1. Acid, Base, Electrolytes Regulation for BALANCE

2. Fluid Compartments

3. Fluid Compartments: 20 – 40 – 60 Rule

4. Fluid Movement

5. Water and Electrolyte Balance Input = output Hormones Na+ / K+ Renin Aldosterone ANP Reproductive Hormones GCC Ca++ / Mg++ Calcitonin PTH H2O ADH Anions follows passively Cl- HCO3-

6. Electrolyte Fluid Composition

7. Cations and Anions balance for Electroneutrality

8. Acid Base Terms Define pH Acid Strong Weak Volatile : CO2 from CH20 and Fat Metabolism Nonvolatile: H2SO4, H2PO4 from protein metabolism Base Strong Weak Salt Buffer

9. Acid Sources

11. pH Define pH = log (1/[H+]) pH = -log [H3O+] Water Dissociation H2O + H2O  H3O+ + OH- Scale Blood values Venous Arterial Abnormal Values Acidemia Alkalemia

12. pH formula and scale

13. Acid Base Chart

14. pH of Solutions

15. Acid Base Regulation for Balance Systems Chemical Buffer Systems Respiratory System Renal Time Seconds to Minutes Minutes to Hours Hours to Days / Weeks Strength Problems (reference 7.4 as normal average): + / - 0.1 changes result in respiratory rate changes + / - 0.2 to 0.3 changes result in CV and Nervous changes + / - 0.4 to 0.5 changes result in death

16. Chemical Buffer Systems Define 3 types Name of System Buffer formula or name of chemical Location Effectiveness [pKa buffer = pH location] Why important

17. pH changes with/without buffers

18. Buffer Effectiveness HA  [H+] + [A-] pKa = -logKa

19. Titration of Buffer System

20. pK of Bicarbonate System

21. Formulas K = [H+] [HCO3-] / [H2CO3] pH = log (1 / [H+]) Henderson-Hasselbach Equation: CO2 is directly related to H2CO3, as CO2 + H20  H2CO3; can substitute this equivalent [amount x solubility coefficient] in the above equation (0.03 X pCO2)

22. Bicarbonate Chemical Buffer H2CO3, HCO3- Plasma buffer pK = 6.1 Important: Can measure components pCO2 = 40 mmHg HCO3- = 24 mM Can adjust concentration / ratio of components HCO3- @ kidneys CO2 @ lungs Recalculate pH of buffer system in ECF using Henderson-Hasselbach pH = 6.1 + log(24 / 0.03x40) pH = 6.1 + log (20/1) pH = 7.4

23. Bicarbonate pK

24. Bicarbonate Buffer System

25. Phosphate Chemical Buffer H2PO4-, HPO4= ICF, Urine pK = 6.8 Important Intracellular buffer ICF pH = ~ 6.5 – 6.8 Renal Tubular Fluids Urine pH ranges 6.0 – 7.0

26. Protein Chemical Buffer Proteins With Histadine: AA contain imidazole ring, pKa = 7.0 R-COOH  R-COO- + H+ R-NH2  R-NH3+ ICF (hemoglobin), ECF pK = 7.4 Important Most numerous chemicals Most powerful chemical buffer

27. Proteins in acid base

28. Acid-Base Properties of Alanine

29. Hemoglobin

30. Protein Chains

31. Hemoglobin Buffer for H+

32. CO2 transport and RBC buffer

33. Respiratory for A/B Balance Occurs in minutes CO2 only Rate changes

34. Respiratory Controls for Acid /Base balance Volatile Acid: CO2 pH changes in CSF Respiratory Rate Pons Medulla Oblongata Chemoreceptors pCO2 pO2

35. CO2 and pH Increase CO2 Increase H+ Decrease pH Decrease CO2 Decrease H+ Increase pH

36. Renal Control for Long Term Acid / Base Balance

37. Renal processes in A/B balance

38. Renal Physiology Filtration Remove metabolic acids: Ketones, Uric acid Filter Base [HCO3-] @ Renal Filtration Membrane Reabsorption Base @ PCT Reverse CO2 equation to create HCO3- Secretion H+ @ PCT, late DCT and Cortical CD CO2 equation to create H+ for secretion

39. Renal Mechanisms for A/B

40. Renal Ion Exchanges Na+ / K+ antiporter Na+ / H+ antiporter Na+ / HCO3- cotrans H+ / K+ ATPase H+ ATPase Cl- / HCO3- exchanger

41. Renal Reabsorption of HCO3-

42. Renal Movement of Ions and CO2, HCO3-, and H+  Acidic Urine

43. Renal Tubular Buffer: Phosphate Buffer System

44. Use of HPO4 buffer system

45. Ammonium Buffer System in Renal Tubules Deamination of Glutamine creates HCO3- for more base creates NH3 for buffering H+

46. Increase of HCO3- Buffer

47. Renal Buffer Mechanisms

49. Normal Acid Base Values

50. Respiratory and Renal Balance

51. Acid-Base Problems Acidosis State of excess H+ Acidemia Blood pH < 7.35 Alkalosis State of excess HCO3- Alkalemia Blood pH >7.45

52. Classifying Respiratory Acid Base Problems (pCO2 changes) Respiratory Acidosis Respiratory Rate Decreases Any Respiratory Disease Obstruction Pneumonia Gas exchange / transport problems Respiratory Membrane RBC / Hemoglobin Respiratory Alkalosis Respiratory Rate Increases

54. Classifying Metabolic Acid Base Balance Problems (H+/ HCO3-) Systems Renal Endocrine GI Cardiovascular / Fluid administration Metabolic Acidosis Retain Acid Lose Base Metabolic Alkalosis Retain Base Lose Acid

58. Other System diseases in Metabolic Acid/Base Problems GI Vomiting Diarrhea Medications : Antacids Endocrine DM Hyperaldosteronism Metabolism Increase acid production

59. Ketones

62. ECF Cations, Anions, and Anion Gap Anion Gap Difference between major plasma cations and major plasma anions AG = ([Na+] + [K+]) – ([Cl-] + [HCO3-]) Normal AG = 12 +/- 4 Check in metabolic Acidosis to help identify non-measured acids

63. Compensation

64. Adjustments for Acid/Base Balance Imbalance Respiratory Acidosis Incr pCO2 Respiratory Alkalosis Decr pCO2 Metabolic Acidosis Decr HCO3- Incr H+ Metabolic Alkalosis Incr HCO3- Decr H+ Compensation Increase renal acid excretion, Incr HCO3- Decrease renal acid excretion, decr HCO3- Hyperventilate to lower pCO2 Hypoventilate to increase pCO2

65. Compensation Summary

66. Summary for A/B Balance