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Physiology-
Acid Base Balance
Dr Naim
.
• Understanding by keeping in mind several
fundamental principles always viewing any
complexities of acid-base regulation through the
lens of these fundamentals.
• H2CO3 H+ + HCO3-
.
[proton acceptor]
• pH = pKa + log
[proton donor]
The Henderson-
Henderson-Hasselbalch (H
(H--H) Equation
• [A ]/[HA] = 1;
• ACIDOSIS :
• pH < 7.4
• ↓ HCO - = metabolic
3
• ↑ H2CO3- = respiratory
.
• ALKALOSIS:
• pH > 7.4
• ↑ HCO3- = metabolic
↓
• H2CO3- = respiratory
.
CO2 + H2O
CD CD
blood:
Figure 27.11a
.
Figure 27.11b
.
• EXAMPLE
• SIMILARLY,
GI Secretions
“New” HCO3-
.
.
“New” HCO3-
.
• Rate of tubular H+ secretion is about
4400mEq/day
“New” HCO3-
.
• Point of emphasis:
• H2PO4 - H+ + HPO4 --
.
“New” HCO3-
.
40mmol
“New” HCO3- per day
HYDROGEN ION EXCRETION ON
AMMONIUM
108
Production and Secretion of NH4+ and HCO3- by
Proximal, Thick Loop of Henle,
Henle, and Distal
Tubules
H++NH3
“New” HCO3-
ACIDIFICATION OF URINE BY EXCRETION OF AMMONIA
Capillary Distal Tubule Cells
NH2
NH
NH3 3 H+
WHAT
HAPPENS
NEXT?
Tubular urine to
be excreted
110
ACIDIFICATION OF URINE BY EXCRETION OF AMMONIA
Capillary Distal Tubule Cells Notice the
H+ - Na+
NH3 exchange to
maintain
electrical
neutrality
Dissociation of
carbonic acid
NaNaCl
+ + Cl-
H23CO
HCO - + H+
3
NaHCO3
NH3Cl-
NH4Cl
Click
Click
Mouse
Mouseto to
Start
See
Animation
AnimationAgain Tubular Urine
111
ACIDIFICATION OF URINE BY EXCRETION OF AMMONIA
Capillary Distal Tubule Cells Notice the
H+ - Na+
NH3 exchange to
maintain
electrical
neutrality
NaNaCl
+ + Cl-
H23CO
HCO - + H+
3
NaHCO3
NH3Cl-
NH4Cl
Click
Click
Mouse
Mouseto to
Start
See
Animation
AnimationAgain Tubular Urine
112
Kidney tubules and pH Regulation
Figure 27.10a, b
Control of rate of tubular secretion & H+
reabsorption
.
H++NH3
“New” HCO3-
.
• First,
the generation of glutamine by the liver is
increased by low extracellular pH. In this case, the
liver shifts some of the disposal of ammonium ion
from urea to glutamine.
.
• Consumption of antacids