The document discusses the kidney's role in acid-base regulation through excretion of hydrogen ions, reclamation of bicarbonate ions, and excretion of titratable acid and ammonia. It also discusses the buffer system, respiratory and renal mechanisms for compensating for metabolic acidosis and alkalosis. Metabolic acidosis results from loss of bicarbonate and is classified as uncompensated, partially compensated or fully compensated based on pH, pCO2 and bicarbonate levels. Metabolic alkalosis can result from excessive intake of alkali and involves respiratory retention of CO2 and decreased renal hydrogen ion excretion for compensation.
ACID & BASE
Acid is a molecule or an ion that can function as a proton donor. Base is the molecule or an ion that can function as a proton acceptor.
pH
pH is negative log of H+ ion concentration.
Normal pH of arterial blood is 7.4 and that of venous blood and
ACID & BASE
Acid is a molecule or an ion that can function as a proton donor. Base is the molecule or an ion that can function as a proton acceptor.
pH
pH is negative log of H+ ion concentration.
Normal pH of arterial blood is 7.4 and that of venous blood and
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2. Dr. Ashok Kumar J; IMS; MSU
Kidney plays a major role in acid-base regulation
2. Reclamation the bicarbonate ions present in the
ultra-filtrate
1. Excretion of H+
3. Excretion of titrable acid
4. Excretion of ammonia
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7. When there is an excess of acid production in the body, H+
are excreted in urine as titrable acid and ammonia
Dr. Ashok Kumar J; IMS; MSU
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8. Dr. Ashok Kumar J; IMS; MSU
Anion Gap
In Extracellular fluid
Sum of anions = Sum of cations - Electrical neutrality
•Sodium (Na+) and
Potassium (K+) together
accounts for 95% of
the cations
•Chloride and
bicarbonate accounts
for only 86% of the
anions
• Measured cations
Sodium 136 mEq/L
Potassium 4 mEq/L
• Unmeasured Cation
Calcium 4.5 mEq/L
Magnesium 1.5 mEq/L
• Measured anions
Chloride 98mEq/L
Bicarbonate 25mEq/L
• Unmeasured anion
Protein 15mEq/L
Phosphate 2mEq/L
Organic acids 5mEq/L
Sulfate 1mEq/L
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9. Dr. Ashok Kumar J; IMS; MSU
• Unmeasured anions constitute the anion gap
• Calculated as difference between measured cations and measured anions
Anion Gap = (Na+ + K+) - (Cl- + HCO3
-)
• Normal is about 12 mEq/L
e.g:
= ( 140 + 4) – (103 + 25)
= 16
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10. Dr. Ashok Kumar J; IMS; MSU
Acidosis : Clinical state where acids accumulate or bases are lost
Alkaosis : Clinical state where accumulation of base or loss of acids
[Bicarbonate]
pH pKa log10
[Carbonic acid]
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11. Dr. Ashok Kumar J; IMS; MSU
[Bicarbonate]
[Carbonic acid]
pH pKa log10
Regulated by Kidney
Metabolic component
Decreased Bicarbonate
Decreases the ratio
Decreases pH
Metabolic acidosis :- Primary alkali (bicarbonate) deficit
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12. Dr. Ashok Kumar J; IMS; MSU
[Bicarbonate]
[Carbonic acid]
pH pKa log10
Regulated by Kidney
Metabolic component
Increased Bicarbonate
Increases the ratio
Increases pH
Metabolic alkalosis :- Primary alkali (biocarbonate) excess
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13. Dr. Ashok Kumar J; IMS; MSU
• Diabetic ketoacidosis ; Starvation ketoacidosis; Lactic acidosis ;
Salicylate intoxication
• Renal failure ; Renal tubular acidosis type II
• Severe diarrhoea ; Renal tubular acidosis type I;
Ureterosigmoidostomy
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14. Dr. Ashok Kumar J; IMS; MSU
Loss of bicarbonate
a. From gastrointestinal tract as in
• severe diarrhoea
b. From the kidney as in
• Ureterosigmoidostomy
• Renal tubular acidosis
is replaced by chloride
Results in hyperchloremic acidosis
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16. BUFFER SYSTEM
Mainly bicarbonate buffer minimizes change in pH
HCO3 concentration is decreased and ratio of HCO3/H2 CO3 less than 20/1
RESPIRATORY MECHANISM
Increases rate and depth of respiration (Kussumauls breathing)
Elimination of carbonic acid as CO2 ,
Decrease in pCO2 and consequently decrease in H2CO3
Dr. Ashok Kumar J; IMS; MSU
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17. Dr. Ashok Kumar J; IMS; MSU
RENAL compensation seta in 2 to 4 days
Increases excretion of acid and preserves the base by increased rate of
Na- H exchange
Increases ammonia formation and increased reabsorption of HCO3
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19. Dr. Ashok Kumar J; IMS; MSU
Metabolic alkalosis
•Therapeutic administration of large dose of alkali
– chronic intake of excess antacids
- Intravenous administration of bicarbonateetc
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20. Dr. Ashok Kumar J; IMS; MSU
RESPIRATORY MECHANISM:
Increase in pH depresses the respiratory center, causes retention of CO 2
pCO2which in turn increases the H 2CO 3 .
RENAL MECHANISM:
Kidney decreases H+ excretion
decreased reclamation of bicarbonate.
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