BLOCK XV
ACID BASE HOMEOSTASIS
MALIYAH MADIYAN, dr., SU
DEPT. OF BIOCHEMISTRY
[Link] MEDICINE
GADJAH MADA UNIVERSITY
1
IMPORTANCE OF
HOMEOSTASIS
Fluid and electrolyte and acid base
balance are critical to health and well
being
* Maintained by intake & output
* Regulation by renal & pulmonary
systems
2
Major Chemical Base Buffer
in the body
Carbonic acid-Bicarbonate buffering
system
needed for acid-base balance
normal level 22-26 mEq/L
Regulation by kidneys
3
Acid-Base Balance
pH = measures amount of H+
concentration [H+]
7 = neutral; <7 = acidic ; >7
basic/alkaline
needed to maintain cell membrane
integrity and speed of cellular enzymatic
action.
Normal range: 7.35-7.45 [+7.4]
regulated by buffers
4
Buffer
Substance or group of subtances that
can absorb or release H+ to correct an
acid-base imbalance
* Processes to regulate acid-base
balance
5
Physiological Regulation
(Buffer) by Lungs & Kidneys
Lungs adapt fast:
H+ & CO2 levels provide stimulus for
respirations
Kidneys take from a few hours -
several days :
reabsorb HCO3- in cases of acid
excess;
excrete it in cases of acid deficit.
6
Acid-Base Balance
Arterial blood gas is best measure
1. pH : measures [H+] = [7.35-7.45]
2. Pa-CO2 : measures CO2 (pulmonary
ventilation) [35-45]
3. Pa-O2 : O2 in arterial blood [80-106]
4. O2 saturation (how much Hb is carrying O2
[95-99%]
5. Base excess (how much blood buffer is
present) [> = alkalosis; < = acidosis]
6. HCO3- (major renal component of acid-base
balance)
7
Common Disturbances
in Acid-Base Balance
Metab-acidosis (pH<7.35; HCO3- <22)
Increased acid [H+]; decreased NaHCO3.
High anion gap {Na+ - (Cl- + HCO3-)}
Causes : * starvation *lactic acidosis * diabetic
ketoacidosis *drug use (paraldehyde, aspirin) *
renal failure
S & S (signs & symptomes) :*tachypneu + deep
respirations *headache, *lethargy * anorexia *
abdominal cramps.
8
Metabolic Alkalosis (pH>7.45; HCO3- >26)
Loss of [H+] or increased [HCO3]-
Most common cause :
* vomiting & gastric secretions
* hypokalemia * hypercalcemia*excess
aldosterone
*drugs use (steroids, bicarbonates, diuretics)
S & S: *numbness *tingling *tetany
*muscle cramps
9
Respiratory Acidosis pH<7.35 ; CO2>45
Increased CO2, excess H2CO3. Increase [H+]
Causes HYPOVENTILATION
*atelectasis * pneumonia*cystic fibrosis
* respiratory failure * airway obstruction
* chest wall injury * paralysis of respiratory
muscles * head injury * obesity
S&S : * confusion * dizziness * lethargy
* headache* warm flushed skin
10
Respiratory Alkalosis pH > 7.45;CO2 <35
Decreased [CO2] , decrease [H+]
Causes : HYPERVENTILATION
*asthma *pneumonia * inappropriate ventilator
settings * anxiety * hypermetabolic states, CNS
disorders *salicylate overdose
S &S : *dizziness *confusion *dysthrythmia *
tachypneu *numbness & tingling *convultions
*coma.
11
Laboratory Analysis
Blood creatinine (kidney function)
BUN (blood urea nitrogen) : kidney
function
Urine specific gravity
Blood gases
12
Assessing Blood Gases
1st, Look at pH
[>7.45 = alkalosis; <7.35 = acidosis].
2nd. Check [CO2] (should move in opposite
direction as pH).
- abnormal --> respiratory cause
- normal --> metabolic cause
3rd. Evaluate [HCO3-]
- abnormal --> metabolic cause
- normal --> respiratory cause
13
Assessing blood gases (cont)
4th. Both [CO2 ]& [HCO3-] abnormal ?
- Which more closely corresponds
to pH and deviates more from normal ?
14
A Case example
Female 21 yrs old
4 yr history of type 1 of DM
hospitalized due to coma
insulin injection 92 u regularly
Blood pressure 92/20
pulse 122/min
deep respirations = 32/min
15
Lab Data (conted)
Serum glucose = 1200 mg/dL
hematocrit = 49%
Na+ = 134 meq/L
K+ = 6.4 meq/L
BUN(blood urea nitrogen)= 74 mg/dL
pH = 6.80
pCO2 = 10 mm Hg
plasma ketones = ++++
16
Therapy (conted)
8 u regular insulin --> IV
8 u insulin IV by infusion pump
Results :
serum glucose decrease 100 mg/dL/hr
in 7 hr, ventilation + blood pH --> normal
following IV injection of NaHCO3 & vigorous
fluid & electrolyte replacement
17
Biochemical questions
1. Describe the mechanism of acid base
imbalance
2. Calculate [total CO2]
3. Explain the purpose of NaHCO3 injection &
fluid replacement
4. What electrolyte replacement should be
given IV ?
18
Explanation
1. Acid base imbalance:
loss of body fluid -->low systolic/diastolic
(hematocrit is high --> dehydration)
pH 6.80 --> extreme acidosis caused by
production of ketone bodies (acetoacetic acid,
-OH-butyrate)
compensation: increase respiration rate =
32/min (normal= 12-15/min). --> to decrease
CO2
19
Conted
Low blood pressure --> decreased GFR
--> metab of urea from amino acid increases --
> 74 (normal = 20-40)
The acid-base imbalance derives from :
- Ketone bodies production >>
- hyperventilation
- kidney function impaires
20
2. Total [CO2]
H+ + HCO3- <---> H2CO3 <---> H2O + CO2 --->
expired
pH = 6.1 + log [total CO2] - 0.0301 pCO2
0.0301 pCO2
6.8 = 6.1 + log [total CO2] - 0.0301 x 10
0.0301 x 10
log [total CO2] - 0.301 = 0.7
0.301
21
Conted
[total CO2] - 0.301 = 5.01
0.301
Total CO2 = (1.508 + 0.301) =1.8 meq/L
[HCO3-] = (1.8- 0.3) = 1.5 meq/L
22
3. NaHCO3 injection was needed
Principle buffer system in ECF (extracellular
fluids) --> exhausted because it was utilized
to neutralize the H+ produced by ketosis -->
NaHCO3 injection is needed quickly.
23
4. The osmolarity of electrolyte replacement ?
-[Na+ + K+] = 140 meq/L (>normal)= same conc
to anion
-MW of glucose = 180; urea = 60.
-Glucose = 1200 x 1000 = 70 meq/L
180 100
-urea = 74 x 1000 = 12 meq/L
60 100
-The osmolarity = 140 + 140 + 70 + 12 = 362
mosm (n = 285-295 mosm)
Thank you very much
24
