acid and alkali

关于泌尿系统病生酸碱平衡的思维导图，主要内容有acid、alkali、material resourse、Butter system in body等。

acid and alkali

• acid
  • Volatile acid
    • H2CO3
  • Fixed acid(unvolatile acid)
    • medicine
      • 氯化铵(ammonium chloride)、水杨酸(salicylic acid)
    • 磷酸(phosphoric acid)、乳酸(lactic acid)、尿酸(uric acid)、酮体(ketone body)、三羧酸(tricarboxylic acid)、硫酸(sulphuric acid）
• alkali
• material resourse
  • alkali
    • mainly from food intake
  • acid
    • mainly from the body
  • entirety
    • acid drainage and alkali retention
• Butter system in body
  • blood buffering system
    • bicarbonate /carbonic acid
      • features
        • 1.strongest capacity(55%)
        • 2.open regulation available throngh kidney and lungs
        • 3.can buffer all unvolatile acid,haven't capacity to buffer volatile acid
        • 4.The blood's pH is decided by the ratio of H2CO3 and HCO3-
  • the regulation of lungs
    • regulate the ratio of carbonic acid through the regulation of the emiton of carbon dioxide(volatile acid)
    • centrol control
      • PaCO2
        • normal value
          • 40mmHg△2mmolHg
          • 60mmHg---10 times
          • >80mmHg---carbondioxide narcosis---inhibitory effect
    • peripheral control
  • cell regulation
    • mainly through the exchange of ion in and out of cell
      • acidosis
        • hyperkalemia (高血钾）
      • alkalosis
        • hypokalemia (低血钾）
  • renal regulation
    • excrete fixed acid
    • maintian the value of carbon dioxide in plasma
    • H+secretion and NaHCO3 reabsorption in proximal renal tubules
      • exchange of Na+ and H+
      • the activity of CA(carbonic anhydrase)
        • can catalyze the cobination of H2O and CO2 to H2CO3 then dissociate toH+ and HCO3-
      • urine acidification is not obvious
    • H+secretion and NaHCO3 reabsorption in distal renal tubules and collecting ducts
      • H+---ATP
      • CA activity
      • urine acidification is obvious
    • Excretion of NH4+(severe acidosis)
      • Proximal convoluted tubules:
        • Glutaminase(谷氨酰胺酶） activity
        • Na+- NH4+exchange
      • Distant curved tubules and manifolds:
        • When pH<4.8, secrete NH3 to neutralize H+
    • Secretion of H+, NH4+and reabsorption of HCO3-
• laboratory parameters of acid-base disturbance
  • pH
    • normal value 7.35·7.45
    • PH ＜ 7.35 decompensated acidosis
    • PH ＞ 7.45 decompensated alkalosis
    • • • Normal acid-base balance
      • • Compensatory acid-base poisoning
      • • Acid and alkali poisoning co-exist and mutually offset
  • • Inversely proportional to alveolar ventilation与肺泡通气量成反比
      • Respiratory factors呼吸性因素
    • PaCO2 ＜ 33mmHg pulmonary hyperventilation, found in primary respiratory alkali or compensatory acid
    • PaCO2 ＞ 46mmHg pulmonary hypoventilation, seen in primary respiratory acid or compensated offspring alkali
  • SB、AB
    • 代谢性因素 呼吸性因素
    • Normal value: 22~27 mmol/L (average 24 mmol/L)
    • Normal person AB=SB
      • AB=SB ＜ 22 mmol/L, found in primary acid
      • AB=SB>27 mmol/L can be seen in primary alkali
    • Respiratory factors of difference between AB and SB
      • If SB is normal, AB>SB, it indicates CO2 retention, which is found in primary expiratory acid
      • If SB is normal, AB ＜ SB, it indicates that CO is discharged too much, which can be seen in the primary respiratory alkali
  • buffer base， BB
    • Concept: the sum of all negative ion bases with buffering effect in the blood.
      • Metabolic factor
    • Normal value: 45~52mmol/L (average 48 mmol/L)
      • BB ＜ 45 mmol/L can be seen in primary acid
      • BB ＞ 52 mmol/L can be seen in primary alkali
  • • Metabolic factor
    • Normal value: - 3.0~+3.0 mmol/L
      • The increase of negative BB value indicates that the alkali is insufficient in the primary generation of acid
      • The increase of positive BB value indicates that the excess alkali is found in the primary generation of alkali
  • 6.Aniongap,AG
    • UA(+)-UC(-)
      • normal value10-14mmol/L
      • meaning
        • Reflect the content of plasma fixed acid
        • Distinguish the acid type (AG ＞ 16 mmol/L,which tips the metabolic acidosis)
        • Diagnosis of mixed acid-base balance disorder
  • summary
    • metabolic
      • AB,SB,BB,BE
    • repiratory
      • AB-SB,PaCO2
    • AG
      • type of (metabolic) acidosis (>16mmol/L)
• Classification of acid-base disorders
  • Compensability
    • Decompensatory
    • Compensatory
  • type
    • simple
      • metabolic acidosis
        • PH decrease caused by increase of fixed acid and/or loss of HCO3 -
        • Characteristics: Primary decrease of plasma HCO3-
        • Causes and mechanisms
          • Acidosis
            • Increased production of fixed acid
              • Lactic（乳酸） acidosis: shock, heart failure
              • Ketoacidosis(酮症酸中毒）: diabetes（糖尿病）, severe hunger, alcoholism
            • Reduced acid excretion
              • Severe renal failure
              • Type I RTA (renal tubular acidosis)
                • ----Distal convoluted tubular（远曲小管) acidosis
                  • Dysfunction of H+secretion
                  • Urine cannot be acidified H+accumulation
            • Excessive intake of exogenous fixed acid
            • Hyperkalemia
          • Alkalosis
            • HCO3 - excessive direct loss
              • Severe diarrhea（严重腹泻）, small intestine (肠道萎管) and biliary tract atrophy（胆道萎管）, etc
              • HCO3 - reduction of absorption
                • Type II RTA: proximal convoluted tubule(近曲小管） acidosis
                • Application of carbonic anhydrase (CA) inhibitor (reduce the formation of H2CO3, the secretion of H+, and the reabsorption of HCO3 -)
              • Hemodilution HCO3 decrease
                • A large amount of sugar water or salt water is input in a short time
        • classification
          • AG increased metabolic acidosis"Normal blood chlorine（氯） metabolic acidosis"
            • features
              • AG increased (fixed acid increased)
              • Normal blood chlorine
            • cause
              • Fixed acid retention
                • Lactic acidosis
                • ketoacidosis
                • Poisoning by salicylic acid（水杨酸）
                • Phosphoric acid（磷酸） and sulfuric（硫酸） acid excretion disorder
          • Normal AG metabolic acidosis"Hyperchloric metabolic acidosis"
            • features
              • AG is normal
              • Increased blood chlorine
            • causes
              • Alkali deficiency
                • diarrhea(腹泻）
                • Hyperkalemia（高钾血症)
                • Renal tubular acidosis(肾小管性酸中毒)
                • A large amount of normal saline(生理盐水）
                • Excessive input of chloric acid salt（含氯酸性盐摄入过多）
    • mixed