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1、AcidAcidBaseBalanceandAcidBaseBalanceBaseBalanceandandDisturbanceDisturbanceDisturbance酸碱平衡紊乱酸碱平衡紊乱Dr.PanDr.Pansl.pan.berkeley@gmail.comsl.pan.berkeley@gmail.comOutlineOutlineOutline---GeneralAcidGeneralAcidGeneralAcid-BaseHomeostasis--BaseHomeostasisBaseHomeos
2、tasis••ReviewReview••GenerationofAcidsandBasesGenerationofAcidsandBases••RegulationofacidRegulationofacid--basebalancebasebalanceplasmabufferingsystemplasmabufferingsystemShortShort--termregulationtermregulation----lungslungslonglong--termregulationtermregulati
3、on----kidneyandlungskidneyandlungs••HowtoanalyzeacidHowtoanalyzeacid--basebalance?basebalance?pH,pH,PaCO2,Base(AB,SB,BB,BE),AGPaCO2,Base(AB,SB,BB,BE),AG••CommonacidCommonacid--basedisturbancebasedisturbancesimple,complex(mixed)simple,complex(mixed)reviewreviewI
4、nternalenvironmentandhomeostasisInternalenvironmentandhomeostasisBODYFLUID:BODYFLUID:VolumeVolume:ICF:ICF--40%wt40%wtECFECF--20%wt20%wtelectrolyteelectrolyte：：NaNa+,K,K+,,ClCl-,HCO,HCO--……33osmoticpressure:280osmoticpressure:280--310310mOsmmOsm/L/Lacidity&acidi
5、ty&basicitybasicity：：7.357.35～～7.457.45reviewreviewGeneralconceptofacidandbaseGeneralconceptofacidandbase••Acid=Protondonor(HA)Acid=Protondonor(HA)••Base=Protonacceptor(ABase=Protonacceptor(A--))GGenerationofacidenerationofacidCO+HO+ATPHCO2223GenerationofacidGe
6、nerationofacidSO2-4HPO2-3GenerationofacidGenerationofacidO2CO+HO22TricarboxylicanaerobicglycolysisAcidO2LacticacidCycleKetonebodyInsulinAcetoneAcetoacetateHungerβ-hydroxybutyrateGenerationofbaseGenerationofbaseextrinsicOrganicacidicsalt:H2CO3citricacid柠檬酸H++HCO
7、-3malicacid苹果酸CO+HOtartaricacid酒石酸22acetate乙酸intrinsicintrinsicGenerationofbaseGenerationofbase••AAspartatespartate--NH2NH2NHNH3++……••GGlutamatelutamate--NH2NH2intrinsicGenerationofbaseGenerationofbaseRenalreabsorptionofbicarbonateRenalreabsorptionofbicarbonate
8、••Proximaltubule:Proximaltubule:7070--85%85%••LoopofLoopofHenleHenle::1010--20%20%••DistaltubuleandDistaltubuleandcollectingducts:collectingducts:44--7%7%CA:CA:carboniccarbo
