Acid Base Balance

Dr.Osama Ali Ibraheim,MD Associate Professor, Consultant, Department of Anesthesia , College of Medicine King Saud University 01/24/10

When you first study clinical acid-base balance, this is the natural question! ,[object Object],[object Object]

ACID BASE HOMEOSTASIS ,[object Object],[object Object]

ACID-BASE HOMEOSTASIS Acids Bases Acids Acids = Bases Acids > Bases Acids < Bases Acids Buffers

ACID-BASE BALANCE ,[object Object],[object Object],[object Object],H + HCO 3 -

ACID-BASE REGULATION ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ACID-BASE REGULATION ,[object Object],[object Object],[object Object],H + OH - H + H + OH - OH - Buffer

ACID-BASE REGULATION ,[object Object],[object Object],[object Object],CO 2 CO 2 CO 2 CO 2 CO 2 CO 2 Cell Metabolism

ACID-BASE REGULATION ,[object Object],[object Object],[object Object],[object Object]

ACID-BASE REGULATION ,[object Object],[object Object],[object Object]

ACIDS ,[object Object],[object Object],Click Here

ACIDS ,[object Object],[object Object],H+ H+ H+ H+ OH- OH- OH- OH-

ACIDS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lactic acid Pyruvic acid Carbonic acid Phosphoric acid

BASES ,[object Object],[object Object],[object Object],Click Here

BASES ,[object Object],[object Object],[object Object],H+ H+ H+ H+ OH- OH- OH- OH-

BASES ,[object Object],[object Object],[object Object],Biphosphate Bicarbonate

PH ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object]

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],ACIDS, BASES OR NEUTRAL??? 1 2 3 OH - OH - OH - OH - OH - OH - H + H + H + H + OH - OH - OH - OH - OH - H + H + H + H + OH - OH - OH - H + H + H + H + H + H + H +

[object Object],[object Object],pH = log 1 / H + concentration 4 X 10 -8 (0.00000004)

[object Object],[object Object],[object Object],[object Object],pH = log 1 / H + concentration 4 X 10 -8 (0.00000004)

[object Object],[object Object],ACIDOSIS ALKALOSIS NORMAL DEATH DEATH Venous Blood Arterial Blood 7.3 7.5 7.4 6.8 8.0

ACIDOSIS / ALKALOSIS (Academia/Alkalemia) ,[object Object],[object Object],[object Object]

ACIDOSIS / ALKALOSIS ,[object Object],[object Object],[object Object],[object Object]

CHANGES IN CELL EXCITABILITY ,[object Object],[object Object],[object Object],[object Object]

INFLUENCES ON ENZYME ACTIVITY ,[object Object],[object Object]

[object Object],H + OH - ,[object Object],H + OH -

[object Object],[object Object],[object Object],BASE ACID H 2 CO 3 H + HCO 3 -

[object Object],[object Object],[object Object],[object Object],[object Object]

SOURCES OF HYDROGEN IONS C C C C C C H H H H H H H H H H H H

SOURCES OF HYDROGEN IONS ,[object Object],[object Object],[object Object],[object Object],[object Object]

SOURCES OF HYDROGEN IONS ,[object Object],[object Object],[object Object]

SOURCES OF HYDROGEN IONS ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object],CO 2 H + CO 2 H + pH pH

CO 2 CO 2 Red Blood Cell Systemic Circulation HCO 3 - Cl - (Chloride Shift) CO 2 diffuses into plasma and into RBC Within RBC, the hydration of CO 2 is catalyzed by carbonic anhydrase Bicarbonate thus formed diffuses into plasma carbonic anhydrase Tissues Plasma CO 2 H 2 O H + HCO 3 - + +

CO 2 Red Blood Cell Systemic Circulation H 2 O H + HCO 3 - carbonic anhydrase Plasma CO 2 CO 2 CO 2 CO 2 CO 2 CO 2 CO 2 Click for Carbon Dioxide diffusion + + Tissues H + Cl - Hb H + is buffered by Hemoglobin

1) CO 2 DIFFUSION ,[object Object],[object Object],Hb Cl - H + H + H + H + H + H + H + H + Cl - Cl - Cl - Cl - Cl - Cl - Red Blood Cell Cl -

CARBON DIOXIDE DIFFUSION CO 2 CO 2 Red Blood Cell Systemic Circulation HCO 3 - Cl - (Chloride Shift) CO 2 diffuses into the plasma and into the RBC Within the RBC, the hydration of CO 2 is catalyzed by carbonic anhydrase Bicarbonate thus formed diffuses into plasma carbonic anhydrase Tissues Plasma CO 2 H 2 O H + HCO 3 - + +

Red Blood Cell Pulmonary Circulation CO 2 H 2 O H + HCO 3 - + + HCO 3 - Cl - Alveolus Plasma CO 2 Bicarbonate diffuses back into RBC in pulmonary capillaries and reacts with hydrogen ions to form carbonic acid The acid breaks down to CO 2 and water

Red Blood Cell Pulmonary Circulation CO 2 H 2 O H + + + HCO 3 - Cl - Alveolus Plasma CO 2 CO 2 H 2 O

Basic Concepts ,[object Object],[object Object],01/24/10

pH ,[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

pH ,[object Object],[object Object],01/24/10

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

[object Object],[object Object],[object Object],[object Object],01/24/10

Question... ,[object Object],[object Object],[object Object],Veins! Why? Because veins pick up the byproducts of cellular metabolism, including… CO 2 !

01/24/10 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Henderson-Hasselbalch Equation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

ABGs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

Acid Base Control ,[object Object],[object Object],01/24/10

[object Object],[object Object],[object Object],01/24/10

Compensation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

A Stepwise Approach to Acid-Base Interpretation: ,[object Object],[object Object],[object Object],01/24/10

[object Object],[object Object],01/24/10

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

Steps to Assess ABGs ,[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

ABGs ,[object Object],[object Object],[object Object],[object Object],01/24/10

ABGs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

ABGs ,[object Object],[object Object],[object Object],[object Object],[object Object],01/24/10

Acid Base Balance

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