upc internet praha Basic Concepts in Biochemistry in .NET framework

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Basic Concepts in Biochemistry
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Kidneys can secrete [H ] (by an energy-dependent proton pump) directly into the filtrate, lowering the pH of the urine Because of the lowered pH, more of the initially filtered bicarbonate exists as the gas, CO2, which can freely cross membranes Diffusion of this acidic gas back to the blood (through the epithelial cells) and hydration and loss of the proton to form bicarbonate results in reclaiming the initially filtered bicarbonate The kidney reclaims bicarbonate by actually reclaiming the acid form (CO2), and the net effect is reclaiming bicarbonate and a proton The excess protons must actually exit the body on another buffer in the urine (usually phosphate) The net results is that as the pH of the urine falls, the kidney reclaims more and more of the bicarbonate Reclaiming more HCO 3 in response to a decreased serum pH ([H ] ) causes the [HCO 3] to rise, restoring the pH to normal [H ] 24pCO2 [HCO 3 ]
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The kidneys, by reclaiming bicarbonate, can compensate for an increased pCO2 caused by a problem with the lungs
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ACIDOSIS AND ALKALOSIS
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Acidosis: pH 74 Alkalosis: pH 74 Respiratory acidosis: pCO2 Respiratory alkalosis: pCO2 Metabolic acidosis: [HCO 3 ] Metabolic alkalosis: [HCO 3 ] Normally everything is in balance The lungs have the numerator (pCO2), and the kidneys have the denominator ([HCO 3 ]) The amount of CO2 produced by metabolism is balanced by the amount of CO2 blown off by the lungs and let go by the kidney It s the same way with the other metabolic acids they leave the body as CO2 or they are excreted by the kidneys If everything always stayed in balance, you wouldn t have to learn all this but as usual it doesn t, and you do When blood pH is not normal, something must not be working correctly or the capacity of the system must have been exceeded Using the magic equation [H ] 24pCO2 [HCO 3 ]
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pH, pKa, pRoblems
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we can see that there are two things that might cause the [H ] to be abnormal: a change in pCO2 or a change in [HCO 3 ] The 24 never changes If the [H ] is abnormally high (low pH), the condition is called acidosis If the [H ] is abnormally low, the condition is called alkalosis For each type of [H ] imbalance (too high or too low), there are two possible causes An abnormally high [H ] could have been caused either by an abnormally high pCO2 (increased numerator of the magic equation) or by an abnormally low [HCO 3 ] (decreased denominator) Since pCO2 is regulated by the lungs, the label respiratory is attached to effects that cause the pCO2 to change An acid base imbalance caused by a change in pCO2 is termed respiratory acidosis or alkalosis depending on whether the pCO2 is increased or decreased The bicarbonate concentration is the province of the kidney and is determined by how much bicarbonate the kidney reclaims Changes in the bicarbonate concentrations are labeled metabolic When something goes wrong with acid base balance, something is not working right If the lungs are at fault and the pCO2 changes, it is called respiratory acidosis if pCO2 increases ([H ] increases) or respiratory alkalosis if the pCO2 decreases ([H ] decreases) When the kidneys are at fault, and [HCO 3 ] is too high or low, it s called metabolic alkalosis or acidosis If the bicarbonate concentration drops, then its called metabolic acidosis, and if the bicarbonate concentration rises, it s called metabolic alkalosis, because the change in [H ] must be opposite that of the bicarbonate (look at the magic equation again) Thus, we have four possible causes of acid base imbalance: respiratory acidosis, respiratory alkalosis, metabolic acidosis, and metabolic alkalosis The simple thing to remember is cause (metabolic or respiratory) and direction (acidosis or alkalosis) The body has two options when acid base balance breaks down fix the original problem or do something else to provide a temporary fix until a more permanent fix can be implemented If a person hypoventilates (breathes out too little CO2), blood pCO2 rises and the pH decreases ([H ] increases) This is respiratory acidosis Obviously, if the body could increase respiration, there wouldn t be a problem Since that doesn t seem to be an option, the next strategy would be to change the bicarbonate concentration to get the pH back to normal Which direction should it go Look at the magic equation If pCO2 is increased (numerator), the only way to get the [H ] back to normal is also to increase [HCO 3 ] metabolic alkalosis 24pCO2 [HCO 3 ]
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[H ]
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