Dialysis/Artificial Kidney

• Is a procedure in which principles of diffusion are applied for the

treatment of renal failure
• Types
• Hemo dialysis
• Peritonial dialysis

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 Hemo Dialysis
• Solution is prepared in which
• Waste products are absent
• Electrolytes are adjusted
• Nutrients are provided
• Solutio is seperated fro patie t’s lood y a dialyzi g e ra e.
• Blood is normalised by the process of diffusion

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Blo,od re,moved for
cleansing

Dialyzer

Clean
blood
returned
to the
',body

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 Peritoneal Dialysis
• I it diffusio takes pla e a ross the patie t’s ow perito eal
membrane
• About 1 L of sol. is introduced in peritoneal cavity
• Kept for 20 to 60 min & replaced by fresh fluid

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Peritoneal Dialysis

• Indications
• In acute renal failure, most of the time condition is
reversible. Dialysis can support the patient for a
few weeks during the period of crisis
• In patient of chronic renal failure it is life saving
• Permanent sol. is Renal Transplantation

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 Renal Transplantation
• Were among the first transplants to be done and are among the most
successful transplants
• Both cadavar & live donors are used
• Detailed antigen typing of both is done
• Immuno suppression is required
• Occasionally a graft is rejected

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 pH expression
• H+ concentration is very low & their expression is very cumbersome
• It is customary to express them on a logarithm scale

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Normal H+ is 40nEq/L (0.00000004 Eq./L. & the ph
is .

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 pH of body
• pH is –ve log. of H+concentration
• Normal H+ concen. in body fluids
• 0.00004mEq/ L (40 nEq/ L)
• Normal variation
• 3 to 5 nEq/L
• H+ concen. is maintained in a very narrow range

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pH of some body fluids
• Plasma pH
• Arterial ------7.4
• Venous -----7.35
• Extra cellular fluid-----7.35 to 7.45
• Intra cellular fluid----- 6 to 7.4
• Urine--------------------6 (4.5 to 8)
• Gastric HCl-------------0.8

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 pH
• pH compatible with life 6.8 to 8.0 & person can live for few hours.
• Daily H+production or ingestion about 80mEq
• These excess of ions must be removed

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 Acid produced in body
• Acids produced in body
• Volatile acids
• Non volatile acids

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 Volatile Acids
• Co2 a major end product of metabolism
• Removed by lungs as CO2
• CO2 + H2O → H2CO3 → H+ + HCO3-
• It accounts for about 12000 mEq./L of H+/day

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Nonvolatile /Fixed Acids
• Sulphuric acid—end product of sulpher containing aminoacids eg.
Cystenine, methionine metabolism
• Phosphoric acid—end product of phospholipid metabolism
• Hydrochloric acid—end product of lysine, arginine & histidine mata.

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 Fixed Acids
• Organic Acids
• Lactic acid---severe anemia
• Acetoacetic acid, hydroxy butric acid---uncontrolled D.M.
• Uric acid---metabolism of nucleoproteins

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 Base production
• Negligible amount
• Bicarbonate---metabolism of organic anions eg. Citrates
• Ammonia---from metabolism of aminoacids is converted to urea, so
not important

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Buffering of H+ ions

• Any substance that can reversibly bind H+ ions is

buffer
• Reaction can go in both directions

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 Regul. Of pH
• Body Buffers—3 Systems
• Chemical Buffers ---come into action with in fraction of seconds. They keep H+
ions tied up
• Respiratory System---acts with in minutes Renal System---acts over a period of
hours to days. Most efficient

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 Chemical Buffers
• Forms I line of defence
• Three types
• Bicarbonate buffers
• Phosphate buffers
• Protein buffers

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 Bicarbonate buffer
• Has two components
• Weak Acid------H2CO3
• A salt with strong Base—NaHCO3
When a strong acid is added. Like HCl
• HCl +NaHCO3 → NaCl + H2CO3
• A strong acid is converted to a weak acid

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 cont…..
• If a strong base is added, NaOH
• NaOH +H2CO3 → NaHCO3+ H2O
• Weak base is formed
• Thus change in pH is minimized

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Quantative dynamics

• BICARBONATE BUFFER
• H2CO3 is ionized

• It’s disso iatio o sta t is

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Cont…

• The amount of free H+ is

• H2CO3 can not be measured but is proportionate

to CO2

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Cont..

• The solubility coefficient for CO2 is 0.03mmol/mm

Hg at body temp.
• Therefore, equation 3 can be written as

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……
• H+concentration is expressed as pH units
• pH = -log of H+ ions
• Similarly dissociation constant can be expressed as
• pK= -log K

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……

• Thus

• therefore

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……

• If we change the sign

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Bicarbonate buffer system titration curve

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Handerson-Hasselbalch Eq.

• PH = pK + log HCO3- /CO2

• HCO3 controlled by Kidneys

• CO2 by Lungs

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Phosphate Buffer
• Two components are
• H2PO4- &
• HPO4—
• lmportant buffer in
• Renal tubules &
• Intracellular fluid ( high concentration)

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 Protein Buffer
• Have
• Free carboxyl group
• Free amino gp.
• Important intracellular buffer

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 pK of some Buffer Systems
• Bicarbonate System-----6.1
• Dibasic System-----------6.8
• Proteins-------------------
• Ammonia-----------------9.0
• Effective buffers are those with pKs close to the pH. of fluid in which
they are operating

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Principal Buffers in the body fluids
• 1 Whole blood
• Hemoglobin
• Proteins
• Bicarbonates
• 2 Intrestitial fluid--Bicarbonate
• 3 Intracellular fluid
• Proteins
• phosphates

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 Respiratory System
• II line defense
• Hyperventilation----Alkalosis
• Hypoventilation-----Acidosis
• Effect is mediated by change in CO2 concen.

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 Renal System
• III line defense
• Acts by
• Reabsorbation of bicarbonates
• Generation of new bicarbonates
• H+ excretion

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Disorders of Acid-Base Balance
• Simple
• Metabolic Acidosis
• Metabolic Alkalosis
• Respiratory Acidosis
• Respiratory Alkalosis

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Mixed disorders
• Metabolic Acidosis & Resp. Acidosis
• “ & Res. Alkalosis
• Metabolic Alkalosis & Res. Alkalosis
• “ & Res. A idosis

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 <7.4 >7.4

Pco2 HC03
>40 mm Hg >24 mEqiL

Allplratoly FteniJ Aelpl ratorr Renal

compenlllion ｾ＠ compensation compensation
Pco2 HCO- Pco1 HCO-
<40mm Ho >24 ｭｾｑＯｬ＠ >40 mm Ho <24 ｭｾｑｉｌ＠
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 Anion Gap
• The concentration of anions & cations must be equal in plasma, so
there is no real gap
• We measure only some anions & cations
• The anion gap is a diagnostics concept

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 Anion Gap
• Is the difference between unmeasured anions & unmeasured cations
• [Na] - [HCO3 + Cl-]
• 142 - [25 + 105]
• 142 – 130 = 12 mEq/L
• Normal range is 8 – 16 mEq/L

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