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    Balance{ Water} Balance{ Water} Presentation Transcript

    • BALANCE WATER ACID-BASE ELECTROLYTE
    • WATER BALANCE
      • NORMAL WATER CONTENT OF BODY
      • 75% AT BIRTH
      • 55-60% YOUNG ADULTS
        • MEN SLIGHTLY HIGHER THAN WOMEN
        • (MORE FAT, LESS WATER)
      • 45% IN ELDERLY, OBESE
    • WATER BALANCE
      • TOTAL BODY WATER
      • ~40 LITERS
      • SEVERAL FLUID COMPARTMENTS
        • 65% INTRACELLULAR FLUID (ICF)
        • 35% EXTRACELLULAR FLUID (ECF)
          • 25% INTERSTITIAL FLUID (TISSUE FLUID)
          • 8% BLOOD PLASMA AND LYMPH
          • 2% TRANSCELLULAR FLUID
            • SYNOVIAL, PLEURAL, PERICARDIAL, ETC.
    • WATER BALANCE
      • TOTAL BODY WATER
      • ENTERS BODY
        • OSMOSIS FROM DIGESTIVE TRACT
          • ALSO PRODUCED BY AEROBIC RESPIRATION
          • ALSO PRODUCED BY CONDENSATION REACTIONS
      • EXITS BODY
        • URINARY, DIGESTIVE, RESPIRATORY, & INTEGUMENTARY SYSTEMS
    • WATER BALANCE
      • TOTAL BODY WATER
      • FLUID EXCHANGED BETWEEN COMPARTMENTS
        • CAPILLARY WALLS, PLASMA MEMBRANES
        • DRIVEN BY TRANSIENT OSMOTIC GRADIENTS
        • OSMOTIC GRADIENTS DEPENDENT ON SOLUTE MOLECULES
        • MOST ABUNDANT SOLUTES ARE ELECTROLYTES
        • WATER BALANCE AND ELECTROLYTE BALANCE ARE CLOSELY RELATED
    •  
    • WATER BALANCE
      • WATER BALANCE
      • FLUID GAIN = FLUID LOSS
      • BOTH TYPICALLY ~2500 ML / DAY
    • WATER BALANCE
      • WATER GAIN
      • TYPICALLY ~2500 ML / DAY
      • 1600 ML FROM DRINK
      • 700 ML FROM FOOD
      • 200 ML FROM METABOLISM
        • AEROBIC RESPIRATION
        • CONDENSATION REACTIONS
          • A.K.A. DEHYDRATION REACTIONS
    • WATER BALANCE
      • WATER LOSS
      • TYPICALLY ~2500 ML / DAY
      • 1500 ML EXCRETED AS URINE
      • 200 ML ELIMINATED IN FECES
      • 300 ML EXPIRED IN BREATH
      • 100 ML SECRETED AS SWEAT
      • 400 ML LOST AS CUTANEOUS TRANSPIRATION
        • DIFFUSES THROUGH EPIDERMIS, EVAPORATES
    •  
    •  
    • WATER BALANCE
      • WATER LOSS
      • CAN VARY GREATLY
        • INCREASED RESPIRATORY LOSS IN COLD WEATHER
        • INCREASED SWEAT LOSS IN WARM WEATHER
        • INCREASED RESPIRATORY AND SWEAT LOSS, DECREASED URINE OUTPUT DURING PHYSICAL EXERTION
    • WATER BALANCE
      • WATER LOSS
      • OBLIGATORY WATER LOSS
        • RELATIVELY UNAVOIDABLE
        • EXPIRED AIR, CUTANEOUS TRANSPIRATION, SWEAT, FECAL MOISTURE, MINIMUM URINE OUTPUT (~400 ML/DAY)
    • WATER BALANCE
      • REGULATION OF WATER INTAKE
      • GOVERNED BY THIRST
        • PROVOKED BY INCREASED PLASMA OSMOLARITY
        • PROVOKED BY BLOOD LOSS
      • THIRST CENTER IN HYPOTHALAMUS
        • RESPONDS TO SIGNS OF DEHYDRATION
          • ANGIOTENSIN II
          • ANTIDIURETIC HORMONE (ADH)
          • SIGNALS FROM OSMOCENTERS
        • INHIBITS SALIVATION
    • WATER BALANCE
      • REGULATION OF WATER INTAKE
      • INHIBITED SALIVATION
        • DRY MOUTH
        • SENSE OF THIRST
        • INGESTION OF WATER
          • COOLS AND MOISTENS MOUTH
          • DISTENDS STOMACH AND INTESTINES
          • REHYDRATES BLOOD
        • THIRST INHIBITED
    •  
    • WATER BALANCE
      • REGULATION OF WATER OUTPUT
      • CONTROLLED VIA ALTERATIONS IN URINE VOLUME
      • URINE VOLUME AFFECTED BY
        • SODIUM REABSORPTION
          • WATER FOLLOWS SODIUM REABSORPTION
          • MORE LATER
        • ANTIDIURETIC HORMONE (ADH)
          • BLOOD VOLUME  , [Na+]  , OSMORECEPTORS STIMULATED, PITUITARY RELEASES ADH
          • AQUAPORINS PRODUCED IN KIDNEY’S COLLECTING DUCTS
          • FACILITATE REABSORPTION
          • ALSO WORKS IN REVERSE
    •  
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • FLUID DEFICIENCY
        • VOLUME DEPLETION (HYOVOLEMIA)
        • DEHYDRATION
      • FLUID EXCESS
        • VOLUME EXCESS
        • HYPOTONIC HYDRATION
      • FLUID SEQUESTRATION
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • FLUID DEFICIENCY: HYPOVOLEMIA
      • CAUSED BY PROPORTIONATE LOSS OF WATER AND SODIUM WITHOUT REPLACEMENT
      • TOTAL BODY WATER DECREASED
      • OSMOLARITY UNCHANGED
      • CAUSES
        • HEMORRHAGE
        • SEVERE BURNS
        • CHRONIC VOMITING OR DIARRHEA
          • MAJOR CAUSE OF INFANT MORTALITY
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • FLUID DEFICIENCY: DEHYDRATION
      • CAUSED BY LOSS OF MORE WATER THAN Na +
      • TOTAL BODY WATER DECREASED
      • ECF OSMOLARITY INCREASES
      • CAUSES
        • LACK OF DRINKING WATER
        • DIABETES MELLITUS
        • ADH HYPOSECRETION
        • PROFUSE SWEATING
        • OVERUSE OF DIURETICS
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • FLUID DEFICIENCY: DEHYDRATION
      • AFFECTS ALL FLUID COMPARTMENTS
      • INFANTS MORE VULNERABLE THAN ADULTS
        • HIGHER METABOLISM  MORE WASTES
          • MORE WASTES  MORE URINE VOLUME
        • IMMATURE KIDNEYS
          • URINE LESS CONCENTRATED
        • GREATER SURFACE AREA-TO-VOLUME RATIO
          • GREATER WATER LOSS BY EVAPORATION
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • EFFECTS OF FLUID DEFICIENCY
      • CIRCULATORY SHOCK
        • DUE TO LOSS OF BLOOD VOLUME
      • NEUROLOGICAL DYSFUNCTION
        • DUE TO DEHYDRATION OF BRAIN CELLS
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • FLUID EXCESS
      • LESS COMMON THAN FLUID DEFICIENCY
        • KIDNEYS ARE TYPICALLY ABLE TO EXCRETE MORE URINE
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • FLUID EXCESS: VOLUME EXCESS
      • CAUSED BY PROPORTIONATE RETENTION OF EXCESS WATER AND SODIUM
      • TOTAL BODY WATER INCREASED
      • OSMOLARITY UNCHANGED
      • CAUSES
        • ALDOSTERONE HYPERSECRETION
        • RENAL FAILURE
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • FLUID EXCESS: HYPOTONIC HYDRATION
      • “ WATER INTOXICATION”, “POS H 2 0 BALANCE”
      • CAUSED BY RETENTION OF MORE WATER THAN SODIUM
      • TOTAL BODY WATER INCREASED
      • ECF OSMOLARITY DECREASES
      • CAUSES
        • REPLACEMENT OF WATER AND SALT WITH WATER
          • LACK OF PROPORTIONATE INTAKE OF ELECTROLYTES
        • ADH HYERSECRETION
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • EFFECTS OF FLUID EXCESS
      • PULMONARY EDEMA
      • CEREBRAL EDEMA
    • WATER BALANCE
      • WATER BALANCE DISORDERS
      • FLUID SEQUESTRATION
      • EXCESS FLUID ACCUMULATES IN A PARTICULAR LOCATION
      • TOTAL BODY WATER MAY BE NORMAL
      • CIRCULATING VOLUME MAY DROP
      • EXAMPLES
        • EDEMA (IN INTERSTITIAL SPACES)
        • HEMORRHAGE (LOST TO CIRCULATION)
        • PLEURAL EFFUSION (IN PLEURAL CAVITY)
    • ELECTROLYTE BALANCE
      • IMPORTANCE OF ELECTROLYTES
      • SALTS
        • E.G. NaCl, Ca 3 (PO 4 ) 2 , ETC.
        • INCLUDE IONS IN DEFINITION
      • MANY ROLES
        • INVOLVED IN METABOLISM
        • DETERMINE ELECTRICAL MEMBRANE POTENTIALS
        • AFFECT OSMOLARITY OF BODY FLUIDS
        • AFFECT WATER CONTENT AND DISTRIBUTION
        • ETC.
    • ELECTROLYTE BALANCE
      • SODIUM
      • PRINCIPAL EXTRACELLULAR CATION
        • 90 – 95% OF OSMOLARITY FROM SODIUM SALTS
      • ROLES
        • DEPOLARIZATION
          • MUSCLES, NERVES
        • AFFECT TOTAL BODY WATER
        • AFFECT WATER DISTRIBUTION
        • COTRANSPORT
          • GLUCOSE, AMINO ACIDS, CALCIUM, ETC.
        • ETC.
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS
      • 0.5 G / DAY DIETARY REQUIREMENT
      • RECEIVE 3 – 7 G / DAY FROM OUR DIET
      • KIDNEYS EXCRETE EXCESS (~5 G / DAY)
      • EXCRETION REGULATED BY 3 HORMONES
        • ALDOSTERONE
        • ANTIDIURETIC HORMONE (ADH)
        • ATRIAL NATRIURETIC FACTOR (ANF)
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS
      • REGULATION BY ALDOSTERONE
      • “SALT-RETAINING HORMONE”
      • STEROID HORMONE
      • ALDOSTERONE SECRETION STIMULATED BY:
        • HYPONATREMIA
        • HYPERKALEMIA
        • HYPOTENSION
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS
      • REGULATION BY ALDOSTERONE
      • TARGET CELLS
        • DISTAL CONVOLUTED TUBULE
        • COLLECTING DUCT
      • TRANSCRIBE GENE FOR Na + -K + PUMP
        • SODIUM REABSORPTION INCREASES
        • H + AND K + SECRETION INCREASES
        • URINE pH DROPS
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS
      • REGULATION BY ALDOSTERONE
      • AVERAGE Na + EXCRETION 5 G / DAY
      • ALDOSTERONE REDUCES TO ~0
      • WATER REABSRBED PROPORTIONALLY
      • SODIUM CONCENTRATION IN BODY UNCHANGED
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS
      • REGULATION BY ALDOSTERONE
      • INHIBITED BY HYPERTENSION
      • KIDNEYS THEN REABSORB LITTLE Na +
      • EXCRETION INCREASED TO ~30 G / DAY
    •  
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS
      • REGULATION BY ADH
      • INDEPENDENTLY MODIFIES SODIUM AND WATER EXCRETION
        • CAN CHANGE SODIUM CONCENTRATION
      • HIGH BLOOD [Na + ]  ADH SECRETION
        • INCREASES WATER REABSORPTION
          • SODIUM CONCENTRATION DECREASED
        • ADH ALSO STIMULATES THIRST
      • ALSO HAPPENS IN REVERSE
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS
      • REGULATION BY ANF
      • HYPERTENSION  ANF SECRETION
        • INHIBITS ADH AND RENIN SECRETION
        • INHIBITS SODIUM & WATER REABSORPTION
        • MORE SODIUM AND WATER EXCRETED
        • BLOOD PRESSURE DECREASED
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS
      • REGULATION BY OTHER HORMONES
      • ESTROGENS MIMIC ALDOSTERONE
        • WATER RETENTION DURING PREGNANCY
        • MENSTRUAL WATER RETENTION
      • PROGESTERONE
        • REDUCES SODIUM REABSORPTION
        • DIURETIC AEFFECT
      • GLUCOCORTICOIDS
        • PROMOTE SODIUM REABSORPTION, EDEMA
    • ELECTROLYTE BALANCE
      • SODIUM HOMEOSTASIS: IMBALANCES
      • RELATIVELY RARE
      • HYPERNATREMIA
        • CAN RESULT FROM IV SALINE
        • CAUSES WATER RETENTION, HYPERTENSION, EDEMA
      • HYPONATREMIA
        • GENERALLY FROM WATER EXCESS
        • HYPOTONIC HYDRATION
        • CORRECTED BY EXCRETION OF EXCESS WATER
    • ELECTROLYTE BALANCE
      • POTASSIUM
      • PRINCIPAL INTRACELLULAR CATION
      • AFFECTS INTRACELLULAR OSMOLARITY
      • AFFECTS CELL VOLUME
      • ROLES
        • PRODUCES RESTING & ACTION POTENTIALS
        • COTRANSPORT
        • THERMOGENESIS
        • COFACTOR FOR PROTEIN SYNTHESIS
    • ELECTROLYTE BALANCE
      • POTASSIUM HOMEOSTASIS
      • HOMEOSTASIS LINKED TO THAT OF Na +
        • K + AND Na + COREGULATED BY ALDOSTERONE
      • 90% OF K + REABSORBED IN PCT
        • REMAINDER EXCRETED IN URINE
      • CONTROL IMPARTED IN DCT & COLLECTING DUCT (CD)
        • HIGH [K + ]  SECRETE MORE INTO FILTRATE
        • LOW [K + ]  SECRETE LESS INTO FILTRATE
        • EXCHANGED FOR Na +
    • ELECTROLYTE BALANCE
      • POTASSIUM HOMEOSTASIS
      • REGULATION BY ALDOSTERONE
      • HIGH [K + ]  ALDOSTERONE PRODUCTION
        • Na + -K + PUMP PRODUCED
        • Na + AND K + COREGULATED
        • INCREASE K + SECRETION
        • DECREASE Na + SECRETION
    • ELECTROLYTE BALANCE
      • POTASSIUM HOMEOSTASIS: IMBALANCES
      • MOST DANGEROUS ELECTROLYTE IMBALANCES
      • HYPERKALEMIA
        • EFFECTS DEPEND ON SPEED OF CONC RISE
        • QUICK RISE  NERVE/MUSCLE CELLS VERY EXCITABLE
        •  CARDIAC ARREST
          • E.G., K+ RELEASED FROM INJURED CELLS
          • E.G., TRANSFUSION WITH OLD BLOOD
          • E.G., EUTHANASIA, CAPITAL PUNISHMENT LETHAL INJECTION
            • K+ HAS LEAKED FROM ERYTHROCYTES
        • SLOW RISE  NERVE/MUSCLE CELLS LESS EXCITABLE
        • (Na+ CHANNELS INACTIVATED)
          • E.G., ALDOSTERONE HYPOSECRETION, RENAL FAILURE, ACIDOSIS
          • E.G., SUPPLEMENTAL K+ TO RELIEVE MUSCLE CRAMPS
    • ELECTROLYTE BALANCE
      • POTASSIUM HOMEOSTASIS: IMBALANCES
      • HYPOKALEMIA
        • NERVE/MUSCLE CELLS LESS EXCITABLE
        • MUSCLE WEAKNESS, LOSS OF MUSCLE TONE, DEPRESSED REFLEXES, IRREGULAR HEART ACTIVITY
        • E.G., HEAVY SWEATING, CHRONIC VOMITING OR DIARRHEA, EXCESSIVE LAXATIVES, ALDOSTERONE HYPERSECRETION, ALKALOSIS
        • E.G., DEPRESSED APPETITE, BUT RARELY FROM DIETARY INSUFFICIENCY
    •  
    • ELECTROLYTE BALANCE
      • CHLORIDE
      • MOST ABUNDANT ANION IN ECF
        • MAJOR CONTRIBUTION TO OSMOLARITY
      • ROLES
        • FORMATION OF HCl
        • CHLORIDE SHIFT
          • CO 2 LOADING/UNLOADING
        • REGULATION OF BODY pH
    • ELECTROLYTE BALANCE
      • CHLORIDE HOMEOSTASIS
      • Cl - STRONGLY ATTRACTED TO SOME CATIONS (E.G., Na + , K + , Ca 2+ )
        • CANNOT KEEP THEM APART
      • HOMEOSTASIS ACHIEVED AS AN EFFECT OF Na + HOMEOSTASIS
        • Cl - PASSIVELY FOLLOWS Na +
    • ELECTROLYTE BALANCE
      • CHLORIDE IMBALANCES
      • HYPERCHLOREMIA
        • RESULTS FROM DIETARY EXCESS
        • RESULTS FROM INTERVENOUS SALINE ADMINISTRATION
      • HYPOCHLOREMIA
        • SIDE EFFECT OF HYPONATREMIA
        • SIDE EFFECT OF HYPOKALEMIA
          • KIDNEYS RETAIN K+ BY SECRETING Na+, Cl- FOLLOWS
      • EFFECTS
        • ALTERED ACID-BASE BALANCE
    • ELECTROLYTE BALANCE
      • CALCIUM
      • ROLES
        • STRENGTHENS BONE
        • MUSCLE CONTRACTION
        • SECOND MESSENGER FOR HORMONES
        • ACTIVATES EXOCYTOSIS
        • BLOOD CLOTTING
    • ELECTROLYTE BALANCE
      • CALCIUM
      • BINDS TO PHOSPHATE ION
        • CAN FORM Ca 3 (PO 4 ) 2
        • HIGH CONCENTRATIONS OF BOTH IONS WILL FORM PRECIPITATE CRYSTALS
        • INTRACELLULAR [Ca 2+ ] MUST BE KEPT LOW
        • Ca 2+ PUMPED OUT & INTO E.R.
    • ELECTROLYTE BALANCE
      • CALCIUM HOMEOSTASIS
      • REGULATED BY PTH & CALCITROL
        • ALSO BY CALCITONIN IN CHILDREN
      • BLOOD [Ca 2+ ] REGULATED VIA
        • BONE DEPOSITION & REABSORPTION
        • INTESTINAL ABSORPTION
        • URINARY EXCRETION
    • ELECTROLYTE BALANCE
      • CALCIUM IMBALANCES
      • HYPERCALCEMIA
        • REDUCES EMBRANE PERMEABILITY TO Na+
        • INHIBITS DEPOLARIZATION OF NERVES/MUSCLES
        •  MUSCULAR WEAKNESS, CARDIAC ARRHYTHMI, ETC.
        • RESULTS FROM
          • ALKALOSIS
          • HYPERPARATHYROIDISM
          • HYPOTHYROIDISM
    • ELECTROLYTE BALANCE
      • CALCIUM IMBALANCES
      • HYPOCALCEMIA
        • INCREASES EMBRANE PERMEABILITY TO Na+
        • NERVES/MUSCLES OVERLY EXCITABLE
        •  TETANUS IF CONCENTRATION DROPS TO LOW
        • RESULTS FROM
          • ACIDOSIS
          • VITAMIN D DEFICIECY
          • DIARRHEA
          • PREGNANCY OR LACTATION
          • HYPOPARATHYROIDISM
          • HYPERTHYROIDISM
    • ELECTROLYTE BALANCE
      • PHOSPHATES
      • RELATIVELY CONCENTRATED IN ICF
      • ROLES
        • COMPONENTS OF BONES
        • COMPONENTS OF DNA & RNA
        • COMPONENTS OF PHOSPHOLIPIDS
        • ACTIVATE / DEACTIVATE ENZYMES
        • BUFFER pH OF BODY FLUIDS
    • ELECTROLYTE BALANCE
      • PHOSPHATES
      • COMPONENTS OF
        • NUCLEIC ACIDS (DNA, RNA)
        • NTPs AND dNTPs (ATP, dATP, GTP, dGTP, etc)
        • cAMP
        • PHOSPHOLIPIDS
        • VARIOUS OTHER PHOSPHORYLATED MOLECULES
      • GENERATED VIA ATP HYDROLYSIS, ETC.
      • EXIST AS MIXTURE OF THREE FORMS
        • PO 4 3- (PHOSPHATE ION)
        • HPO 4 2- (MONOHYDROGEN PHOSPHATE ION)
        • H 2 PO 4 - (DIHYDROGEN PHOSPHATE ION)
    • ELECTROLYTE BALANCE
      • PHOSPHATE HOMEOSTASIS
      • DIET PROVIDES AMPLE PHOSPHATE
      • READILY ABSORBED BY SMALL INTESTINE
      • REGULATION
        • RENAL TUBULES SITE OF REGULATION
        • PTH INCREASES PHOSPHATE EXCRETION
        • EXCRETION RATE AFFECTED BY URINE pH
    • ELECTROLYTE BALANCE
      • PHOSPHATE IMBALANCES
      • PHOSPHATE HOMEOSTASIS NOT VERY CRITICAL
      • BODY CAN TOLERATE WIDE VARIATIONS OF PHOSPHATEE CONCENTRATION WITH LITTLE EFFECT
    • ACID-BASE BALANCE
      • ACIDS, BASES, AND pH
      • ACID
        • ANY SUBSTANCE RELEASING H +
        • [H+] INCREASES (pH DECREASES)
      • BASE
        • ANY SUBSTANCE ACCEPTING H +
        • [H+] DECREASES (pH INCREASES)
      • pH
        • A MEASURE OF [H + ]
        • -LOG [H + ]
        • SCALE 0 – 14, 7 IS NEUTRAL
    • ACID-BASE BALANCE
      • WHY IS ACID-BASE BALANCE IMPORTANT?
      • METABOLISM REQUIRES NUMEROUS ENZYMES
      • ENZYMES ARE PROTEINS
      • pH AFFECTS PROTEIN STRUCTURE
      • PROTEIN STRUCTURE AFFECTS FUNCTION
      • DEVIATIONS FROM NORMAL pH CAN INACTIVATE ENZYMES AND SHUT DOWN METABOLIC PATHWAYS
    •  
    • ACID-BASE BALANCE
      • BLOOD pH
      • BLOOD AND TISSUE pH 7.35 – 7.45
        • ENZYMES FUNCTION WELL WITHIN THIS RANGE
        • ENZYMES FUNCTION POORLY (OR NOT AT ALL) WHEN SIGNIFICANTLY OUTSIDE OF THIS RANGE
        • THIS RANGE MUST BE MAINTAINED
          • ACID-BASE BALANCE
    • ACID-BASE BALANCE
      • BUFFERS
      • ANY MECHANISM OF RESISTING SIGNIFICANT CHANGES IN pH
      • ACCOMPLISHED BY CONVERTING:
        • STRONG ACID  WEAK ACID
        • STRONG BASE  WEAK BASE
    • ACID-BASE BALANCE
      • BUFFERS
      • PHYSIOLOGICAL BUFFER
        • SYSTEM STABILIZING pH BY CONTROLLING BODY’S OUTPUT OF ACIDS, BASES, OR CO 2
          • URINARY SYSTEM
            • BUFFERS GREATEST QUANTITY
            • REQUIRES HOURS OR DAYS TO EXERT EFFECT
          • RESPIRATORY SYSTEM
            • SMALLER EFFECT
            • EXERTS EFFECT WITHIN MINUTES
    • ACID-BASE BALANCE
      • BUFFERS
      • CHEMICAL BUFFER SYSTEM
        • COMBINATION OF WEAK ACID AND WEAK BASE
        • BINDS TO H + AS [H + ] RISES, AND
        • RELEASES H + AS [H + ] FALLS
        • CAN RESTORE NORMAL pH ALMOST IMMEDIATELY
        • THREE MAJOR CHEMICAL BUFFER SYSTEMS
          • BICARBONATE SYSTEM
          • PHOSPHATE SYSTEM
          • PROTEIN SYSTEM
    • ACID-BASE BALANCE
      • BICARBONATE BUFFER SYSTEM
      • CARBONIC ACID (H 2 CO 3 )
        • WEAK ACID
      • BICARBONATE ION (HCO 3 - )
        • WEAK BASE
      • CO 2 + H 2 0  H 2 CO 3  H + + HCO 3 -
      • WORKS IN CONCERT WITH RESPIRATORY AND URINARY SYSTEM
        • THESE SYSTEMS REMOVE CO 2 OR HCO 3 -
    • ACID-BASE BALANCE
      • PHOSPHATE BUFFER SYSTEM
      • DIHYDROGEN PHOSPHATE ION(H 2 PO 4 - )
        • WEAK ACID
      • MONOHYDROGEN PHOSPHATE ION (HPO 4 2- )
        • WEAK BASE
      • H 2 PO 4 -  H + + HPO 4 2-
      • STRONGER THAN BICARBONATE BUFFERING SYSTEM
      • MORE IMPARTANT IN BUFFERING ICF AND RENAL TUBULES THAN IN ECF
    • ACID-BASE BALANCE
      • PROTEIN BUFFER SYSTEM
      • PROTEINS ARE MORE CONCENTRATED THAN BICARBONATE AND PHOSPHATE BUFFERS
      • ACCOUNTS FOR ~75% OF ALL CHEMICAL BUFFERING OF BODY FLUIDS
      • BUFFERING ABILITY DUE TO CERTAIN FUNCTIONAL GROUPS OF AMINO ACID RESIDUES
        • CARBOXYL GROUPS
          • --COOH  -COO - + H +
        • AMINO GROUPS
          • --NH 3 +  -NH 2 + H +
    • ACID-BASE BALANCE
      • RESPIRATORY CONTROL OF pH
      • CO 2 + H 2 0  H 2 CO 3  H + + HCO 3 -
      • ADDITION OF CO 2 INCREASES [H + ]
      • REMOVAL OF CO 2 DECREASES [H + ]
      • CAN NEUTRALIZE 2-3 X MORE ACID AS CHEMICAL BUFFERS
    • ACID-BASE BALANCE
      • RENAL CONTROL OF pH
      • CAN NEUTRALIZE MORE ACID OR BASE THAN BOTH RESPIRATORY SYSTEM AND CHEMICAL BUFFERS
      • RENAL TUBULES SECRETE H +
        • H + EXCRETED IN URINE
        • EXCHANGED FOR SODIUM ION (Na + )
        • ONLY POSSIBLE WHEN [H + ] INSIDE TUBULE CELLS IS > [H + ] IN TUBULAR FLUID
    •  
    • ACID-BASE BALANCE
      • ACID-BASE BALANCE DISORDERS
      • AT pH 7.4, 20:1 HCO 3 - :H 2 CO 3 RATIO
      • IF [H 2 CO 3 ] INCREASES, pH DROPS
        • pH BELOW 7.35 = ACIDOSIS
      • IF [HCO 3 - ] INCREASES, pH INCREASES
        • pH ABOVE 7.45 = ALKALOSIS
    • ACID-BASE BALANCE
      • ACID-BASE BALANCE DISORDERS
      • RESPIRATORY ACIDOSIS
        • CO 2 PRODUCTION EXCEEDS RESPIRATORY CO 2 ELIMINATION
        • CO 2 ACCUMULATES IN ECF
        • pH DROPS
      • RESPIRATORY ALKALOSIS
        • RESPIRATORY CO 2 ELIMINATION EXCEEDS CO 2 PRODUCTION
        • EXCESSIVE VENTILATION (HYPERVENTILATION)
        • pH RISES
    • ACID-BASE BALANCE
      • ACID-BASE BALANCE DISORDERS
      • METABOLIC ACIDOSIS
        • INCREASED PRODUCTION OF ORGANIC ACIDS
          • E.G., FERMENTATION  LACTIC ACID
          • E.G., ALCOHOLISM, DIABETES MELLITUS  KETONE BODIES
        • INGESTION OF ACIDIC DRUGS
          • E.G., ASPIRIN
        • LOSS OF BASE
          • E.G., CHRONIC DIARRHEA, OVERUSE OF LAXITIVES
      • METABOLIC ALKALOSIS
        • RARE
        • OVERUSE OF BICARBONATES
          • E.G., ANTACIDS
        • LOSS OF STOMACH ACID FROM CHRONIC VOMITING
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    • ACID-BASE BALANCE
      • ACID-BASE BALANCE DISORDERS
      • ACIDOSIS
      • H + PASSIVELY DIFFUSES INTO CELLS
      • K + DIFFUSES OUT
        • ELECTRICAL BALANCE MAINTAINED
      • H + BUFFERED BY INTRACELLULAR PROTEINS
      • NET LOSS OF CATIONS FROM CELL
      • MEMBRANE IS NOW HYPERPOLARIZED
      • NERVE & MUSCLE CELLS DIFFICULT TO STIMULATE
        • CENTRAL NERVOUS SYSTEM DEPRESSED
          • CONFUSION, DISORIENTATION, COMA
    •  
    • ACID-BASE BALANCE
      • ACID-BASE BALANCE DISORDERS
      • ALKALOSIS
      • H + PASSIVELY DIFFUSES OUT OF CELLS
      • K + DIFFUSES INTO CELLS
        • GAIN IN POSITIVE INTRACELLULAR CHARGE
      • MEMBRANE POTENTIAL SHIFTED
      • NERVOUS SYSTEM HYPEREXCITABLE
        • NEURONS FIRE SPONTANEOUSLY
        • SKELETAL MUSCLES OVERSTIMULATED
          • MUSCLE SPASMS, TETANY, CONVULSIONS, RESPIRATORY PARALYSIS
    • ACID-BASE BALANCE
      • ACID-BASE IMBALANCE COMPENSATION
      • RESPIRATORY SYSTEM COMPENSATION
      • ADJUSTS P CO 2 IN ECF
        • CO 2 EXCESS  INCREASED VENTILATION
        • CO 2 DEFICIENCY  DECREASED VENTILATION
      • EFFECTIVE VS RESPIRATORY ACIDOSIS AND ALKALOSIS
      • NOT VERY EFFECTIVE VS METABOLIC ACIDOSIS AND ALKALOSIS
        • I.E., CANNOT RID BODY OF KETONE BODIES
      • CAN CORRECT pH 7.0 TO 7.2 OR 7.3
        • NOT ALL THE WAY TO 7.4
    • ACID-BASE BALANCE
      • ACID-BASE IMBALANCE COMPENSATION
      • RENAL SYSTEM COMPENSATION
      • SLOWER TO RESPOND
      • CAN FULLY RESTORE NORMAL pH
      • URINE pH NORMALLY 5 – 6
        • MAY DROP TO 4.5 WITH EXCESS H +
          • RESPONSE TO ACIDOSIS
          • RENAL TUBULES INCREASE H + SECRETION
          • H + IN URINE IS BUFFERED
        • MAY RISE TO 8.2 WITH EXCESS HCO 3 -
          • RESPONSE TO ALKALOSIS
          • HCO 3 - CONCENTRATION IN URINE ELEVATED