Download - Chapter 30: Acid-Base Regulation Guyton and Hall, Textbook of Medical Physiology, 12 th edition
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Unit Five: The Body Fluids and Kidneys
Chapter 30: Acid-Base Regulation
Guyton and Hall, Textbook of Medical Physiology, 12th edition
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Acid-Base Regulation
• Hydrogen Ion Concentration is Precisely Regulated
• Acid- molecules that release H+ in solution
• Base- ion or molecule that can accept an H+
• Alkali- formed by the combination of one or more of the alkali metals (i.e. Na) with a highly basicion (i.e. OH); the base portion reacts quickly with hydrogen ions and remove them fromsolution---therefore they act as bases
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Acid-Base Regulation
• Strong Acid- one that rapidly dissociates and releases large amounts of H+ in solution
• Strong Base- one that reacts rapidly and stronglywith H+ and quickly removes them fromsolution
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Acid-Base Regulation
The normal H+ concentration is 40nEq/L(0.00000004); therefore, the normal pH is
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Acid-Base Regulation
H+ Concentration pH
ECF
Arterial Blood 4.0 x 10-5 7.40
Venous blood 4.5 x 10-5 7.35
Interstitial Fluid
4.5 x 10-5 7.35
Intracellular Fluid 1 x 10-3 to 4 x 10-5 6.0-7.4
Urine 3 x 10-2 to 1 x 10-5 4.5-8.0
Gastric HCl 160 0.8
Table 30.1 pH and Hydrogen Ion Concentration of Body Fluids
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Defending Against Changes in H+
• Three primary systems regulate H+ concentrationto prevent acidosis or alkalosis
a. Chemical acid-base buffer systems of body fluids(1st line of defense)
b. The respiratory center which regulates the removal of CO2 and therefore H2CO3 (2nd line of defense)
c. The kidneys which can excrete either acid oralkaline urine
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Bicarbonate Buffer System
• Consists of (1) a weak acid and (2) a bicarbonate salt
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Bicarbonate Buffer System
Fig. 30.1 Titration curve for bicarbonate buffer system
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Phosphate Buffer System
• Addition of a Strong Acid
•Addition of a Strong Base
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Phosphate Buffer System
• Role of Phosphate Buffer
a. Relatively insignificant as an extracellular buffer
b. Important in the tubular fluids of the kidney
1. Phosphate becomes greatly concentrated inthe tubules
2. Tubular fluid usually has a considerably lower pH than extracellular fluid
c. Important in intracellular fluid because of thephosphate concentration
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Proteins As Important Intracellular Buffers
• Proteins are the most plentiful buffer due to highconcentrations inside cells
• In the rbc, hemoglobin is an important buffer
• Approximately 60-70% of the total chemical buffering of body fluids is inside the cells,and most of this comes from intracellularproteins
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Respiratory Regulation of Acid-Base Balance
• Pulmonary Expiration of CO2 Balances MetabolicFormation of CO2
• Increasing Alveolar Ventilation Decreases Extracellular Fluid H+ Concentration and Raises pH
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Fig. 30.2 Change in ECF pH caused by increased or decreased rate of alveolar ventilation, expressed as times normal
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Fig. 30.3 Effect of blood pH on the rate of alveolar ventilation
Respiratory Regulation (cont.)
• Increased H+ Concentration Stimulates
Alveolar Ventilation
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Respiratory Regulation (cont.)
• Feedback Control of H+ Concentration By the
Respiratory System (Negative Feedback)
a. Increased H+ concentration stimulates respiration
b. Increased alveolar ventilation decreases H+ concentration
• Efficiency of Respiratory Control of H+ Concentration- cannot return the
concentrationback to normal when a disturbance outside the respiratory system has altered the pH
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Respiratory Regulation (cont.)
• Buffering Power of the Respiratory System
a. Acts as a physiologic type of buffering system
• Impairment of Lung Function Can CauseRespiratory Acidosis
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Renal Control of Acid-Base Balance
• Secretion of H+ and Reabsorption of HCO3
- Bythe Renal Tubules
30.4 Reabsorption of bicarbonate in different segments of the renal tubule
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Renal Control of Acid-Base Balance
• H+ is Secreted by Secondary Active Transport in
the Early Tubular Segments
30.5 Cellular mechanisms for (1)active secretion of hydrogen ions into the renal tubule, (2) tubular reabsorption of bicarbonate by formation of carbonic acid, and (3) sodium ion reabsorption in exchange for hydrogen ion secretion
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Renal Control of Acid-Base Balance
• Filtered HCO3 is Reabsorbed by Interaction with
H+ in the Tubules
a. Each time an hydrogen ion is formed in thetubular epithelium, an HCO3 is also formedand released back into the blood
b. HCO3 is “titrated” against H+ in the tubules
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Renal Control of Acid-Base Balance
• Primary Active Secretion of H+ in the Intercalated
Cells of Late Distal and Collecting Tubules
Fig. 30.6 Primary active secretion of H ion through the membrane of the intercalated cells
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Renal Control of Acid-Base Balance
• Phosphate Buffer System Carries Excess H+ into
the Urine and Generates New HCO3
Fig. 30.7
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Renal Control of Acid-Base Balance
• Excretion of Excess H+ and Generation of New
HCO3 by the Ammonia Buffer System
Fig. 30.8 Production and secretion of ammonium ion by the proximal tubular cells
Fig. 30.9 Buffering of the hydrogen ion secretion by ammonia in the collecting tubules
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Quantifying Renal Acid-Base Excretion
• Bicarbonate excretion is calculate as the urine
flow rate multiplied by urinary HCO3
concentration
• The amount of new HCO3 contributed to the blood
at any given time is equal to the amount of H+
secreted that ends up in the tubular lumen
• The rest of the non-bicarbonate, non-ammmonia
buffer excreted is measured by determining a
value known as titratable acid
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Quantifying Renal Acid-Base Excretion
• Regulation of Renal Tubular H+ Secretion
Increase H+ Secretion andHCO3 Reabsorption
Decrease H+ Secretion and HCO3 Reabsorption
Increase PCO2 Decrease PCO2
Increase H+ Decrease HCO3 Decrease H+ Increase HCO3
Decrease ECF volume Increase ECF volume
Increase Angiotensin II Decrease Angiotensin II
Increase Aldosterone Decrease Aldosterone
Hypokalemia Hyperkalemia
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Renal Correction of Acidosis
• Acidosis Decreases the ration of HCO3/H+
in Renal Tubular Fluid
a. In metabolic acidosis, an excess of H+ overHCO3 occurs in the tubular fluid primarilybecause of decreased filtration of HCO3
b. There is also a decrease in pH and a rise inECF H+ concentration
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Renal Correction of Alkalosis
• Alkalosis Increases the Ratio of HCO3/H+ inRenal Tubular Fluid
pH H+ PCO2 HCO3
Normal 7.4 40 mEq/L 40 mm Hg
24 mEq/L
RespiratoryAcidosis
RespiratoryAlkalosis
MetabolicAcidosis
Metabolic Alkalosis
Table. 30.3 Characteristics of Primary Acid-Base Disturbance
The primary event is indicated by the double arrows. Respiratory acid-base disorders are initiatedBy an increase or decrease in PCO2; metabolic disorders are initiated by an increase or decrease in HCO3