Transport of carbon dioxide Flashcards

1
Q

What is the typical carbon dioxide content in arterial blood?

A

48ml/dl

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2
Q

What are the forms in which carbon dioxide is carried in the blood?

A

Free in physical solution (3 ml/dl)
In chemical combination (45 ml/dl)
* Carbamino compound (3 ml/dl)
* Bicarbonate (42 ml/dl)

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3
Q

Describe the composition of the carbamino compounds carrying of carbon dioxide

A

In RBCs: Carb-Hb (CO2 + Hb)
In plasma: Carbamino protein (CO2 + plasma)

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4
Q

Describe the composition of bicarbonate compounds carrying of carbon dioxide

A

In RBCs: KHCO3
In plasma: NaHCO3

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5
Q

What is tidal CO2?

A

Level of carbon dioxide released at the end of an exhaled breath

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6
Q

What is the typical value of tidal CO2?

A

Under normal resting conditions = 4ml CO2/100ml blood

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7
Q

What is the buffering of tidal CO2?

A

Acid-base homeostatic mechanism involving the balance of carbonic acid (H2CO3), bicarbonate ion (HCO−3), and carbon dioxide (CO2) in order to maintain pH in the blood and duodenum, among other tissues, to support proper metabolic function

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8
Q

How much of each compound is maintained in the buffering of tidal CO2?

A

Technique 1: 0.4ml (10% of tidal CO2): Dissolve in physical solution → decrease PH from 7.4 to 7.34
Technique 2: 1ml (25% of tidal CO2): Change to carbamino compound. Oxy Hb + CO2 = reduced Hb
Technique 3: 2.6ml (65% of tidal CO2): Buffered by Hb with production of HCO3- (Cl- shift phenomenon)

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9
Q

Technique 3: Describe the Cl- shift phenomenon at the tissue level

A

CO2 enters RBC
CO2 hydrated to H2CO3 by carbonic anhydrase
H2CO3 is in equilibrium with H+ and its conjugate base, HCO3 −
H+ interacts with deoxyhemoglobin to form reduced Hb, whereas HCO3− can be transported outside of the cell via anion exchanger 1 (AE1 or Band 3) with Cl-
I.e. for each CO2 molecule that enters the red cell, there is an additional HCO3− or Cl− in the cell

Because of this chloride shift, the Cl− content of the red cells in venous blood is significantly greater than that in arterial blood.

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10
Q

Technique 3: Describe the Cl- shift phenomenon at the lung level

A

HCO3- passes from plasma to RBCs and Cl- moves out of the RBCs into the plasma
Carbonic acid dissociates into H2O and CO2
CO2 diffuses to the alveoli to go outside with expiration.

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11
Q

What is the CO2 dissociation curve?

A

Shows the relationship between the total CO2 content of blood and CO2 tension (PCO2)

↑ PCO2 = ↑ CO2 content

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12
Q

Value of PCO2 and CO2 content in the lungs and tissue

A

At the lung: PCO2 = 40mmHg → CO2 content = 48ml/dl
At the tissues: PCO2 = 46mmHg → CO2 content = 52ml/dl

Therefore, Tidal CO2 = 52-48 = 4ml/dl

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13
Q

What is the Haldane effect?

A

Oxygenation of blood in the lungs displaces carbon dioxide from hemoglobin, increasing the removal of carbon dioxide to the alveoli

Binding O2 with the Hb → displace (release) CO2 from the blood to the alveoli

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14
Q

Haldane effect but on a graph

A

At the tissues (point A):
PO2 = 40mmHg
PCO2 = 46mmHg → CO2 content = 52ml/dl
At the lung (point B):
PO2 = 100mmHg
PCO2 = 40mmHg → CO2 content = 48ml/dl
Without PO2 shift, CO2 content will reduce from 52 ml/dl to 50 ml/dl (only 2 ml of CO2 loss)
But on entering the lung, PO2 rise → shift of CO2 dissociation curve down → additional 2ml loss of CO2 to become 48ml/dl

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15
Q

What is the Bohr effect?

A

Increase CO2 and H+ → Shift of O2 dissociation curve to the right → Release of O2 to the body tissues

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16
Q

Which is more important between the Haldane effect and the Bohr effect?

A

Haldane effect

17
Q

What is hypoxia?

A

Oxygen deficiency at the tissue level

18
Q

What are the types of hypoxia and their causes?

A

HASH
Hypoxic hypoxia (or hypoxemia): Decreased oxygen in inspired air
Anemic hypoxia: Anemia
Stagnant hypoxia: Cardiovascular disease
Histotoxic hypoxia: Tissues are unable to use oxygen

19
Q

What is cyanosis?

A

Bluish discoloration of the skin and mucous membrane when the amount of reduced hemoglobin increases above 5gm/100ml capillary blood

20
Q

What are the typical sites of cyanosis?

A

Lips, fingers (nail bed), ear lobes and tip of nose

21
Q

What are the typical causes of hypoxia?

A

Hypoxic hypoxia
Stagnant hypoxia
Asphyxia