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pH = Log10[H+]
pH : potenz (power) of Hydrogen Peter Sorensen (1909, Denmark) Negative Log Hydrogen ion concentration Wasserstoffionen exponent (Jerman)
pH 1 2 3 4 5 6 7
0.00000001
0.000000001 0.0000000001 0.00000000001 0.000000000001 0.0000000000001 0.00000000000001
10-8
10-9 10-10 10-11 10-12 10-13 10-14
8
9 10 11 12 13 14
The regulation of the internal environment includes the regulation of the body fluid hydrogen ion concentration, [H+] Although [H+] is very small compared to most solutes, being around 107 equ/liter, it has marked effects on an important part of the body machinery - enzymes.
An introduction to acid-base balance, Watson Philip D., 2004
Neutral pH
7.40 (7.35-7.45) Extracellular fluid: 7.4 Intracellular: 7.0-7.2 Viable range: 6.80 - 7.80
Acid-base balance
Acid-base balance refers to the mechanisms the body uses to keep its fluids close to neutral pH so that the body can function normally
In plasma, there is very little CO2 in the form of carbonate (CO3 ) and carbonic acid Nearly all the CO2 is in the bicarbonate form The control of PCO2 level necessitates either excretion or retention of CO2 by the lungs The respiratory system can produce rapid compensation for changes in pH by altering the level of PaCO2
Buffering
The ability to reduce the magnitude of changes in [H+] by binding or releasing [H+]
7.4
If 1.2meq HCl is added to 1 litre of a solution of 24meq NaHCO2 in water, 1.2meq HCO3- will be converted to H2CO3
If the H2CO3 is held constant 1.2meq HCl causes the [HCO3- ] to diminish by 1.2meq but the H2CO3 level remains constant at 1.2meq/l
[HCO3-] pH = pK + log [H2CO3] [HCO3-] pH = pK + log [0.03 x PCO2] Plasma has a [HCO3-] of approximately 24meq/l and [H2CO3] of 1.2meq/l pH = 6.1 + log 20 1 pH = 7.4
Acid-base imbalance Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis
High
Low
High
Acid-Base Diagram
From Goldberg, M., Green, S.B., Moss, M.L., et al.: JAMA 223:269-275, 1973
Interpretation
22 to 26 Respiratory acidosis
< 7.35
< 7.35 > 7.45 > 7.45
36 to 44
> 44 < 36 36 to 44
< 22
< 22 > 26
Metabolic acidosis Mixed acidosis Metabolic alkalosis Mixed alkalosis Compensated respiratory acidosis
22 to 26 Respiratory alkalosis
> 7.45
closer to 7.35 closer to 7.35 closer to 7.45
< 36
> 44 < 36 < 36
> 26
> 26 < 22 < 22
closer to 7.45
> 44
> 26
Metabolic Acidosis
Metabolic Alkalosis
Effectiveness of Oxygenation
Further evaluation of the arterial blood gas requires assessment of the effectiveness of oxygenation of the blood Hypoxemia decreased oxygen content of blood - paO2 less than 60 mm Hg and the saturation is less than 90% Hypoxia inadequate amount of oxygen available to or used by tissues for metabolic needs
Mechanisms of Hypoxemia
Inadequate inspiratory partial pressure of oxygen Hypoventilation Right to left shunt Ventilation-perfusion mismatch Incomplete diffusion equilibrium
PaO2
Low FIO2 Alveolar hypoventilation Altered gas exchange Regional V/Q mismatch Intrapulmonary R to L shunt Impaired diffusion Anatomical R to L shunt (intrapulmonary or intracardiac)
N=normal
PaCO2
/N/ N/ N/ N/
RA
N N
100%
N N N/ N
Stewart Approach
A quantitative Acid-Base Primer for Biology and Medicine Peter A. Stewart, Edward Arnold, London 1981
PCO2
pH [HCO3-] Etc.
Protein Concentration
Ions
Strong ions (entirely dissociated)
Kation : Na+,K+,Mg+,Ca++ Anion : Cl-,SO4-,PO4=, laktat-, keto-
Independent variables
Strong ion difference
pCO2
(Na+ + K+ + Mg2+ + Ca2+) (Cl + lactate)
H2O + CO2 H2CO3 H+ + HCO3
Ion
Concentration (meq/L) Sodium 140 Potassium 4 Calcium 3 Magnesium 1 Total strong Cations 148 Chloride 104 Lactate 8 Total strong anions 112 Difference (Cations - Anions) 36
Concentration (meq/L) 36 6.6 x 10-10 12.2 36
Concentration (meq/L) SID 36 pCO2 (mmHg) 40 ] [HCO3 35.8 +] [H 27 x 10-6 pH 7.6 [OH] microEq/L <1
Concentration (meq/L) SID 36 pCO2 (mmHg) 40 Protein 11.4 ] [HCO3 26 [H+] 40 x 10-9 pH 7.4
I. Respiratory
II. Nonrespiratory (metabolic) 1. Abnormal SID a. Water excess/deficit*
PCO2
PCO2
SID, [Na+] SID, [Na+] SID, [Cl-] SID, [Cl-] [Alb] [Pi]
Fencl, Jabor, Kazda, et al.: Metabolic Acid-Base Disturbances, American Journal Of Respiratory and Critical Care Medicine Vol 162 2000
Disturbances
Lactic acidosis Keto acidosis Vomiting Diarrhea Renal failure
PCO2
Chemistry
Law of Mass Action Charge Balance etc.
pH [HCO3-] Etc.
Protein Concentration
Malnutrition Dehydration Nephrotic syndrome
Diarrhea Lung disease and ventilation rate Heart failure Dehydration Malnutrition and nephrotic syndrome