Acids base balance

Normal PH is 7.35-7.45 and should be constant it.

- if it belowthan 7.35 it is called (acidosis)
- If it more than 7.45 it is called (alkalosis )
If it below 6.8 or above 7.7 it is fatal
The main funcation of lung is
(gas exchanges)
but it also have another funcation one of them is (regulation PH)
Most important definition :
1- acids ; proton donor
Classification according to
-All organic acid are weak acids even (fatty Acids)
- It is only mineral weak acid )H2CO3)

BASE ALKALIS
Both proton acceptor
No have OH Contain OH
NH3 (ammonia ) NaoH ( sodium hydroxide )
- All alkalis are base but not all bases are alkalis.

3-buffer ;mixture of weak acid and it is conjugate base or mixture of weak acidand it is salt
of strong base

Mean that (2 side one deal with acid and another one deal with base .

*function of buffer :resistance of change of PH

Example : bicarbonate buffer HCO3

HCO3 +Na give salt named (sodium bicarbonate )

strong ‫ يكون‬acids ‫ ال‬buffer ‫ ف غياب ال‬/ ‫مالحظة‬

buffer ‫وبالتالي مايتحمله الجسم فمن الضروري والمهم انه يعادله ال‬

have limit to prevent deviation buffer : ‫ذكر امثلة للتوضيح‬

sodium bicarbonate ‫ يأخذ كمية من‬uncontrolled diabetic) ‫ مثل‬pathologic condition ‫موجود‬

buffer ‫ويدخلها في كمية من الحمض او القاعدة فوق قدرة ال‬

‫مثل اثناء ممارسة الرياضة يتراكم الالكتيك اسد يا انه‬

‫تنأخذ ويعمل جلوكوز‬ -1

buffer ‫وتفرزه ويع ادله ال‬kidney ‫ تأخذه ال‬- 2

Water balance : water intake by (drinking ) or (metabolic water ) =water loss by (urea )or
(sweating )

And it is based on electrolyte balance

Distribution water in cells should be maintain because ;

if the water inside cell more than outside cell will (swelling).

If the opposite cell will shrank (edema ).

‫ مهم‬-Water go from less salt concentration to more salt concentration

Extracellular Intracellular
monovalent catin+ Na + K+
divalent catin++ Ca ++ Mg++
monovalent anion- Cl- ,bicarbonate protein and phosphate

.)main ( ‫ الموجود في الداخل موجود في الخارج ولكن يعتبر اكثر تركيز وال‬: ‫مالحظة‬
 -protein is negative because amino acid losed H+ and CO2

Electrolyte balance: electrolyt have charge go to anode or cathode, but there is

Total body water is about ‫ا‬some material dosen’t have charge like Starch( non-
60-65%, if weight 70 -75Kg should have 40 -45Liter water.
L=Kilo
Cathode - is attracted to the cat ion+

Anode+ is attracted to the anion -

-Majority of water in intracellular fluid- ‫مهم سؤال اختياري‬

Intracellular 2/3 of water & extracellular 1/3.
Extracellular fluid distribution mainly in blood (5Liter) & interstium fluid (8 -10
Liter), it is very important to be maintain in volume and composition by:
1-water balance
2-electrolyte balance
3-acid base balance
Any deviation in blood PH is very dangerous For CNS (medulla)
*Normal heart rate is (60 -90 beats/mins)

Respiratory central is very sensitive to:

1-PH(H+ consintration)
2-O2 consintration
3-Co2 concentration

We have 3 mechanisms to maintain PH:

1-buffer system (specially blood)
2-lung
3-kidny

The main buffer in blood is Carbonate or bicarbonate buffer

( carbonatbicarbonate)

Amino acid act as buffer (ampholyte)

It can act as acid and base
Amino acid&proten are very important buffer inside & outside cells

So the distribution of buffer in blood is: ‫مرتبه من الاوم سؤال مهم‬

 1-biocarbonate
2-plasma protein (Amino acid and albumen)
3-Hemogloben
)‫ ( اخر حاجه تهحط‬4-phosphate (not main buffer so it should be last one)

- Intracellular fluid: mainly phosphate and protein (not plasma protein)

Interstttial fluid(tissue fluid): bicarbonate buffer

Kidney, all component of blood filtration in kidney in nephron except

cell&plasma protein

Role of kidney to maintain of PH:

1-get of excess acid like “sulfate” (from sulfur containing amino acid) or
organic acid or keto acid

(casein) ‫ مثل الموجود في الحليب‬Phosphor protein

2- get rid of proton it’s self by 3 mechanisms :

‫(فقط اعرفووا تعداد قال التفاصيل مو مهمه بس عشان تفهمونها لو جاء شورت اساي عليها‬
1- sodium proton exchange
- 2resynthisis (reclamation) of bicarbonate
3- Production of ammonia & excretion of NH4+ from glutamine by glutamines
enzyme,NH3 + H ——> NH4

‫الموضح بالهايالت موضع اسئلة ذكرها ركزوا عليها‬

DONE

ً‫ ستسعد غداً بتذكره وستكون فخوراً جدا‬,‫تذكر ما تبذل جهدك اليوم في سبيمه ويؤرق راحتك‬
‫ بالتوفيق‬. ‫بمشاركته مع من حولك لذا ال تيأس واستمر بالتقدم‬

‫سمر الظهواني – وصايف الهذلي‬



Lecture 1 part 2 .

• Lung is important in transporter of O2 from lung to

peripheral tissue to get the body rid of the wist are

continuously produce by metabolic process (Co2).

• - every cycle of metabolic give 2 molecule co2.

• - get rid of proton (H+)

• Hemoglobin: 4 poly peptides chain (tetroma ) each peptide

have (Crevs ‫) زي الكهف او الحجرة‬, have heme that bind with O2 ,

and Polypeptide bind with Proton and Co2 ,so it have very

important role in buffering System.

• CO2 accumulation/retention low PH (acidosis)

• Lack of Co2 high PH (Alkalosis).

What is main ways to get rid of Co2?

• 15% of co2 bind with amino terminal of submetabolic Peptide

chain(Hemoglobin‫)ا'كونة من‬.

How?

each Protien has 2 terminal: amino terminal & carboxyl terminal.

Co2 bind with amino terminal to form (carbamino) NH COO or

NH COOH. 2

2

• much of remaining (more than 80%) of Co2 transported by

RBCs In form of Co2 bicarbonate.

How

the CO2 Transported (in form of bicarbonate)?
•

first when Co2 release by peripheral tissue to the blood RBCs

will take the majority of Co2.

•
RBcs have (Carbonic Anhydrase) Enzyme that hydrate the Co2

by added H2O (this reaction is reversible).
•
Forming Carbonic acid (H2CO3)

•
(H2CO3) will ionization to = HCO3 + H+
•

H+ will bind to deoxyhemoglobin (!‫) بعد ما فقد ا&وكسج‬

•
RBcs circulating in the blood. Will carries the HCO3 to the

lung.


•
In the lung side the HCO3 bind with H+( ‫الناتجة عن انفصالها من‬

!‫ )الهيموقلوب‬forming H2CO3.

•
H2CO3 by (Carbonic Anhydrase) will converted to Co2 & H2O.

‫مع‬
‫طيب بالنسبة &نتقالها عن طريق الهيموقلوب! قلنا فوق انها حتشبك‬

:‫عنها‬

‫همه‬K‫ لكن قال بعض النقاط ا‬peptide chain
•

each hemoglobin can bind only 2 H+ (proton).

•
In the lung side the concentration of of O2 will be more and the

PH slightly higher that is help in binding of O2 with

hemoglobin (change the structure) and release of H+ and Co2.

(Co2 will exhale out the body and H+ will bind with HCO3 ‫زي ما‬

‫ قلنا فوق‬.

This

process called Bohr Effect.

• Carbonic Anhydrase:

Very important enzyme Present in the cells of stomach

that produce HCl, also in the kidney has many isomerse

and has very important role in acid synthesis.


‫ وشرح بعض تركيبه بالتفصيل بعدين توقف بنص الشرح وقال مو مهم حاولت‬hemoglobin ‫مره ثانية اتكلم الدكتور عن الـ‬

:‫مه‬L‫خيرة بك‬O‫ألخص اللي قاله ووقفت مكان ما وقفت الفكرة ا‬

Hemoglobin : 4 Polypeptide chain acts as a buffer each Hemoglobin have

amino terminal (binding with CO2&H+) and carboxyl terminal.

ueryimpoTrta iron

rag

fasterdileniegM 4 Polypeptide

w
1

Et B o
A iron
q iron

2 3bisphosphoglycrate

- cross section:

place of Or binding

Nitrgin f e Nitrogin

Histadine of

polypeptidetrain

iron: electro positive atom

3 sn

O2:electro negative atom n

III

ionicbond fIS iron

Perpheraltissue's Ozimbingncovalent g D

of ghistadine III im iron

f.fi
sIgQUchangeinpdypeptidchain

Distractionforall ionicbond

PerpheraltissuefsDeoxy hemoglobin j j s


- RBCs: Will get the body rid of CO2 and H+.

- (Carbonic Anhydrase ‫يدة‬$‫مو مهمه فقط قراءة )س‬

• What is the major organ to regulate ECF composition & volume?

this the main function of kidney that relase the wist and water (urine).

The change in PH is fetal if it is by original cause.

• Compinsatry mechanism:

‫ يحاول يتدارك ويقاوم هذا التغيير‬PH‫بمعنى انو الجسم اذا حس بتغيير في ال‬

‫لو جاء البيشنت وماعنده أعراض واضحة معناته انو جسمه في ذي الفترة‬

‫ لنا الخلل او التغير‬V‫زم عينة دم تب‬Y‫ف‬

We have 2 types:

Renal

• Pulmonary

flake Alkalosis
Maggy

Acidosis

incensed im

ChangeInfPH
nespiraagaea.is

A CO2 acidosis
respiratory

X.ngtahadiu.fr.Induction
Medications

The metabolic and medications

metabolic ‫نسميها‬

addiction ofbase Alkalij

medication


Metabolic

acidosis:

In

diabetic uncontrol
‫الجسم‬

‫يا فيصير‬L‫ يساعد لدخوله للخ‬W‫ريض ما ياخذ انسول‬Y‫موجود في الدم بس ا‬ ‫الجلوكوز‬

:
keton acid ‫ وينتج منه‬lipid ‫يستخدم الـ‬
•

Acetoacidic Acid
•
Betahydroxy acid

buffiring

system

bicarbonate

‫حيتعامل معاه بالـ‬

over come the buffiric capicty ‫اللي في الدم بس لو ارتفع مره حيصير‬

‫فنسميها‬

metabolic acidosis

lactic acid

‫الى‬

‫كتيك برضو يودي‬L‫تراكم ال‬

metabolic

acidosis

Metabolic alkalosis

:

In
peptic ulcer patient taken local antiacid to reduce the acidity . Lung

use

of alkaline may lead to alkalosis.

•
Acidity PH below than 7.4
•

Alkalosis PH above than 7.4

Amal Alqahtani.

L1 part 3

Acidosis: low pH that happen in original or Metabolic causes

e.g: uncontrolled diabetic patient with ketoacidosis

- The Respiratory center and higher center that responsible for

regulation of respiration are very sensitive for minimal change in pH
(proton concentration), partial pressure of O2 (O2 concentration)
and CO2 (in Medicine).

so in ketoacidosis the respiratory center work to raise the pH and

reduce the acidity
then The respiratory rate going to be high to get rid of CO2 leading
to raise the pH.

The uncontroled diabetic patient may came in compensatory stage

and already has high respiratory rate so the blood sample shows
the real level of bicarbonate and the pH of the blood.
So The real problem he has "Metabolic acidosis because of the
medication" Not "respiratory alkalosis" because of the high
respiratory rate.
But maybe The compensatory stage makes the doctor confuse.

we have 2 Compensatory mechanisms:

**‫**ﻣﮭم‬
Respiratory compensation: faster than kidney
depends on: Respiratory center which is respond to change in (O2,
Co2, H+)
Mechanism: Elevate or reduce the respiratory rate immediately

Renal compensation: very slow

depends on: enzymes and (ammonia interact with proton)
***compensatory mechanisms MCQs or fill in the blanks***


- Respiratory acidosis: low pH due to any cause which decrease

the respiratory rate.

The respiratory rate decreased by:

Central: something inhibit the center.
Peripteral: in lungs (blocking or painful that don't let the petent to
take the breath) like holding the respiration (Pneumonia, plurasy)
"the rest on the slide"

- Metabolic acidosis: Reaction leads to production of

abnormal amount of acid and beyond the capacity of the
buffering system.

-Chronic Alcoholics: do 2 things

Raise the Keton bodies
Raise Lactic acid: normal comes from RBCs and
muscular exercise but can comes from Hypoxia and severe
anaemia so the most of the tissue depends on the
anaerobic glycolysis then will be produce acids in high
amount above the efficiency of the liver and kidney to convert
it to glucose then the accumulation of acid will happen.

- Renal failure: the efficiency of the kidney to excrete excess

acid is low that lead to accumulation of acid also the H+ in
the blood.

- the Decrease of bicarbonate consumed to maintain the pH

"the rest on the slide"

- Respiratory alkalosis: increase of blood pH due to any

factor which increase original cause (increase the
respiratory rate)
- pulmonary embolus = embolism
- More renal compensation

* Note: Damage on the respiratory center means trauma

that inhibit the respiratory rate which cause (Respiratory
acidosis).
but Damage Near to the respiratory center or haemorrhage
Near to it that cause irritanting molecules cause irritation in
the respiratory center that increase the respiratory rate
means (Respiratory alkalosis).

- Metabolic alkalosis:
The main causes is
Local antiacid: like NaHCO3 and aluminum hydroxide
for prolonged time in large doses can cause absorbtion of
the hydroxide or
bicarbonate with large amount leading to high pH.
loss of HCL for prolonged time with large amount:
like severe gastroenteritis or cholera.

Reminder:
Na+ in serum: 135-145 mEq/L = milliequivalent per liter.
K+ in serum: 3.5-5. 1 mEq/L

Reem AlOsaimi
Good luck