OpenStax-CNX module: m46409 1 Acid-Base Balance * OpenStax This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 3.0 By the end of this section, you will be

More information

Arterial Blood Gas Analysis

Arterial Blood Gas Analysis Arterial Blood Gas Analysis L Lester www.3bv.org Bones, Brains & Blood Vessels Drawn from radial or femoral arteries. Invasive procedure Caution must be taken with patient on anticoagulants ph: 7.35-7.45

More information

Interpretation of Arterial Blood Gases. Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB)

Interpretation of Arterial Blood Gases. Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB) Interpretation of Arterial Blood Gases Prof. Dr. W. Vincken Head Respiratory Division Academisch Ziekenhuis Vrije Universiteit Brussel (AZ VUB) Before interpretation of ABG Make/Take note of Correct puncture

More information

WATER, SODIUM AND POTASSIUM

WATER, SODIUM AND POTASSIUM WATER, SODIUM AND POTASSIUM Attila Miseta Tamás Kőszegi Department of Laboratory Medicine, 2016 1 Average daily water intake and output of a normal adult 2 Approximate contributions to plasma osmolality

More information

Principles of Anatomy and Physiology

Principles of Anatomy and Physiology Principles of Anatomy and Physiology 14 th Edition CHAPTER 27 Fluid, Electrolyte, and Acid Base Fluid Compartments and Fluid In adults, body fluids make up between 55% and 65% of total body mass. Body

More information

Chapter 26 Fluid, Electrolyte, and Acid- Base Balance

Chapter 26 Fluid, Electrolyte, and Acid- Base Balance Chapter 26 Fluid, Electrolyte, and Acid- Base Balance 1 Body Water Content Infants: 73% or more water (low body fat, low bone mass) Adult males: ~60% water Adult females: ~50% water (higher fat content,

More information

3/17/2017. Acid-Base Disturbances. Goal. Eric Magaña, M.D. Presbyterian Medical Center Department of Pulmonary and Critical Care Medicine

3/17/2017. Acid-Base Disturbances. Goal. Eric Magaña, M.D. Presbyterian Medical Center Department of Pulmonary and Critical Care Medicine Acid-Base Disturbances Eric Magaña, M.D. Presbyterian Medical Center Department of Pulmonary and Critical Care Medicine Goal Provide an approach to determine complex acid-base disorders Discuss the approach

More information

ARTERIAL BLOOD GASES PART 1 BACK TO BASICS SSR OLIVIA ELSWORTH SEPT 2017

ARTERIAL BLOOD GASES PART 1 BACK TO BASICS SSR OLIVIA ELSWORTH SEPT 2017 ARTERIAL BLOOD GASES PART 1 BACK TO BASICS SSR OLIVIA ELSWORTH SEPT 2017 WHAT INFORMATION DOES AN ABG GIVE US? ph = measure of hydrogen ion concentration (acidity or alkalinity) PaCO2 = partial pressure

More information

9/14/2017. Acid-Base Disturbances. Goal. Provide an approach to determine complex acid-base disorders

9/14/2017. Acid-Base Disturbances. Goal. Provide an approach to determine complex acid-base disorders Acid-Base Disturbances NCNP October 10, 2017 Eric Magaña, M.D. Presbyterian Medical Center Department of Pulmonary and Critical Care Medicine Goal Provide an approach to determine complex acid-base disorders

More information

Potassium regulation. -Kidney is a major regulator for potassium Homeostasis.

Potassium regulation. -Kidney is a major regulator for potassium Homeostasis. Potassium regulation. -Kidney is a major regulator for potassium Homeostasis. Normal potassium intake, distribution, and output from the body. Effects of severe hyperkalemia Partial depolarization of cell

More information

Renal physiology II. Basic renal processes. Dr Alida Koorts BMS

Renal physiology II. Basic renal processes. Dr Alida Koorts BMS Renal physiology II Basic renal processes Dr Alida Koorts BMS 7-12 012 319 2921 akoorts@medic.up.ac.za Basic renal processes 1. filtration 2. reabsorption 3. secretion Glomerular filtration The filtration

More information

Biochemistry of acid-base disorders. Alice Skoumalová

Biochemistry of acid-base disorders. Alice Skoumalová Biochemistry of acid-base disorders Alice Skoumalová Main topics of the lecture: Measurement of acid-base dysbalance Classification of the acid-base disorders 4 basic acid-base disorders and their compensaiton

More information

Acid/Base Disorders 2015

Acid/Base Disorders 2015 Objectives - 2 1. Identify acid/base disorders 2. Discuss etiologies for 1 0 acid/base disorders (will not include mixed disorders) 3. Interpret acid/base disorders by interpreting arterial blood gas &

More information

Control of Ventilation [2]

Control of Ventilation [2] Control of Ventilation [2] สรช ย ศร ส มะ พบ., Ph.D. ภาคว ชาสร รว ทยา คณะแพทยศาสตร ศ ร ราชพยาบาล มหาว ทยาล ยมห ดล Describe the effects of alterations in chemical stimuli, their mechanisms and response to

More information

Disorders of Acid-Base

Disorders of Acid-Base Disorders of Acid-Base Balance Bởi: OpenStaxCollege Normal arterial blood ph is restricted to a very narrow range of 7.35 to 7.45. A person who has a blood ph below 7.35 is considered to be in acidosis

More information

Acid-Base Balance. Every day, metabolic reactions in the body produce and. George A. Tanner, Ph.D.

Acid-Base Balance. Every day, metabolic reactions in the body produce and. George A. Tanner, Ph.D. 25 C H A P T E R Acid-Base Balance George A. Tanner, Ph.D. CHAPTER OUTLINE A REVIEW OF ACID-BASE CHEMISTRY PRODUCTION AND REGULATION OF HYDROGEN IONS IN THE BODY CHEMICAL REGULATION OF PH RESPIRATORY REGULATION

More information

0, ,54 0, , , ,5. H+ Ca++ mmol.l -1

0, ,54 0, , , ,5. H+ Ca++ mmol.l -1 Acidbase equilibrium Physiologic ph Plasma and most extracellular fluids ph = 7.40 ± 0.02 Significance of constant ph ph influences properties of proteins enzyme activity structure of cell components permeability

More information

Acid - base equilibrium

Acid - base equilibrium Acid base equilibrium ph concept ph = log [H + ] ph [H+] 1 100 mmol/l D = 90 mmol/l 2 10 mmol/l D = 9 mmol/l 3 1 mmol/l 2 ph = log [H + ] 3 ph ph = log [H + ] ph of capillary blood norm: 7,35 7,45 Sorensen

More information

1. What is the acid-base disturbance in this patient?

1. What is the acid-base disturbance in this patient? /ABG QUIZ QUIZ 1. What is the acid-base disturbance in this patient? Presenting complaint: pneumonia 1 point Uncompensated metabolic alkalosis Partially compensated respiratory alkalosis Mixed alkalosis

More information

Dr. Suzana Voiculescu

Dr. Suzana Voiculescu Dr. Suzana Voiculescu Definition All the processes inside the body which keep the H+ concentration within normal values. Depends on water and ion balance blood gas homeostasis Blood acidity may be expressed

More information

Hyperaldosteronism: Conn's Syndrome

Hyperaldosteronism: Conn's Syndrome RENAL AND ACID-BASE PHYSIOLOGY 177 Case 31 Hyperaldosteronism: Conn's Syndrome Seymour Simon is a 54-year-old college physics professor who maintains a healthy lifestyle. He exercises regularly, doesn't

More information

Dr. Suzana Voiculescu Discipline of Physiology and Fundamental Neurosciences Carol Davila Univ. of Medicine and Pharmacy

Dr. Suzana Voiculescu Discipline of Physiology and Fundamental Neurosciences Carol Davila Univ. of Medicine and Pharmacy Dr. Suzana Voiculescu Discipline of Physiology and Fundamental Neurosciences Carol Davila Univ. of Medicine and Pharmacy AB balance parameters Extracellular ph (plasmatic ph)= 7.35-7.45 < 7.35= acidosis

More information

Physiology week 16 Renal 2 (volume/buffers)

Physiology week 16 Renal 2 (volume/buffers) Physiology week 16 Renal 2 (volume/buffers) Defense of Tonicity and Volume Defense of tonicity Tonicity = osmolality of a solution relative to plasma Osmolality measures [ ] all particles in solution,

More information

Acid-Base Physiology. Dr. Tamás Bense Dr. Alexandra Turi

Acid-Base Physiology. Dr. Tamás Bense Dr. Alexandra Turi Acid-Base Physiology Dr. Tamás Bense Dr. Alexandra Turi What is a blood gas assessment? We get it from an arterial sample (a.radialis, a. brachialis, a. femoralis) Invasive technique If the patient is

More information

Ch 17 Physiology of the Kidneys

Ch 17 Physiology of the Kidneys Ch 17 Physiology of the Kidneys Review Anatomy on your own SLOs List and describe the 4 major functions of the kidneys. List and explain the 4 processes of the urinary system. Diagram the filtration barriers

More information

ACID/BASE. A. What is her acid-base disorder, what is her anion gap, and what is the likely cause?

ACID/BASE. A. What is her acid-base disorder, what is her anion gap, and what is the likely cause? These fluid and electrolyte problems are modified from those in a previous textbook for this sequence, Renal Pathophysiology edited by James A. Shayman M.D., Professor of Internal Medicine, University

More information

Biology December 2009 Exam Four FORM W KEY

Biology December 2009 Exam Four FORM W KEY Biology 251 3 December 2009 Exam Four FORM W KEY PRINT YOUR NAME AND ID NUMBER in the space that is provided on the answer sheet, and then blacken the letter boxes below the corresponding letters of your

More information

Acid-Base Physiology

Acid-Base Physiology AcidBase Physiology 1990 Write short notes on buffers. 1. A buffer is a solution which has the ability to minimised changes in ph when an acid or base is added to it. It usually consists of a weak acid

More information

The equilibrium between basis and acid can be calculated and termed as the equilibrium constant = Ka. (sometimes referred as the dissociation constant

The equilibrium between basis and acid can be calculated and termed as the equilibrium constant = Ka. (sometimes referred as the dissociation constant Acid base balance Dobroslav Hájek dhajek@med.muni.cz May 2004 The equilibrium between basis and acid can be calculated and termed as the equilibrium constant = Ka. (sometimes referred as the dissociation

More information

Acid Base Disorders. J. Vymětal

Acid Base Disorders. J. Vymětal Acid Base Disorders J. Vymětal ph alkalinity/acidity of internal enviroment 7,4 ± 0,04 mmol/l pco 2 respiratory component of ABB 4,5-6,5 kpa po 2 partial pressure O 2 10-13,3 kpa shco 3 metabolic component

More information

a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure.

a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. B. 10 Applied Respiratory Physiology a. Describe the physiological consequences of intermittent positive pressure ventilation and positive end-expiratory pressure. Intermittent positive pressure ventilation

More information

** Accordingly GFR can be estimated by using one urine sample and do creatinine testing.

** Accordingly GFR can be estimated by using one urine sample and do creatinine testing. This sheet includes the lecture and last year s exam. When a patient goes to a clinic, we order 2 tests: 1) kidney function test: in which we measure UREA and CREATININE levels, and electrolytes (Na+,

More information

3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D.

3. Which of the following would be inconsistent with respiratory alkalosis? A. ph = 7.57 B. PaCO = 30 mm Hg C. ph = 7.63 D. Pilbeam: Mechanical Ventilation, 4 th Edition Test Bank Chapter 1: Oxygenation and Acid-Base Evaluation MULTIPLE CHOICE 1. The diffusion of carbon dioxide across the alveolar capillary membrane is. A.

More information

Acid Base Balance by: Susan Mberenga RN, BSN, MSN

Acid Base Balance by: Susan Mberenga RN, BSN, MSN Acid Base Balance by: Susan Mberenga RN, BSN, MSN Acid Base Balance Refers to hydrogen ions as measured by ph Normal range: 7.35-7.45 Acidosis/acidemia: ph is less than 7.35 Alkalosis/alkalemia: ph is

More information

ABG Interpretation Regulation of Acid Base Balance Regulation of Volatile Acids by the Lungs

ABG Interpretation Regulation of Acid Base Balance Regulation of Volatile Acids by the Lungs 11 ABG Interpretation Regulation of Acid Base Balance Normal serum ph is 7.35-7.45 Seriously bad things start happening when ph falls to 7.2 or rises to 7.55 Three physiologic systems act interdependently

More information

Human Anatomy and Physiology - Problem Drill 23: The Urinary System, Fluid, Electrolyte and Acid-Base Balance

Human Anatomy and Physiology - Problem Drill 23: The Urinary System, Fluid, Electrolyte and Acid-Base Balance Human Anatomy and Physiology - Problem Drill 23: The Urinary System, Fluid, Electrolyte and Acid-Base Balance Question No. 1 of 10 Which of the following statements about the functions of the urinary system

More information

RENAL FUNCTION An Overview

RENAL FUNCTION An Overview RENAL FUNCTION An Overview UNIVERSITY OF PNG SCHOOL OF MEDICINE AND HEALTH SCIENCES DIVISION OF BASIC MEDICAL SCIENCES DISCIPLINE OF BIOCHEMISTRY & MOLECULAR BIOLOGY PBL MBBS II SEMINAR VJ. Temple 1 Kidneys

More information

Disclaimer. Chapter 3 Disorder of Water, Electrolyte and Acid-base Professor A. S. Alhomida. Disorder of Water and Electrolyte

Disclaimer. Chapter 3 Disorder of Water, Electrolyte and Acid-base Professor A. S. Alhomida. Disorder of Water and Electrolyte Disclaimer King Saud University College of Science Department of Biochemistry The texts, tables, figures and images contained in this course presentation (BCH 376) are not my own, they can be found on:

More information

Principles of Fluid Balance

Principles of Fluid Balance Principles of Fluid Balance I. The Cellular Environment: Fluids and Electrolytes A. Water 1. Total body water (TBW) = 60% of total body weight 2. Fluid Compartments in the Body a. Intracellular Compartment

More information

Technical University of Mombasa Faculty of Applied and Health Sciences

Technical University of Mombasa Faculty of Applied and Health Sciences Technical University of Mombasa Faculty of Applied and Health Sciences DEPARTMENT OF MEDICAL SCIENCES UNIVERSITY EXAMINATION FOR THE DEGREE OF BACHELOR OF MEDICAL LABORATORY SCIENCES BMLS 12S -Regular

More information

ACID BASE BALANCE & BODY FLUID. Ani Retno Prijanti Renal and Body Fluids Module Juni 2008

ACID BASE BALANCE & BODY FLUID. Ani Retno Prijanti Renal and Body Fluids Module Juni 2008 ACID BASE BALANCE & BODY FLUID Ani Retno Prijanti Renal and Body Fluids Module Juni 2008 1 Continuous Mixing of Body Fluids 2 Water Balance and ECF Osmolality To remain properly hydrated, water intake

More information

Dr. Suzana Voiculescu Discipline of Physiology and Fundamental Neurosciences Carol Davila Univ. of Medicine and Pharmacy

Dr. Suzana Voiculescu Discipline of Physiology and Fundamental Neurosciences Carol Davila Univ. of Medicine and Pharmacy Dr. Suzana Voiculescu Discipline of Physiology and Fundamental Neurosciences Carol Davila Univ. of Medicine and Pharmacy Definition All the processes inside the body which keep the H+ concentration within

More information

Respiratory Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross

Respiratory Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross Respiratory Physiology Part II Bio 219 Napa Valley College Dr. Adam Ross Gas exchange Gas exchange in the lungs (to capillaries) occurs by diffusion across respiratory membrane due to differences in partial

More information

Urine Formation. Urinary Physiology Urinary Section pages Urine Formation. Glomerular Filtration 4/24/2016

Urine Formation. Urinary Physiology Urinary Section pages Urine Formation. Glomerular Filtration 4/24/2016 Urine Formation Urinary Physiology Urinary Section pages 9-17 Filtrate Blood plasma minus most proteins Urine

More information

Acid-Base disturbances Physiological approach

Acid-Base disturbances Physiological approach AcidBase disturbances Physiological approach Pieter Roel Tuinman, M.D., PhD, intensivist Department of Intensive Care, VU Medical Center, Amsterdam, The Netherlands p.tuinman@vumc.nl Content Introduction

More information

MS1 Physiology Review of Na+, K+, H + /HCO 3. /Acid-base, Ca+² and PO 4 physiology

MS1 Physiology Review of Na+, K+, H + /HCO 3. /Acid-base, Ca+² and PO 4 physiology MS1 Physiology Review of,, / /Acidbase, Ca+² and PO 4 physiology I. David Weiner, M.D. Professor of Medicine and Physiology University of Florida College of Medicine Basic principles Proximal tubule Majority

More information

BIO132 Chapter 27 Fluid, Electrolyte and Acid Base Balance Lecture Outline

BIO132 Chapter 27 Fluid, Electrolyte and Acid Base Balance Lecture Outline BIO132 Chapter 27 Fluid, Electrolyte and Acid Base Balance Lecture Outline Fluid divisions 1. Extracellular fluid (ECF) 2. Intracellular fluid (ICF) Stabilization 1. Fluid balance 2. Electrolyte balance

More information

Acid-Base 1, 2, and 3 Linda Costanzo, Ph.D.

Acid-Base 1, 2, and 3 Linda Costanzo, Ph.D. Acid-Base 1, 2, and 3 Linda Costanzo, Ph.D. OBJECTIVES: After studying this lecture, the student should understand: 1. The relationship between hydrogen ion concentration and ph. 2. Production of acid

More information

Renal Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross

Renal Physiology Part II. Bio 219 Napa Valley College Dr. Adam Ross Renal Physiology Part II Bio 219 Napa Valley College Dr. Adam Ross Fluid and Electrolyte balance As we know from our previous studies: Water and ions need to be balanced in order to maintain proper homeostatic

More information

Chapter 24 Water, Electrolyte and Acid-Base Balance

Chapter 24 Water, Electrolyte and Acid-Base Balance Chapter 24 Water, Electrolyte and Acid-Base Balance Total body water for 150 lb. male = 40L 65% ICF 35% ECF 25% tissue fluid 8% blood plasma, lymph 2% transcellular fluid (CSF, synovial fluid) Water Movement

More information

ACID-BASE DISORDERS. Assist.Prof.Dr. Filiz BAKAR ATEŞ

ACID-BASE DISORDERS. Assist.Prof.Dr. Filiz BAKAR ATEŞ ACID-BASE DISORDERS Assist.Prof.Dr. Filiz BAKAR ATEŞ Acid-Base Regulation Metabolic processes continually produce acid and, to a lesser degree, base. Hydrogen ion (H+) is especially reactive; it can attach

More information

014 Chapter 14 Created: 9:25:14 PM CST

014 Chapter 14 Created: 9:25:14 PM CST 014 Chapter 14 Created: 9:25:14 PM CST Student: 1. Functions of the kidneys include A. the regulation of body salt and water balance. B. hydrogen ion homeostasis. C. the regulation of blood glucose concentration.

More information

Interpretation of ABG. Chandra Shekhar Bala, FCPS( Medicine) Junior Consultant NINS and Hospital, Dhaka

Interpretation of ABG. Chandra Shekhar Bala, FCPS( Medicine) Junior Consultant NINS and Hospital, Dhaka Interpretation of ABG Chandra Shekhar Bala, FCPS( Medicine) Junior Consultant NINS and Hospital, Dhaka ABG analysis of Ms Rubi Ms. Rubi, 20 year-old lady PH 7.29 presented with breathlessness. She had

More information

SHOCK. Pathophysiology

SHOCK. Pathophysiology SHOCK Dr. Ahmed Saleem FICMS TUCOM / 3rd Year / 2015 Shock is the most common and therefore the most important cause of death of surgical patients. Death may occur rapidly due to a profound state of shock,

More information

Neaam Al-Bahadili. Rana J. Rahhal. Mamoun Ahram

Neaam Al-Bahadili. Rana J. Rahhal. Mamoun Ahram 5 Neaam Al-Bahadili Rana J. Rahhal Mamoun Ahram In this sheet we will continue taking about Titration curve and Buffers in human body. Let s begin Titration curve of phosphate buffer: 1. There are 3 buffering

More information

Neaam Al-Bahadili. Rana J. Rahhal. Mamoun Ahram

Neaam Al-Bahadili. Rana J. Rahhal. Mamoun Ahram 5 Neaam Al-Bahadili Rana J. Rahhal Mamoun Ahram In this sheet we will continue taking about Titration curve and Buffers in human body. Let s begin Titration curve of phosphate buffer: 1. There are 3 buffering

More information