5 Maret 2010 - Fluid
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Transcript of 5 Maret 2010 - Fluid
FLUID, BUFFER, ACID-BASE BALANCE
Rondang Soegianto
2010
Fluid content in individuals vary due to
variability in amt of adipose tissue.
High body water lean
Low body water obese
Plasma > 90% H2O
Skin, muscle, internal organs 70-80% H O
Skeleton only 22% dry tissue
Fat 10% lowest
2
Intracellular fluid (ICF)
Extracellular fluid (ECF)
ICF compartment ~ 2/3 total body water
ECF: plasma = 1/5 of ECF
Interstitial fl ~ 4/5 of ECF
Minor ECF compartments:
- Lymph- Transcellular fluid: Cerebrospinal fl Interoccular fl Synovial fl Cardial, intrapleural, peritoneal fl Digestive juicesTranscelr fl does not affect fl balance of cellException: Vomiting, diarrhea
Metabolism and Acid-Base Balance
A-B balance related to
- Respiration
- Metabolism
Impaired A-B balance of ECF - Lactic acidosis
- Ketosis
Chemical Terms
Acidity = [H ] (proton)
Pure water [H ] = 10
[H ] > 10 = Acid
[H ] < 10 = Alkaline
pH = 7 [H+] = 10-7 M = 0.0001 mM
pH = 7.4 0.00004 mM
+
+ -7
-7
-7+
+
Note:
1. Absolute conc’s of H+ in organism much <<
other solutes
Ex. [Na ] inECF = 145 mM
2. pH units are logarithmic not linear scale
Rise of one unit pH = 10 fold rise in [H ]
+
+
pH of ECF (incl plasma) = 7.35 – 7.45
Outside this range: Acidosis <----- > Alkalosis
Compatible with life: pH 7.0 - 7.8
Exceeding this range may inhibit brain function
Source of Protons
1. Dietary
a. Phospholipids: hydrol. of phosph. acids
b. Sulphur containing amino acids
Cystein and metionine from proteins
Degrd’ion in liver sulphates and H
2. Respiratory ( ~ 12.5 moles/day)
CO + H O H CO + H + HCO+
+
2 2 2 3 3
-
3. Metabolic products- Lactic acid
- Ketone bodies
- ATP hydrolysis
- NAD+ reduction
Totally per day: ~150 moles proton
Reversal by body reactions no net charge
in protons
Body pH raised due to:
- Ingestion of weak acids (citric acid) as
- Na or K salts (from fruits)
- Hyperventilation (loss of CO )
- Vomiting (loss of HCl from stomach)2
Mechanism for pH adjustments
A. Buffer
B. Respiration
C. Renal acid secretion
A. BuffersWeak acid (binds added OH )
andConjugate base (binds added proton)
# Resists changes in pH when acid or base added
# Conjugate base = weak acid - proton Conj acid = weak base + proton
Blood buffer H CO : HCO
-
2 33
-
Salts Can Change pH of Blood or Lab Sol’n
- Acidic salts ex NH NO NH4+ is weak acid- Basic salts ex CH COO-Na CH3COO- is weak base- Neutral salts ex NaCL, KNO No weak acids or weak bases
4 3
3
3
Buffer Capacity
BC = Ability to consume added H+ and added OH
BC depends on - Buffer conc’n - pKaUseful buffering is at pH within pKa + 1 or pKa - 1
-
Examples of Buffers
a. Proteins. Have many ionizable groups
and pKa values.
Present in differing conc’ns.
H.Prot H + Prot
H.Prot H + Prot
Ex. Hb in erythrocytes (large amt)
H+ can penetrate eryth membrane
This buffering action influences plasma pH
+
+
+
-
b. Phosphates
One ionizable group, pKa = 6.8
Inorganic phosphates
H PO H + HPO
Organic phosphates (not much)
24- + 2-
4
c. Bicarbonates
H CO H + HCO , pKa ~ 3
Only slightly useful to buffering cap at pH=7.4
Important, since conc of H CO and HCO
can be regulated in response to pH change
Dynamic Buffer System
Active in respiratory system
2 3+
2 3
3
-
3
-
B. Respiration
H CO H O + CO
Enzyme: Carbonic anhydrase in RBC
and other tissues
Henderson-Hasselbalch eqn:
[salt]
pH – pKa + log _______________
[undiss. acid]
2 3 2 2
For carbonic acid: [HCO ]
pH = 3.0 + log ____________
[H CO ]
# Lung ventilation >> loss of CO2 >>
Blood H CO << pH >>
= Respiratory alkalosis
Ventilation << Resp acidosis
2 3
2 3
3
-
Quantitative Values of Buffer on Acid Load 1. Plasma protein 1% of total buffering of acid administration2. Erythrocytes ~6% (H+ penetrate RBC)3. ECF carbonic/bicarbonate system ~42%4. Intracellular protein ~51% EC H+ exchanges for IC Na (36%) and for IC K (15%) Some Na+ derived from bone apatite crystals In chronic acidosis bone resorption Ca and phosphate released
+
+
2+
Kidney in Acid-Base Balance ControlMaintains many solutes in plasma by adjustingrate of excretion in urine thru
- reabsorption from glomerular filtrate- secretion into urine
Glomer. Filtr.: high Na+ and bicarbonate (equals conc in plasma0
Loss of HCO pH of blood <<
Recovery: Protons secreted into lumen from tubular cells
In the lumen:HCO + H H CO H CO H O + CO CO2 diffuses back into tubuli
3+
2
2 3 22
-
3
-
Importance of Various Buffer Systems
* Protein buffer system primarily important intracellularly
* Hb buffer system buffers H+ generated from carbonic acid (H CO )
* The phosphate buffer system is an important urinary buffer
2 3
Line Order of Defense Mechanisms Against Changes in [H ]
1. Chemical buffer systems First line of defense. H not eliminated but incorporated into buffers
2. Respiratory system, second line of defense a. Works thru pulmonary ventilation Increase of arterial [H ] by metabolism stimulates resp. Center in brain stem >> pulm. ventilation
+
+
+
b. When arterial [H ] falls, pulm. Vent. <<
shallow breathing. Metab.
CO diffuses from cell blood, faster than CO removed
from
blood lungs. CO accuml in
blood restores [H ]
+
2
2
2+
3. Kidneys, third line of defense Most potent A-B regulating mechanism - vary removal of proton from any source - conserve or eliminate bicarbonate ion
Ex. Renal compensation for acidosis For each H to urine, new HCO returns to plasma to buffer another H
still remaining in body fluid
+
+3
-
Thus:
Kidneys are able to restore pH to normal
Respond continuously to pH change until
compensation is complete
Lungs can only adjust amt of CO that forms
H in the body
2+
1. CHEMICAL BUFFER
2. PHYSIOLOGICAL
BUFFER
MECHANCAL RESPIRATION
EXCRETION OF CO2
RENAL MECHANISM
EXCRETION OF H+
Kidneys Secrete Ammonium
H+ transp. actively from tubular cells tubular plasma. Capacity limited to urinary pH = 4.5H in tub fl must be buffered to << free HImportant urinary buffers:
1. Filtered phosphate buffer2. Secreted ammonia
+ +
Secreted H first buffered by phosph buffer.Phosph in tub fl comes from ingested phosph= dietary excessWith high H excretion, buff cap. of phosphExceeded. Kidney cannot respond by >> phosexcrt’n. Only phosph reabsorption subjectedto control mechanism.Next: Tubular cells secrete NH3NH + H NH urineNH synthesized from glutamine in tub. cells
+
+
3+
4
3
Acid-Base Balance
Ratio of [HCO ] : [CO ]
Normal = 20/1Resp acd < 20/1 CO >> Resp alk > 20/1 CO <<Met ac < 20/1 [HCO ] << Met alk > 20/1 [HCO ] >>
3-2
2
2
3-3
-
Compensation:
Resp Ac. Kidneys conserve filtered HCOResp Alk: Kidneys conserve H
Excrete more HCOMet Ac : Renal and chemical
- buffers take up H - lungs blow off CO - kidneys excrete H - conserve HCO
Met Alk: Liberation of HVentilation <<, CO retained in body fld
+
+
2
+
2
3
-
3-
3-
Causes of A-B Imbalance
Resp Ac : Hypoventilation Lung disease Depression of resp centr by drug or disease
Resp Alk. Fever, Anxiety, Aspirin poisoning
Met Ac Severe diarrhea, DM Strenuous exercise, Uremia (renal failure)
Met Alk Vomiting Ingestion of alkaline drugs
References:1. Biochemistry for the Medical Sciences E.A. Newsholme and A.R. Leech John Wiley & Sons, 1983 2. Biochemistry. A Foundation Peck Ritter Broks/Cole Publ Co, 19963. Human Physiology. From Cells to Systems L. Sherwood Brooks/Cole, 20044. Medical Biochemistry A.C Brownie, J.C. Kernohan Elsevier, 2005