The document discusses acid-base balance and the mechanisms that maintain it in the human body. It begins by defining acids and bases, and describing the different types of acids found in the body. It then discusses pH and how acid-base balance is regulated through three lines of defense - chemical buffers, respiratory regulation, and renal mechanisms. The bicarbonate buffer system and Henderson-Hasselbalch equation are explained. Respiratory regulation controls acid-base balance by regulating carbon dioxide levels in the blood and lungs. The kidneys maintain balance long-term by reabsorbing bicarbonate and excreting acids like ammonium ions.
Role of kidneys in regulation of Acid Base balance.pptx
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ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
Role of kidneys in regulation of Acid Base balance.pptx
HCO3 reabsorption and Hydrogen ion secretion
Acidosis and alkalosis
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metabolic alkalosis
This presentation discuss about acid-base-gas normal ratio and its indication in relation to varying abnormal level and how to manage it. This includes clinical analysis practice.
ABGs or VBGs interpretation made simple straight forward easy to remember and easy to apply. The presentation is designed to help the residents and junior ER physicians. The second part will discuss the oxygenation and the third part will review the "Stewart Approach" while fourth and last part is meant for the Experts.
The state of equilibrium between proton donors and proton acceptors in the buffering system of the blood that is maintained at approximately pH 7.35 to 7.45 under normal conditions in arterial blood.
The state of equilibrium between proton donors and proton acceptors in the buffering system of the blood that is maintained at approximately pH 7.35 to 7.45 under normal conditions in arterial blood.
Buffer is any mechanism that resists changes in pH by converting a strong acid or base to a weak one.
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
4. Renal Block-Acid Base Balance-for Medical students.pptxRajendra Dev Bhatt
Acid–Base balance (also known as pH HOMEOSTASIS ) : one of the essential functions of the body, it is concerned with the precise regulation of free (unbound) hydrogen ion concentration in body fluids.
Acid and base Balance by Dr. Tehmas (Part 1)Tehmas Ahmad
Lecture of Biochemistry about Acid and Base Balance and Imbalance. 1st of 2 Lectures, delivered to students of 2nd professional MBBS students of Bannu Medical College, Bannu
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
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
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
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.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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2. Concept of Acid & base.
pH and H ion concentration.
Handerson-Hasselbalch equation.
What is Acid Base Balance
Mechanisms to maintain acid base balance.
Applied aspects.
Agenda
3. Any compound which forms H+ ions in solution(proton
donors) eg: Carbonic acid releases H+ ions.
Strong acids ? HCL, H2SO4
Weak acids ? H2CO3
ACIDS
4. 1. Volatile Acids:
Can leave the solution and enter the
environment.
H2CO3 is the only volatile acid in the body.
2. Non-Volatile Acids (Fixed Acids/Metabolic Acids):
Acids that do not leave the solution.
All other acids in the body.
Ex: Pyruvic acid, Lactic acid, Phosphoric acid etc.
H2CO3 H2O + CO2
ACIDS – Types of Acids in Body
5. Any compound which combines with H+ ions in solution(proton
acceptors)
Physiologically important bases:
Bicarbonate (HCO3
-)
Biphosphate (HPO4)
OH- +H+ H2O
BASE
eg: Bicarbonate(HCO3
- ) accepts H+ ions
6. pH
Normal pH :7.35-7.45
pH = - log [H+]
Different compartment of human body has specific pH.
pH has role in Enzyme activity.
7. pH – Effects of Abnormal pH
Acidosis
Physiological state resulting from abnormally low plasma pH
Alkalosis
Physiological state resulting from abnormally high plasma pH
plasma pH> 7.45
plasma pH< 7.35
ACIDOSIS ALKALOSIS
NORMAL
DEATH DEATH
Venous
Blood
Arterial
Blood
7.3 7.4 7.5
6.8 8.0
**pH of the ECF is regulated very precisely
8. pH changes have dramatic effects on normal cell function
pH – Effects of ph Change
Changes in excitability of nerve and muscle cells
Influences enzyme activity
Influences K+ levels
pH decrease (more acidic) depresses the central nervous system
Can lead to loss of consciousness
pH increase (more basic) can cause over-excitability
Tingling sensations, nervousness, muscle twitches
9. ■pH increases or decreases can alter the shape of the
enzyme rendering it non-functional
pH – Influences on enzyme activity
■Changes in enzyme structure can result in accelerated
or depressed metabolic actions within the cell
10. Addition of various acids or
alkalies by metabolic activities
alters body/blood pH.
pH – Why blood pH is Altered
11. Most Effective Buffer
By the law of mass action, at equilibrium
Henderson-Hasselbalch Equation
HA +
H+ A-
[H+] = K [HA]/[A-]
pH = log 1/ [H+]
Log 1/[H+] = log 1/K +log [A-]/[HA] pH = pK + log [A-]/[HA]
Thus pH= pK
Thus most effective buffers in the body are those with pK close to the pH
in which they operate.
This equation reflects that buffering capacity of buffer system is greatest
when amount of anion[A-] and undissociated acid [HA] is same.
K = [H+][A-] / [HA] K = Dissociation constant of acid
12. Acid Base balance is a homeostatic mechanism
Acid Base Balance is a physiological
and biochemical mechanism
associated to maintain body/blood pH.
Acid Base Balance
Carried out to regulate the altered pH of blood
and other body compartments to its normal
constant range.
Maintenance of Acid Base balance is a prime
requisite to maintain normal healthy and active life
13. 13
First Line of Defense
Chemical Buffer System
Second Line of Defense
Respiratory Mechanism
Third Line of Defense
Renal Mechanism
Factors Regulating Acid Base Balance
React very rapidly (less than a second)
Reacts rapidly (seconds to minutes)
Reacts slowly (minutes to hours)
14. Depend on absolute concentration of salt & acid.
Chemical Buffer
Buffers mixture of weak acids and its salt with a strong base
Resist change in pH of blood when small amount of
acids or alkalis added to the medium.
Most effective within 1 pH unit of the pK of the buffer
15. Sodium Bicarbonate (NaHCO3) and carbonic acid (H2CO3)
Maintain a 20:1 ratio : HCO3
- : H2CO3
HCl + NaHCO3 ↔ H2CO3 + NaCl
NaOH + H2CO3 ↔ NaHCO3 + H2O
Chemical Buffer – Bicarbonate Buffer
Weak acid H2CO3 formed during buffering action of Bicarbonate buffer is then expired out by Lungs.
Thus Bicarbonate buffer is connected to the respiratory system
Bicarbonate buffer is also termed as Respiratory buffer.
Alkali reserve is represented by the concentration of NaHCO3 in the
blood.
Alkali reserve concentration(HCO3-) determines the strength of buffering action towards
added H+ ions by acids.
More the concentration of Alkali reserve ,more is the buffering action and vice a versa.
16. ■ This system is most important because the concentration
of both components can be regulated:
Loss of HCl
Addition of lactic acid
Exercise
Vomiting
CO2 + H2O H2CO3
Chemical Buffer – Bicarbonate Buffer
■ Carbonic acid by the respiratory system
■ Bicarbonate by the renal system
17. REMEMBER…….
Buffer cannot remove H+ ions from the body temporarily reduce free
H+ ions
Chemical Buffer – Bicarbonate Buffer
Buffers act quickly but not permanently
H+ ions have to be ultimately removed by the renal mechanism.
The blood buffers are effective as long as The acid load added is not
very high and the alkali reserve (HCO3 -) is not exhausted.
18. Na2
HPO4+ H+ NaH2
PO4+ Na+
Chemical Buffer – Phosphate Buffer
■ Most important in the intracellular system
19. Chemical Buffer – Protein Buffer
■ The most abundant buffer of the body.
■ Behaves as a buffer in both plasma and cells
■ Hemoglobin is by far the most important protein buffer.
■ Most important intracellular buffer.
O
H-
O
H-
O
H-
H
+
H
+
O
+
H-
H
+
H
+
H
+
H
+
O
H-
O
H-
H
+
O
H-
O
H+-
H+
O
H-
H
+
O
H-
H+
H
+
H
+
H+O
H-
H
+
H
+
H
+
H
+
H
+
20. ■ Bound H+to Hb (Hemoglobin) does not contribute to the acidity of blood.
Hb
O
2
O
2
O
2
O
2
■ Liberated H+from H2O combines with HCO3
-
HCO3
- H2CO3 CO2(exhaled)
Chemical Buffer – Protein Buffer
■ H+generated at the tissue level from the dissociation of H2CO3produced
by the addition of CO2.
■ As H+Hb picks up O2from the lungs the Hb which has a higher affinity
for O2releases H+and picks up O2
■ The Imidazole group of Histidine present in Hb structure has
buffering capacity
21. CO2 +H2O H2CO3 H+ + HCO3
Respiratory Regulation
■ Hyperventilation in response to increased CO2 or H+(low pH)
■ Hypoventilation in response to decreased CO2or H+(high pH)
■ Respiratory center in brain is able to detect blood concentration levels of CO2
and H+
■ Increases in CO2 and H+stimulate the respiratory center ↑ RR
■ But the effect diminishes in 1 -2 minutes
■ Respiratory regulation is by increasing or decreasing the exhalation of CO2
from the body.
22. Role of respiration in acid base balance is short term regulatory
process.
VOLATILE ACIDS
Doesn’t affect fixed
acids like lactic acid.
Role of Respiratory Regulation
Respiratory system plays second line of defense mechanism of
Acid Base Balance
24. H2CO3 formed from Bicarbonate Buffer, is exhaled
out through respiratory system.
Increased H2CO3 stimulates the respiratory centre in
Medulla Oblongata.
This in turn stimulates hyperventilation which
promptly removes H2CO3 from blood by expiration.
H+ + HCO3
- ↔ H2CO3 ↔ CO2 + H20
Role of Respiratory Regulation
25. Low H2CO3 concentration
Depresses respiratory center
Hypoventilation
Slow and shallow respiration.
Retains H2CO3 in blood
Role of Respiratory Regulation
26. Blood pH can be
adjusted through
respiratory
mechanism. By
changing rate and
depth of breathing.
If Nervous centre /
Respiratory system
fails.
Acid Base Balance
fails.
Role of Respiratory Regulation
27. Renal mechanism is the third line of
defense mechanism.
Renal Mechanism
Role of renal mechanism is long term
regulatory process.
28. Renal System maintains Acid Base Balance through:
Renal Mechanism
Excretion of Ammonium ions
(Glutaminase activity)
Reabsorption of Bicarbonate (HCO3-) ions.
Excretion of H ions
Excretion of titrable acids(Acid Phosphates)
29. Renal Mechanism
■ Secreted H+ is buffered with :
■ Secretion of H+ occurs in all segments of nephron
■ HCO3
-in proximal segments resulting in absorption of HCO3-
■ Na2
HPO4& NH3in distal segments in production of new HCO3-
31. 31
Excretion Of H+ ions
~Elimination of nonvolatile acid
~Excretion of H+
~Occurs in PCT
~Regeneration of bicarbonate
~H+ combine with non carbonate base and excreated
32. ~Measure of acid excreated by kidney
~Role of phosphate buffer
Reclamation of bicarbonate.
33. 33
EXCRETION OF AMMONIUM ION
NH3 is obtained from Deamination of Glutamine
NH4
+ cant diffuse back
2/3 of body acid load liberated in the form of NH4
+
34.
35.
36. MECHANISM FOR REGULATION OF
ACID BASE BALANCE
Buffer system: temporary solution
Respiratory mechanism provide short time regulation
Renal mechanism : permanent solution
Urine pH < plasma pH ,4.5-9.5
Eliminate nonvolatile acid, buffered by cation (principally
Na+)
Maintain alkali reserve