Blood gas analyseis

ACID-BASE HOMEOSTASIS

Buffers

Acids
Acids =
< Bases
Bases
Acids > Bases

Acids
 EFFECTS OF pH
© The most general effect of pH changes
are on enzyme function
ª Also affect excitability of nerve and
muscle cells

p Excitability
H
p Excitabilit
 ACID-BASE BALANCE

© Acid - Base balance is primarily

concerned with two ions:
ª Hydrogen (H
(H++) PH alkalosis

asiss.SI
JPH
ª Bicarbonate (HCO
(HCO33- )

H+ HCO
HCO33
ACID-BASE REGULATION
 ACID-BASE REGULATION
© Maintenance of an acceptable pH range
in the extracellular fluids is accomplished
by three mechanisms:
ª 1) Chemical Buffers
¨ React very rapidly( within a second)
2) Respiratory Regulation
¨ Reacts rapidly (seconds to minutes)
ª 3) Renal Regulation
¨ Reacts slowly (minutes to hours)
 ACID-BASE REGULATION
© Chemical Buffers
ª The body uses pH buffers in the blood to guard against sudden
changes in acidity
ª A pH buffer works chemically to minimize changes in the pH of a
solution

Buffe
 ACID-BASE REGULATION
© Respiratory Regulation
ª Carbon dioxide is an important by-product of metabolism and is
constantly produced by cells
ª The blood carries carbon dioxide to the lungs where it is exhaled

Cell
CO CO CO
CO2 CO2CO2
Metabolis
2
2 2
m
 ACID-BASE REGULATION
© Respiratory Regulation
ª When breathing is increased, the blood carbon dioxide level
decreases and the blood becomes more Basi
Basic
c
ª When breathing is decreased,the blood carbon dioxide level
increases and the blood becomes more Acidic
 ACID-BASE REGULATION
© Kidney Regulation
ª Excess acid is excreted by the kidneys,
largely in the form of ammonia
ª The kidneys have some ability to alter
the amount of acid or base that is
excreted, but this generally takes
several days
ACID-BASE REGULATION
 ACIDS
© Physiologically important acids include:
ª Carbonic acid (H (H2
2CO
CO3 3)
ª Phosphoric acid (H (H3 3PO
PO4 4)
ª Pyruvic acid (C(C33H 4 O 3 )
ª Lactic acid (C
(C33H 6 O 3 )
© These acids are dissolved in body fluids
Phosphoric
Lactic
acid
acid
Pyruvic
acid
 BASES
© Physiologically important bases include:
ª Bicarbonate (HCO
(HCO33- )
ª Biphosphate (HPO
(HPO44-2 )

Biphosphat
e

Bicarbonate
 pH
pH SCALE
SCALE
© Pure water is Neutral
Neutral
ª (H
H++ = OH
OH-- ) ACIDS, BASES OR NEUTRAL???
¨ pH = 7
OH H
OH H HH OH H
OH H
© Acid
Acid HH
++
--
H
OH
OH++
H -- HH
HH OH
++OH
OH
OH++H
-- H H
H
++
OH
OH
--
-- H H OH
OH
+OH
+
--
OH
ª (H
H++ > OH
OH-- ) OH
OH ++ OH
OH ++ HH--
OH++ H
OH H H++ --
H
-- -- H OH
OH
¨ pH < 7 OH H
OH ++HH
-- ++ OH
OH ++ --
-- ++ ++ --
33
© Base
Base 1 22

ª (H
H++ < OH
OH-- )
¨ pH > 7

© Normal blood pH is 7.35

7.35 -- 7.45
7.45
© pH range compatible with life is 6.8
6.8 -- 8.0
8.0
 pH SCALE

ACIDOSIS
ACIDOSIS NORMAL ALKALOSIS
ALKALOSIS

DEATH
DEATH DEATH
DEATH

6.8
6.8 7.3 7.4 7.5 8.0
8.0
Venou Arterial
Arterial
s Blood
Blood
 ACIDOSIS
ACIDOSIS // ALKALOSIS
ALKALOSIS

© Acidosis
Acidosis
ª A condition in which the blood has too
much acid (or too little base),
frequently resulting in a decrease in
blood pH
© Alkalosis
Alkalosis
ª A condition in which the blood has too
much base (or too little acid),
occasionally resulting in an increase in
 ACIDOSIS
ACIDOSIS // ALKALOSIS
ALKALOSIS
© Acidosis and alkalosis are not diseases
but rather are the results of a wide
variety of disorders
© The presence of
acidosis or
alkalosis provides
an important clue
to physicians that
a serious
metabolic
problem exists
 ACIDOSIS
ACIDOSIS // ALKALOSIS
ALKALOSIS
© pH changes have dramatic effects on
normal cell function
ª 1)
1) Changes in excitability of nerve and
muscle cells
ª 2)
2) Influences enzyme activity
ª 3)
3) Influences K
K++ levels
 CHANGES
CHANGES IN
IN CELL
CELL
EXCITABILITY
EXCITABILITY
© pH decrease (more acidic) depresses
the central nervous system
ª Can lead to loss of consciousness
© pH increase (more basic) can cause
over-excitability
ª Tingling sensations, nervousness,
muscle twitches
 INFLUENCES
INFLUENCES ON
ON ENZYME
ENZYME
ACTIVITY
ACTIVITY
© pH increases or decreases can alter the
shape of the enzyme rendering it non-
functional
© Changes in enzyme structure can result in
accelerated or depressed metabolic
actions within the cell
 ACIDOSIS
ACIDOSIS // ALKALOSIS
ALKALOSIS
BASE ACID
© Normal ratio of HCO
HCO33-- to H
H22CO
CO33 is 20:1
ª H
H22CO
CO33 is source of H
H++ ions in the body

© Deviations from this ratio are used to identify

Acid-Base
Acid-Base imbalances

H
H 2 CO +
HCO
HCO33
 ACIDOSIS
ACIDOSIS // ALKALOSIS
ALKALOSIS
© Normal values of bicarbonate
(arterial)
ª pH
pH = 7.4
ª PCO
PCO22 = 40 mm Hg
ª HCO
HCO33-- = 24 meq/L
 ACIDOSIS
ACIDOSIS
© A decrease
decrease in a normal 20:1 base to
acid ratio
ª An increase in the number of
hydrogen ions
(ex: ratio of 20:2 translated to 10:1)
ª A decrease in the number of
bicarbonate ions (ex: ratio of 10:1)
© Caused by too much acid or too little base

ACID BASE
 ALKALOSIS
ALKALOSIS
© An increase
increase in the normal 20:1 base to
acid ratio
ª A decrease in the number of hydrogen
ions
(ex: ratio of 20:0.5 translated to 40:1)
ª An increase in the number of
bicarbonate ions (ex: ratio of 40:1)
© Caused by base excess or acid deficit

ACID BASE
 SOURCES
SOURCES OF
OF HYDROGEN
HYDROGEN IONS
IONS
© 1) Cell Metabolism (CO
(CO22)
© 2) Food Products
© 3) Medications
© 4) Metabolic
Intermediate by-products
© 5) Some Disease
processes
 CARBON
CARBON DIOXIDE
DIOXIDE DIFFUSION
DIFFUSION
Systemic Circulation
Red Blood
Plasm
Cell
a

Cl
carbonic -
(Chloride Shift)
anhydrase
CO + H2 H + HCO
2 O + 3-
HCO
3-
CO2 diffuses into plasma and into RBC
CO Within RBC, the hydration of CO2 is
2 catalyzed by carbonic anhydrase
Bicarbonate thus formed diffuses into plasma

CO Tissues
 CARBON
CARBON DIOXIDE
DIOXIDE DIFFUSION
DIFFUSION
Systemic Circulation
Red Blood
Plasm
Cell
a carbonic
anhydrase
Cl
-

+ H + HCO3
+ -
H+ is buffered by
Hemoglobin
Hb
H2
O Click
Click for
for
Carbon
Carbon Dioxide
Dioxide
diffusion
diffusion

CO CO CO CO
Tissues
CO CO CO CO
 CARBON DIOXIDE DIFFUSION
Red Blood Systemic
Plasma
Cell Circulation
Cl
carbonic -
(Chloride Shift)
anhydrase
CO + H2 H + HCO3
2 O + - HCO
3- into the RBC
CO2 diffuses into the plasma and

Within the RBC, the hydration of CO2 is

catalyzed by carbonic anhydrase
CO
2
CO Bicarbonate thus formed diffuses into plasma
2 Tissues
 BICARBONATE
BICARBONATE DIFFUSION
DIFFUSION
Red Blood
Pulmonary
Plasma Circulation
Cell

Cl
-
HCO3
CO + H2 H + HCO3 -
2 O + -

CO Bicarbonate diffuses back into RBC in pulmonary

2 capillaries and reacts with hydrogen ions to form
carbonic acid

The acid breaks down to CO2 and water

Alveolus
 BICARBONATE
BICARBONATE DIFFUSION
DIFFUSION
Red Blood
Pulmonary
Plasma Circulation
Cell

Cl
-

CO + H2 +
HCO3
2 O
-

CO H
2 +

Alveolus
 PARIETAL
PARIETAL CELL
CELL SECRETION
SECRETION
© Secrete hydrogen ions into the lumen of
the stomach
Blood Parietal
Parietal Lumen
Lumen
of
of
© Bicarbonate CO
CO2
Cells
Cells
2 ++
Stomac
Stomac
h
h
ions diffuse into H
H22O
O
the bloodstream Cl
Cl--
HCl
to maintain H+
electrical
neutrality in the
HCO
parietal cell 3-
Click
Click to
to see
see
ion movement
movement
 PANCREATIC
PANCREATIC CELL
CELL SECRETION
SECRETION
© In pancreatic cells the direction of ion
movement is reversed
Blood Pancreatic
Pancreatic Pancreatic
Pancreatic
duct
duct
© H
H++ ions are Cells
Cells

secreted into
the blood and
bicarbonate H+
ions diffuse into
pancreatic juice HCO
HCO
HCO
3-
Click
Click to
3
3
to see
-
-
ion
ion movement
 ACIDOSIS
ACIDOSIS // ALKALOSIS
ALKALOSIS
© Deviations from normal Acid-Base
status are divided into four
four general
categories, depending on the source and
direction of the abnormal change in HH++
concentrations
ª Respiratory
Respiratory Acidosis
Acidosis
ª Respiratory
Respiratory Alkalosis
Alkalosis
ª Metabolic
Metabolic Acidosis
Acidosis
ª Metabolic
Metabolic Alkalosis
Alkalosis
RESPIRATORY
ACIDOSIS
 RESPIRATORY
RESPIRATORY ACIDOSIS
ACIDOSIS
© Caused by hyperkapnia due to
hypoventilation
ª Characterized by a pH decrease
and an increase in CO
CO22
pp
CO
CO2 2 HH CO
CO22
CO
CO2 2 CO
CO22
CO
CO22 CO
CO22 CO
CO22
COCO
CO2CO2
2 2 CO
CO22 CO
CO22
pp CO
CO22
CO
CO2
HH2
 HYPOVENTILATION
HYPOVENTILATION
© Hypo = “Under”

Elimination
Elimination of
of
CO
CO2 2
H
H++

pH
pH
 RESPIRATORY
RESPIRATORY ACIDOSIS
ACIDOSIS
© Decreased COCO22 removal
can be the result of:
1) Obstruction
Obstruction of of air
air
passages
passages
2) Decreased
Decreased
respiration
respiration
(depression
(depression of of
respiratory
respiratory centers)
centers)
3) Decreased
Decreased gas gas
exchange
exchange between
between
pulmonary
pulmonary
capillaries
capillaries and
and airair
sacs
sacs of
of lungs
lungs
RESPIRATORY
RESPIRATORY ACIDOSIS
ACIDOSIS
-metabolic
metabolic balance
balance before
before onset
onset of
of
acidosis
acidosis
-pH
pH == 7.4
7.4

-respiratory
respiratory acidosis
acidosis
-pH
pH == 7.1
7.1
-breathing
breathing is
is suppressed
suppressed holding
holding
CO
CO22 in
in body
body

-body’s
body’s compensation
compensation
-kidneys
kidneys conserve
conserve HCO
HCO3 3-- ions
ions to
to
restore
restore the
the normal
normal 40:2
40:2 ratio
ratio
-kidneys
kidneys eliminate
eliminate H
H++ ion
ion inin acidic
acidic
urine
urine
-- therapy
therapy required
required to
to restore
restore
metabolic
metabolic balance
balance
444000
-- lactate
lactate solution
solution used
used in
in therapy
therapy is is
converted
converted toto bicarbonate
bicarbonate ionsions in
in the
the
liver
liver
RESPIRATORY ALKALOSIS
 RESPIRATORY
RESPIRATORY ALKALOSIS
ALKALOSIS
© Normal 20:1 ratio is increased
ª pH of blood is above 7.4

HH 2 CO
2 CO HCO
HCO33
3 HCO
HCO33

7.4
3 -

==
-

0.5
11 : 20
20
 RESPIRATORY
RESPIRATORY ALKALOSIS
ALKALOSIS
© Cause is Hyperventilation
Hyperventilation
ª Leads to eliminating excessive
amounts of COCO2
2
ª Increased loss of COCO2 2 from the lungs
at a rate faster than it is produced
ª Decrease in H
H++
CO
CO CO
CO
CO
CO CO
CO CO
CO CO
CO CO
CO
CO
CO 2 CO
CO 22 CO
CO
22 22 CO 2
CO CO2
CO 22
22 2 22
22 2
 HYPERVENTILATION
HYPERVENTILATION
© Hyper = “Over”

Elimination
Elimination of
of
CO
CO2 2
H
H++

pH
pH
 RESPIRATORY
RESPIRATORY ALKALOSIS
ALKALOSIS
© Can be the result of:
ª 1)
1) Anxiety,
Anxiety, emotional
emotional
disturbances
disturbances
ª 2)
2) Respiratory
Respiratory center
center
lesions
lesions
ª 3)
3) Fever
Fever
ª 4)
4) Salicylate
Salicylate poisoning
poisoning
(overdose)
(overdose)
ª 5)
5) Assisted
Assisted respiration
respiration
ª 6)
6) High
High altitude
altitude (low
(low P
PO 2 ))
RESPIRATORY
RESPIRATORY ALKALOSIS
ALKALOSIS
-metabolic
metabolic balance
balance before
before onset
onset
of
of alkalosis
alkalosis
-pH
pH == 7.4
7.4

-respiratory
respiratory
alkalosis
alkalosis
-pH
pH == 7.7
7.7
-- hyperactive
hyperactive breathing
breathing ““ blows
blows off
off ””
CO
CO2 2

-- body’s
body’s
compensation
compensation
-- kidneys
kidneys conserve
conserve H H++ ions
ions and
and
eliminate
eliminate HCO
HCO33-- in
in alkaline
alkaline urine
urine

-- therapy
therapy required
required to
to restore
restore
metabolic
metabolic balance
balance

-- HCO
HCO33-- ions
ions replaced
replaced by
by Cl
Cl--
ions
ions
METABOLIC ACIDOSIS
 METABOLIC
METABOLIC ACIDOSIS
ACIDOSIS
© Occurs when there is a decrease in the
normal 20:1 ratio
ª Decrease in blood pH
pH and bicarbonate
level
© Excessive H
H++ or decreased HCO
HCO33--

H 2 CO HCO
HCO333
HCO
HCO3
- -

== 7.4
7.4
H23CO
3

11 :: 10
20
10
20
 METABOLIC
METABOLIC ACIDOSIS
ACIDOSIS
© The causes of metabolic acidosis can
be grouped into five
five major categories
ª 1)
1) Ingesting
Ingesting an acid or a substance
that is metabolized to acid
ª 2)
2) Abnormal
Abnormal Metabolism
Metabolism
ª 3)
3) Kidney
Kidney Insufficiencies
Insufficiencies
ª 4)
4) Strenuous
Strenuous Exercise
Exercise
ª 5)
5) Severe
Severe Diarrhea
Diarrhea
 METABOLIC
METABOLIC ACIDOSIS
ACIDOSIS
© This leads from excessive production of
ketones:
ketones:
ª Acetone
Acetone
ª Acetoacetic
Acetoacetic acid
acid
ª B-hydroxybutyric
B-hydroxybutyric acid
acid
© Contribute excessive numbers of
hydrogen ions to body fluids
Acetone
Acetone
H H
H H
Acetoacetic acid
acid
+
+ ++
HH HH H H
Hydroxybutyric
Hydroxybutyric acid
acid
++
H
H ++ ++
Na
Na == CL
CL ++ HCO3
HCO3 ++ UA
UA ((
AG)
AG)
140
140 == 105
105 ++ 25
25 ++ (( ))
 METABOLIC
METABOLIC ACIDOSIS
ACIDOSIS
-- metabolic
metabolic balance
balance before
before onset
onset
of
of acidosis
acidosis
-- pH
pH 7.4
7.4

- metabolic
metabolic
acidosis
acidosis
--- pH
pH
HCO7.1
7.1
HCO33-- decreases
decreases because
because of
of
excess
excess presence
presence of
of ketones,
ketones,
chloride
chloride oror organic
organic ions
ions
-- body’s
body’s
-compensation
-compensation
hyperactive
hyperactive breathing
breathing to
to ““ blow
blow
off
off ”” CO
CO22
-- kidneys
kidneys conserve
conserve HCO
HCO3 3-- and
and
eliminate
eliminate H H+
+ ions
ions in
in acidic
acidic urine
urine
-- therapy
therapy required
required to
to restore
restore
metabolic
metabolic balance
balance
-- lactate
lactate solution
solution used
used in
in therapy
therapy is
is
0.5
0.5 10
10 converted
converted to to bicarbonate
bicarbonate ions
ions
in
in the
the liver
liver
METABOLIC ALKALOSIS
 METABOLIC
METABOLIC ALKALOSIS
ALKALOSIS
© Elevation of pH
pH due to an increased
20:1 ratio
ª May be caused by:
¨ An increase
increase of bicarbonate
¨ A decrease
decrease in hydrogen ions
ª Imbalance again cannot be due to CO
CO22
ª Increase in pH
pH which has a non-
respiratory origin
7.4
 METABOLIC
METABOLIC ALKALOSIS
ALKALOSIS
© Can be the result of:
ª 1)
1) Ingestion
Ingestion of
of Alkaline
Alkaline Substances
Substances
ª 2)
2) Vomiting
Vomiting (( loss
loss of
of HCl
HCl ))
 METABOLIC
METABOLIC ALKALOSIS
ALKALOSIS
© Gastric juices contain large amounts of
HCl
HCl
© During HCl
HCl secretion, bicarbonate is
added to the plasma

K
K++ H+
HCl
HCl
HCO
HCO33--

Cl
Cl-- Click
Click to
to
View
View Animation
Animation
 METABOLIC
METABOLIC ALKALOSIS
ALKALOSIS
© The bicarbonate is neutralized as HCl
HCl is
reabsorbed by the plasma from the
digestive tract

K+
HCl
H
HHCl
++ Cl
Cl--

H
HHCO
22C
C3-
HCO3
Click
Click to
to
O
O33 View
View Animation
Animation
 METABOLIC
METABOLIC ALKALOSIS
ALKALOSIS
© During vomiting H
H++ is lost as HCl
HCl and the
bicarbonate is not neutralized in the plasma
ª Loss of HCl
HCl increases the plasma bicarbonate and thus results in an
increase in pH
pH of the blood

K+
HCl
HCl
Bicarbonate not
neutralized

HCO
HCO33-
Click
Click to
to
View
View Animation
Animation
 METABOLIC
METABOLIC ALKALOSIS
ALKALOSIS
-- metabolic
metabolic balance
balance before
before onset
onset
of
of alkalosis
alkalosis
-- pH
pH == 7.4
7.4

- metabolic
metabolic
alkalosis
alkalosis
-- pH
pH
HCO== 37.7
HCO3 7.7
-- increases
increases because
because of
of loss
loss
of
of chloride
chloride ions ions or
or excess
excess
ingestion
ingestion of of NaHCO
NaHCO3 3

-- body’s
body’s
-compensation
-compensation
breathing
breathing suppressed
suppressed toto hold
hold
CO
-CO2 2
- kidneys
kidneys conserve
conserve H
H++ ions
ions and
and
eliminate
eliminate HCO
HCO33-- in
in alkaline
alkaline urine
urine

-- therapy
therapy required
required to
to restore
restore
metabolic
metabolic balance
balance

11..22 2255 -- HCO

HCO33-- ions
ions replaced
replaced by
by Cl
Cl--
55
ions
ions
 ACID
ACID –– BASE
BASE DISORDERS
DISORDERS
Clinical State Acid-Base Disorder
Pulmonary Embolus Respiratory Alkalosis
Cirrhosis Respiratory Alkalosis

Pregnancy Respiratory Alkalosis

Diuretic Use Metabolic Alkalosis

Vomiting Metabolic Alkalosis

Chronic Obstructive Pulmonary Disease Respiratory Acidosis

Shock Metabolic Acidosis

Severe Diarrhea Metabolic Acidosis

Renal Failure Metabolic Acidosis

Respiratory Alkalosis,
Sepsis (Bloodstream Infection)
Metabolic Acidosis
It
It is
is very
very easy
easy toto solve
solve the
the case
case
with
with acid
acid base
base disorders
disorders byby
RIADH
RIADH HENWA
HENWA as as mentioned
mentioned at at
the
the title
title of
of lec
lec

HOW
HOW ?????
?????
BY
BY seen
seen these
these 33 parameters
parameters
1-See the PH 1
1st
st and
determin the state

2- see the CO2 & HCO3 and

determin which one consist
with or go with

3- the other ( which is

oppsite) is for compensation
 THE END OF
ACID - BASE BALANCE