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cn bng acid-base
TS. Phan Hi
Nam
i cng
H2O
V [H+ ]= [OH-] =>[H+]x[OH-] = [H+]2 = 10-14
Log [H+]2 = Log 10 -14 =>2 Log [ H+] = - 14 -> Log
[ H+] = -7
Qui c: pH l gi tri m ca Log nng H +,
tnh:
pH = - Log [ H+]
Cc h m ca mu
H m mu= H huyt tng + H
Hng
H cu
Bicarbona
Protein
PPhosphat
m
t
(45%)
(1-2%)
(53%)
(35%)
(10%)
H2CO3/KHCO
HHb/KHb,
HbO2/KHbO2
(18%)
( 35%)
NaH2PO4/Na2H
PO4
KH2PO4/K2HPO4
Vai tr ca cc h m/ iu ho
CBAB
H huyt tng:
H m huyt tng
* H m protein:
+ Cu to t cc A.A (COOH, NH2), c tnh lng
tnh:
- COOH
COO- + H+ ( + base) - chng li
kim ho
- NH2 + H+
NH3+ - chng li acid ho.
+ Chng li acid = a.a kim (Arg, Lys)/ NH2 + H+
NH3+.
+ Chng li kim = a.a acid (Glu, Asp)/ H+ + base
(OH-).
Vai tr m: ng k (60 80 g/l)
* H m phosphat (NaH2PO4/ Na2HPO4 )
- Tt v c pK = 6,8 (~ 7,40).
- Vai tr m: yu v c nng thp/ M (1
2 mmol/l)
H m hng cu
CA
HCO3- HHb
O2
H+
H2CO3 KHbO2
H2O
HHb
M
KHbO2
O2
HCO3H+
KHbO2
H2CO3
CA
CA
CO2
CO2
Ch.ho
HHb
K+
H2O
Th ra
Phi iu ho CBAB
CO2 + H2O
HCO3CO2 th
ra
acid
+
(H
/M):
. TK
phi (TS, B
th)
-> o thi
CO2
H2 O
CO2
H2CO3
H2CO3
Nhim
base (OH-
Ph
i
HCO3
(chng acid)
CO2
H+ +
H+
Mu
T
chc
/M):
. TK phi ( TS, B
th) ->
o thi CO2
. CO2 TC > CO2/
Phi
Phi
CO2
HCO3
-
CO2
OH
Mu
Thn iu ho CBAB
* c im: chm, hiu qu mnh, duy tr HCO3-/ H.t &
DGB
* Ti hp Lng
thu gn
gn, 10%
.T hon ton
Mao
TBHCO
ng3 l:n90%/ TB L
L xa. (NTB)
qun
gn
NaHCO3
Na
+
HCO3
E1
H2CO3
CA
K+
Na
H+
HCO3-
H2CO3
H 2O
E2
K+
Na
+
HCO3(90%)
E1HCO3-.ATPase
E2- Na+,K+CO2
ATPase
H2O CO2
CO2
+
THT HCO3- : + PCO2 (CC b tr ca thn khi c th nhim base,
acid h hp)
+ THT Na+/ TB ng thn.
HPO4--
H+
R
H2
PO4-
R
H
TB ng ln
xa
E2
Mao qun
Na+
K
E1
H+
HCO3H2CO3
H2 O
NH3
Glutaminase
CO2
Na+
K+
HCO3(~10
%)
CO2
Glu
NH4+
Gln
+ o thi H+: Acid (RH), mui amoni, mui
+
Ti hp thu HCO3- : ~ 10%
phosphat
+ Tn to HCO3-: : n bt-> 50- 100 mmol H+/ 24h/: H2SO4
(SPCH a.a S);
H3PO4 (SPTH ca P0-Lipid, acid nucleic); A.uric-
1. pH mu
2. PaCO2
3. Bicarbonat
4. Bicarbonat thc ( Actual Bicarbonat = AB)
5. Bicarbonat chun (Standard bicarbonat = SB)
6. CO2 ton phn ( Total CO2 = t.CO2)
7. Base m (Bufer base = BB)
8. Base d (Base excess = BE)
pH mu
pH mu/ M = 7,38 7,42.
pH < 7,38 nhim acid
pH > 7,42 - nhim base
pH mu/TM < M 0,02
pH -> nh gi mc b tr ca c th:
- Acidose:
pH 7,38 7,42: b ton phn
(nhim acid)
7,37 7,25: b 1 phn
< 7,25: mt b.
- Alcalose:
pH 7,38 7,42 : b ton phn
(nhim base)
7,43 7,55: b 1 phn
> 7,55: mt b.
+ pH < 7,30: Nhim toan h hp: ph qun ph
vim
Nhim toan CH nng: T.
+ pH > 7,55: Nhim kim h hp: CTSN
Nhim kim chuyn ho nng: a
chy ko di..
: PaCO2 = 40 mmHg
. : t.CO2 = 25 - 30 (mmol/l).
Bicarbonat ( HCO3-)
+ L lng HCO3- c trong H.T 37OC, gm B thc v B chun.
- Bicarbonat thc (actual bicarbonat = AB):
. L nng thc t HCO3- ca mu mu M ly K ko tip
xc vi ko kh, n tng ng vi pH v PaCO2 thc ca mu
mu.
. : AB = 25 mmol/l.
- Bicarbonat chun (standard bicarbonat= SB):
. SB: l lng HCO3- (mmol/l) ca h.t c qui v K chun
nh PaCO2= 40 mmHg, To= 37oC, pH = 7,40.
. : SB = 24 2 (mmol/l).
+ L TS cho bit RLCBAB lin quan ti NN chuyn ho.
BL: HCO3-: NT h hp, NKCH: nn nhiu, ht dch DD, a chy
: Nhim toan CH, gp:
. T do ng cc th cetonic
. Ph phi cp, ng kinh: RLCH glucid-> ng acid
lactic.
. Vim thn cp; mn: ko thi c acid
. a chy cp lm mt HCO3-
( PaCO2)
(HCO3-, BE)
PaCO
2
4
0
Nhim toan h hp
t/c kim
+ Do mt acid: - Nn nhiu (HCL , K+ )
- Ht D.dy (Cl- ), a
chy(H+ )
- Thuc li niu nhiu -> K +
* KQXN cc thng s:
- pH mu (> 7,5, mt b)
- pCO2 (> 40mmHg do thng kh )
- HCO3- (> 25mmol/l) v tCO2, BB , BE
Nhim kim h hp
- t.CO2
- BB
- BE (-)
Nhim toan hn hp
L s kt hp nhim toan CH v h hp =>
pH mu
* XN: - pH mu mnh
- p CO2
- HCO3-
- SB va
- BB
- BE(-)
Nhim kim hn hp
L kt hp ca nhim kim h hp v nhim
kim chuyn ho => pH mu rt nhiu
* XN: - pH mu
- pCO2 t
- HCO3-
- SB : 34-36 mmol/l (bt 24mmol/l)