ACIDBASEBALANCE

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 HYDROGENIONHOMEOSTASIS

FreeH+ionsarepresentinveryminute
quantityintheblood
(is around 1 in 3 million ofNa+
concentration)
H+ionconcentrationis0.00004meq/L
Na+ionconcentrationis145meq/L
HenceFreeH+ionsinbloodis
expressedaspH,unitofexpression
NormalpHis7.4(7.35to7.45)

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 HYDROGENIONHOMEOSTASISCONT..

pHisdefinedasthenegativelogarithm
ofFreeH+ionconcentration
BothpHandH+ionconcentration
areinverselyrelatedtoeachother
LowerthepHGreatertheH+ion
Ex:acidosispH<7.4
GreaterthepHLowertheH+ion
Ex:AlkalosispH>7.4
ExamplesofpHincompatiblewithlifeare
<than6.7(Acidosis)
>than7.7(Alkalosis)
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 SEVEREACIDOSIS

Depressesmyocardium

Sensitizesthehearttoarrhythmias

Producesarteriolardilatationandhypotension

Predisposestopulmonaryedema

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 SEVEREALKALOSISCANPRODUCE

Tetanyandconvulsion

AlkalosisreducesionizedCalcium

AcidosisincreasesionizedCalcium

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 SOURCEOFHYDROGENIONSINTHEBODY

CO2 ( In an adult of 70kg 530 L/ day or24000

mM/day)

Diet ( around 70 mM of H+ ions daily in an adult

1mM/kg/day)

FromSulphurandProteincontainingaminoacids

Incompleteoxidationoffatsandcarbohydrates
(Intheabsenceofdiet,fromthebodymetabolism)
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BASICPROCESSINMAINTAININGH+ION
HOMEOSTASIS

TransportofCO2inBlood
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 BASICPROCESSINMAINTAININGH+ION
HOMEOSTASISCONT..
BICARBONATERECLAMATION

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 BASICPROCESSINMAINTAININGH+ION
HOMEOSTASISCONT..
ThusthereisnochangeintheFreeH+ionconcentration,
maintainingHydrogenionHomeostasis

An unique buffer system for Homeostasis isCO2

productioninthebodyresultsinequalamountifH+ions
and HCO3 ions which is part of H2CO3: Na HCO3an
importantbufferinthebody

Ex:Lacticacid+NaHCO3=NaLactate+H2CO3

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 BASICPROCESSINMAINTAININGH+ION
HOMEOSTASISCONT..

H2CO3isaweakacidwherethereispoorionizationof
H+ionsduetolesserdissociation

Lacticacidisastrongacidduetogreaterionicstate

ThusNaHcO3convertsLacticacidintocarbonicacid&
hence increase in free H+ ions & change in pHis
minimalthusactingasanimportantbuffer

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 BICARBONATESREGENERATION

Inanhealthyadultof70kg
70mMHCO3areRegeneratedinkidneys24Hrs

70mMofH+formedinthebody24Hrs

40mMofHCO3byphosphatebuffersystem

30mMofHCO3byammoniabuffersystem

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PHOSPHATEBUFFERSYSTEM

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 PHOSPHATEBUFFERSYSTEMCONT..

IntherenaltubulesHCO3areformedfrom

CO2+H2OH2CO3HCO3+Hand

From Glutamine through phosphate+

ammoniabuffersystem

Themechanismforbicarbonates

Reclamation and regeneration areenergy

requiringActiveprocesses

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AMMONIABUFFERSYSTEM

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DISORDERSCONCERNINGH+IONHOMEOSTASIS

Inacidosis

H+ionincrease

pHdecrease

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 RESPIRATORYACIDOSIS

Resp.acidosisRespirationdepressedpHdecrease

pCO2+HCO3increased

Causes:

Birthasphyxia

Phenobarbitonepoisoning

Treatment:Treatthecause

Oxygenation&ventilation
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 RESPIRATORYACIDOSISCONT

Insevereacuterespiratoryacidosis,moderateamount
of NaHCO3 may be given to mitigate theserious
cardiovasculareffectsofsevereacidosis

HereCO2isPrimarilypredominantlyincreased

HCO3secondarilylesspredominantlyincreased

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 MODERATEACIDOSIS

pHdecreased,PCO2&HCO3decreased
Ex:HypoxiaduetolacticacidosisRenalfailuredue
toincreasedfreeH+ion
Diabetic ketoacidosis due to: Acetone,Bhydroxy
butricacid,&Acetoaceticacid
Here HCO3 Primarily predominating & CO2
secondarilylesspredominating

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 TREATMENT

Treatthecause

Supportivetherapy

SpecificmanagementisNaHCO3

NaHCO3isnevergivenbybolus(exceptin
hyperkalaemia&lifethreateningacidosis)

NaHCO32mEq/kg8thhourlybyIVinfusion

EachtimebeforegivingNaHCO3afreshassessment
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 ALKALOSIS

RespiratoryalkalosisRapidbreathingduetohigh
feverduetohystericalcondition

MetabolicalkalosisSeverevomiting(lossofHCl
andmoregenerationofHCO3

Ex:Infantilehypertrophicpyloricstenosis

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 RESPIRATORYALKALOSIS

CO2decreased,HCO3decreased
HereCO2isprimarilypredominantlyreduced
HCO3issecondarily,lesspredominantlydecreased
Inbothrespiratoryandmetabolicalkalosis
pHincreased

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 METABOLICALKALOSIS

HCO3increased,CO2increased

HereHCO3isprimarily,predominantlyelevated.
CO2issecondarilylesspredominantlyelevated

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 PRINCIPLESINTHEMANAGEMENTOFALKALOSIS

Volumecontractionshouldbecorrected
Involumedeficitadditionalaldosteroneissecreted,
absorbingNa+andsecretingH+&K+ions,thus
perpetuatingalkalosis
Anyexistinghypokalemiashouldbecorrected
otherwisetopreserveK+ion,H+ionissecretedout,
thusperpetuatingalkalosis
Anyhypochloremiamustbecorrected.NaClis
absorbedassuchasotherwiseNa+isabsorbedin
exchangeofH+ionorK+ionaggravatingalkalosis

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 CORRECTIONINALKALOSIS

FluidofchoiceNaCl(Saline)solution

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 MIXEDDISORDERS

Isacombinationof2ormoreabnormalprocess

Respiratoryacidosis

Metabolicacidosis

Respiratoryalkalosis

Metabolicalkalosis

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 MIXEDDISORDERSEXAMPLES

Bronchopneumonia with high fever(rapid

breathing)
Metabolicacidosis+Respiratoryalkalosis
(hypoxia) (rapidbreathing)
Phenobarbitonepoisoning
Respiratory acidosis + metabolicacidosis
(Respiratorycenterdepression+hypoxia)
pH, CO2 & HCO3 levels depend on severityof
thecomponents
(Respiratoryormetabolic)affectedandCorrection
dependonit

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ThankYou

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