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Clinical Correlation-Acidosis and Alkalosis PDF
Clinical Correlation-Acidosis and Alkalosis PDF
INTRODUCTION TO
ACIDOSIS AND ALKALOSIS
1
Prerequisite
You should know & you are responsible of:
OBJECTIVES:
2
OBJECTIVES (cont.):
3
Basic concepts and definitions: pH Scale
• H2O H+ + OH-
• Keq = [H+] [OH-]
[H2O]
• [H ] [OH-] = Keq x [H2O]
+
• Neutral pH = 7
• Physiological pH = 7.4
• The ion product of water is the basis for the pH scale where
values of 0 to 14 indicate the concentration of [H+]. 7
conjugate
acid acid
HA + H2O H3 O + + A -
base conjugate
8
base
4
Basic concepts and definitions: pKa
pKa = -logKa
5
Buffering/Titration
At pH 3.76,
10% is ionised
At pH 4.76,
50% is ionised
At pH 5.76,
90% is ionised
11
Acid-Base Buffers
• Acid-base buffer: a solution whose pH resists change upon
addition of either more acid or more base
– consists of a weak acid and its conjugate base
• Examples of acid-base buffers are solutions containing
– CH3COOH and CH3COONa
– H2CO3 and NaHCO3
– NaH2PO4 and Na2HPO4
Buffer Capacity
• Buffer capacity is related to the concentrations of the
weak acid and its conjugate base
– the greater the concentration of the weak acid and its
conjugate base, the greater the buffer capacity 12
6
Selecting a Buffer
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CO 2( aq ) + H 2 O(l) H 2 C O 3 (a q)
H 2 CO 3 (a q) H + (a q) + HCO 3 - (a q)
C O 2( g) + H 2 O(l) H + (a q) + HC O 3 - (a q)
– hyperventilation can result in increased blood pH
– hypoventilation can result in decreased blood pH
– Carbonic anhydrase catalyses the reaction:
CO2 + H2O H2CO3
– Possible to adjust blood pH by altering concentration of
dissolved CO2.
14
– To lower CO2, breathe more rapidly.
7
Henderson-Hasselbalch equation
in practice
• A patient with uncontrolled diabetes has a low blood pH, due
to the accumulation of compounds called ketone bodies, that
are acidic. To try to compensate for this a diabetic patient will
change his/her breathing rate.
8
Basic concepts and definitions:
” -EMIA”: describes a condition of the blood
For describing blood pH problems we say:
• Alkalemia: pH >7.45
Normal blood pH range is 7.35-7.45
pH limits of 6.8 or 7.8 are incompatible with life
” -OSIS”: Describes a process
• The most important way that the pH of the blood is kept relatively
constant is by buffers dissolved in the blood.
Most important buffer for maintaining acid-base balance in the blood. The
simultaneous equilibrium reactions of interest are:
18
9
The Carbonic-Acid-Bicarbonate Buffer in the Blood
acid-base reaction
K1 K2
H3O+(aq) + HCO3- (aq) H2CO3 (aq)+ H2O(l) 2 H2O(l) +
CO2(g)
not an acid-base reaction
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20
10
Open System Closed
Concept
CO2=11.2
HCO3- = 14
pH = 6.20
+ 10 CO2 lost
+ 10 H+
CO2 = 1.2
HCO3- = 24
pH = 7.40
CO2 = 1.2 CO2 = 0.9
HCO3- = 14 HCO3- = 14
pH = 7.17 pH = 7.29
Open Compensated
H+(aq) + HCO3- (aq) H2CO3 (aq) H2O(l) + CO212(g)
• The most important way that the pH of the blood is kept relatively
constant is by buffers dissolved in the blood.
• The lungs provide a faster way to help control the pH of the blood.
The increased-breathing response to exercise helps to counteract the pH-
lowering effects of exercise by removing CO2, a component of the principal
pH buffer in the blood. Acidosis that results from failure of the lungs to
eliminate CO2 as fast as it is produced is known as respiratory acidosis.
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Lung and kidney help enhance the homeostatic
function of the buffers.
CO2
[Kidney] (slow)
pH ~
~ [Lung] (fast)
HCO3- + H+
HCO3- H+ : Phosphoric
acid, NH4+
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H+(aq) + HCO3- (aq) H2CO3 (aq) H2O(l) + CO2(g)
50
0 6 12 24 72
Hours 24
12
Gastrointestinal losses can create acid-base
disturbances
Vomiting:
Loss of H+
leading to
alkalosis
Highly acidic, pH =1.0
Secretes HCO3-
Diarrhea:
pH varies from
Loss of HCO3- 4.0 to 8.0
leading to
acidosis
25
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To diagnose an acid-base imbalance, ask 3 questions:
•Does the pH indicate acidosis or
alkalosis?
•Is the cause of the pH imbalance
respiratory or metabolic? CO2
•Is there compensation for the acid-
base imbalance?
ACID-BASE Parameters
HCO3- + H+
H+
27
HCO3-
14
A 1st year medical student was anxious about her performance on the 1st
biochemistry test. She felt numbness around her mouth and tingling in her
hands and went to the clinic. A workup revealed: pH 7.48, PaCO2 30, HCO3- 23
I knew I should
have studied
my
Biochemistry
notes….
ACID-BASE Parameters
pH pH
7.48 7.4
CO2
30
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A 1st year medical student who did really well on his 1st biochemistry test
celebrated too much afterwards. After a weekend of atonement, his lab values
are: pH 7.48, PaCO2 51, HCO3- 29
ACID-BASE Parameters
32
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45 yo man with pneumonia. Admitted for evaluation and complaining
of progressive difficulty breathing. His acid-base data are:
pH 7.36, PaCO2 50, HCO3- 34
ACID-BASE Parameters
(7.4)
Acid Normal Alkaline
pH
PaCO2 HCO3-
The diagnosis is now clear: respiratory acidosis with complete compensation.
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ACID-BASE Parameters
(7.4)
Acid Normal Alkaline
pH
PaCO2 HCO3-
pH is normal while the other parameters are not. Therefore, complete compensation.
Adjusted pH is alkaline and falls into the same column as HCO3- so the full diagnosis
is metabolic alkalosis with complete compensation. Because of his increased alkali
intake, his respiratory system normalized the pH by retaining CO2. 34
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