Acid – Base Status - pathophysiology.info file14 Respiratory Alkalosis Carbonic acid deficit pCO2...
Transcript of Acid – Base Status - pathophysiology.info file14 Respiratory Alkalosis Carbonic acid deficit pCO2...
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Acid – Base Status
Blagoi Marinov, MD, PhD
Pathophysiology Dept.
Medical University of Plovdiv
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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
Weak – dissociate only partially in solution
Lactic acid, carbonic acid (H2CO3)
Bacic Terms
H+ Concentration
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Henderson-Hasselbach Equation
pH Summary
pH = - log10 [H+]
H+ is really a proton
Range is from 0 - 14
If [H+] is high, the solution is acidic; pH<7
If [H+] is low, the solution is alkaline; pH > 7
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pH values in real life
Small changes in pH can produce major disturbances
Most enzymes function only in narrow pH ranges
Acid-base balance can affect electrolytes (Na+, K+, Cl-)
Acid-base balance can also affect hormone action
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In the body there are more acids than bases
Acids taken with food
Acids produced by break-down of lipids and proteins
CO2 produced by cellular metabolism
CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3-
Control of Acids
Buffer systems
Take up H+ or release H+ as conditions change
Buffer pairs – weak acid and a base
Exchange a strong acid or base for a weak one
Results in a much smaller pH change
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Buffer systems
Regulation of pH Respiratory mechanisms
Exhalation of CO2
Powerful, but only works with volatile acids
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
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Regulation of pH Kidney excretion
Can eliminate large amounts of acid
Can also excrete bases
Can conserve and produce bicarbonate ions
Most effective regulator of pH
If kidneys fail, pH balance fails
Regulation of pH Rates of correction
Buffers function almost instantaneously
Respiratory mechanisms take several minutes to hours
Renal mechanisms may take several hours to days
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Lines of Defence against pH shift Summary
Normal Laboratory Values
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The Body and pH
Homeostasis of pH is tightly controlled
Extracellular fluid = 7.4
Blood = 7.36 – 7.44
< 6.8 or > 8.0 death occurs
Acidemia - below 7.35
Alkalemia - above 7.45
pH nosology
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Basic Terminology
Main acid-base disorder entities
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Respiratory Acidosis Etiology
Carbonic acid excess caused by blood levels of CO2 above 45 mm Hg (Hypercapnia) Chronic conditions: Depression of respiratory center in brain that
controls breathing rate – drugs or head trauma Paralysis of respiratory or chest muscles Emphysema
Acute conditons: Adult Respiratory Distress Syndrome
Pulmonary edema
Pneumothorax
Respiratory Acidosis Etiology
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Respiratory Acidosis Onset
Respiratory Acidosis Compensations
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Symptoms of Respiratory Acidosis
Breathlessness
Restlessness
Lethargy and disorientation
Tremors, convulsions, coma
Respiratory rate rapid, then gradually depressed
Skin warm and flushed due to vasodilation caused by excess CO2
Treatment of Respiratory Acidosis
Restore ventilation
I.V. lactate solution
Treat underlying dysfunction or disease
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Respiratory Alkalosis
Carbonic acid deficit
pCO2 less than 35 mm Hg (hypocapnea)
Most common acid-base imbalance
Primary cause is hyperventilation
Respiratory Alkalosis Etiology
Conditions that stimulate respiratory center: Oxygen deficiency at high altitudes Pulmonary disease and Congestive heart
failure – caused by hypoxia Acute anxiety Fever, anemia Early salicylate intoxication Cirrhosis Gram-negative sepsis
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Respiratory Alcalosis Onset
Respiratory Alcalosis Compensations
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Effects of alkalosis
Alkalosis causes over excitability of the central and peripheral nervous systems.
Numbness Lightheadedness It can cause :
Nervousness Muscle spasms or tetany Convulsions Loss of consciousness Death
Treatment of Respiratory Alkalosis
Treat underlying cause
Breathe into a paper bag
I.V. Chloride containing solution – Cl-
ions replace lost bicarbonate ions
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Metabolic Acidosis Etiology
Bicarbonate deficit - blood concentrations of bicarb drop below 22mEq/L
Causes:
Loss of bicarbonate through diarrhea or renal dysfunction
Accumulation of acids (lactic acid or ketones)
Failure of kidneys to excrete H+
Metabolic Acidosis Onset
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Metabolic Acidosis Compensations
Symptoms of Metabolic Acidosis
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Metabolic Acidosis Types
Metabolic Acidosis Treatment
Treatment of main disease
Pathogenetic “correction” of pH (in extreme cases - <7.15)
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Metabolic Alkalosis Etiology
Bicarbonate excess - concentration in blood is greater than 26 mEq/L Causes: Excess vomiting = loss of stomach acid Excessive use of alkaline drugs Certain diuretics Endocrine disorders Heavy ingestion of antacids Severe dehydration
Metabolic alkalosis Onset
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Metabolic alkalosis Generation and progression
Metabolic Alkalosis Compensations
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Symptoms of Metabolic Alkalosis
Respiration slow and shallow
Hyperactive reflexes ; tetany
Often related to depletion of electrolytes
Atrial tachycardia
Dysrhythmias
Treatment of Metabolic Alkalosis
Electrolytes to replace those lost
I.V.chloride containing solution
Treat underlying disorder
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Summary of Simple Acid-Base Disorders
Mixed Acid-Base Disorders
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Diagnostic approach Acid-Base abnormalities
Thank you !