ACID-BASE BALANCE

 Acid- substance that can yield a hydrogen ion (H+) or hydronium ion when dissolved in water
 Base- substance that can yield hydroxyl ions (OH−)
 Buffer- combination of a weak acid or weak base and its salt, is a system that resists changes in pH

A. ECF Buffers
1. Hemoglobin – second most important blood buffer; contains 38 histidine residues that bind H +
2. Plasma proteins – have free carboxyl and amino groups that are able to bind to H +
3. Bicarbonate/Carbonic Acid
 CO2 shifts the equilibrium to the right producing more H+ and HCO3-
 H+, CO2 shift the reaction to the left
 Henderson-Hasselbach equation
 When the ratio is 20:1, the pH is _____
 pH may be increased by an increase in ____ or by a decrease in _____
 pH may be decreased by a decrease in ____ or by an increase in _____

B. Arterial Blood Gas Parameters

Parameter Method/Derivation Reference Range

pH pH electrode
pCO2 pCO2 electrode
pO2 O2 electrode
HCO3- Total CO2 - 1
Total CO2 HCO3- + H2CO3 + CO2
Base excess Calculated
O2 saturation Co-oximetry

Factors that affect ABG values

1. Temperature _________________________________
2. Specimen exposure to air _______________________
3. Prolonged storage of specimen ___________________

D. Acid-Base Imbalances

Condition Major Cause/s pH HCO3 pCO2 Compensation

Metabolic acidosis
Metabolic alkalosis
Respiratory acidosis
Respiratory alkalosis

VITAMINS AND TRACE METAL ELEMENTS

Vitamins Functions Food sources RDA Deficiency Syndromes Toxicity

Fruits and
vegetables: Citrus
Chronic megadoses of
fruits, red and green M: 90 mg
Ascorbic 10–150 times the RDA
Many redox reactions. peppers, F: 75 mg
acid (vitamin Scurvy (1–15 g), cramps,
Hydroxylation of collagen strawberries, Smokers:
C) diarrhea, nausea, kidney
tomatoes, broccoli, 125 mg
stones
potatoes, green
leafy vegetables
Dermatitis, glossitis,
Liver, kidneys,
Cofactor in carboxylation hair loss, anorexia,
Biotin peanut butter, egg AI 30 µg No known toxicity
reactions depression, and
yolks, yeast
hypercholesterolemia
Cobalamin Folate metabolism and Meat, fish, poultry, Megaloblastic anemia,
M/F: 2.4 µg No known toxicity
(vitamin DNA synthesis, eggs, and dairy peripheral neuropathy
B12) maintenance of products
myelinization of spinal
tracts
M/F: 400
Leafy green
µg Teratogenic effect in
Transfer and use one- vegetables,
Pregnancy: Megaloblastic anemia, rodent model. No
Folate carbon units in DNA and legumes, cereals,
600 µg neural tube defects adverse effects at high
amino acid synthesis some fruits and
Lactation: oral doses
juices
500 µg
NE = 1 mg
niacin or 60
Meats, poultry, fish, mg Excess pre-formed niacin
Niacin Incorporated into NAD
legumes, enriched tryptophan Pellagra: Dementia, and nicotinic acid cause
(nicotinic and NAD phosphate,
cereals, milk, coffee, M: 16 mg dermatitis, diarrhea vascular dilation,
acid) redox reactions
and tea NE/day F: “flushing”; hepatotoxic
14 mg
NE/day
Whole grain cereals,
Pantothenic Incorporated in No syndrome
legumes, meat, fish, AI 5 mg Very high doses: Diarrhea
acid coenzyme A recognized
poultry
Derivatives are
Whole grains, Cheilosis, glossitis, Long-term megadose
coenzymes in many
Pyridoxine cereals, legumes, M/F: 1.3 dermatitis, peripheral supplementation causes
intermediary reactions;
(vitamin B6) chicken, fish, pork, mg neuropathy, ataxia and sensory
amino acid, phospholipid,
and eggs convulsions neuropathy.
and glycogen metabolism
Milk, enriched
Ariboflavinosis,
Converted to flavin grains, broccoli,
cheilosis, angular has not been reported.
Riboflavin coenzymes. Cofactor for asparagus, dark M: 1.3 mg
stomatitis, glossitis, Absorption limited
(vitamin B2) many enzymes in leafy greens, whole F: 1.1 mg
dermatitis, corneal normally
intermediary metabolism grains, enriched
vascularization
breads, cereals
Dry (neuromuscular)
Whole or enriched
As pyrophosphate, is and wet (cardiac Headache, muscle
Thiamine grains and flour, M: 1.2 mg
coenzyme in failure) beriberi, weakness, cardiac
(vitamin B1) lean pork, legumes, F: 1.1 mg
decarboxylation reactions Wernicke-Korsakoff arrhythmia, convulsions
seeds, and nuts
syndrome
Acute: Can cause
drowsiness, headache,
A component of retinal vomiting, stupor, skin
night blindness,
rod pigment. Role in peeling, and papilledema.
deep green, yellow, M: 900 µg reproductive
Vitamin A vision in dim light, Chronic: Teratogenic,
and orange fruits RAE F: 700 disorders,
(retinol) growth; reproduction. osteoporosis,
and vegetables µg RAE vulnerability to
Maintenance of hepatotoxicity.
infection
resistance to infection Carotenoids in excess,
distinct orange-yellow
skin color
AI M/F: 5 High intake of vitamin D:
µg Ages: Hypercalcemia and
Promotes absorption of Rickets in children;
Butter, egg yolks, 51–70 hypercalciuria, toxicity
calcium and phosphorus; osteomalacia in
Vitamin D liver, and fatty fish years, 10 above UL of 50 µg. Bone
mineralization of bones adults; hypocalcemia,
Sunlight exposure µg >70 demineralization,
and teeth tetany
years, 15 constipation, muscle
µg weakness, renal calculi
α-
Antioxidant, scavenges Mild GI distress, nausea,
tocopherol
Vitamin E free-radicals; cellular Vegetable oils, corn, Spinocerebellar coagulopathies in
equivalents
(tocopherol) respiration, primarily in soy, safflower degeneration, ataxia patients receiving
= α-TE M/F:
muscle, RBC integrity anticonvulsants
15 mg α-TE
 Vitamin K
synthesized by
Cofactor of
bacteria in jejunum
procoagulants—hepatic Excess amounts of
and ileum; dietary AI M: 120 Defective clotting,
Vitamin K factors II (prothrombin), vitamin K may decrease
intake is still µg F: 90 µg bleeding disorder
VII, and X, proteins C and clotting time
required. Dark
S
green leafy
vegetables

TRACE ELEMENTS
TISSUE BODY EFFECTS OF
ELEMENT EFFECTS OF TOXICITY EXCRETION
DISTRIBUTION CONTENT DEFICIENCY
oxidative damage,
hyperglycemia,
skin ulcers, contact
4–6 mg peripheral Urine 100–200
Chromium (Cr) Spleen, heart dermatitis, asthma,
Cr(III) neuropathy, ng/day
renal and hepatic
hyperlipidemia
necrosis, lung cancer
Cardiomyopathy,
heart failure, goiter,
Anemia, anorexia,
Cobalt (Co) Muscle, liver, fat 1.1 mg hypothyroidism; Urine 80%
growth depression
warm sensation,
vomiting, diarrhea
Wilson disease:
Autosomal recessive,
Menkes’ kinky hair
Muscle and liver failure to excrete Cu Feces includes
syndrome, In
Liver 30–50 µg/g in bile: Excess Cu in bile and
Copper (Cu) 50–80 mg prematurity: Bone
dry; 50%–70% of liver, kidneys, brain, unabsorbed
fractures, skeletal
body Cu eyes, hepatic necrosis, dietary Cu
defects
hypertension, Kayser-
Fleischer rings in eye
Thyroid: 70%–80% Goiter,
of total body I in hypothyroidism, Urine 100–150
Iodine (I) 15–20 mg Goiter, thyrotoxicosis
thyroxine bound to cretinism in infants, µg/day
thyroglobulin myxedema in adults
RBC Hb 400–600 4–5 g (3 4 in Hemochromatosis:
Bile 84 µg/kg,
mg/L, liver, spleen, Hb) 50 Hypochromic Iron deposition in
Iron (Fe) blood loss,
bone marrow 25%, mg/kg 2.5 g microcytic anemia liver, pancreas, heart,
menses
myoglobin in RBCs and skin
Least toxic of trace
elements, Psychiatric
disorders: Memory,
Bile and
Liver, bone, skeletal and cartilage speech,
Manganese (Mn) 12–20 mg intestinal
pancreas defects hallucinations;
secretions
syndrome resembles
Parkinson’s and
Wilson’s diseases
growth depression,
Anemia, goiter,
hypercuprinemia,
Liver, kidney, bone, Blood 30– thyrotoxicosis, Urine 90%, bile
Molybdenum (Mo) defective keratin
adrenal 700 nmol/L hypouricemia, 10%
form, goiter,
hyperoxypurinemia
cretinism
Keshan disease:
Hair and nail loss,
Cardiomyopathy,
selenosis, tooth
cardiomegaly, heart Urine 60%, feces
Selenium (Se) Liver, kidney, muscle 15 mg decay, neuropathy,
failure, cataracts, 40%
liver failure, garlic
osteoarthritis in
odor on breath
children, myopathy,
 discolored/thickened
nails, impaired
growth
In children, low
height, hypogeusia,
growth retardation,
Relatively nontoxic:
Muscle 60%, bone infertility, immune Feces, gut
Nausea, vomiting, and
Zinc (Zn) 30%, liver, prostate, 1.2–2.3 g deficits, delayed secretions, GI
GI irritation; causes
semen wound healing, mucosal cells
copper deficiency
glossitis, seborrheic-
like dermatitis,
osteoporosis