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Acid: H+ donor
Base: H+ acceptor
pH
pH
pH
pH
pH
7.40
7.00
7.36
7.44
40 nM
100 nM
44 nM
36 nM
Buffers
extracellular
carbonic acid /
bicarbonate (H2CO3 /
HCO3-)
Henderson-Hasselbalch equation:
pH = 6.1 + log([HCO3-] / 0.03 pCO2)
haemoglobin
intracellular
proteins
phosphoric acid /
hydrogen phosphate
(H3PO4 / H2PO4- +
HPO42-)
metabolism of ammonium
Total CO2:
= [HCO3] + [H2CO3]
+ [carbamino CO2]
+ [dissolved CO2]
Why is pH so important ?
Exceptions:
macromolecules (proteins)
lipids
waste products
alveolar ventilation
disturbances
acidemia
alkalemia
Proximal tubular
mechanisms:
Distal tubular
mechanisms:
net excretion of H+
normally 70mmol/day
max. 700mmol/day
Formation of titratable
acidity (TA)
Addition of NH4+ to
luminal fluid
Reabsorption of
remaining HCO3-
range
pH
7.40
7.35-7.45
pH
7.33-7.43
pCO
40 mmHg
35 45
pCO2
41 51
pO2
95 mmHg
80 95
pO2
35 49
Saturation
95 %
80 95
Saturation
70 75
BE
HCO3-
24 mEq/l
BE
22 - 26
HCO3-
24 - 28
Causes
Respiratory
acidosis
alkalosis
Metabolic
acidosis
alkalosis
acute (pH)
chronic (pH or normalisation of pH)
causes:
Airway disorders
Guillain-Barre syndrome
Myasthenia gravis
muscle relaxant drugs
toxins e.g. organophosphates,
snake venom
various myopathies
acute on COPD
chest trauma -contusion,
haemothorax
pneumothorax
diaphragmatic paralysis
pulmonary oedema
adult respiratory distress
syndrome
restrictive lung disease
aspiration
External factors
RA - rare causes
malignant hyperthermia
sepsis
depression of
intracellular
metabolism
cerebral effects
cardiovascular system
extremely high
hypercapnia:
anaesthetic effects
(pCO2>100mmHg)
hypoxaemia
RA - compensation
proteins (haemoglobin
and phosphates) are the
most important
intravascular buffers for
CO2 but their
concentration is low
relative to the amount of
carbon dioxide requiring
buffering
Chronic RA - renal
bicarbonate retention
severe hypotension
post hypercapnic alkalosis
MA - causes
ketoacidosis
diabetic, alcoholic,
starvation
lactic acidosis
acute renal failure
toxins
diarrhoea
drainage of pancreatic or
bile juice
MA - metabolic effects
respiratory
hyperventilation
shift of haemoglobin
dissociation curve to
the right
decreased 2,3 DPG
levels in red cells
(shifting the ODC back
to the left)
cardiovascular
others
increased bone
resorption (chronic
acidosis only)
shift of K+ out of cells
causing hyperkalaemia