Академический Документы
Профессиональный Документы
Культура Документы
2
Acids are H+ donors.
Bases are H+ acceptors, or give up OH- in
solution.
Acids and bases can be:
Strong – dissociate completely in solution
HCl, NaOH
3
The Body and pH
Homeostasis of pH is tightly controlled
Extracellular fluid = 7.4
Blood = 7.35 – 7.45
< 6.8 or > 8.0 death occurs
Acidosis (acidemia) below 7.35
Alkalosis (alkalemia) above 7.45
4
5
The body produces more acids
than bases
Acids take in with foods
Acids produced by metabolism of lipids and
proteins
Cellular metabolism produces CO2.
CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3-
6
7
ACID-BASE BALANCE
Acid - Base balance is primarily concerned
with two ions:
Hydrogen (H+)
Bicarbonate (HCO3- )
H+ HCO3-
8
Hydrogen Ion Regulation
The body maintains a narrow pH range by 3
mechanisms:
1. Chemical buffers (extracellular and intracellular)
react instantly to compensate for the addition or
subtraction of H+ ions.
2. CO2 elimination is controlled by the lungs
(respiratory system). Decreases (increases) in pH
result in decreases (increases) in PCO2 within
minutes.
3. HCO3- elimination is controlled by the kidneys.
Decreases (increases) in pH result in increases
(decreases) in HCO3-. It takes hours to days for the
renal system to compensate for changes in pH.
9
ACID-BASE
REGULATION
10
ACID-BASE REGULATION
Maintenance of an acceptable pH range in the
extracellular fluids is accomplished by three
mechanisms:
1) Chemical Buffers
React very rapidly
(less than a second)
2) Respiratory Regulation
3) Renal Regulation
12
Phosphate buffer
Major intracellular buffer
H+ + HPO42- ↔ H2PO4-
13
Protein Buffers
Includes hemoglobin
Carboxyl group gives up H+
Amino Group accepts H+
14
Bicarbonate buffer
Sodium Bicarbonate (NaHCO3) and carbonic
acid (H2CO3)
Maintain a 20:1 ratio : HCO3- : H2CO3
15
2. Respiratory mechanisms
Carbon dioxide is an important by-product of
metabolism and is constantly produced by cells
The blood carries carbon dioxide to the lungs where
it is exhaled
Exhalation of carbon dioxide
Doesn’t affect fixed acids like lactic acid
CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3-
Body pH can be adjusted by changing rate and
depth of breathing
16
Respiratory Regulation
When breathing is increased,
the blood carbon dioxide level
decreases and the blood
becomes more Base
When breathing is decreased,
the blood carbon dioxide level
increases and the blood becomes more Acidic
By adjusting the speed and depth of breathing, the
respiratory control centers and lungs are able to
regulate the blood pH minute by minute
17
3. Kidney excretion
Can eliminate large amounts of acid
Can also excrete base
Can conserve and produce bicarbonate ions
Most effective regulator of pH
If kidneys fail, pH balance fails
18
Kidney Regulation
Excess acid is excreted by the
kidneys, largely in the form of
ammonia
The kidneys have some ability
to alter the amount of acid or
base that is excreted, but this
generally takes several days
19
20
Acid-Base Imbalances
pH< 7.35 acidosis
pH > 7.45 alkalosis
The body response to acid-base imbalance is
called compensation
May be complete if brought back within normal
limits
Partial compensation if range is still outside
norms.
21
ACIDOSIS / ALKALOSIS
Acidosis
A condition in which the blood has too much
acid (or too little base), frequently resulting in a
decrease in blood pH
Alkalosis
A condition in which the blood has too much
base (or too little acid), occasionally resulting in
an increase in blood pH
22
ACID BASE DISORDERS
RESPIRATORY: pCO2
pCO2 : respiratory acidosis
pCO2 : respiratory alkalosis
METABOLIC: [HCO3_]
[HCO3_] : metabolic alkalosis
[HCO3_] : metabolic acidosis
23
24
25
Diagnosis of Acid-Base Imbalances
1. Note whether the pH is low (acidosis) or high
(alkalosis)
2. Decide which value, pCO2 or HCO3- , is
outside the normal range and could be the
cause of the problem. If the cause is a change
in pCO2, the problem is respiratory. If the
cause is HCO3- the problem is metabolic.
26
Compensation
If underlying problem is metabolic,
hyperventilation or hypoventilation can help :
respiratory compensation.
If problem is respiratory, renal mechanisms can
bring about metabolic compensation.
27
Respiratory Compensation
A metabolic acidosis excites the chemoreceptors
and initiates a prompt increase in ventilation and
a decrease in arterial PCO2.
31
Getting an
arterial blood
gas sample
32
Blood Gas Report
Acid-Base Information
• pH
• PCO2
• HCO3
Oxygenation
Information
• PO2 [oxygen tension]
• SO2 [oxygen saturation]
33
Pulse Oximeter Measures SaO2
34
Pulse Oximeter Measures SaO2
35
36
Normal value gas measurement
--------------------------------------------------------------------------------------------------------
Arterial Venous
---------------------------------------------------------------------------------------------------------
[H+] 36-43 mmol/L 35-45 mmol/L
37
38