Presentation on theme: "PROFESSOR. ASHRAF HUSAIN"— Presentation transcript:
1PROFESSOR. ASHRAF HUSAIN ACID - BASE PHYSIOLOGYPROFESSOR. ASHRAF HUSAINDEPT. OF PHYSIOLOGYCOLLEGE OF MEDICINEKING SAUD UNIVERSITYRIYADH.Modified byThe Legendary Genius
2Acid Base Physiology Definition: pH is defined as potential of H+ Ion concentration in body fluid. The amount of H+ ion concentration is so low in the body hence it is expressed as –ve logarithm to base of the H+ ion concentration in mEq/lit.pH = log 1/ [H+ ]= - log [H+ ]
3The H Intake or Production The Acid-Base BalanceBalance of H conc. In ECF .To Achieve Homeostasis .Balance Between :The H Intake or ProductionThe H Removal
4NORMAL VALUE Arterial blood = 7.35 – 7.45 Can be explained as follows; Normal value of H+ ion conc. is about 40nEq/lit.40 nEq/lit = Eq/lit.Therefore pH = - log [ ]= 7.4
5Acid – Base Imbalance Acidosis = Decrease in arterial PH ( <7.35 ) Due to excess H+Alkalosis = Elevation in Arterial PH ( >7.45)Due to excess base .
6pH and H+ ion concentration 6.07.08.09.0H+ ion in nmol/lit1000100101.0Note : one point drop in pH results in a ten fold decrease in H+ ion conc.
7Scale of pH measurement The pH scale is between 0 – 14.Zero onwards below 7 is acidic.After 7 upto 14 the solution is alkaline.At 7 (neutral e.g. water) where the amount of H+ and Hydroxyl ion are equal at 23o
8Examples of pH zero, one & two. pH 0 = 1 lit. of HCl contains 1gm of H+ = 10opH 1 = 10 lit. of N/10 HCl contains 1gm of H+Therefore 1 lit. will contain 1/10gm of H+ =10-1pH 2 = 100 lit. of N/100 HCl contains 1gm of H+Therefore 1 lit. will contain 1/100gm of H+ =10-2And so on..It will be noted that a solution of pH 2 does not have twice the H+ ion conc. at a pH of 4 rather it has 100 times H+ ion conc.
9Since pH is inversely related to H+ ion conc Since pH is inversely related to H+ ion conc. so a low pH corresponds to high H+ ion conc. (Acidic) and a high pH corresponds to low H+ ion conc. (Alkaline)AcidicNeutralAlkaline714
10The Negative logarithmic relationship between [H+] and pH
11About H+H+ are derived from hydrogen atoms. Hydrogen atom has proton a positive electrical charge with a negative charge electron which is revolving around it. The hydrogen ion is formed when negative ion (electron) is lost and it contains only proton. The H+ is the smallest ionic particle, highly reactive with a very short life and unable to survive on its own.
12A very tight control is needed for normal metabolic functions. eg. Enzymatic activity, blood clotting and neuromuscular activity.Hydrogen ions are the toxic end product of metabolism and they adversely affect all physical and biochemical cellular process in our body.
13AcidMolecules containing H atoms that can release (donate) H ions in solutions .Example , HCL .Strong acids :- Completely dissociate : (HCL , H2SO4 )Weak acid :- Partially dissociate : ( H2CO3)
14Base An Ion that accept a H ion . An example of a base is the Bicarbonate( HCO3 ) .
15Buffers Substances that Neutralize acids or bases. Chemical Reactions which Reduce the effect of adding acid or base to a solution PH .
16How the body defends against fluctuations in PH Three Systems in the body :Buffers in blood .Respiration through the lungs .Excretion by the kidney .
17Blood BufferThese buffer systems serve as a first line of defense against changes in the acid-base balance :- HCO3(Regulated by Renal and Respiratory) .- Protein- Phosphate- Hemoglobin
18ProteinAcidic and Basic Amino acid in plasma and cell protein act as buffers .HB is an important buffer , can’t be regulated physiological .
19Phosphate & Intracellular Buffers Both Intra and Extra cellular phosphate act as a buffer . But its role is minor compared to HB or HCO3.Intracellular buffers are needed because H doesn’t cross Plasma Membrane .Intracellular PH is more acidic . (7.2)
22Factors that increase or decrease H secretion and HCO3 Reabsorption by renal tubules :Decrease H ion secretion and HCO3 ion reabsorptionIncrease in H ion secretion and HCO3 ion reabsorptionPCO2H , HCO3ECF volumeAngiotensin IIAldosteroneHyperkalemiaHypokalemia
23Respiratoy Regulation of PH Maintaining Normal PH by maintaining constant PCO2 .Normal gas Exchange and ventilation .Controlled by chemoreceptors .PCO PH
24Renal Regulation Tubular Mechanisms of H+ Tubular Reabsorption of HCO3 .
25Three ways to measure acid-base balance in the body : Blood PHBlood PCO2Blood HCO3
26CompensationIf underlying problem is metabolic :Hyperventilation and Hypoventilation mechanismswill help through Respiratory Compensation .If the problem is Respiratory , Renal mechanisms , then Renal mechanisms will help throughMetabolic Compensation .
27AcidosisPrincipal effect of acidosis is Depression of the CNS through the decrease in synaptic transmission .Generelized Weakness .Deranged CNS is the greatest thread .severe acidosis causes :1- Disorientation2- Coma3- Death
28AlkalosisCauses over excitability of the central and peripheral nervous systems .NumbnessLightheadednessIt can cause :- nervousness .- muscle spasms or tetany .- convulsions- looss of consciousness- death .
30-In the Metabolic(acidosis\alkalosis) the PCO2 is Constant . - In the Respiratory(acidosis\alkalosis) the HCO3 is Constant .
31Loss of excessive alkali - Hysterical- PneumoniaLoss of excessive alkaliLoss of Gastric acid = VomitingExcessive intake of alkali = antiacid
32Correction for Respiratory Alkalosis : HCO3 reabsorption by kidneysblood HCO decreases PH to normal value .The urine will be excreted with high HCO3.In blood : PH= normalHCO3 = Low , PCO2 = low
33Correction for Respiratory acidosis : Correction : HCO3 reabsorption by the kidney Blood HCO3 PH back to normal . In blood : PH = normal PCO2 = high , HCO3 = High- The urine will be excreted with Low HCO3.
34Correction of Metabolic Alkalosis Depress ventilation Blood PCO2PH is back to normal .In blood :PH=~ NormalHCO3 = highPCO2 = high
35Correction for Metabolic Acidosis - Stimulate ventilation ( Hyperventilation )PCO PH Back to normal .In blood :PH =~ normalHCO3 = LowPCO2 = Low
36The body response to acid-base IMBALANCE is called Compensation If the Range is still outside the normal then ,It is PartialIf the body is bruoght to the normal limits then,It is Complete
46A 44-year – old woman with a long history of indigestion begins to vomit at home. She becomes unwell after 4 days and is admitted to hospital because of marked muscle weakness. Her arterial blood gases are [H+] 28nmol/l,PaCO2 6.5kPa,[HCO3- 40mmol/l,PaO210.3kPa,plasma potassium 2.1 mmol/l.Q. What is the likely diagnosis and what treatment is required?
47Metabolic alkalosis is less common than metabolic acidosis Metabolic alkalosis is less common than metabolic acidosis. It is characterized by an increase in plasma bicarbonate, a fall in [H+], and a small compensatory rise in PaCO2.
482. A 32 – year-old man is admitted in a very ill state 2. A 32 – year-old man is admitted in a very ill state. He had been drinking with friends, but had not been seen for some hours. On admission he is barely conscious and breathing heavily.His arterial blood gases are;[H+] 98nmol/l,PaCO2 2.7kPa,[HCO3- 6mmol/l,PaO2 13kPa.Q. What is likely diagnosis, how should it be confirmed, and what treatment is required?
49Metabolic acidosis is characterized by a reduction in plasma bicarbonate and a rise in [H+]. The PaCO2 is reduced secondarily by hyperventilation, which mitigates the rise in [H+].
503. a 56-year-old man, who has smoked heavily for many years, develops a worsening cough with purulent sputum, and is admitted to hospital because of difficulty in breathing. He is drowsy and cyanosed. His arterial blood gases are[H+] 65nmol/l,PaCO2 9.5kPa,[HCO3- 28mmol/l,PaO26.2kPa,Q. What is likely diagnosis and what treatment is required?
51Respiratory acidosis arises when effective alveolar ventilation fails to keep pace with the rate of CO2 production. As a result PaCO2, blood [HCO3-] and [H+] all rise.
524. a 13-year-school boy is brought the casualty department, having become acutely unwell in the headmaster’s office. He is alert and agitated, the respiratory rate is 35/min, and he complains of tingling in his hands. His arterial blood gases are;[H+] 29nmol/l,PaCO2 2.8kPa,[HCO3- 22mmol/l,PaO2 16kPa.Q. What is the likely diagnosis and what treatment is required?
53Respiratory alkalosis occurs when there is excessive loss of CO2 due to over-ventilation of the lungs. PaCO2 and [H+] fall. The low PaCO2 results in reduced renal Na+/H+ exchange.