山东大学基础医学院：《病理生理学 Pathophysiology》课程PPT教学课件（7年制）04 acid-base banlance and acid-base disturbance 酸碱平衡紊乱

Acid-base balance and acid-base disturbance

Acid-base balance and acid-base disturbance

I. regulation of acid-base balance 1. origin of acid and base in the body volatile acid: H2CO3 (15mol/day) sulfuric acid 1) acids phosphoric acid fixed acid: uric acid (90mmol/L) mesostate 2)base: salt of organic acid; NH3

I. regulation of acid-base balance 1. origin of acid and base in the body volatile acid: H2CO3 (15mol/day) sulfuric acid 1) acids phosphoric acid fixed acid: uric acid (90mmol/L) mesostate 2) base: salt of organic acid; NH3

2. regulation of acid-base balance 1)role of buffer HCO-r/cor 53%o Hb/HHb buffer system Hbo.2/HHbO2J 35% Pr/hPr 7 Phosphate 5 Henderson-hasselbalch ph= pKa+ lg Hco 3/H2CO31 =61+g20/1=61+13=74 buffer of fixed acid: hco3HCO buffer of volatile acid: hb/HHb

2. regulation of acid-base balance 1) role of buffer HCO- 3 /H2CO3 53% Hb- /HHb buffer system HbO- 2 /HHbO2 35% Pr- /HPr 7% Phosphate 5% Henderson-Hasselbalch pH = pKa + lg [HCO- 3]/[H2CO3] = 6.1 + lg 20/1 = 6.1 + 1.3 =7.4 buffer of fixed acid: HCO- 3/H2CO3 buffer of volatile acid: Hb- /HHb

血红蛋白缓冲对的缓冲作用 CO,+H,O CA H2CO3 HCO3 H+--Hb CI RBC

血红蛋白缓冲对的缓冲作用 CO2 Cl￾CO2+H2O C.A. H2CO3 HCO- 3 H+ --Hb￾RBC

2)respiratory regulation alteration of ventilation alteration of breathe out of co2 Paco2 t, central [HIt peripheral respiration t PaO2↓J( receptor) Paco2 tt (80mmHg) inhibition of respiratory center 3)cellular action exchanges of Ht and K

2) respiratory regulation alteration of ventilation alteration of breathe out of CO2 PaCO2 central [H+ ] peripheral respiration PaO2 (receptor) PaCO2 (＞80mmHg) inhibition of respiratory center 3) cellular action exchanges of H+ and K+

4)renal regulation (1 acidification of proximal renal tubule 血管 肾小管上皮管腔 N Nat cl HCO 3 K H2 CO3 H2 CO3 NH3 Nat CA HCO3 H20+CO2 H20 泌与Cr重吸收拮抗与泌NH3协同

4) renal regulation ① acidification of proximal renal tubule 血管 肾小管上皮 管腔 Na+ Cl￾HCO- 3 H2CO3 H20 泌H+ 与Cl- 重吸收拮抗与泌NH3协同 K+ NH3 Na+ H+ H2CO3 Na+ C.A. HCO- 3 H2O+CO2

@2 acidification of distal renal tubule 肾小管上皮细胞 H -pump H2CO3→H+ NH3 NH4 HCO 3 H20+CO2 K 泌Ⅳ与泌K+拮抗,与泌NH3协同, 与肾小管液流量正变

② acidification of distal renal tubule H+ -pump NH+ 4 泌H+与泌K+拮抗，与泌NH3协同， 与肾小管液流量正变 肾小管上皮细胞 H2CO3 H+ NH3 HCO- 3 H2O+CO2 K+

II. parameters of acid-base 1. pH important and inexact parameter normal range: 7.35-7.45 2. Paco2 partial pressure of co2 of dissolved in arterial plasma(respiratory parameter) normal range: 4.4-6.25kPa(33-46mmHg primary change. respiratory acidosis - Paco, T respiratory alkalosis→PaCO2↓ secondary change: meta bolic acidosis PacO,I metabolic alkalosis Paco, l

Ⅱ.parameters of acid-base 1. pH important and inexact parameter normal range: 7.35~7.45 2. PaCO2 partial pressure of CO2 of dissolved in arterial plasma (respiratory parameter) normal range: 4.4~6.25kPa(33~46mmHg) primary change: respiratory acidosis PaCO2 respiratory alkalosis PaCO2 secondary change: metabolic acidosis PaCO2 metabolic alkalosis PaCO2

3. standard bicarbonate(sb and actual bicarbonate (aB) SB: HCO 31 in plasma under standard condition (38C; PO2=150mmHg; PCO2=40mmHg) AB: HCO 3 in plasma under actual condition Normal range: 22-27 mmol/L; AB=SB 4. buffer base (bb) sum of all buffer base in blood normal range: 45-55mmol/L 5. base excess(be) normal range:±3mmo/L

3. standard bicarbonate(SB) and actual bicarbonate(AB) SB: [HCO- 3] in plasma under standard condition (38℃; PO2=150mmHg; PCO2=40mmHg) AB: [HCO- 3] in plasma under actual condition Normal range: 22~27mmol/L ; AB=SB 4. buffer base(BB) sum of all buffer base in blood normal range: 45 ~ 55mmol/L 5. base excess(BE) normal range: ±3mmol/L

6. anion gap (AG) N AG Normal range: 12 +2 mmol/L

6. anion gap (AG) + - Normal range: 12 ± 2 mmol/L Na+ Cl￾AG HCO- 3