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COMPOSITION OF THE HUMAN
BODY:
FLUIDS, ELECTROLYTES AND ACID-
BASE BALANCE
Dr. Matwa Christopher
BSc[Hons]-physio; MBChB; MMed-PRAS (UoN)
OBJECTIVES
 Students should understand the following at the
end of the presentation:
 Chemical & fluid composition of the body
 The normal concentrations of the body chemicals and
fluids
 The major two body compartments and distribution of
chemicals & fluids therein
 Factors affecting chemical and fluid distribution in body
compartments
 Regulation of chemical and fluid distribution
INTRODUCTION :
CHEMICAL LEVEL OF ORGANISMS
 Living material is composed of free elements, ions,
radicals, molecules and compounds.
 Four elements compose of over 95% of the body.
 Hydrogen (H) 10%,
 Oxygen (0) 65%,
 Carbon (c) 18 % and
 Nitrogen (N) 3 %.
 Additional elements common to the body include
calcium (Ca), Sodium (Na), Potassium (K)
Phosphorus (P), Sulfur (S) and Magnesium (Mn).
 These elements combine to form macromolecules
that make up the cells
BODY COMPOSITION
 In an average young adult male,
 60-70% is water
 15-20% is fat
 15-18% of the body weight is protein and related
substances
 5-7% is minerals, nucleic acids, radicals
% OF BODY WEIGHT
Material MALE FEMALE
Water
Protein
Lipids
Carbohydrates
Others (nucleic) acids, radicals
62
18
14
1
5
59
15
20
1
5
BODY FLUIDS AND COMPARTMENTS
 Water.
 The principal fluid medium of the cell
 Present in most cells, except for fat cells, in a
concentration of 70 to 85 per cent.
 Many cellular chemicals are dissolved in the water.
 Others are suspended in the water as solid particulates.
 Chemical reactions take place among the dissolved
chemicals or at the surfaces of the suspended particles
or membranes.
 Directly related to muscle mass (70% water)
 Inversely related to fat content (10% water)
TWO MAJOR COMPARTMENTS OF BODY WATER
 Intracellular fluid
 Cytosol
 40% of total body weight or
 2/3 of total body water
 Extracellular fluid
 Interstitial fluid, plasma, lymph, CSF, synovial fluid,
serous fluid, etc
 20% of total body weight or
 1/3 of total body water
CONT’D
Comparment % total body water
Cytosol 62.5
Plasma 7
Connective tissue 5
Interstitial fluid and lymph 18
Bone 5
Transcellular 2.5
CLINICAL IMPLICATION OF FLUID
COMPARTMENTS
 Dehydration
 Shock (hypovolemic)
 Electrolyte imbalances
 Hypokalemia
 Hyponatremia
 Hypocalcemia
 Infections
 Sepsis
 Shock (septic)
CONT’D
 Stabilizing ECF and ICF involves:
 1) Fluid Balance
 Must have equal gain (food & metabolism) and loss (urine &
perspiration) of water
 2) Electrolyte Balance
 Electrolytes = ions from dissociated compounds that will conduct
an electrical charge in solution
 Must have equal gain (absorption in GI) and loss (urine in kidney
and perspiration in skin)
 3) Acid-Base Balance
 The production of hydrogen ions by metabolism must be matched
by loss of these H+ ions at the kidney and lungs (carbonic acid)
 How is stabilization achieved?
 Homeostasis: the regulation of composition and volume of
both fluid divisions
FLUID FLOW
 Diffusion
 Movement of particles down a concentration gradient.
 Osmosis
 Movement of solvent molecules into a region of higher solute
concentration across a semipermeable membrane
impermeable to the solute
 Active transport
 Movement of particles up a concentration gradient ; requires
energy
 Movement of fluids due to:
 hydrostatic pressure
 Capillary filtration
 Interstitial hydrostatic pressure
 osmotic pressure
 Capillary colloidal osmotic pressure
 Tissue colloid osmotic pressure
FLUID BALANCE
 There is continuous flow between ICF and ECF and
the external environment:-
 The flow between ICF and ECF:-
 Hydrostatic pressure pushes water from the plasma into
the interstitial fluid
 Colloid osmotic pressure draws water from the interstitial
fluid to the plasma
FLUID BALANCE
 Fluid exchange between environment and ECF:-
 Water losses (2500mL/day)
 Insensible loss
 Cannot be controlled or measured
 Includes fecal, respiration, skin evaporations and perspiration
losses
 40-600mL/day
 Obligatory loss
 Minimal amount of urine needed to excrete metabolic wastes
 600mL/day
 Facultative or sensible loss
 Controlled and measured
 Urine loss
 1500mL/day
FLUID BALANCE
 Water Gains
 Must match water losses or dehydration will result
 1000 mL from drink,1200 mL from food and 300 mL
metabolic “waste”
 Systems of gain: GIT – intake
 Systems of loss:
 GIT – fecal (diarrhea)
 Renal – urine
 Integumentary, Respiratory – insensible
 Applies to electrolytes and acid/bases
ELECTROLYTES
 The electrolytes vary depending on the fluid division:
 ECF
 Principal cation = Na+
 Principal anions = Cl- , HCO3-
 ICF
 Principal cation = K+, Mg2+
 Principal anions = HPO4
2- and negatively charged proteins-
 Although different ions dominate, both fluid divisions
have the same osmotic concentrations.
 The ions cannot pass freely through cell membranes,
but the water can by osmosis, and will move to
equilibrium.
 Thus, solute/electrolyte concentrations of the fluid
divisions will directly impact water distribution
ELECTROLYTE BALANCE
 Sodium
 Major ECF ion
 Where sodium goes, water follows
 The total amount of Na+ in the ECF is due to a balance
between Na+ uptake in the digestive system and Na+
excretion in urine and perspiration.
 The overall sodium concentration in body fluids rarely
changes because water always moves to compensate
 Minor gains and losses of Na+ in the ECF are
compensated by water in the ICF and later adjusted by
hormonal activities:
 ECF volume too low → renin-angiotensin system is activated
to conserve water and Na+
 ECF volume too high → natriuretic peptides released: block
ADH and aldosterone resulting in water and Na+ loss
CONT’D
 Potassium
 Major ICF ion
 Amount in concentration determined by GIT absorption
and renal excretion in exchange with Na+
 The rate of tubular secretion of K+ in the kidney is
controlled by three factors:
 Changes in the K+ concentration of the ECF
 ↑ K+ in ECF = ↑ K+ secretion
 Changes in blood pH:- acidosis causes hyperkalemia
 at low pH, H+ shifts K+ out of cells into ECF
 In renal tubules, K+ at the exchange pump is ↓ as Na+ is
exchanged with H+ = ↓ K+ secretion (K+ accumulates)
 Aldosterone levels
 ↑ aldosterone = ↑ Na+ reabsorption and ↑ K+ secretion
 The most important factor in Acid –Bade balance is
the maintenance of hydrogen ion concentration of
ECF within the range that is optimal for survival of
the organism.
 Function of cells are very sensitive to changes in H+
ion concentration.
 Intracellular H+ ion concentration is dependent on
ECF H+ ion concentration
ACID – BASE BALANCE
CONT’D
 H+ ion concentration in blood is very low compared to
other cations thus:
 The normal plasma Na+ ion concentration is 145 meq/l,
 K+ is 5 meq/l and
 [H+] is 0.00004 meq/l.
 The pH therefore is a more sensible way of denoting
[H+] as it’s the negative logarithm of [H+].
 Negative logarithm of 0.00004 = pH = 7.4,
 NB a decrease of pH of one unit means a 10 fold increase in
H+ concentration i.e. from 7 to 6.
 pH of blood = True pH of plasma
 Plasma pH is in equilibrium with that of RBC because RBCs
contain hemoglobin which is one of the most important blood
buffers
PH AND BUFFERING
 Acid
 A substance that dissociates to release H+ ions
 Base
 A substance that dissociates to release OH- ions or absorbs H+ ions.
 The pH scale is used to measure the concentration of H+ ions in a
solution
 pH = potential of Hydrogen
 Water is neutral: H+ = OH-, pH 7
 An acid solution
 pH O - 7
 has more H+ than OH-
 A basic or alkaline solution
 pH 7 – 14
 has more OH- than H+
 Strong acids or bases dissociate completely in solution
 Weak acids or bases do not completely dissociate: many
molecules remain intact
CONT’D
 Normal pH of the ECF = 7.35 – 7.45.
 Above or below this range will disrupt cell
membranes and denature proteins
 Acidosis = ECF pH below 7.35
 Alkalosis = ECF pH above 7.45
 Acidosis is the more common problem since
metabolism generates acid waste products
CONT’D
 Types of Acids
 Volatile Acids
 Can leave solution and enter the atmosphere
 CO2 + H2O ↔ H2CO3- ↔ H+ + HCO3-
lungs blood
 Fixed Acids
 Remain in solution until they are excreted e.g. sulfuric acid,
phosphoric acid
 Organic Acids
 The products of metabolism
 These are usually metabolized into other wastes, but they can
build up under anaerobic conditions or starvation e.g. Lactic acid,
Ketone bodies
ACID/ ALKALINE SOURCES
 Sources of Hydrogen ion.
 Dietary – degradation of protein yield sulphates and phosphates
which hydrate them.
 SO4 + H+ + OH – H2 SO4
 PO4 + 3H – H3PO4
 H+ load from this source is 150 meq/day
 Other common sources of extra hydrogen ions include:
 Strenuous exercise
 lactic acid
 Diabetic ketoacidosis
 Acetoacetic and B-hydroxybutyric acid.
 Ingestion of acidifying salts i.e.
 NH4Cl
 CaCl2
 The net effect of these acids is to add HCl to blood
 Failure of kidneys due to kidney disease to excrete H+
 Has net effect of increasing H+ ion concentration in blood.
CONT’D
 Sources of Alkali
 Fruits are main source of Alkali because they contain K+
and Na+ salts of weak organic acids
 the anion of these salts are metabolized to CO2 leaving
NaHCO3 and KHCO3 in body.
 NaHCO3 and other alkalinizing salts are sometimes
ingested in large amounts e.g. baking soda.
 Commonest cause of Alkaloses is vomiting due to loss
of gastric HCL
 Increase in PCO2 result in respiratory acidosis and a
decrease mean respiratory alkalosis.
 When acidosis and alkalosis occur changes are produced in
the kidneys which then tend to compensate for acidosis or
alkalosis hence adjusting the pH towards normal
MECHANISM OF PH CONTROL
 Buffers
 Dissolved compounds that can remove H+ ions to
stabilize pH
 Usually buffers are a weak acid and its
corresponding salt
 Three major buffering systems:
 The Protein Buffer System
 The carbonic acid – bicarbonate buffer system
 Phosphate buffer system
PROTEIN BUFFER SYSTEM
 Proteins are used to regulate pH in the ECF and ICF
(most effective in the ICF)
 Amino acids can be used to accept or release H+ ions:
 At typical body pH, most carboxyl groups exist as COO- and
can accept H+ ions if the pH begins to drop
 Histidine and Cysteine remain as COOH at normal pH and
can donate H+ if the pH rises.
 All proteins can provide some degree of buffering with
their carboxyl terminal.
 Hemoglobin can have a great effect on blood pH
 The Hemoglobin (Hb) Buffering System
 Most effective in the ECF: blood
 In RBCs the enzyme carbonic anhydrase converts CO2 into
H2CO3 which then dissociates
 The H+ remains inside RBCs, but the HCO3- enters the
plasma where it can absorb excess H+
CARBONIC ACID – BICARBONATE BUFFER
SYSTEM
 The most important buffer for the ECF (free in plasma or
aided by Hb)
 Carbon dioxide and water form carbonic acid which
dissociates into hydrogen ions and bicarbonate ions
 The bicarbonate ions can be used to absorb excess H+ ions
in the ECF and then can be released as CO2 and H2O at the
lungs
 This buffering only works if:
 CO2 levels are normal
 Respiration is functioning normally
 Free bicarbonate ions are available
 Bicarbonate ions can be generated from
 CO2 + H2O or
 NaHCO3-
 but to have free HCO3-, H+ ions must be excreted at the kidney
PHOSPHATE BUFFER SYSTEM
 Phosphate is used to
buffer ICF and urine
 H2PO4 or Na2PO4 can
dissociate to generate
 HPO4
2-, which can
absorb H+
 As long as H+ is
excreted at the kidney
MAINTENANCE OF ACID – BASE
 Buffering will only temporarily solve the H+ problem:
permanent removal as CO2 at the lungs or through
secretion at the kidney is necessary to maintain pH near
neutral
 pH homeostasis:
 Respiratory Compensation
 Respiration rate is altered to control pH
 ↑ CO2 = ↓ pH
 ↓ CO2 = ↑ pH
 Renal Compensation
 The rate of H+ and HCO3- secretion or reabsorption can be
altered as necessary
 ↑ H+ = ↓ pH
 ↑ HCO3- = ↑ pH
RESPIRATORY ACIDOSIS AND ALKALOSIS
 Changes in arterial pCO2 from any cause will affect
the [H2CO3]/HCO-
3} ratio and hence the pH
 Rise in pCO2 means a rise in H2CO3 and resulting
in HCO-
3 and consequently a rise of [H+]. The
overall net effect is a fall in pH and vice versa
 Resp. acidosis
 Hypoventilation:
 in CNS depression, drugs, illnesses like mysthenia gravis
 Build up of CO2 hence reduced pH
 Resp. alkalosis
 Hyperventilation
 CNS disorders, drugs, increased ammonia, pregnancy
 Blow out of CO2 hence increase in pH
METABOLIC ACIDOSIS AND ALKALOSIS
 Metabolic acidosis
 When body is producing too much acid or renal failure
to excrete H+
 Anion gap classification
 Increased anion gap:
 Ketoacidosis
 Lactic acidosis
 Chronic renal failure
 Intoxication ie methanol
 Normal anion gap
 Intractable diarrhea
 Renal tubular acidosis
 intoxication
CONT’D
 Metabolic alkalosis
 Renal loss of H+
 Excessive retaining of HCO3-
 Hyperaldosteremia
 Alkalotic agents eg ie excessive antiacids
UNCOMPENSATED METABOLIC ACIDOSIS OR
ALKALOSIS
 Before renal mechanisms which are far much slower sets in,
the respiratory system has the very important duty of either
decreasing [H+] or adding up [H+] into the blood system.
 In metabolic alkalosis, H+ ions are depleted from blood
evoking respiratory response of inhibiting ventilation thus
resulting in CO2 build up in blood.
 In metabolic acidosis, the acid anions that replace HCO-
3 are
excreted in combination with a cation principally Na+
effectively maintaining electrical neutrality.
 Note, for each H+ lost in urine one Na+ + one HCO-
3 are
reabsorbed.
 The H+ in urine must be buffered to prevent decrease of pH to
below 4.5 which is injurious to cells.
 Urine H+ is buffered by
 HCO-
3 system which results H2O + CO2,
 HPO4 + H+ results in - H2PO4 and
 with NH3 to NH+
4
POTASSIUM METABOLISM AND ACID BASE
BALANCE
 K+ ion and H+ ion produce parallel effect in plasma,
 when there’s excess of H+ ion in plasma, K+ ion is
reabsorbed by renal tubule as H+ ion is lost.
 In case of excess of K+ ion, K+ ion is lost by renal tubule
as H+ ion is reabsorbed ,
 When H+ ion is low, K+ ion is lost as H+ ion is
reabsorbed and when H+ ion is in excess H+ ion is lost
as K+ ions is reabsorbed.
Thank YOU

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Human Body Fluids, Electrolytes and Acid-Base Balance

  • 1. COMPOSITION OF THE HUMAN BODY: FLUIDS, ELECTROLYTES AND ACID- BASE BALANCE Dr. Matwa Christopher BSc[Hons]-physio; MBChB; MMed-PRAS (UoN)
  • 2. OBJECTIVES  Students should understand the following at the end of the presentation:  Chemical & fluid composition of the body  The normal concentrations of the body chemicals and fluids  The major two body compartments and distribution of chemicals & fluids therein  Factors affecting chemical and fluid distribution in body compartments  Regulation of chemical and fluid distribution
  • 3. INTRODUCTION : CHEMICAL LEVEL OF ORGANISMS  Living material is composed of free elements, ions, radicals, molecules and compounds.  Four elements compose of over 95% of the body.  Hydrogen (H) 10%,  Oxygen (0) 65%,  Carbon (c) 18 % and  Nitrogen (N) 3 %.  Additional elements common to the body include calcium (Ca), Sodium (Na), Potassium (K) Phosphorus (P), Sulfur (S) and Magnesium (Mn).  These elements combine to form macromolecules that make up the cells
  • 4. BODY COMPOSITION  In an average young adult male,  60-70% is water  15-20% is fat  15-18% of the body weight is protein and related substances  5-7% is minerals, nucleic acids, radicals % OF BODY WEIGHT Material MALE FEMALE Water Protein Lipids Carbohydrates Others (nucleic) acids, radicals 62 18 14 1 5 59 15 20 1 5
  • 5. BODY FLUIDS AND COMPARTMENTS  Water.  The principal fluid medium of the cell  Present in most cells, except for fat cells, in a concentration of 70 to 85 per cent.  Many cellular chemicals are dissolved in the water.  Others are suspended in the water as solid particulates.  Chemical reactions take place among the dissolved chemicals or at the surfaces of the suspended particles or membranes.  Directly related to muscle mass (70% water)  Inversely related to fat content (10% water)
  • 6. TWO MAJOR COMPARTMENTS OF BODY WATER  Intracellular fluid  Cytosol  40% of total body weight or  2/3 of total body water  Extracellular fluid  Interstitial fluid, plasma, lymph, CSF, synovial fluid, serous fluid, etc  20% of total body weight or  1/3 of total body water
  • 7.
  • 8. CONT’D Comparment % total body water Cytosol 62.5 Plasma 7 Connective tissue 5 Interstitial fluid and lymph 18 Bone 5 Transcellular 2.5
  • 9. CLINICAL IMPLICATION OF FLUID COMPARTMENTS  Dehydration  Shock (hypovolemic)  Electrolyte imbalances  Hypokalemia  Hyponatremia  Hypocalcemia  Infections  Sepsis  Shock (septic)
  • 10. CONT’D  Stabilizing ECF and ICF involves:  1) Fluid Balance  Must have equal gain (food & metabolism) and loss (urine & perspiration) of water  2) Electrolyte Balance  Electrolytes = ions from dissociated compounds that will conduct an electrical charge in solution  Must have equal gain (absorption in GI) and loss (urine in kidney and perspiration in skin)  3) Acid-Base Balance  The production of hydrogen ions by metabolism must be matched by loss of these H+ ions at the kidney and lungs (carbonic acid)  How is stabilization achieved?  Homeostasis: the regulation of composition and volume of both fluid divisions
  • 11. FLUID FLOW  Diffusion  Movement of particles down a concentration gradient.  Osmosis  Movement of solvent molecules into a region of higher solute concentration across a semipermeable membrane impermeable to the solute  Active transport  Movement of particles up a concentration gradient ; requires energy  Movement of fluids due to:  hydrostatic pressure  Capillary filtration  Interstitial hydrostatic pressure  osmotic pressure  Capillary colloidal osmotic pressure  Tissue colloid osmotic pressure
  • 12. FLUID BALANCE  There is continuous flow between ICF and ECF and the external environment:-  The flow between ICF and ECF:-  Hydrostatic pressure pushes water from the plasma into the interstitial fluid  Colloid osmotic pressure draws water from the interstitial fluid to the plasma
  • 13. FLUID BALANCE  Fluid exchange between environment and ECF:-  Water losses (2500mL/day)  Insensible loss  Cannot be controlled or measured  Includes fecal, respiration, skin evaporations and perspiration losses  40-600mL/day  Obligatory loss  Minimal amount of urine needed to excrete metabolic wastes  600mL/day  Facultative or sensible loss  Controlled and measured  Urine loss  1500mL/day
  • 14. FLUID BALANCE  Water Gains  Must match water losses or dehydration will result  1000 mL from drink,1200 mL from food and 300 mL metabolic “waste”  Systems of gain: GIT – intake  Systems of loss:  GIT – fecal (diarrhea)  Renal – urine  Integumentary, Respiratory – insensible  Applies to electrolytes and acid/bases
  • 15. ELECTROLYTES  The electrolytes vary depending on the fluid division:  ECF  Principal cation = Na+  Principal anions = Cl- , HCO3-  ICF  Principal cation = K+, Mg2+  Principal anions = HPO4 2- and negatively charged proteins-  Although different ions dominate, both fluid divisions have the same osmotic concentrations.  The ions cannot pass freely through cell membranes, but the water can by osmosis, and will move to equilibrium.  Thus, solute/electrolyte concentrations of the fluid divisions will directly impact water distribution
  • 16.
  • 17. ELECTROLYTE BALANCE  Sodium  Major ECF ion  Where sodium goes, water follows  The total amount of Na+ in the ECF is due to a balance between Na+ uptake in the digestive system and Na+ excretion in urine and perspiration.  The overall sodium concentration in body fluids rarely changes because water always moves to compensate  Minor gains and losses of Na+ in the ECF are compensated by water in the ICF and later adjusted by hormonal activities:  ECF volume too low → renin-angiotensin system is activated to conserve water and Na+  ECF volume too high → natriuretic peptides released: block ADH and aldosterone resulting in water and Na+ loss
  • 18. CONT’D  Potassium  Major ICF ion  Amount in concentration determined by GIT absorption and renal excretion in exchange with Na+  The rate of tubular secretion of K+ in the kidney is controlled by three factors:  Changes in the K+ concentration of the ECF  ↑ K+ in ECF = ↑ K+ secretion  Changes in blood pH:- acidosis causes hyperkalemia  at low pH, H+ shifts K+ out of cells into ECF  In renal tubules, K+ at the exchange pump is ↓ as Na+ is exchanged with H+ = ↓ K+ secretion (K+ accumulates)  Aldosterone levels  ↑ aldosterone = ↑ Na+ reabsorption and ↑ K+ secretion
  • 19.  The most important factor in Acid –Bade balance is the maintenance of hydrogen ion concentration of ECF within the range that is optimal for survival of the organism.  Function of cells are very sensitive to changes in H+ ion concentration.  Intracellular H+ ion concentration is dependent on ECF H+ ion concentration ACID – BASE BALANCE
  • 20. CONT’D  H+ ion concentration in blood is very low compared to other cations thus:  The normal plasma Na+ ion concentration is 145 meq/l,  K+ is 5 meq/l and  [H+] is 0.00004 meq/l.  The pH therefore is a more sensible way of denoting [H+] as it’s the negative logarithm of [H+].  Negative logarithm of 0.00004 = pH = 7.4,  NB a decrease of pH of one unit means a 10 fold increase in H+ concentration i.e. from 7 to 6.  pH of blood = True pH of plasma  Plasma pH is in equilibrium with that of RBC because RBCs contain hemoglobin which is one of the most important blood buffers
  • 21. PH AND BUFFERING  Acid  A substance that dissociates to release H+ ions  Base  A substance that dissociates to release OH- ions or absorbs H+ ions.  The pH scale is used to measure the concentration of H+ ions in a solution  pH = potential of Hydrogen  Water is neutral: H+ = OH-, pH 7  An acid solution  pH O - 7  has more H+ than OH-  A basic or alkaline solution  pH 7 – 14  has more OH- than H+  Strong acids or bases dissociate completely in solution  Weak acids or bases do not completely dissociate: many molecules remain intact
  • 22. CONT’D  Normal pH of the ECF = 7.35 – 7.45.  Above or below this range will disrupt cell membranes and denature proteins  Acidosis = ECF pH below 7.35  Alkalosis = ECF pH above 7.45  Acidosis is the more common problem since metabolism generates acid waste products
  • 23. CONT’D  Types of Acids  Volatile Acids  Can leave solution and enter the atmosphere  CO2 + H2O ↔ H2CO3- ↔ H+ + HCO3- lungs blood  Fixed Acids  Remain in solution until they are excreted e.g. sulfuric acid, phosphoric acid  Organic Acids  The products of metabolism  These are usually metabolized into other wastes, but they can build up under anaerobic conditions or starvation e.g. Lactic acid, Ketone bodies
  • 24. ACID/ ALKALINE SOURCES  Sources of Hydrogen ion.  Dietary – degradation of protein yield sulphates and phosphates which hydrate them.  SO4 + H+ + OH – H2 SO4  PO4 + 3H – H3PO4  H+ load from this source is 150 meq/day  Other common sources of extra hydrogen ions include:  Strenuous exercise  lactic acid  Diabetic ketoacidosis  Acetoacetic and B-hydroxybutyric acid.  Ingestion of acidifying salts i.e.  NH4Cl  CaCl2  The net effect of these acids is to add HCl to blood  Failure of kidneys due to kidney disease to excrete H+  Has net effect of increasing H+ ion concentration in blood.
  • 25. CONT’D  Sources of Alkali  Fruits are main source of Alkali because they contain K+ and Na+ salts of weak organic acids  the anion of these salts are metabolized to CO2 leaving NaHCO3 and KHCO3 in body.  NaHCO3 and other alkalinizing salts are sometimes ingested in large amounts e.g. baking soda.  Commonest cause of Alkaloses is vomiting due to loss of gastric HCL  Increase in PCO2 result in respiratory acidosis and a decrease mean respiratory alkalosis.  When acidosis and alkalosis occur changes are produced in the kidneys which then tend to compensate for acidosis or alkalosis hence adjusting the pH towards normal
  • 26. MECHANISM OF PH CONTROL  Buffers  Dissolved compounds that can remove H+ ions to stabilize pH  Usually buffers are a weak acid and its corresponding salt  Three major buffering systems:  The Protein Buffer System  The carbonic acid – bicarbonate buffer system  Phosphate buffer system
  • 27. PROTEIN BUFFER SYSTEM  Proteins are used to regulate pH in the ECF and ICF (most effective in the ICF)  Amino acids can be used to accept or release H+ ions:  At typical body pH, most carboxyl groups exist as COO- and can accept H+ ions if the pH begins to drop  Histidine and Cysteine remain as COOH at normal pH and can donate H+ if the pH rises.  All proteins can provide some degree of buffering with their carboxyl terminal.  Hemoglobin can have a great effect on blood pH  The Hemoglobin (Hb) Buffering System  Most effective in the ECF: blood  In RBCs the enzyme carbonic anhydrase converts CO2 into H2CO3 which then dissociates  The H+ remains inside RBCs, but the HCO3- enters the plasma where it can absorb excess H+
  • 28.
  • 29. CARBONIC ACID – BICARBONATE BUFFER SYSTEM  The most important buffer for the ECF (free in plasma or aided by Hb)  Carbon dioxide and water form carbonic acid which dissociates into hydrogen ions and bicarbonate ions  The bicarbonate ions can be used to absorb excess H+ ions in the ECF and then can be released as CO2 and H2O at the lungs  This buffering only works if:  CO2 levels are normal  Respiration is functioning normally  Free bicarbonate ions are available  Bicarbonate ions can be generated from  CO2 + H2O or  NaHCO3-  but to have free HCO3-, H+ ions must be excreted at the kidney
  • 30. PHOSPHATE BUFFER SYSTEM  Phosphate is used to buffer ICF and urine  H2PO4 or Na2PO4 can dissociate to generate  HPO4 2-, which can absorb H+  As long as H+ is excreted at the kidney
  • 31. MAINTENANCE OF ACID – BASE  Buffering will only temporarily solve the H+ problem: permanent removal as CO2 at the lungs or through secretion at the kidney is necessary to maintain pH near neutral  pH homeostasis:  Respiratory Compensation  Respiration rate is altered to control pH  ↑ CO2 = ↓ pH  ↓ CO2 = ↑ pH  Renal Compensation  The rate of H+ and HCO3- secretion or reabsorption can be altered as necessary  ↑ H+ = ↓ pH  ↑ HCO3- = ↑ pH
  • 32. RESPIRATORY ACIDOSIS AND ALKALOSIS  Changes in arterial pCO2 from any cause will affect the [H2CO3]/HCO- 3} ratio and hence the pH  Rise in pCO2 means a rise in H2CO3 and resulting in HCO- 3 and consequently a rise of [H+]. The overall net effect is a fall in pH and vice versa  Resp. acidosis  Hypoventilation:  in CNS depression, drugs, illnesses like mysthenia gravis  Build up of CO2 hence reduced pH  Resp. alkalosis  Hyperventilation  CNS disorders, drugs, increased ammonia, pregnancy  Blow out of CO2 hence increase in pH
  • 33. METABOLIC ACIDOSIS AND ALKALOSIS  Metabolic acidosis  When body is producing too much acid or renal failure to excrete H+  Anion gap classification  Increased anion gap:  Ketoacidosis  Lactic acidosis  Chronic renal failure  Intoxication ie methanol  Normal anion gap  Intractable diarrhea  Renal tubular acidosis  intoxication
  • 34. CONT’D  Metabolic alkalosis  Renal loss of H+  Excessive retaining of HCO3-  Hyperaldosteremia  Alkalotic agents eg ie excessive antiacids
  • 35. UNCOMPENSATED METABOLIC ACIDOSIS OR ALKALOSIS  Before renal mechanisms which are far much slower sets in, the respiratory system has the very important duty of either decreasing [H+] or adding up [H+] into the blood system.  In metabolic alkalosis, H+ ions are depleted from blood evoking respiratory response of inhibiting ventilation thus resulting in CO2 build up in blood.  In metabolic acidosis, the acid anions that replace HCO- 3 are excreted in combination with a cation principally Na+ effectively maintaining electrical neutrality.  Note, for each H+ lost in urine one Na+ + one HCO- 3 are reabsorbed.  The H+ in urine must be buffered to prevent decrease of pH to below 4.5 which is injurious to cells.  Urine H+ is buffered by  HCO- 3 system which results H2O + CO2,  HPO4 + H+ results in - H2PO4 and  with NH3 to NH+ 4
  • 36. POTASSIUM METABOLISM AND ACID BASE BALANCE  K+ ion and H+ ion produce parallel effect in plasma,  when there’s excess of H+ ion in plasma, K+ ion is reabsorbed by renal tubule as H+ ion is lost.  In case of excess of K+ ion, K+ ion is lost by renal tubule as H+ ion is reabsorbed ,  When H+ ion is low, K+ ion is lost as H+ ion is reabsorbed and when H+ ion is in excess H+ ion is lost as K+ ions is reabsorbed.