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management of DKA in children.detailed word document

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ACID BASE BALANCE
BY EMASE BILDAD
H12/70278/11B
MB ChB YR5

Normal urinary acidification
• It involves two processes;
1. Bicarbonate reabsorption
2. Hydrogen ion excretion
• About 85% of filtered bicarbonate is reabsorbed in the proximal convoluted
tubule
• In children, bicarbonate reabsorption is less efficient
• Bicarbonate reabsorped by an indirect process
• Normal plasma pH is in the range of 7.35 to 7.45
• Normal Hydrogen ion concentration is 36-44 mmol/L
• Normal HCO3 concentration 20-30 mmol/L

• PCT reabsorption of bicarb begins by the secretion of a hydrogen ion
in exchange for a sodium ion.
• The Hydrogen ion in the lumen then binds with bicarbonate to form
CO2 and water, this being under the influence of carbonic anhydrase.
• CO2 then diffuses into the adjacent PCT cell and after a series of rxns
there is creation of a bicarbonate molecule, this enters the
peritubular capillary, and a hydrogen ion which can take part in
further buffering of bicarb in the tubular lumen.
• The remaining 15% of bicarbonate is reabsorped distally

• Secretion of the daily acid load is accomplished by;
a) Hydrogen ion secretion
b) Ammoniagenesis
c) Formation of titratable acids

Disorders of acid-base balance;
a) Metabolic acidosis
• Results from either generation or ingestion of acid
• It could also be from the loss of bicarbonate ions with consequent
accumulation of hydrogen ions in the circulation
• Compensation through an increase in ventilation will result in a
consequent drop in the levels of CO2 and HCO3 ions.

Features of metabolic acidosis
a) Low plasma HCO3 ion conc, < 20mmol/L
b) Low arterial CO2 ion conc, < ...


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