Syre-base regulering og bikarbonat

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1 Syrebase regulering og bikarbonat Peter Bie Institut for Molekylær Medicin Syddansk Universitet, Odense The (only) example of acidbase metabolism in normal man H + 80 Nonorganic acids 80 NH 3 Organic ions RCOO Røde tal er mmol per døgn 1

example of acidbase metabolism in normal man H + 80

2 The example of acidbase metabolism in normal man Nonorganic acids 80 NH 3 Organic ions RCOO The example of acidbase metabolism in normal man ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO Nonorganic acids 80 NH 3 Organic ions RCOO 2

3 P CO2 = 0 mmhg ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO Nonorganic acids 80 NH 3 Organic ions RCOO P CO2 = 0 mmhg ph = 7.0 [H + ] = 0 nmol/l 60 + HPO 2 H 2 PO Nonorganic acids 80 NH 3 Organic ions RCOO 3

acids 80 NH 3 Organic ions RCOO 0 [H + ] = 0

4 P CO2 = 0 mmhg ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO TA RCOO 10 NH + SO Cl Nonorganic acids 80 NH Organic ions RCOO 3 NH 3 + H + NH + P CO2 = 0 mmhg ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO TA RCOO 10 NH + SO Cl Nonorganic acids 80 NH Organic ions RCOO 3

5 P CO2 = 0 mmhg ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO TA RCOO 10 NH + SO Cl Nonorganic acids 80 NH Organic ions RCOO 3 [HCO 3 ] ~0 mmol/l UVol = 1 L P CO2 = 0 mmhg ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO Buffer TA RCOO 10 NH + SO Cl Nonorganic acids 80 NH Organic ions RCOO 3 [HCO 3 ] ~0 mmol/l UVol = 1 L 5

NH Organic ions RCOO 3 [HCO 3 ] ~0 mmol/l UVol = 1 L 0 [H + ] = 0 nmol/l +

6 P CO2 = 0 mmhg FILTRATE: 180 l/d ph = 7.0 [H + ] = 0 nmol/l [HCO 3 ] = 2 mmol/l Phosphates = 1 mmol/l ph = 7.0 [H + ] = 0 nmol/l Filtered phosphates HPO 2 H 2 PO TA RCOO NH + 10 Phosphates SO Cl Nonorganic acids 80 NH Organic ions RCOO 3 [HCO 3 ] ~0 mmol/l UVol = 1 L P CO2 = 0 mmhg FILTRATE: 180 l/d ph = 7.0 [H + ] = 0 nmol/l [HCO 3 ] = 2 mmol/l Phosphates = 1 mmol/l Filtered phosphates reabsorbed ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO TA RCOO NH + 10 Phosphates 0 SO Cl Nonorganic acids 80 NH Organic ions RCOO 3 [HCO 3 ] ~0 mmol/l UVol = 1 L 6

] ~0 mmol/l UVol = 1 L P CO2 = 0 mmhg FILTRATE: 180 l/d ph = 7.

7 P CO2 = 0 mmhg FILTRATE: 180 l/d ph = 7.0 [H + ] = 0 nmol/l [HCO 3 ] = 2 mmol/l Phosphates = 1 mmol/l Filtered phosphates ph = HPO : 32 H 2 PO : 8 reabsorbed ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO TA RCOO NH + 10 Phosphates 0 HPO : 7 H 2 PO : 33 SO Cl Nonorganic acids 80 NH Organic ions RCOO 3 [HCO 3 ] ~0 mmol/l UVol = 1 L P CO2 = 0 mmhg FILTRATE: 180 l/d ph = 7.0 [H + ] = 0 nmol/l [HCO 3 ] = 2 mmol/l Phosphates = 1 mmol/l Filtered phosphates HPO : 32 H 2 PO : 8 re absorbed ph = 7.0 [H + ] = 0 nmol/l + HPO 2 H 2 PO TA RCOO NH + 10 Phosphates 0 HPO : 7 H 2 PO : 33 [HCO 3 ] ~0 mmol/l UVol = 1 L SO Cl Nonorganic acids 80 NH Organic ions RCOO 3 Metabolisk syreproduktion (acid load) 80 mmol/d Metabolisk syreneutralisation mmol/d Renal syreudskillelse (net acid load) 60 mmol/d Titrerbar aciditet (til ph 7.) mmol/d 7

= 7.0 [H + ] = 0 nmol/l [HCO 3 ] = 2 mmol/l Phosphates = 1 mmol/l Filtered phosphates 180 0 10 HPO : 32 H 2 PO : 8 re absorbed ph = 7.

8 Renal changes attributable to senescence: Hemodynamics Filtration rate Sodium and potassium handling Concentrating and diluting ability Indeed, with the possible exception of the lung, the changes in kidney function with normal aging are the most dramatic of any human organ or organ system. Epstein M: Aging and the Kidney J. Am. Soc. Nephrol. 7: , 1996 Renal filtration and perfusion vs. age Davies, DF & Shock NW: Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. J.Clin.Invest. 29: 96507,

system. Epstein M: Aging and the Kidney J. Am. Soc. Nephrol. 7:11061122, 1996 Renal filtration and perfusion vs.

9 Renal filtration, plasma Cl and blood acidbase variables vs. age Frasetto LA, Morris RC Jr., & Sebastian A: Effect of age on blood acidbase composition in adult humans: role of agerelated renal functional decline. Am.J.Physiol. 271: F111F1122, Blood acidbase variables vs. renal filtration Frasetto LA, Morris RC Jr., & Sebastian A: Effect of age on blood acidbase composition in adult humans: role of agerelated renal functional decline. Am.J.Physiol. 271: F111F1122,

decline. Am.J.Physiol. 271: F111F1122, 1996. Blood acidbase variables vs. renal filtration Frasetto LA, Morris RC Jr.

10 End notes Generally, kidneys in the elderly maintain ph and blood bicarbonate within normal ranges Reduced capacity to excrete acid load due reduced activity of proton pump in cortical collecting duct cells Normal performance, but reduced capacity to synthesize and excrete ammonia Zhou XJ et al.: Renal senescence in 08: progress and challenges. Int.Urol.Nephrol.0: ,

collecting duct cells Normal performance, but reduced capacity to synthesize and excrete

11 11

Acid/Base Homeostasis (Part 3)

Acid/Base Homeostasis (Part 3) Graphics are used with permission of: Pearson Education Inc., publishing as Benjamin Cummings (http://www.aw-bc.com) 27. Effect of Hypoventilation Now let's look at how the