Friday, December 14, 2012

Ammonia buffer


Ammonia buffer

Most ammonia (60%) is synthesized in proximal tubule cells by deamidation and deamination of the amino acid glutamine [rest comes from glycine and alanine].

Ammonia is secreted into the urine by two mechanisms.
1.   As NH3 (because of its lipid soluble nature), it diffuses into the tubular urine; as NH4 +, it substitutes for H+ on the Na+/H+ exchanger. In the lumen, NH3 combines with secreted H+ to form NH4+, which is excreted [because of its polar nature and therefore can not diffuse back into the tubular epithelium].
For each mEq of H+ excreted as NH4+, one mEq of new HCO3_ is added to the blood. The hydration of CO2 in the tubule cell produces H+ and HCO3 _.

2.   Two H+s are consumed when the anion α2-ketoglutarate2_ is converted into CO2 and water or into glucose in the cell. The new HCO3_ returns to the blood along with Na+.



If excess acid is added to the body, urinary ammonia excretion is increased for two reasons.
·        More acidic urine traps more ammonia (as NH4+) in the urine.
·        Renal ammonia synthesis from glutamine increases over several days which is a lifesaving adaptation because it allows the kidneys to remove large H+ excesses and add more new HCO3_ to the blood. With severe metabolic acidosis, ammonia excretion may increase almost 10-fold.
Renal ammonia synthesis is increased through an increase in the glutaminase activity.



Wednesday, December 12, 2012

Phosphate buffer and protein buffers


Phosphate buffer

The pKa for phosphate, H2PO4 , is 6.8, close to the desired blood pH of 7.4, so phosphate is a good buffer.

 In the ECF, phosphate is present as inorganic phosphate in a very low concentration  (about 1 – 2 mmol/L), so it plays a minor role in extracellular buffering.

Phosphate is an important intracellular buffer  for the reasons:

1.    Cells contain large amounts of phosphate in such organic compounds as adenosine triphosphate (ATP), adenosine diphosphate (ADP), and creatine phosphate. Although these compounds primarily function in energy metabolism, they also act as pH buffers.
2.    Intracellular pH is generally lower than the pH of ECF and is closer to the pKa of phosphate which is 6.8 (e.g.The cytosol of skeletal muscle has a pH of 6.9.).


Phosphoric acid is triprotic weak acid and has a pKa value for each of the three dissociations:
pKa1 = 2
pKa2 = 6.8
pKa3 = 12
H3PO4
<= = = >
H+ + H2PO4- 
<= = =>
H+ + HPO4-2
< = = = >
PO4-3 + H+

The three pKa values are sufficiently different so that at any one pH only the members of a single conjugate pair are present in significant concentrations.

The pKa2 is 6.8 and this makes the closed phosphate buffer system a good buffer intracellularly and in urine. The pH of glomerular ultrafiltrate is 7.4 and therefore phosphate is predominantly in the monohydrogen form so as to  combine with more H+ in the renal tubules efficiently. This makes the phosphate buffer more effective in buffering against a drop in pH than a rise in pH.







Protein buffer


Proteins act as efficient buffers because of their amino acid structure which  have a central carbon with four groups off of it.

The carboxyl and amino groups are what enable proteins to act as buffers.

Protein buffers in blood include haemoglobin (150g/l) and plasma proteins (70g/l). Buffering is by the imidazole group of the histidine residues which has a pKa of about 6.8. This is suitable for effective buffering at physiological pH (7.4).

Haemoglobin is quantitatively about 6 times more important than the plasma proteins as it is present in about twice the concentration and contains about three times the number of histidine residues per molecule. For example if blood pH changed from 7.5 to 6.5, haemoglobin would buffer 27.5 mmol/l of H+ and total plasma protein buffering would account for only 4.2 mmol/l of H+.

Deoxyhaemoglobin is a more effective buffer than oxyhaemoglobin and this change in buffer capacity contributes about 30% of the Haldane effect. The major factor accounting for the Haldane effect in CO2 transport is the much greater ability of deoxyhaemoglobin to form carbamino compounds.

Haemoglobin has a special place in the pHstabilizing mechanisms of blood because
(a)  Haemoglobin and oxyhaemoglobin have different iso-electric points and different ionization constants so that at the pH of blood, absorption of about 0.7 g. of hydrogen ion [from carbonic acid mainly] (and the release of an equivalent amount of potassium ion in exchange) takes place during liberation of oxygen from 1 g molecule of oxyhemoglobin.
(b)  (b) Haemoglobin, more easily than other proteins, reacts reversibly with carbonic acid to form a still weaker carbaminoacid; and an increasing accumulation of carbamino-haemoglobin as the blood passes through the capillaries and a sharp reversal when, in the lungs, the equilibrium is disturbed, carbon dioxide being excreted, carbonic acid converted to carbon dioxide under the influence of carbonic anhydrase, and, consequently, carbaminohaemoglobin  is decomposed.

(Frazer &Stewart, J. clin. Path. (1959), 12, 195-206)


For more details readers are advised to go through the above mentioned paper and then directed to the link http://www.madsci.org/posts


Tuesday, December 11, 2012

major buffer systems in the body


Major chemical buffers in the body






Bicarbonate buffer

A normal adult produces about 300 L of CO2 daily from metabolism. CO2 from tissues enters the capillary blood, where it reacts with water to form H2CO3, which dissociates instantly to yield H+ and HCO3 –.

Blood pH would rapidly fall to lethal levels if the H2CO3 formed from CO2 were allowed to accumulate in the body.
Fortunately, H2CO3 produced from metabolic CO2 is only formed transiently in the transport of CO2 by the blood and does not normally accumulate. Instead, it is converted to CO2 and water in the pulmonary capillaries and the CO2 is expired. As long as CO2 is expired as fast as it is produced, arterial blood CO2 tension, H2CO3 concentration, and pH do not change.


pK of the HCO3-/CO2 is 6.1.
pH of plasma is 7.4.
 According to Henderson-Hasselbalch equation

7.4 = 6.1 + log [HCO3-]/ [CO2]

1.3= log [HCO3-]/ [CO2]

20= [HCO3-]/ [CO2]


i.e. At pH 7.4, concentration of bicarbonate should be 20 times that of Carbon dioxide.

As described in the previous post, it is the salt portion that neutralizes external acids, so a higher concentration of bicarbonate should suffice. This explains the relative importance of bicarbonate/CO2 buffer over other buffers because most metabolic end products are acidic in nature.

Concentration of HCO3 -   in plasma or ECF normally averages 24 mmol/L.  CO2 is measured from PCO2 which is about 40 mm Hg and that amounts to 1.2mmol/L of CO2 (0.03* 40) {The solubility coefficient for CO2 in plasma at 37°C is 0.03 mmol CO2/L per mm Hg PCO2 }.  Although the concentration of dissolved CO2 is lower, metabolism provides a nearly limitless supply. Hence [HCO3-]/ [CO2] = 24/1.2=20 supports the theoretical calculations performed above using Henderson-Hasselbalch equation.


The Henderson-Hasselbalch Equation for HCO3_/CO2
In aqueous solutions:

CO2(d)   +    H2O      give       H2CO3
(dissolved)

At equilibrium, CO2(d) is greatly favored; at body temperature,  [CO2(d)] : [H2CO3] is about 400:1 [If [CO2(d)] is 1.2 mmol/L, then [H2CO3] equals 3 μmol/L].

H2CO3     instantaneously breaks into H+ + HCO3-

The Henderson-Hasselbalch Equation for the above equation is:

pH= 3.5 +  log [HCO3-]/ [H2CO3]

H2CO3 is a fairly strong acid (pKa = 3.5). Its low concentration in body fluids lessens its impact on acidity. Because [H2CO3] is so low and hard to measure so [CO2(d)] is used instead.

pH= 3.5 +  log [HCO3-]/ [CO2(d)]/400

pH= 3.5+ log 400 + log [HCO3-]/ [CO2(d)]

pH= 6.1+ log [HCO3-]/ [CO2(d)]


pH= 6.1+ log [HCO3-]/ 0.03*pCO2

pH= 6.1  + log [24]/[1.2]

pH=7.4




Monday, December 10, 2012

Physiological buffers: a brief introduction


Physiological Buffers

A "buffer system," which minimizes pH changes on addition of acid or base, consists of a solution containing a weak acid together with one of its soluble salts e.g. H2CO3 and NaHCO3.

The acid, being weak, is slightly ionized but the soluble salt is ionized to a large extent. The mixture thus provides a reservoir of base (anions) which can combine with added H+ (neutralize added acid) and a reservoir of acid (undissociated acid molecules) which can donate hydrogen ions to neutralize added base.



Efficacy of the buffer depends on the pH of the buffer i.e. the concentration of weak acid and base added to constitute the buffer. This relationship is expressed by the Henderson-Hasselbalch equation.

pH= pK+ log [salt]/[acid]



A buffer is most effective when the concentration of its salt and acid are equal. pK of a buffer is that pH at which its salt and acid forms are in equal concentration. Hence a buffer is most effective in a solution the pH of which is equal to the pK of the buffer. The most effective physiological buffers are those whose pK is around 7.4.

In a solution which has various buffer systems then they should be in mutual equilibrium. If the acid:base is known for any one of the buffer systems, the pH of the mixture can be known. This can be described in terms of isohydric principle:

[H+] = K1*[acid 1]/[salt 1] = K2*[acid 2]/[salt 2]= K3*[acid 3]/[salt 3]


In plasma, H2CO3-NaHCO3 buffer is the easiest to measure and most important quantitatively. Therefore total CO2 content of plasma (sum of HCO3- and H2CO3 + CO2) can represent the total buffering capacity.









Thursday, November 29, 2012

Acids and Bases



Acids and bases

Acid: An "acid" is defined, according to (Lowry and Bronsted), as a substance  which, in solution, tends to liberate hydrogen ions (protons).

These hydrogen ions may
1.   remain as such
2.   may combine with the solvent forming, e.g., hydroxonium ions, H30+
3.   may combine with negatively charged ions.


 Base: A “base " is defined as a substance which tends to accept hydrogen ions.

Thus
H+ donor ↔ H+ + H+ acceptor
                                  (Acid)     (Base)


·        Acids, may not always be  undissociated molecules.
·        Bases, may be molecules, though the class includes all anions.


Thus the cation NH4+ liberated from ammonium salts is an acid because it is capable of producing hydrogen ions according to the
equation:
NH4+ ↔ H+ + NH3
                                                (Acid)            (Base)

Similarly the anion HPO4-2 is a base because it can accept H+ to form H2PO4- and the acid molecule H3P04.

The anions H2PO4- and HPO4-2 can also act as acids because they can lose H+ to form the base PO4-3 (" amphoteric").




Strength of acids




The " strength " of an acid is measured by its tendency to donate hydrogen ions ( by its degree of dissociation)

·        The freely dissociated mineral acids (HCI, etc.) are strong acids; slightly dissociated acids such as carbonic acid are weak.

·        A strong base has a great affinity for hydrogen ions whereas a weak base is a poor acceptor.

·        The anion of a strong acid is a weak base, e.g., Cl-, and the anion of a weak acid is a strong base, e.g., HCO3 -, OH-.




As I was searching literature for a short  and crisp note on acids and bases for the students of medicine, I came across a brilliant paper by 
Frazer and Stewart (J. clin. Path. (1959), 12, 195). I would advise the readers to go through the paper once if time permits. On my part I would definitely strive to elaborate upon all the subtopics explained in the paper and of course all the related material as well. Subsequent posts will lay stress on the physiological buffers and acidosis/ alkalosis.

I wish to have suggestions from the readers in order to improve my blog. Please feel free to ask any doubts related to these topics. As far as the explanation is concerned I think these topics can act as ready-made notes to be covered before each professional examination.

Poorvi


Wednesday, November 28, 2012

Serum anion gap


Anion Gap

Anion gap (plasma or serum) is an entity which can be calculated from the electrolytes measured in laboratory.

Definition:
“Anion gap is defined as the sum of serum chloride and bicarbonate concentrations subtracted from the serum sodium concentration.”

Normal value:  can vary widely, reflecting both differences in the methods that are used to measure its constituents and substantial interindividual variability. The average serum anion gap in healthy individuals measured varies from 11 ± 2.5   to 15 ±2.5 m eq/l .

Indications: This entity is used mainly for the detection and analysis of acid-base disorders, assessment of quality control in the chemical laboratory, and detection of such disorders as multiple myeloma, bromide intoxication, and lithium intoxication.


Gamblegram:

serum cations=serum anions

The sum of both entities must always be equal. This equivalency is the foundation of the derivation of the serum anion gap.

A graphic display of the ionic environment of the serum (Gamble J, 1950)




Total cations in serum = total anions in serum =155 meq/l
As a routine procedure, only sodium, potassium, chloride, bicarbonate ions are measured. Therefore other remaining cations and anions are called unmeasured cations (UC) and unmeasured anions (UA) respectively.
UC include magnesium (3 meq/l) and calcium (5 meq/l) ions mainly.
UA include proteins (16 meq/l); phosphate (2 meq/l), sulphate (1 meq/l), other miscellaneous anions( 6 meq/l).
Therefore,
Na+ + K+ + UC = Cl- + HCO3-+ UA……….(i)
By rearranging:
Na+ + K+  - (Cl- + HCO3-) = UA-UC..........(ii)
Under normal conditions, in a healthy individual, UA> UC (UA=25 meq/l; UC=8 meq/l); therefore, there is anion gap.
The concentration of potassium in the blood usually is relatively small compared with that of sodium, chloride, and bicarbonate;
therefore, many a times when calculating the anion gap potassium ion is omitted as

UA-UC = Na+ - (Cl- + HCO3-) …………(iii)

Measured cations (MC)= 147 meq/l
Measured anions (MA) = 130 meq/l
MC-MA = UA-UC
147-130= 25-8
17=17


taken from an indepth review by Kraut and Madias (Clin J Am Soc Nephrol 2: 162–174, 2007).
Deviations in the normal values of serum anion gap would be discussed in some other post.






Saturday, February 27, 2010

poem: welcome to holland

Last night, saw a tv program about a disabled child and got to know about this poem.


Welcome To Holland

by
Emily Perl Kingsley



I am often asked to describe the experience of raising a child with a disability - to try to help people who have not shared that unique experience to understand it, to imagine how it would feel. It's like this......

When you're going to have a baby, it's like planning a fabulous vacation trip - to Italy. You buy a bunch of guide books and make your wonderful plans. The Coliseum. The Michelangelo David. The gondolas in Venice. You may learn some handy phrases in Italian. It's all very exciting.

After months of eager anticipation, the day finally arrives. You pack your bags and off you go. Several hours later, the plane lands. The stewardess comes in and says, "Welcome to Holland."

"Holland?!?" you say. "What do you mean Holland?? I signed up for Italy! I'm supposed to be in Italy. All my life I've dreamed of going to Italy."

But there's been a change in the flight plan. They've landed in Holland and there you must stay.

The important thing is that they haven't taken you to a horrible, disgusting, filthy place, full of pestilence, famine and disease. It's just a different place.

So you must go out and buy new guide books. And you must learn a whole new language. And you will meet a whole new group of people you would never have met.

It’s just a different place. It's slower-paced than Italy, less flashy than Italy. But after you've been there for a while and you catch your breath, you look around.... and you begin to notice that Holland has windmills....and Holland has tulips. Holland even has Rembrandts.

But everyone you know is busy coming and going from Italy... and they're all bragging about what a wonderful time they had there. And for the rest of your life, you will say "Yes, that's where I was supposed to go. That's what I had planned."

And the pain of that will never, ever, ever, ever go away... because the loss of that dream is a very very significant loss.

But... if you spend your life mourning the fact that you didn't get to Italy, you may never be free to enjoy the very special, the very lovely things ... about Holland.

* * *