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Acid & Base - Introduction
Physiologic pH = 7.35 – 7.45
BASE
ACID
0-----7-----14
Basic
Alkalotic
HCO3
-
Alkalemia
Acidic
Acidotic
H+
Acidemia
H2O + CO2 H2CO3 H+ + HCO3
-
Retaining CO2
increases H+
 acidosis
Bicarbonate-Carbon Dioxide Buffering System
Eliminating CO2
decreases H+
 alkalosis
H2O + CO2 H2CO3 H+ + HCO3
-
Eliminating or
reabsorbing
bicarbonate and
hydrogen
Bicarbonate-Carbon Dioxide Buffering System
Acid-Base Disorders
BASE
ACID
7.35 – 7.45
pH
Acidemia
<7.35
Decreased
HCO3
-
Metabolic
Acidosis
Increased
PCO2
Respiratory
Acidosis
Alkalemia
>7.45
Increased
HCO3
-
Metabolic
Alkalosis
Decreased
PCO2
Respiratory
Alkalosis
pH = 7.35 – 7.45
PaCO2 = 38 - 42
HCO3
- = 22 - 26

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Acid-Base Introduction

  • 1. Acid & Base - Introduction
  • 2. Physiologic pH = 7.35 – 7.45 BASE ACID 0-----7-----14 Basic Alkalotic HCO3 - Alkalemia Acidic Acidotic H+ Acidemia
  • 3. H2O + CO2 H2CO3 H+ + HCO3 - Retaining CO2 increases H+  acidosis Bicarbonate-Carbon Dioxide Buffering System Eliminating CO2 decreases H+  alkalosis
  • 4. H2O + CO2 H2CO3 H+ + HCO3 - Eliminating or reabsorbing bicarbonate and hydrogen Bicarbonate-Carbon Dioxide Buffering System
  • 5. Acid-Base Disorders BASE ACID 7.35 – 7.45 pH Acidemia <7.35 Decreased HCO3 - Metabolic Acidosis Increased PCO2 Respiratory Acidosis Alkalemia >7.45 Increased HCO3 - Metabolic Alkalosis Decreased PCO2 Respiratory Alkalosis pH = 7.35 – 7.45 PaCO2 = 38 - 42 HCO3 - = 22 - 26

Editor's Notes

  1. Enzymes, present throughout the body, are dependent on normal, physiologic temperature and pH for proper functioning Common examples of enzymes include: Liver transaminases – ALT and AST Cardiac and muscle enzymes - CK-MM, CK-MB, CK-BB and Coagulation Factors. Catecholamines such as adrenaline, are also depend upon enzymes for proper functioning
  2. pH is a measurement of how acidic or basic a substance is. The pH scale runs from 0 to 14. Zero is the most acidic, 14 is the most basic, 7 is neutral. If there is excess acid, the environment is called acidic or acidotic. The most common acidic ions are hydrogen ions. If there is an excess of base, the environment is call basic or alkalotic. There are many basic ions in the body, but bicarbonate is very common. Too much acid in the blood is called acidemia. Too much base in the blood is called alkalemia. Normal physiologic pH in the human body is 7.35 – 7.45. If the pH is less than 7.35 there is an acidemia and if greater than 7.45 an alkalemia is present. When the pH falls outside of this physiologic range, certain functions within cells and tissues may not work properly leading to organ dysfunction.
  3. Within the body there are several buffering systems that work to keep the pH in physiologic range to ensure proper functioning of enzymes, cells and tissues. The two most important organs that function to regulate pH are the lungs and the kidneys. This occurs through the bicarbonate-carbon dioxide buffering system, a reversible reaction. The respiratory system can increase or decrease the amount of carbon dioxide removed from the blood. Breathing quickly removes more CO2. Removing CO2 pulls the buffer equation to the left. Pulling the equation to the left decreases the amount of acidic hydrogen ions. This decreases acidosis and creates a more alkaline environment. Conversely, decreased respiratory rates or apnea lead to a retention of carbon dioxide. Increases in retained CO2 results in more hydrogen ions and a more acidotic state. A physiologic process that leads to increasing acid is called an acidosis, whereas a process that leads to a more basic state is called an alkalosis. The lungs can create or compensate for acid and base states very quickly within minutes.
  4. pH can also be regulated through the kidneys, which are capable of resorbing or excreting both hydrogen ions and bicarbonate. In a state of acidosis, the kidneys will work to retain bicarbonate and excrete hydrogen ions. In a state of alkalosis, the kidneys will work to excrete bicarbonate and retain hydrogen ions. In addition to the bicarbonate-carbon dioxide buffer system, the kidneys have other ways to excrete acid and hydrogen ions, called urine soluble acids. Examples include phosphoric acid and ammonium. Unlike the minutes it takes for the respiratory system to respond to acid/base changes, the kidneys take hours to days.
  5. In normal physiologic states, pH ranges from 7.35 to 7.45. The partial pressure of carbon dioxide in the blood ranges from 38-42mmHg. Bicarbonate ranges from 22-26 mEq/L. A pH less than 7.35 results in an acidemia and a pH greater than 7.45 results in an alkalemia. Acidemia can occur from too little bicarbonate or too much carbon dioxide. Alkalemia can occur from too little carbon dioxide or too much bicarbonate. When the process is driven by carbon dioxide it is termed – “respiratory”. When the process is driven by bicarbonate, it is termed – “metabolic”. Therefore, it is possible to have a metabolic acidosis or a metabolic alkalosis. It is also possible to have a respiratory acidosis or a respiratory alkalosis. In many cases, it is possible to have a combination of acid/base disorders.