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IMPORTANCIA DE LOS SISTEMAS BUFFERS

IMPORTANCIA DE LOS SISTEMAS BUFFERS. 1 L H 2 O. 10 mmoles HCL cc ( H + + CL - ). pH 7.0 100 nEq/L H +. pH 2.0 ( H + = 10.000.000 nEq/L ). pH = 7.40 H = 40 nEq/L. 1 L 30 Mm PO4H 2- / PO4H - 2. 10 mmoles HCL cc ( H + + CL - ).

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IMPORTANCIA DE LOS SISTEMAS BUFFERS

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  1. IMPORTANCIA DE LOS SISTEMAS BUFFERS 1 L H2O 10 mmoles HCL cc ( H+ + CL- ) pH 7.0 100 nEq/L H+ pH 2.0 ( H+ = 10.000.000 nEq/L ) pH = 7.40 H = 40 nEq/L 1 L 30 Mm PO4H2-/ PO4H-2 10 mmoles HCL cc ( H+ + CL- ) pH 6.39 ( H+ = 405 nEq/L ) 100 nEq/L H+ ( PO4H2- + H+ PO4H-2 )

  2. SISTEMA CERRADO VS ABIERTO • SISTEMA ABIERTO: AH y A- SON INDEPENDIENTES ENTRE SI • SISTEMA CERRADO: AH es proporcional A- ( o viceversa ) • pH= pK + log BASE • ACIDO • Ejemplo: adicion de 5 mmoles HCL • pH = 7.40, H = 40 nEq/L, pCO2 = 40 mmHg, • CO3H- = 24 mmoles/L, CO3H2 = 1.2 mEq/L • SISTEMA CERRADOSISTEMA ABIERTO • CO3H- = 19 mEq/L CO3H- = 19 mEq/L • CO3H2 = 6.2 “ CO3H2= 1.2 “ • pCO2 = 206 mmHg pCO2 = 40 mmHg • H = 257 nEq/l H= 50 nEq/L • pH = 6.59 pH = 7.30 4 H+ 6 A- 6 AH 10 AH + 2 A-

  3. PRINCIPIO ISOHIDRICO SANGRE: SOLUCION HOMOGENEA DE n BUFFERS ( UNICO pH ) AH 1 A1- + H1+ K1 = [A1-] [H1+] [H1+] = K1 [AH1] [AH1] [A1-]  AH 2 A2- + H2+ K2 = [A2-] [H2+] [H2+] = K2 [AH2] [AH2] [A2-] AH 3 A3- + H3+ K3 = [A3-] [H3+] [H3+] = K3 [AH3] [AH3] [A3-] [H1+] = [H2+] = [H3+] = [Hn+] [H] = K1 [AH1]= K2 [AH2]= K3 [AH3]= Kn [AHn] [A1-] [A2-] [A3-] [An-]

  4. ACCION BUFFER EN ALTERACIONES RESPIRATORIAS • ACIDOSIS RESPIRATORIA AGUDA: pH CO3H- pCO2 CO2 + H2O CO3H2 CO3H- + H+ + BUFFER- BUFFERH c/10 mmHg pCO2 1 mEq/L CO3H- • ALCALOSIS RESPIRATORIA AGUDA pCO2 pH CO3H- c/10 mmHg pCO2 2.5 mEq/L CO3H-

  5. TRANSPORTE DE CO2 TEJIDO PLASMA GLOBULO ROJO AC CO2 (g) CO2 (g) CO2 + H2O CO3H2 + (10-15 Mol/dia) a x pCO2 = CO2 (d) 8% Hb HbO2 H++ CO3H- 0.03 40 HbCO2 1.2 mEq/l 10% HbH Cl- ClNa CO3H- 82%

  6. ELIMINACION DE CO2 PULMON PLASMA GLOBULOS ROJOS CO2Hb O2O2 (g) O2 + HbH a x Po2 = O2 (d) H++ CO3H- CO3H2 HbO2 CO2+H2O CO2(d) CO3H2 H+ + CO3H- CO2(g) CO2(g) AC. RESP. ALC. RESP. BALANCE NETO CO2 = 0

  7. FUENTES DE ACIDOS Y BASES ENDOGENAS • ACIDOS ENDOGENAS: • Aa sulfurados H2SO4 + UREA + CO2 + H2O • Acidos de fosfoesteres H3PO4 • Glucosa Ac. Lactico / Piruvico • TG Acidos grasos • Nucleoproteinas Ac. Urico • BASES ENDOGENAS: • Aniones organicos CO3H- + UREA + CO2 + H2O • Sales de fosfoesteres CO3H- + H2PO4- O2 H2O O2 H2O

  8. FUENTES DE ACIDOS Y BASES ENDOGENAS • ACIDOS ENDOGENAS: • Aa sulfurados H2SO4 + UREA + CO2 + H2O • Acidos de fosfoesteres H3PO4 • Glucosa Ac. Lactico / Piruvico • TG Acidos grasos • Nucleoproteinas Ac. Urico • BASES ENDOGENAS: • Aniones organicos CO3H- + UREA + CO2 + H2O • Sales de fosfoesteres CO3H- + H2PO4- O2 H2O O2 H2O

  9. ACIDOSIS TUBULAR PROXIMAL

  10. DEFECTOS DE ACIDIFICACION RENAL y ATR DISTAL

  11. ACIDEZ TITULABLE Y FOSFATOS VN Ppl = 4.0 mg/dl Ppl ( mg/dl ) = 4.0 x 10 = 1.33 mmol/l 25% UNIDO A ALB. = 1.0 mM 31 Carga filtrada de P = IFG x Ppl filtrable = 180 L/dia x 1.0 = 180 mmol/dia Reabsorcion proximal P = 75 % 180 x 0.25 = 45 mmol /dia PO4H2- : PO4H-2 pH = 7.40 80 % 20% AT. (PO4H2-) = 0.8 x 45 = 36 mmol/dia + ( 5 mmol/dia Citrato ) AT total = 40 mmol/dia

  12. REABSORCION PROXIMAL DE FOSFATOS • AUMENTA EL TRANSPORTE • ALC. METABOLICA CRONICA • HIPERKALEMIA • BAJA DIETA DE P • STANIOCALCINA • HORMONAS TIROIDES • DISMINUYE EL TRANSPORTE • AC. METABOLICA CRONICA • ACIDOSIS RESPIRATORIA AGUDA • HIPOKALEMIA • ALTA DIETA EN P • PTH

  13. RESPUESTA RENAL A LA CARGA FILTRADA DE FOSFATOS

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