AB balance

1
AB balance
lungs
kidneys
CO2 HCO3-
H

titr.acidity
H2CO3
NH4
H2O
H

A- CO2 20000 mmol/den
HA- 60 mmol/den


2
H, Na a K transport



GRADIENTS H

concentration

K
electrochem.

H
Na
pH
FEET BACK
Na

positive
Nae Nai


negative


K
ATP
ADP
H
Na
3
Transport H, Na a K



GRADIENTS H

concentration

K
electrochem.

H
Na

FEEDBACKS
Na


positiv Nae Nai


negativ


Acidosis
K
ATP
ADP
H
Na
4
Transport H, Na a K



GRADIENTS H

concentration

K
electrochem.

H
Na

FEEDBACKS
Na


positiv Nae Nai


negativ


Alkalosis
K
ATP
ADP
H
Na
5
Transport H, Na a K



GRADIENTS H

concentration

K
electrochem.

H
Na

FEEDBACKS
Na

positiv
Nae Nai


negativ


Alkalosis hypokalemia
K
ATP
ADP
H
4
1
3
Na
2
intracelulární acidóza
6
Acidosis
METABOLIC
RESPIRATORY


VA normochloremic hyperchloremic
laktate
chlorids overdose
ketoacidosis loss of HCO3-
GIT diabetic
tubular starvation
reabsorption of HCO3- (I) alcoholic
secretion of H
(II) strong acids
GFR (III) intoxications (salicylate)
hypoaldosteronism (IV) uremic

7
Alkalosis
METABOLIC
RESPIRATORY HCO3-

VA infusion

hypoxia (dehydration)
artificial
ventilation

psychogenic H
hypochloremic hyperaldosteronism (ICT
pH) Bartters sy
8
Compensation of respiratory acidosis

VA chronic
acute

PaCO2 renal exkretion of H
pH
renal reabsorption of HCO3- influx
H to cells
HCO3- in plasma
9
Compensation of metabolic acidosis
H
concentration
pH
HCO3- in ECT

renal H excretion
influx H to cells renal HCO3-
reabsorption central chemoreceptors

VA

HCO3- in ECT H2CO3
pH



10
Plasma anion gap Na - (HCO3 Cl)
144 - (24 108) 12
mEq/L
anoxia in newborn
diabet. koma in COLD
acute mountain sickness metab. alkalosis
11
Liver and kidneys in pH control

urea acidosis
alkalosis

prox. tub. H

Na HCO3-

H2CO3
H2O CO2 NH4



Na

NH4
NH2 glutamate







H

Cl-
AMK
dist.
HCO3- H 2 HCO3
2NH4

glutamine
12
pH a kalemia
K (mmol/l)
exchange K - H(ECT cells)
8 6
4
2 0
6,9 7,4
7,9 pH renal
compensation
13
Vomiting

vomiting H and Cl-
loss pH

prox. tubulus

Na and Cl- reabsorption


Na
dist. tubulus
Na
reabsorption
K a H excretion



pH of urine
hypovolemia
depletion of chlorides