Lectures on respiratory physiology

Acid-Base Balance

Some definitions
An acid is a molecule that releases
hydrogen ions in solution
A base is a molecule that can accept a
hydrogen ion
A buffer is a substance that can
reversibly bind hydrogen ions

Titration curve for the bicarbonate buffer system

Law of Mass Action

CA

CO2 + H2O

H2CO3

H+

+ HCO3

AT EQUILIBRIUM,

[H+]

[H+]

x [HCO3 ]
[H2CO3]

x [HCO3 ]
SOLUBILITY x PCO2

+
[H ]

x [HCO3 ]
0.03 x PCO2

WHICH, AFTER TAKING LOGS, BECOMES:

pH = pK + Log(

[HCO3 ] )
0.03 x PCO2

- THE HENDERSON - HASSELBALCH EQUATION

Derivation of normal pH

Davenport Diagram

[HCO3-]
1.2

PLASMA [HCO3-], meq/l

pH = 6.1 + Log(

50

PCO2 = 40

40
30

24

NORMAL

20
10
0
6.8

7.40
7.0

7.2

7.4

pH

7.6

7.8

8.0

PLASMA [HCO3-], meq/l

50
40

10080
PCO2:
60

30

40
30
20

20

10

10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

PLASMA [HCO3-], meq/l

[HCO3-]
pH = pK + Log(
)
0.03 x PCO2
50
40

80

BUFFER
LINE

40

30

20

20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

ACID - BASE DISTURBANCES:

* RESPIRATORY ACIDOSIS
* RESPIRATORY ALKALOSIS
* METABOLIC ACIDOSIS
* METABOLIC ALKALOSIS

RESPIRATORY ACIDOSIS:
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40

30

20

20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

RESPIRATORY ACIDOSIS:
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40

30

20

20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

RESPIRATORY ACIDOSIS:
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40

30

20

20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

RESPIRATORY ALKALOSIS:
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40

30

20

20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

RESPIRATORY ALKALOSIS:
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40

30

20

20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

METABOLIC ACIDOSIS:
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40

30

20

20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

METABOLIC ACIDOSIS:
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40

30

20

20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

METABOLIC ALKALOSIS
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40
20

30
20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

METABOLIC ALKALOSIS
-

PLASMA [HCO3-], meq/l

H+ + HCO3
50
40

CO2 + H2O
80

BUFFER
LINE

40
20

30
20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

COMPENSATED RESPIRATORY ACIDOSIS

PLASMA [HCO3-], meq/l

COMPENSATED METABOLIC ALKALOSIS

50
40

80

BUFFER
LINE

40
20

30
20
10
0
6.8

7.0

7.2

7.4

pH

7.6

7.8

8.0

Oxygen Delivery to Tissues

VENTILATION
LUNGS
DIFFUSION
CAPILLARIES

HEART AND
CIRCULATION

PERFUSION
CAPILLARIES

DIFFUSION
TISSUE
THE OXYGEN TRANSPORT SYSTEM

Fick equation for diffusion through a tissue sheet

Distribution of PO2 between capillaries

Critical PO2 for mitochondrial respiration

Classification of tissue hypoxia:

*

Hypoxic hypoxia

*
*

Anemic hypoxia
Circulatory hypoxia

Histotoxic hypoxia