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Acid base balance
Normal physiology
• Normal plasma pH 7.35-7.45
• Less than 7.35 – Acidosis
• More than 7.45 - Alkalosis
Concept of pH
Concept of pH
• Negative logarithm of hydrogen ion concentration
• Dimensionless quantity
Concept of pH
Normal pH – 7.4
[H+] = 40 nmol/L
Basic concepts…
• Acid
• Base
• pH
• Buffer
Strong and weak acids…
More concepts…
• pKa
• Henderson Hasselbalch equation
To know values…
• pH 7.35 to 7.45
• Hydrogen ion concentration [H+]- 40 nmol/L
• [HCO3-]  22-28 mmol/L
• pCO2  35-45 mm Hg
Need for pH regulation…
• Acids constantly produced
• Volatile acids – CO2  20 mol  Lungs
• Non-volatile acids – Lactic acid, sulfuric acid 
70-100 mmol  Kidneys
Three lines of defence for pH homeostasis
• Buffers
• Respiratory regulation
• Renal regulation
Buffer systems
• Bicarbonate buffer system
• pKa – 6.1
• Highly effective buffer
• High concentration
• Can be easily disposed off or retained by lungs
• Renal absorption can be moderated
Buffer systems
• Phosphate buffer system
• pKa – 6.8
• Very less concentration
• Plays a role in renal excretion of acids
Buffer systems
• Plasma protein buffer system
• Albumin
• Histidine residue – imidazole ring
• Plays a role in renal excretion of acids
Some definitions
• Buffer value – Amount of base required to cause a change of one unit
of pH
Respiratory regulation of pH
https://www.youtube.com/watch?v=myag4d5uGa4
Renal regulation of pH
• pH of urine in random specimens ranges from 4.5-8.0
• Four mechanisms of renal regulation
Reabsorption of HCO3-
Excretion of H+
Excretion of NH4+
Excretion of H2PO4-
https://www.youtube.com/watch?v=gUe2J400ULo
Relation between potassium levels & pH
Summary
Case 1
As part of a class experiment, a medical student volunteered to give a
sample for arterial blood gas analysis. The demonstrator took some time
to explain the procedure to the class, during which time the student
became anxious and started hyperventilating. As the blood was being
drawn she complained of tingling sensation in her face and all over the
body
Her ABG results were as follows:
pH: 7.61
pCO2 : 20 mmHg
p O2: 90 mmHg (N: >80 mmHg)
Bicarbonate : 20 mmol/L
sO2: 96% (N: 94-98%)
Case 2
A 35 yr old man was admitted to the trauma ward following a
road traffic accident. H e had sustained a crush injury of the
chest. His ABG results are as follows
• pH: 7.25
• pCO2: 60 mmHg
• pO2: 60 mmHg (N: >80 mmHg)
• Bicarbonate: 26 mmol/L
• sO2: 88% (N: 94-98%)
Case 3
A 42 year old female patient was admitted with a week-long history of
severe vomiting. She was severely dehydrated.
Her ABG results were as follows
• pH: 7.55
• pCO2: 52 mmHg
• pO2: 92 mmHg (N: >80 mmHg)
• Bicarbonate: 45mmol/L
• sO2: 96% (N: 94-98%)
• Chloride - 92 mmol/L (N: 96-106 mmol/L)
Case 4
A 24 year old male patient was admitted with complaint of taking illicit
liquor. Many people who have taken from the same shop had died. The
patient was disoriented and the ABG results were as follows
• pH: 7.25
• pCO2: 28 mmHg
• pO2: 92 mmHg (N: >80 mmHg)
• Bicarbonate: 12mmol/L
• sO2: 96% (N: 94-98%)
• Chloride: 96mmol/L (N: 96-106 mmol/L)

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Acid base balance class-1.pptx

  • 2. Normal physiology • Normal plasma pH 7.35-7.45 • Less than 7.35 – Acidosis • More than 7.45 - Alkalosis
  • 4. Concept of pH • Negative logarithm of hydrogen ion concentration • Dimensionless quantity
  • 5. Concept of pH Normal pH – 7.4 [H+] = 40 nmol/L
  • 6. Basic concepts… • Acid • Base • pH • Buffer
  • 7. Strong and weak acids…
  • 8. More concepts… • pKa • Henderson Hasselbalch equation
  • 9. To know values… • pH 7.35 to 7.45 • Hydrogen ion concentration [H+]- 40 nmol/L • [HCO3-]  22-28 mmol/L • pCO2  35-45 mm Hg
  • 10. Need for pH regulation… • Acids constantly produced • Volatile acids – CO2  20 mol  Lungs • Non-volatile acids – Lactic acid, sulfuric acid  70-100 mmol  Kidneys
  • 11. Three lines of defence for pH homeostasis • Buffers • Respiratory regulation • Renal regulation
  • 12. Buffer systems • Bicarbonate buffer system • pKa – 6.1 • Highly effective buffer • High concentration • Can be easily disposed off or retained by lungs • Renal absorption can be moderated
  • 13. Buffer systems • Phosphate buffer system • pKa – 6.8 • Very less concentration • Plays a role in renal excretion of acids
  • 14. Buffer systems • Plasma protein buffer system • Albumin • Histidine residue – imidazole ring • Plays a role in renal excretion of acids
  • 15. Some definitions • Buffer value – Amount of base required to cause a change of one unit of pH
  • 16. Respiratory regulation of pH https://www.youtube.com/watch?v=myag4d5uGa4
  • 17. Renal regulation of pH • pH of urine in random specimens ranges from 4.5-8.0 • Four mechanisms of renal regulation Reabsorption of HCO3- Excretion of H+ Excretion of NH4+ Excretion of H2PO4- https://www.youtube.com/watch?v=gUe2J400ULo
  • 20. Case 1 As part of a class experiment, a medical student volunteered to give a sample for arterial blood gas analysis. The demonstrator took some time to explain the procedure to the class, during which time the student became anxious and started hyperventilating. As the blood was being drawn she complained of tingling sensation in her face and all over the body Her ABG results were as follows: pH: 7.61 pCO2 : 20 mmHg p O2: 90 mmHg (N: >80 mmHg) Bicarbonate : 20 mmol/L sO2: 96% (N: 94-98%)
  • 21. Case 2 A 35 yr old man was admitted to the trauma ward following a road traffic accident. H e had sustained a crush injury of the chest. His ABG results are as follows • pH: 7.25 • pCO2: 60 mmHg • pO2: 60 mmHg (N: >80 mmHg) • Bicarbonate: 26 mmol/L • sO2: 88% (N: 94-98%)
  • 22. Case 3 A 42 year old female patient was admitted with a week-long history of severe vomiting. She was severely dehydrated. Her ABG results were as follows • pH: 7.55 • pCO2: 52 mmHg • pO2: 92 mmHg (N: >80 mmHg) • Bicarbonate: 45mmol/L • sO2: 96% (N: 94-98%) • Chloride - 92 mmol/L (N: 96-106 mmol/L)
  • 23. Case 4 A 24 year old male patient was admitted with complaint of taking illicit liquor. Many people who have taken from the same shop had died. The patient was disoriented and the ABG results were as follows • pH: 7.25 • pCO2: 28 mmHg • pO2: 92 mmHg (N: >80 mmHg) • Bicarbonate: 12mmol/L • sO2: 96% (N: 94-98%) • Chloride: 96mmol/L (N: 96-106 mmol/L)