role of lung in acid base balance

ACIDS are proton (H+) donors BASES are proton (H+) acceptors Ionic substances dissociate in solutions STRONG ACIDS dissociate completely WEAK ACIDS dissociate incompletely pH is a measure of H+ in solution

 Normal blood pH necessary for normal enzyme activity 7.35 - 7.45 Below 7.35 = acidosis Above 7.45 = alkalosis Changes in pH due to by-products or end products of metabolism.

 [H+]= 35- 40meq/L or nmol/L Pco 2 [approximately 1.1 kPa (8 mmHg) higher in venous blood] and Po2 [approximately 7.5 kPa (56 mmHg) lower in venous blood].

PRODUCTION OF ACID
Volatile acid Carbonic acid Non-volatile acid phosphoric acid (nucleoproteins) lactic acid (anaerobic glycolysis) sulphuric acid (S-AA) ketones and fatty acids (fat metabolism Animal protein Acidic

PRODUCTION OF BASE
Normally negligible. HCO3 by metabolism of lactate and citrate. NH3 AA metabolism urea base Veg diet salts of organic acid (sodium lactate) + utilize H+. Alkalizing effect on the body. Urine excretion neutral or slight alkaline.

REGULATION OF BLOOD pH
Chemical Buffer Systems Intracellular Extracellular Bicarbonate buffer system Na HCO3/ H2CO3 Phosphate buffer system Na2 HPO4/ NaH2PO4 Protein buffer system Na+ Protein/ Protein RBC buffer KHb/ HHb

Respiratory System
Renal Mechanisms

CHEMICAL BUFFER SYSTEMS

Molecules that resist pH change. Bind or release H+ to control pH. Limited in ability to control pH. Weak acids and its conjugate salt.

Bicarbonate buffer system is most important ECF.

Phosphate & protein buffer systems are important ICF.

BICARBONATE BUFFER SYSTEM

(40-50%) Pka 6.1
Carbonic acid Hydrogen ions + Bicarbonate ions

H2CO3

H+ + HCO3

PHOSPHATE BUFFER SYSTEM

(Pka 6.8)
Dihydrogen phosphate monohydrogen phosphate

H2PO4-3

HPO4-2

PROTEIN BUFFER SYSTEM

Amino Acid NH3-C-COOH R Some can accept H+ Weak base Some can donate H+ Weak acid

RESPIRATORY MECHANISM FOR pH REGULATION

Lungs excrete 20,000 40,000 mEq H+/day. By regulating conc. of carbonic acid. About 300 L CO2/ day endanger, acid base equilibrium. All CO2 eliminated in the expired air. Respiratory centers in medulla sensitive to pH change. pH hyperventilation blow off CO2 H2CO3.

Hb AS A BUFFER
Tissue level Hb binds to H+ & help to transport CO2 as HCO3 Lungs Hb combines with O2 H+ removal
2H + 2HCO3- 2H2CO3 2H2O + 2CO2 (Exhaled)

Transport of CO2 through the mediation of Hb

2CO2 + 2H2O
Carbonic Anhydrase

CO2

2CO2 + 2H2O C. A 2H2CO3

2H2CO3 2HCO3
-

2H+

HbO2

2H+ + 2HCO3-

4O2

Hb2H+

4O2

Henderson-Hasselbach Equation
Demonstrates interrelationship between
Carbonic acid Bicarbonate pH

pH = pK + log [HCO3-] /[H2CO3]

Kassirer-Bleich equation
[H+] = 24 x PCO2/ [HCO3-] Can be used to calculate any component of buffer system provided other 2 components are known

Fundamental acid base disorders

Respiratory Disorder first affect pCO2 Metabolic disorder first affect HCO3-

DISORDERS OF ACID BASE BALANCE

Acidosis blood pH Respiratory acidosis - CO2 Metabolic acidosis - HCO3 Alkalosis blood pH Respiratory alkalosis CO2 Metabolic alkalosis HCO3

RESPIRATORY ACIDOSIS
Low pH due to high pCO2 pH = 6.1 + log [HCO-3]
[PCO2] x 0.3

RESPIRATORY ACIDOSIS
Causes: in alveolar ventilation [Emphysema, pneumonia] COPD like Asthma Overdose of Respiratory depressant drugs Trauma to medulla oblongata Cystic fibrosis Compensation: - Kidney retains bicarbonate

RESPIRATORY ALKALOSIS
High pH due to low pCO2

pH = 6.1 + log

[HCO3-] [PCO2 ] x 0.3

RESPIRATORY ALKALOSIS
Caused by Hyperventilation Hysterical over breathing incracranial pressure Brain stem lesions stimulate respiratory centre High altitude, Hypoxia stimulate Resp. centre Anxiety Drugs Salicylate overdos Compensation Kidney secrete bicarbonate

Results seen:
ACID-BASE DISORDER H+ PH Metabolic acidosis

HCO3

PCO2

BODY COMPENSATION Increased breathing rate (hyperventilation) to increase CO2 elimination

Metabolic alkalosis
Respiratory acidosis Respiratory alkalosis

Slowed breathing (hypoventilation) to decrease CO2 elimination

Kidney increases production of HCO3and excretion of H+ (acid) Decreased production of HCO3- and excretion of H+

increased level; greatly increased level; decreased level; greatly decreased level

Electrolytes refers to a group of four tests: Na+ (sodium), K+ (potassium), Cl- (chloride) and bicarbonate (total CO2 content). An anion gap can be calculated from the electrolytes and provides a clue to the cause of the acid/base imbalance. Depending on the suspected cause, a number of other tests may be ordered: CMP (comprehensive metabolic panel), ketones in blood and ketones in urine, lactate, salicylates, ethylene glycol, and methanol, to name a few.

Anion Gap
AG= [Na+] ([HCO3] + [Cl-]) Normal anion gap is 7 +/- 4 Is the unmeasured anion concentration

Thank you