Acid-Base Physiology

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11

General Principles
CO2 + H2O H2CO3 H+ + HCO3-

22

Daltons Law
In a mixture of gases, the total pressure is equal to the sum of the partial pressures of the individual gases Air Sea Level 4000 Feet pN2 597 78% 512 pO2 159 21% 138 pCO2 0.3 0.03% 0.2 Other3.7 0.1% 0.7 Total 760 mm Hg (TORR) 656 mm Hg
33

Henrys Law
The amount of gas that can dissolve in a liquid is proportional to the partial pressure of the gas to which the liquid is exposed.

44

55

Bohr Effect
Unloading of O2

Haldane Effect
Loading of CO2

66

General Principles
Control of Ventilation
n

Stimulation hyperventilation
w pCO2 w pH w temperature w pO2

Depression hypoventilation
w pCO2 w pH
77

General Principles
Oxygen Transport
n

Transport
wDissolved O2 wCombined with hemoglobin
n

O2 + Hgb

HbO2

88

General Principles
Oxygen transport
n

Factors affecting amount of O2 bound to Hgb

wpO2 wAmount of functional Hgb
n n

Decreased amount of Hgb Decreased functional Hgb n CoHgb, methemoglobin, sulfhemoglobin, changes in polypeptide chains of Hgb

wAffinity of Hgb

Oxygen dissociation curve

99

sO2% >95%

1010

General Principles
Oxygen transport
n

Factors affecting amount of O2 bound to Hgb

w pO2 w Amount of functional Hgb
n n

Decreased amount of Hgb Decreased functional Hgb n CoHgb, methemoglobin, sulfhemoglobin, changes in polypeptide chains of Hgb Temperature pH pCO2 2,3-DPG 1111

w Affinity of Hgb
n n n n

Oxygen dissociation curve

P50

1212

Definitions
Acid
n

donate H+ accept H+ negative ion that dissociates from H+ when an acid is dissolved in water a weak acid and its conjugate base that protects the body from H+ 1313 changes

Base
n

Conjugate base
n

Buffer
n

Acid - Base
H2PO4- + H+ H3PO4 H2PO4- + OH- H+ + HPO4= ACID
n n n

CONJUGATE BASE
ClACHCO31414

HCl HAC H2CO3

Equations
Hendersons equation Henderson-Hasselbalch equation Acid production from carbohydrates, proteins, lipids

1515

7.4 = 6.1 + 1.3

20 1 1616

1717

1818

1919

Maintenance of Acid-Base Balance

Blood buffer systems Respiration Renal regulation

2020

Buffer Systems
Plasma
HCO3-/H2CO3 Proteins HPO4=/H2PO4-

RBC
HGB Proteins HPO4=

Urine
HPO4=/H2PO4NH4+

2121

Buffer Systems
20 1 HCO3- H+ + HCO3- H2CO3 CO2 + H2O H2CO3 OH- + H2CO3 H2O + HCO3-

4 1

HPO4= dibasic

H+ + HPO4=

H2PO4 HPO4= + H2O

2222

H2PO4- monobasic OH- + H2PO4-

Protein as buffer

2323

Buffer Systems
Plasma
HCO3-/H2CO3 Proteins HPO4=/H2PO4-

RBC
HGB Proteins HPO4=

Urine
HPO4=/H2PO4NH4+

2424

C A dCO2
Chloride Shift

C A 2525

Buffer Systems
Plasma
HCO3-/H2CO3 Proteins HPO4=/H2PO4-

RBC
HGB Proteins HPO4=

Urine
HPO4=/H2PO4NH4+

2626

Renal Regulation
HCO3- reabsorption Na-H+ exchange NH4+ excretion

2727

2828

2929

3030

Definitions
HCO3- (22-28 mmol/L)
n n n

dCO2
n n

Second largest anion fraction of plasma Includes plasma HCO3-, carbonate, and CO2 HCO3- = total CO2 - dCO2 Undissociated carbonic acid and physically dissolved CO2 Calculated from solubility coefficient of CO2 in blood
w0.03 X pCO2 (40) = 1.22 mmol/L
3131

Definitions
pH
n

Negative logarithm of H+ = 7.35-7.45 Partial pressure of CO2 in blood = 35-45 mm Hg Partial pressure of O2 in blood = 80-100 mm Hg Amount of O2 combined with Hgb = >95%
3232

pCO2
n

pO2
n

sO2%
n

20 1

3333

Acid-Base Disturbances
Metabolic Acidosis Metabolic Alkalosis Respiratory Acidosis Respiratory Alkalosis

3434

138 - (103 + 12) = 23

3535

Ketoacidosis

3636

138 - (103 + 12) = 23

138 (115 + 12) = 11

3737

Metabolic Acidosis
Compensation
n n

Respiratory hyperventilation Renal w Reabsorption of HCO3w Excretion of H+ w NH4+ production CNS depression
3838

Symptoms
n

>20 1

3939

Metabolic Alkalosis
Compensation
n n

Respiratory hypoventilation Renal

w Reabsorption of HCO3w Excretion of H+ w NH4+ production

Symptoms
n

Overexcitability of CNS
4040

<2 0 1

4141

Respiratory Acidosis
Compensation
n n

Respiratory hyperventilation Renal w Reabsorption of HCO3w Excretion of H+ w NH4+ production CNS depression
4242

Symptoms
n

4343

Respiratory Alkalosis
Compensation
n n

Respiratory hypoventilation Renal

w Reabsorption of HCO3w Excretion of H+ w NH4+ production

Symptoms
n

Overexcitability of CNS
4444

Primary Initial pH Comp disorder change

Met Acid Met Alk Resp Acid Resp Alk HCO3 HCO3 pCO2 pCO2 pCO2 pCO2 HCO3

HCO3
4545

4646

4747

Systematic Approach to Interpretation of Blood Gas Data

4848

4949

Cases
#2 #1 pH 7.37 7.34 pCO2 65 MM Hg 34 HCO3 34 mmol/L 19 mmol/L 1 RespAcid Met Acid Full comp Met Alk Partial compResp Alk
5050

Cases
#4 #3 pH 7.21 7.44 pCO2 32 MM Hg 54 HCO3 21 mmol/L Mixed Alk 1 Resp Resp/Met Acid Full Comp Met Acid
5151

Cases
#5 pH 7.30 pCO2 34 MM Hg HCO3 24 mmol/L Error in lab data HCO3 16 mmol/L 1 Met Acid Partial Comp Resp Alk #6 pH 7.52 pCO2 28 MM Hg HCO3 22 mmol/L 1 Resp Alk Uncomp
5252

Nomogram

5353

SiggaardAnderson Nomogram

5454

Specimen Collection
Radial artery
n

Wrist Junction of arm and forearm Groin

Brachial artery
n

Femoral artery
n

Maintain pressure for 5 minutes

5555

Specimen Collection Changes

Room Temperature
n

n
n

pH pCO2 pO2

0.01 unit/20 min

Aerobic n pH
n

pCO2 pO2
5656

POTENTIOMETRY Reference Electrode

Calomel Hg/HgCl Ag/AgCl

KCl 5757

Indicator Electrode - Glass

Ag/AgCl

HCl
Li+ Li+ H+ H+ H+ 5858

Nernst Equation
E = Eo + RT ln a nF E = Eo + 0.0591 log [a] n 59.16 mV 1 unit pH change

at 25

pH 7 6

1 C = 0.2 mV = 0.003 pH change/ 1 C 5959

Combination Electrode
ISE Ion selective electrodes Na+ K+ Valinomycin ClHCO36060

pH Meter- Trouble Shooting

Unstable erratic readings
n

Long stabilization time

n n

Clogged reference electrode Improper electrode storage Static charge of electrode Old electrode Protein coating Temperature

Difficult calibration
n n

Erroneous results
n

6161

pCO2 Electrode Severinghaus

6262

pO2 Electrode Clark Polarography

Deficient in electrons

6363