Blood Gases

1. 2. 3.
Definitions: Acid, Base, Buffer Acid-Base Balance Assessment of Acid-Base Homeostasis
1.
a. b.
Definitions
Acid substance that can yield H+ in water Base substance that can yield OH- in water
1.
c.
Definitions
pK pH in which protonated and unprotonated forms are equal E.g: Bicarbonate-carbonic acid system - 6.1 H2CO3 HCO3- + H+ Buffer combination of weak acid or weak base and its salt pH Negative log of H+ concentration Inversely proportional to H+ concentration Venous blood = 7.35 : Arteries = 7.45
d. e.
1. 2. 3.
2.
a. b. c.
Acid-Base Balance
Maintenance of H+ Buffer Systems: regulation of H+ Regulation of Acid-Base Balance: Lungs and Kidneys
2.
a.
Acid-Base Balance
Maintenance of H+
H+ concentration: 36-44 nmol/L (pH 7.34-7.44) Excess can lead to alterations in consciousness, tetany, coma and death Acidosis (<7.34) and Alkalosis (>7.44) Maintained by the lungs and the kidneys
2.
a. b.
Acid-Base Balance
Maintenance of H+ Buffer Systems: Acid-Base Balance
2.
b.
Acid-Base Balance
Buffer Systems: Acid-Base Balance
1.

The Bicarbonate-Carbonic Acid System

Weak Acid: Carbonic acid (H2CO3 ) Conjugate Base: Bicarbonate (HCO3-)
2.
b.
Acid-Base Balance
1.

The Bicarbonate-Carbonic Acid System

H2CO3 dissociate into CO2 and H2O CO2 modify the ventilation rate HCO3 can be altered by the kidneys
2.
b.
Acid-Base Balance
1. The Bicarbonate-Carbonic Acid System
2.
b.
Acid-Base Balance
2. Hemoglobin (Hb)
Second most Important buffer system Found inside RBC Most effective single system
2.
b.
Acid-Base Balance
3. Plasma Protein
Ampholyte contains (+) and (-) part Free Carboxyl terminal and amino groups bind H+
4.
PO4 Buffer System (Monohydrogen Phosphate Dihydrogen Phosphate)

Least important in buffering capacity NaH2PO4 Weak Acid Na2HPO4 Conjugate Base
2.
b.
Acid-Base Balance
1. 2. 3. 4. The Bicarbonate-Carbonic Acid System Hemoglobin (Hb) Plasma Protein PO4 Buffer System (Monohydrogen Phosphate- Dihydrogen Phosphate)
2.
a. b.
Acid-Base Balance
Maintenance of H+ Buffer Systems: Acid-Base Balance
1. 2. 3.
3.
a.
Assessment of Acid-Base Homeostasis

b.
c.
The Bicarbonate Buffering System and Henderson Hasselbalch Equation Organs in Acid-Base Balance Acid-Base Disorders: Acidosis and Alkalosis
3.
a.

The Bicarbonate Buffering System and Henderson Hasselbalch Equation
Reference Range at 37C pH 7.35-7.45
pCO2 (mmHg) 35-45 HCO3- (mmol/L) 22-26 H2CO3 (mmol/L) = 0.0307 x PCO2
3.
a.

b.
c.
3.
b.

Organs in Acid Base Balance
1.
i. ii. iii.
Lungs (Respiratory mechanism)

H2CO3 H2O + CO2 Hyperventilation CO2 release = pCO2 ( H2CO3 ) Hypoventilation CO2 release = pCO2 ( H2CO3 )
H2CO3 (mmol/L) = 0.0307 x PCO2 pH 7.35-7.45 pCO2 (mmHg) 35-45 HCO3- (mmol/L) 22-26
3.
b.

2.
i. ii. iii.
Kidneys (Renal mechanism)

H2CO3 H++ HCO3 Excretion of H+ (H + + NH 3 = NH 4+ / H + + HPO4- = H2PO4-) Reabsorption of filtered HCO3 ( HCO3 - pH) vice-versa
H2CO3 (mmol/L) = 0.0307 x PCO2 pH 7.35-7.45 pCO2 (mmHg) 35-45 HCO3- (mmol/L) 22-26
3.
b.

3.
a.

b.
c.
3.
c.

Acid-Base Disorders: Acidosis and Alkalosis
1.
i. ii.
Respiratory Origin
Acidosis Alkalosis
2.
i. ii.
Metabolic Origin
Acidosis Alkalosis
3.
c.

1.
i.
a. b. c. d. e. f.
Respiratory Origin - Alteration in H2CO3 or CO2

Acidosis (Excess H2CO3 or CO2) Causes:
Asthma, Emphysema Bronchopneumonia Depression of respiratory center Hypoventilation due to drugs (E.g. Barbiturates) Congestive heart failure OPD (Obstructive pulmonary disease)
3.
c.

1.
i.
a. b. c. d.
Respiratory Origin - Alteration in H2CO3 or CO2

Acidosis (Excess H2CO3 or CO2) Compensation (Renal)
Na+/H+ exchange NH3 production resorption of HCO3 excretion of acid (H+)
3.
c.

1.
i. ii.
Respiratory Origin
Acidosis Alkalosis
2.
i. ii.
Metabolic Origin
Acidosis Alkalosis
3.
c.

1. Respiratory Origin - Alteration in H2CO3 or CO2
ii.
a. b. c. d.
Alkalosis Excessive reduction in H2CO3 or CO2 Causes:

High fever Hysteria (Hyperventilation) Pulmonary emboli and fibrosis Drugs (salicylates)
3.
c.

1. Respiratory Origin - Alteration in H2CO3 or CO2
ii.
a. b. c. d.
Alkalosis Renal Compensation

Na+/H+ exchange NH3 production resorption of HCO3 excretion of acid (H+)
3.
c.

1.
i. ii.
Respiratory Origin
Acidosis Alkalosis
2.
i. ii.
Metabolic (Nonrespiratory) Origin

Acidosis Alkalosis
3.
c.

2.
i.
a. b. c. d. e. f.
Metabolic Origin - Alteration in HCO3

Acidosis (Primary Bicarbonate Deficit: <24 mmol/L) Causes:
Addition Acidosis (diabetic ketoacidosis) Subtraction acidosis (diarrhea - H2O and Na) Renal tubular acidosis, Acid salt (NH3Cl, CaCl) Starvation, Lactic acidsosis Toxins (methanol, ethanol, ethylene glycol) Excessive loss of electrolytes and intestinal fluids
3.
c.

2.
i.
a.

Acidosis (Primary Bicarbonate Deficit: <24 mmol/L) Compensation (Respiratory)
Hyperventilation
3.
c.

1.
i. ii.
Respiratory Origin
Acidosis Alkalosis
2.
i. ii.
Metabolic Origin
Acidosis Alkalosis
3.
c.

2.
i.

a.
b. c. d.

Alkalosis Bicarbonate Excess Causes:
Addition Alkalosis (ingestion of alkali - NaHCO3 Na Lactate, citrate or acetate Subtraction alkalosis (vomiting - H2O, Na and K) Diuretics, Excessive gastric suctioning Intestinal obstruction
3.
c.

2.
i.

a.

Alkalosis Bicarbonate Excess Compensation (Respiratory)
Hypoventilation
3.
c.

1.
i. ii.
Respiratory Origin
Acidosis Alkalosis
2.
i. ii.
Metabolic Origin
Acidosis Alkalosis
3.
c.

H2CO3 (mmol/L) = 0.0307 x PCO2 H2CO x PCO2 3 (mmol/L) = 0.0307 1) HCO3 = 25 HCO3 (mmol/L) pH = Total CO2 - H2CO3 7.35-7.45
pH 7.35-7.45 35-45 pCO2 (mmHg) pCO2 (mmHg) 35-45 2) HCO3 = 25 HCO3- (mmol/L) 22-26 pCO2 = 35 HCO3- (mmol/L) 22-26
H2CO3 = 32
3) Total CO2 = 27 pCO2 = 31
3.
a.

b.
c.
1. 2. 3.

Blood Gases

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Blood Gases

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1. 2. 3.

Definitions: Acid, Base, Buffer Acid-Base Balance Assessment of Acid-Base Homeostasis

Definitions: Acid, Base, Buffer Acid-Base Balance Assessment of Acid-Base Homeostasis

The Bicarbonate-Carbonic Acid System

The Bicarbonate-Carbonic Acid System

PO4 Buffer System (Monohydrogen Phosphate Dihydrogen Phosphate)

Definitions: Acid, Base, Buffer Acid-Base Balance Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Lungs (Respiratory mechanism)

Assessment of Acid-Base Homeostasis

Kidneys (Renal mechanism)

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Respiratory Origin - Alteration in H2CO3 or CO2

Assessment of Acid-Base Homeostasis

Respiratory Origin - Alteration in H2CO3 or CO2

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Alkalosis Excessive reduction in H2CO3 or CO2 Causes:

Assessment of Acid-Base Homeostasis

Alkalosis Renal Compensation

Assessment of Acid-Base Homeostasis

Metabolic (Nonrespiratory) Origin

Assessment of Acid-Base Homeostasis

Metabolic Origin - Alteration in HCO3

Assessment of Acid-Base Homeostasis

Metabolic Origin - Alteration in HCO3

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

Metabolic Origin - Alteration in HCO3

Assessment of Acid-Base Homeostasis

Metabolic Origin - Alteration in HCO3

Assessment of Acid-Base Homeostasis

Assessment of Acid-Base Homeostasis

3) Total CO2 = 27 pCO2 = 31

Assessment of Acid-Base Homeostasis

Definitions: Acid, Base, Buffer Acid-Base Balance Assessment of Acid-Base Homeostasis

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