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Acid base balance, acid base disorder
1. Acid BaseAcid Base
Balance, AcidBalance, Acid
Base disordersBase disorders
Dr Ifat Ara Begum
Associate Professor
Dept of Biochemistry
Dhaka Medical College
Dhaka
1
3. Acid & BaseAcid & Base
3
Points Acid Base
Definitio
n
Molecules that
can donate proton
(H+
) in aqueous
solution
Molecules that can
accept proton (H+
)
in aqueous
solution
pH <7 >7
When
dissolve
d in
water
Produces H+
Produces OH-
Types Strong acid
Weak acid
Strong base
Weak base
4. Proton is the hydrogen atom with itsProton is the hydrogen atom with its
electron removedelectron removed
4
6. 6
Conjugate base of acid
The remaining anionic
part of an acid after
removal of proton from
the acid
In strong acid, it is
weak & vice versa
Conjugate acid of base
It is the acid formed
by a base after
accepting proton
In strong base, it is
weak & vice versa
7. 7
Strength of an acid / base
is defined in terms of the
tendency to donate (or
accept) the hydrogen ion to
(from) the solvent
(i.e. water in biological
systems)
8. Sources of Acid/Base in our bodySources of Acid/Base in our body
8
Exogenous source:
Foods rich in acid (meat)
Ingestion of acids (salicylic acid)
Intravenous infusion
Endogenous source:
Produced at cellular level during
metabolism
9. 9
Sources of Volatile
acid:
15 – 20 mol/D
Oxidation of :
Glucose
FA
AA
Sources of NVA:
230 mmol/D
Oxidation of :
Basic AA
S containing AA
PO4 containing
substances
Sources of Base (nonvolatile):
160 mmol/D
Oxidation of Acidic AA
Metabolism of dietary organic anions
like citrate, acetate etc
10. ‘‘Our body is net acid producer’Our body is net acid producer’
10
NVA & base neutralize each
other at one to one ratio.
So, after neutralization, 70
mmol/D NVA is left behind
(230-160 = 70)
This 70 mmol/D of NVA,
along with 15-20 mol/D of
volatile acid makes the body
env. acidic
11. Metabolic acid or base production dependsMetabolic acid or base production depends
on:on:
11
Insulin status
Blood flow to tissues
Oxygen supply to tissues
Dietary habit
12. Route for excretion of acid/base from bodyRoute for excretion of acid/base from body
12
Pulmonary route
For excretion of
volatile acids only
High capacity system
On complete failure for
few minutes, it reduces
pH grossly
Renal route
For excretion of NVA &
bases
Low capacity system
On complete failure for
few minutes, no effect
on pH at all
17. How pH can be determined?How pH can be determined?
17
Instrumentally by pH meter
Using H-H Equation (From serum
HCO3 conc. & PCO2)
18. 18
Importance of normal
body pH
Supports optimum
enzyme activity
O2 transport &
chemical control of
respiration
Maintains:
The native molecular
form & structural
conformation of
biomolecules (esp.
protein) to keep them
functionally active
Why Life threatens
beyond clinically safe
range of pH?
Altered :
Enzyme activity
Membrane
permeability
CNS activity
Electrolyte
distribution
Increased myocardial
irritability
Decreased cellular
viability
20. How pH is regulated?How pH is regulated?
20
First Line Defense
Chemical buffer system: It acts within second
to minutes
Pulmonary system: It acts within minutes to
hours by regulating CO2 content in blood
Second line Defense
Renal system: It acts within hours to days by
regulating serum bicarbonate and excretion
of acid
21. BufferBuffer
Any substance / A mixture of weak acid & its
conjugate base / A mixture of weak acid & its
salt with strong base
that can accept / release H+
in a solution
to resist marked changes in H+
conc. & pH of
that solution despite the addition of moderate
amount of acid / base to it
21
22. Principle of buffer action:
Conversion of strong acid in to weak acid
Conversion of strong base in to weak base
22
24. Body
Compartment
Buffer system (In order of
importance)
RBC Hemoglobin, Phosphate, Bicarbonate
Plasma/ ECF Bicarbonate, Phosphate, Protein
Blood Bicarbonate, Hemoglobin , Phosphate,
Protein
ICF Protein, Bicarbonate, Phosphate
Kidney Ammonia, Phosphate, Bicarbonate
Bone Bone buffer
25. Most effective body buffer: BicarbonateMost effective body buffer: Bicarbonate
buffer system: Why?buffer system: Why?
25
32. 32
Abnormality of either HCO3- or PCO2 ,
keeping 2nd
component normal:
Simple ABD
Abnormality of both HCO3- or PCO2
simultaneously:
Complex ABD
(Clinically, existence of >1 simple
ABD)
34. What are the common parameters to checkWhat are the common parameters to check
ABD?ABD?
pH
PCO2
Serum HCO3
-
concentration
Plasma Anion gap
Base excess
35. Normal Acid Base Composition of Arterial BloodNormal Acid Base Composition of Arterial Blood
(ABG analysis)(ABG analysis)
pH PO2
(mm
of
Hg)
O2
saturatio
n (%)
PCO2 (mm of
Hg)
HCO3
conc.
(mmol/L)
7.35
-
7.45
85 -
100
80-100
(>95%)
35 - 45 22-28
Plasma Anion gap: 8 – 16 mEq/L
Base excess : ± 2 mmol/L
37. BE = [HCOBE = [HCO33
--
] p – [HCO] p – [HCO33
--
]std]std
38. 38
The PO2 reflects the amount of
oxygen gas dissolved in the blood. It
primarily measures the effectiveness
of the lungs in pulling oxygen into the
blood stream from the atmosphere
i.e. it provides a good index of
lung function. .
41. Correction of ABDCorrection of ABD
Removal of the cause of ABD
ABD Renal activity to normalize HCO3
-
conc
M. Acidosis Excretion of acidic urine
Generate new HCO3
-
M.
Alkalosis
Excretion of alkaline urine
Inhibition of HCO3
-
reabs. from
PCT to allow its excretion
R. Acidosis Treatment of hypercapnia
Inhibition of HCO3
-
reabs. from PCT
to allow its excretion
R.
Alkalosis
Treatment of hypocapnia
Increased renal HCO3
-
reabs. From
PCT