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These are buffered in plasma by bicarbonate, phosphate, haemoglobin and other plasma proteins. Renal excretion of hydrogen ions is important in their elimination. An important effect of the interaction between hydrogen ions and haemoglobin (Hb) is the reduction in the affinity of Hb for oxygen. As a result, when oxy- Decreased CO2 excretion by the lungs results in increased plasma carbonic acid and hence hydrogen ion concentration. g. opiate overdose) and diseases of lung parenchyma that result in inefficient gas transfer.

This is known as a third-space loss. Vomiting Vomitus is also solute rich. In addition, it is highly acidic and the loss of hydrogen ions has an important effect on acid-base balance in the body. Fistulae Gastrointestinal fistulae bypass the capability of fluid reabsorption further down the gastrointestinal tract. 29 Losses therefore, particularly from high fistulae and particularly to the skin, can be large and solute rich. patients, generalised oedema and acute heart failure can be easily precipitated.

An enormous range of surgical implants is available, all with their own idiosyncrasies. However, they can fail for a number of common reasons, for example, incorrect application results in forces being applied that the implant is unable to cope with. Material defects occur occasionally and design faults can take up to several years to become apparent and be corrected. Synthetic materials are prone to infection, which often leads to failure, and prophylaxis might be required. Loss of function Where diseased tissue has been removed, the previous function of that area is either compensated for by another area, or the patient suffers effects of loss of function.

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