This document discusses acid-base balance and disorders. It covers 3 key mechanisms to maintain blood pH: 1) blood buffers, 2) respiratory regulation, and 3) renal regulation. The blood's bicarbonate buffer system uses carbonic acid, while tissues also use phosphate and protein buffers. Respiration controls pH by regulating CO2 exhalation. The kidneys compensate for acid-base imbalances over hours by regulating bicarbonate reabsorption and acid excretion. Acid-base disorders include respiratory and metabolic acidosis and alkalosis.
Maintenance of pH of body fluids and its disorders for undergraduate medical students and postgraduate students in medicine, paediatrics, respiratory medicine etc
Maintenance of pH of body fluids and its disorders for undergraduate medical students and postgraduate students in medicine, paediatrics, respiratory medicine etc
A review of ACID AND BASE: What's Acid and Base? what are the normal range and how the body can regulate? finally what will happen if there is error in maintaining acid base balance system
Concepts of acid base balance and its disorders are very important for practice of medicine.It is for the benefit of medical and students of allied fields.
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TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
1. Moderator : Dr. M. S. Somannavar
Presenter : Jay prakash sah
Jawaharlal Nehru Medical college, Belgaum,Karnataka,India
Email:shahjayprakash978@gmail.com
2. INTRODUCTION
REGULATION OF ACID BASE BALANCE
BLOOD BUFFERS
RESPIRATORY MECHANISM
RENAL MECHANISM
ACID BASE DISORDERS
ABG ANALYSIS
3. Normal blood PH : 7.35-7.45
Maintenance of blood pH - important
homeostatic mechanism of the body.
PH less than 7.35 leads to acidosis and
pH more than 7.45 leads to alkalosis.
4. Acids are proton donors.
HA ↔ H+ + A-
HCL ↔ H ++ CL -
Bases are proton acceptors.
NH3+H+ ↔ NH4+
HCO3+H+ ↔ H2CO3
• Weak and strong acids :
HCL → H ++ CL - (COMPLETE) - Strong acid
H2CO3 → H+ + HCO3
- ( PARTIAL) - Weak acid
Acid Base
5. Carbonic acid - Oxidation of c-compounds
Sulphuric acid - Oxidation of sulphur containing amino acids.
Phosphoric acid-metabolism of dietary phosphoproteins ,
nucleoproteins, phosphatides .
Organic acid- oxidation of carbohydrates , fats and proteins.
e.g. pyruvic acid ,lactic acid , acetoacetic acid etc.
Iatrogenic : - certain medicine like NH4Cl, mandelic acid etc.
NOTE:DIET RICH IN ANIMAL PROTEIN RESULTS IN MORE
ACID PRODUCTION.
6. Vegetarian diet has an alkalizing effect.
Intestine Blood Cell
From diet
Acid
From foods ,fruits etc
Salts of potasium tartarate + water
Potasium citrate+water
NaHCO3 + H2O
Acetic acid
Lactic acid
Citric acid
Fatty acid
CARBONIC ACID
Lactic acid
Phosphoric acid
Sulphuric acid
TARTARIC ACID+KOH
CITRIC ACID + KOH
CARBONIC Acid+ NaOH
Carbohydrates ,fat,
proteins
H2O+ CO2
Glycogen breakdown
Nucleoprotein
Phosphoprotein
Phospholipid metabolism
Cysteine , cystine and
methionine metabolism
7. Buffers - resist change in pH.
Two types
a) Mixture of weak acids with their salt with a strong
base.
b) Mixture of weak bases with their salt with a strong
acid.
Example
1. Bicarbonate buffer (H2CO3 / NaHCO3 )
2. Acetate buffer (CH3COOH / CH3COONa)
3. Phosphate buffer (Na2HPO4 /NaH2PO4 )
8. If you go running you build up lactic acid in
your muscles.
Therefore your pH will decrease.
Buffer will act to increase the pH.
And vice versa.
So how does it work using chemistry ?
11. Protein buffer
Amino acid
If pH ↓
In acidic medium amino acid (NH2) act as a base
and absorbs H+.
If pH↑
In alkaline medium amino acid (COOH) act as a
acid and release H+.
12. Acetate buffer
When HCl is added to the acetate buffer, the salts
react with the acid forming the weak acid , acetic
acid and its salts.
CH3COONa + Hcl CH3COOH + Nacl
When NaOH is added, the acid reacts with its
forming salt and water.
CH3COOH + NaoH CH3COONa +Nacl
Thus changes in pH is minimised.
14. 1. Standard buffer solution are used with
indicator for determination of pH.
2. Buffer are used to check the performance of
electrode used for determination of pH.
3. Used for many chemical reactions including
those catalysed by enzymes.
4. Used in the pathological laboratory to control
pH of culture media for bacteria tissues.
5. Very important in regulating the pH of body
fluids e.g. blood, interstitial fluid ,lymph.
17. pH = - log [H+] , dimensionless quantity.
[H+] means gm of hydrated H+ ion present as
H3O+ per litre of fluid .
E.g. H2O contains 1/1000000gm of hydrogen ion
in 1 litre ,means [H+]=10-7.
Decrease of one pH unit represents a ten fold
increase in the H+ activity.
The pH 7.40 corresponds to a hydrogen ion
concentration of 40 nmol/L ( European centre).
18. Represents the negative logarithm of the
ionization constant of a weak acid (ka).
Pk is the pH at which an acid is half
dissociated.
Acids have pk value less than 7 and bases
have have more than 7.
Lower pk = stronger acid
Higher pk = stronger base
20. 3 mechanism
1. Blood buffers : first line of defence
2. Respiratory regulation :second line of defence
3. Renal regulation : third line of defence
21. Can not remove H+ ions from the body.
Temporarily acts as a shock absorbant to reduce
the free H+ ion.
3 buffer system :
1. Bicarbonate buffer
2. Phosphate buffer
3. Protein buffer
22. Extracellular buffer system of the body
NaHCO3/H2CO3= [ SALT ] / [ACID]
NORMAL RATIO= 20 : 1
Base constituent (HCO3 ) - regulated by the kidney
(Metabolic component)
Acid (H2CO3) - respiratory regulation
( Respiratory component ).
23. Neutralization of strong acid and non- volatile
acid entering the ECF is achieved by bicarbonate
buffer ,such acid e.g. HCl , H2SO4,lactic acid etc.
Strong acid react with NaHCO3 component .thus
lactic acid is buffered as follows:
NaHCO3 H+ L-
Na L-
H2CO3 (weak acid) + Na Lactate (salt)
lungs(H2co3)
HCO3 H+
24. H2CO3 H+ + HCO3-
By the law of mass action, at equilibrium
Ka = [H+] [HCO3] --------(1)
[H2CO3 ]
[H+] =Ka [H2CO3 ] -------------(2)
HCO3-
By taking reciprocal and logarithm
Log 1/[H+] = log 1/Ka +log [HCO3] --------(3)
[ H2CO3 ]
Ka = dissociation constant
Ka=log 1/[H+]
25. pH = pka + log [ HCO3 ] -------(4)
[H2CO3 ]
USES;
1. It determines the pH of blood.
2. Serve as an index to understand the
disturbance in acid base balance of the
body.
26. 1. High concentration
2. Alkali reserve
3. Very good physiological buffer and act as
front line of defence.
27. Na2HPO4 /NaH2PO4
Intracellular buffer , pka= 6.8 , 4:1.
When a strong acid enters ,it is fixed up by the
alkaline po4(Na2hpo4) which is converted to acid po4
as follows
Hcl Na2HPO4
Cl- Na+
NaH2PO4 +NaCl
excreted through urine(kidney)
H+ NaHPO4
28. When a alkali enters , buffered by acid PO4,
which is converted to alkaline PO4 and is
excreted in urine.
NaH2PO4 NaOH
NaHPO4 Na+
H2O+Na2HPO4
excreted in urine
H+ OH-
29. Advantage
Very effective and better, as pka approaches
physiological ph.
30. Plasma Protein and Hb - most important
Buffering action of protein depends on pk of
ionizable group of amino acid
Effective group- imidazole group of Histidine
Pk - 6.7
31. In acidic medium, protein acts as a base, NH2
group takes up H+ ions from the medium
forming NH3+, proteins becomes positively
charged.
in alkaline medium , protein act as an acid,
COOH group dissociates and gives H+,
forming COO-. H + combines with OH- to
produce molecule of water , proteins become
negatively charged
32. The respiratory system helps control the
acidity of the blood by regulating the
elimination of CO2 and H2O.
These molecules are exhaled with every
breath.
H2CO3 H2O + CO2
carbonic acid
The brain is sensitive to blood CO2 levels and
pH.
33. → Normal blood
pH
→
↑ ↓
Lower blood pH,
higher CO2 levels
↑ ↓
Decreased blood CO2,
increased blood pH
Respiratory
center
stimulated
↑ ↓
Faster, deeper
breathing
↑ ↓
← Increased
amount
of CO2 exhaled
←
34. A significant decrease in CO2 or increase in pH
- causes breathing to decrease
- results in hypoventilation
- less CO2 is exhaled
- increases CO2 - increases H2CO3 and H+ concentrations
- decreases pH back to normal
→→ Normal blood
pH
→→
↑ ↓
Higher blood pH,
lower CO2 levels
↑ ↓
Increased blood CO2,
decreased blood pH
Respiratory
center
stimulated
↑ ↓
Slower, shallower
breathing
↑ ↓
← Decreased
amount
of CO2 exhaled
←
35. • Third line of defense against change in
hydrogen ion concentration
• permanent solution to the acid base
disturbances.
• Kidneys require hours to days to
compensate for changes in body-fluid pH
36. 1. Excretion of H+.
2. Reabsorption of bicarbonate
3. Excretion of titratable acid
4. Excretion of ammonium (NH4+)
37. Plasma PCT CELL Tubular lumen
Na+
HCO3
-
( alkali is recovered )
Na+
HCO3
- + H+
H2CO3
CA
CO2 + H2O
Na+
H+
Excreted in urine
38. plasma PCT cell Tubular lumen
Na+
HCO3
-
Na+
HCO3
- + H+
H2CO3
CA
CO2 + H2O
NaHCO3 (filtered)
Na+ HCO3
-
H+
H2CO3
CA
CO2 + H2O
39. plasma DCT cell tubular lumen
Na+
HCO3
-
Na+
HCO3
- + H+
H2CO3
CA
CO2 + H2O
Na2HPO4 (ph-7.4)
Na+
H+
NaH2PO4 (ph-5.4)
Excreted in urine
41. A 50 year old man came to emergency department after returning
from foreign travel. His symptom included persistent diarrhoea (over
the past 3 days) and rapid respiration . Blood gases were drawn with
following results :
pH- 7.21 ( )
pCO2 - 19 mmHg ( )
pO2 - 96 mmHg
HCO3- 7 mmol/l
Questions:
1. What is the patient acid base status?
2. Why is the HCO3 level is so low?
3. Why does the patient have rapid respiation?
42. ACIDOSIS: PH <7.35
a ) METABOLIC ACIDOSIS
b ) RESPIRATORY ACIDOSIS
ALKALOSIS : PH >7.45
a ) METABOLIC ALKALOSIS
b ) RESPIRATORY ALKALOSIS
43.
44. The sum of cations and anions in ECF is
always equal , so as to maintain the electrical
neutrality.
Commonly measured electrolytes in plasma
are Na+, K+,Cl-,HCO3- .
Unmeasured anion in the plasma constitutes
the anion gap.
45. This is due to presence of protein anions ,
sulphate , phosphate and organic acids.
Anion gap = (Na + k) - ( HCO3+ Cl- ) .
Normally anion gap is about 15 mEq/l
Normal range = 8-18 mEq/l.
46. High anion gap acidosis
I. Renal failure
II. Diabetic ketoacidosis
III. Lactic acidosis
Normal anion gap acidosis
I. Diarrhoea
II. Hyperchloremic acidosis
Low anion gap
I. Multiple myeloma
47. Primary deficit of bicarbonate.
Due to its utilization in buffering H+ ions,
loss in urine or GIT .
Important cause-excessive production of
organic acids which combine with sodium
bicarbonate and deplete alkali reserve .
NaHCO3+organic acids Na salts of
o organic acids + CO2
48. Severe uncontrolled diabetes mellitus
(ketoacidosis)- production of organic acids
Renal failure
Lactic acidosis
Severe diarrhoea
Renal tubular acidosis
49. Increased production and accumulation of
organic acid causes an elevation in anion gap.
This type is seen in ketoacidosis
COMPENSATION
• Hyperventilation of lungs(elimination of co2)
• Renal compensation-(3-4days) H+ ions
excreted as NH4+
50. Primary excess of carbonic acid .
Causes
• Severe asthma
• Pneumonia
• Cardiac arrest
• Depression of respiratory centre
• COPD
51. Compensation
H2O + CO2 ↔ H2CO3 ↔ H++ HCO3
-
renal mechanism-
• Increase in renal reabsorption of bicarbonate
• excretion of titrable acidity and NH4+ is
elevated in urine
52. Primary excess of bicarbonate
Causes
• Severe vomiting
• Hypokalemia
• Intravenous administration of bicarbonate.
• Cushing syndrome
53. M. alkalosis is commonly associated with
hypokalemia .
In severe k+ deficiency ,H+ ions are retained
inside the cells to replace missing k+ ions.
In the tubular cells, H+ions are exchanged
(instead of k+) with the reabsorbed Na+.
Paradoxically , the patient excretes acid urine
despite alkalosis.
54. COMPENSATION
H2O + CO2 ↔ H2CO3 ↔ H++ HCO3
-
HYPOVENTILATION- to retain co2
Renal mechanism-
excretes more bicarbonate and retains H+
55. Primary deficit of carbonic acid
causes
• Hyperventilation
• High altitude
• Salicylate poisoning
56. Compensation
H2O + CO2 ↔ H2CO3 ↔ H++ HCO3
-
Renal mechanism –
by increasing excretion of bicarbonate by
decreasing reabsorption
secretion of H+ decreases
57. Potassium- affects contractility of heart
Hypokalaemia - life threatening
Insulin – increases K+ uptake by cells
Measurement of plasma k+ concentration
assumes significance in acid-base disorders.
58. Patients with severe uncontrolled DM (M.
acidosis) is usually with hypokalemia.
When such a patient is given insulin , it
stimulates k+ entry into cells.
The result is that plasma k+ level is further
depleted.
Hypokalemia affects the heart functioning
and is life threatening.
59. Therefore in the treatment of diabetic ketoacidosis,
k+ has to be given.
K+ and alkalosis
Hypokalemia leads to increased excretion of hydrogen
ions, and thus may cause M. alkalosis.
60. Assessment of acid base status.
Arterial blood
Radial artery – in the Wrist
Brachial artery - in the arm
Femoral artery - in the groin
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