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1 Acid-base balance

2 HA H+ + A-

3 HA H + + A - acid H + + base

4 HA H + + A - acid H + + bázis H 2 CO 3 H + + HCO 3 -

5 HA H + + A - acid H + + base H 2 CO 3 K d dissociation H + + HCO - 3 constans

6 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans

7 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans K d = [H + ] x [A - ] [HA] = [H + ] x

8 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans K d = [H + ] x [A - ] [HA] = [H + ] x [A - ] [HA]

9 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans K d = [H + ] x [A - ] [HA] = [H + ] x log K d = log [H + ] + log [A- ] [HA] [A - ] [HA]

10 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans K d = [H + ] x [A - ] [HA] = [H + ] x log K d = log [H + ] + log [A- ] [HA] ph = - log [H + ] = - log K d + log [A- ] [HA] [A - ] [HA]

11 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans ph = pk d + log [A- ] [HA] Henderson-Hasselbalch

12 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans ph = pk d + log [HCO 3 - ] [H 2 CO 3 ]

13 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans ph = pk d + log [HCO 3 - ] [H 2 CO 3 ] ph = pk + log [HCO 3 - ] [CO 2 ]

14 HA H + + A - acid H + + base CO 2 + H 2 O K d H 2 CO 3 H + + HCO 3 - dissociation constans ph = pk d + log [HCO 3 - ] [H 2 CO 3 ] ph = pk + log [HCO 3 - ] [CO 2 ] ph = log [HCO 3 - ] [CO 2 ]

15 CO 2 + H 2 O H 2 CO 3 H + + HCO 3 - ph = log [HCO 3- ] [0.03 x P ] CO 2 [HCO 3- ] = 24 mmol/l P CO 2 = 40 Hgmm ph = 7.4 [H + ] = 40 nmol/l = mol/l Henry-Dalton s law: C gas =a P gas

16 The blood is not isobicarbonic solution

17 Blood buffer-base, BB

18 Bikarbonate Plazmaprotein Hemoglobin Blood buffer-base

19 Bikarbonate Plazmaprotein Hemoglobin Blood buffer-base 1. pk value 2. Anorganic phosphate buffer has low concentration 3. Only the bicarbonate can be regulated by the kidney

20 Bikarbonate Plazmaprotein Hemoglobin CO 2 volatil acid 2 CO 2 + H 2 O + Hb n- +proteinate m- 2 HCO H Hb (n-1)- + H proteinate (m-1)- Non volatil acid Stronger acid H + + bikarbonate

21 Base excess BE Amount of base or acid, that can shift the ph to the normal value in 1 liter blood. Between -2.5 and +2.5 mmol/l (mval/l)

22 Respiratory and non respiratory component of the ph regulation

23 ph = log [HCO 3- ] [0.03 x P ] CO 2

24 Carotis and aorta glomeruli have chemoreceptors. They are monitoring the arterial H + concentration.

25 80 meq non volatil acid/ day 4320 meq HCO 3 filtration/ day 4400 meq H + secretion/ day HCO 3

26 Proximal, early distal tubulus

27 Collecting duct intercaleted A cells H + pump (ATPase) H + K + ATPase (antiport)

28 Phosphate buffer 30-40mEq / day

29 Phosphate buffer 30-40mEq / day

30 Ammonia buffer

31 Ammonia buffer

32 Acid excretion: + NH 4 + excretion (non titratable) + titratable acid (with NaOH) - HCO 3 - excretion

33

34

35

36 Thermoregulation

37

38 0 C 32.0 F 1 C 33.8 F 2 C 35.6 F 3 C 37.4 F 4 C 39.2 F 5 C 41.0 F 6 C 42.8 F 7 C 44.6 F 8 C 46.4 F 9 C 48.2 F 10 C 50.0 F 20 C 68.0 F 30 C 86.0 F 40 C F T ( F) = T ( C) 9/5 + 32

39 Heat production Basal rate of metabolism of cells of the body muscle + shivering thyroxine, growth hormone, testosteron Epinephrine, norepinephrine Chemical activities of the cells Digestion, absorption, storage of food

40 Organ Blood flow % cardiac output O2 consumption Heat production (%) Heat differences between Input and output blood brain Heart Kidney Intestines Skin Muscle

41

42 Temperature check: ear (near tympanic membrane) oral rectal axillary temperature?

43 Heat loss Core to skin Skin to the surrondings Insulation Skin, subcutaneous tissues, fat

44 Thermoneutral zone: 27 C - 30 C (naked), 21 C - 23 C (dressed) Skin C perspiratio insensibilis Higher temperature: Evaporation Convection Conduction Radiation

45

46

47 Normal heat production Skin : ml/min blood Increased heat production 13 liter cardiac output Skin : 8 liter/min blood Acral areas (fingers, hand, foot, head, nose, ears, lips) have arteriovenosus anastomosis

48

49 Sympatetic noradrenerg Acral skin Sympatetic noradrenerg Non Acral skin kininogen bradykinin noradrenerg? Sweat gland Sympatetic noradrenerg

50 Acral skin

51 + lactat from the secretor cells aldosteron Symphatetic colinergic innervation Can be stimulate by epinephrine and norepinephrine, produced by andrenal medulla during active muscle work

52 Final secretum Primer secretum Concentration mmol/l Concentration mmol/l 4,4 nl/gland/min 10,6 nl/gland/min

53 Acclimatization to heat More sweating Higher aldosteron production (adrenocortical glands) Higher ion adsorbation rate Heat environment: Unacclimatized person lose g /day salt Acclimatized person lose 3-5 g /day salt

54 Panting Hypotalamus stimulation Pneumotaxic respiratory center Pons

55 Heat stroke Throbbing headache Dizziness and light-headedness Lack of sweating despite the heat Red, hot, and dry skin Muscle weakness or cramps Nausea and vomiting Rapid heartbeat, which may be either strong or weak Rapid, shallow breathing Behavioral changes such as confusion, disorientation, or staggering Seizures Unconsciousness

56 Hypothalamus elektrophysiology

57 Hypothalamus measures the temperature Set point: F ~ 37 C

58 Anterior Hypothalamic-Preoptic area (central thermoreceptors)

59 Deep thermoreceptors: spinal cord, liver, big veines Peripheral thermoreceptors: skin, mouth more cold receptors

60 Set point modulation by the skin temperature

61

62 Hot temperature: Vasomotor regulation zone C skin, respiratory evaporation (perspiratio insensibilis) Vasomotor-sudomotor regulation zone + sweating (perspiratio sensibilis) Passive hyperthermia: increasement of the bodytemperature Behavioural responses

63 Cold: Vasomotor regulation zone Metabolic regulation zone : shivering (unvoluntary muscletone increasement) katecholamin secretion thyreoid gland? Neonate, animal brown adipose does not produce ATP-t. Oxidaton produces heat. (sympatetic) Behavioural responses

64

65 Fewer Set point shift Preopticus region will work accordig to the new set point

66

67 Pyrogenes Exogen pyrogenes, endotoxinok (lipopolisacharidok) Macrophages incorporate (eg. Gram - bact) cytokines production: interleukin-1 interleukin-6 endogen pyrogenes interferonok cyytokine receptors of the nervus vagus hypothalamus medulla nucleus of vagus

68 The effectmechanism of the prostaglandines is unclear, But the inhibition if the sinthesis is antipyretic. Aspirin

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