This chapter is most relevant to Section F8(ii) from the 2017 CICM major Syllabus, i beg your pardon expects the exam candidates to be able to "describe the carbon dioxide carriage in blood including ...the chloride shift".

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In summary: 


The chloride transition or "Hamburger effect" describes the motion of chloride right into RBCs which occurs when the buffer results of deoxygenated haemoglobin rise the intracellular bicarbonate concentration, and the bicarbonate is exported from the RBC in exchange because that chloride.This results in a distinction of 2-4 mmol/L of chloride in between the arterial and venous blood (and a similar difference in bicarbonate concentration).The device of the chloride shift:Chloride moves into erythrocytes, and also bicarbonate move out, in venous blood.CO2 diffuses right into the red cellsThere, it is converted to bicarbonate by carbonic anhydraseBicarbonate is then pumped out of the red cell, and chloride pumped into it, by the band 3 exchange protain. This whole procedure happens an extremely rapidly, fine within the circulating timeThe reverse events take place in the pulmonary capillaries:Bicarbonate is pumped ago into the red cell, and chloride pumped outCarbonic anhydrase switch bicarbonate back into carbon dioxide and waterThe chloride transition has signficant effects for the organism:It mitigates the adjust in pH which would certainly otherwise occur in the peripheral circulation as result of metabolic byproducts (mainly CO2)It boosts the CO2-carrying volume of the venous bloodIt boosts the unloading of oxgyen, because of the allosteric modulation that the haemoglobin tetramer through chloride (it stabilises the deoxygenated T-state)

Westen & Prange (2003) offer a reasonable rundown of the situation, yet their write-up is paywalled. So is the excellent document by Klocke (1988) which basically goes through all the measures in the chloride shift process in terrific detail. Surely if you space going to it is in throwing money approximately you may as well buy the official exam textbook. Unfortunately, Hartog Jacob Hamburger"s original file on "Anionenwanderungen in Serum und Blut" is no available, but perhaps the is because that our own good.

Definition the the chloride shift:

Westen & Prange (2003) define the chloride change as:

"the activity of chloride ion from the plasma right into red blood cells together blood undergoes the shift from arterial come venous gas partial pressures" 

There is more than likely something an ext official out there, yet most authors give a description which is therefore close to the one over that it would be meaningless to repeat castle all. In short, if this ever before comes increase in a viva of part sort, so lengthy as one offers the indigenous "chloride" and "erythrocytes" in the very same sentence, one must be close to fifty percent marks already. The most necessary points are:

Chloride moves into erythrocytes, and also bicarbonate move out, in venous blood.The reverse events take location in the pulmonary capillaries

Mechanism of the chloride shift

The molecule mechanisms for the chloride change are defined in information below. In summary, this phenomenon is only possible because of the presence of carbonic anhydrase in RBCs. The is seen as a critically important element (as it is concentrated there, yet essentially absent from the bloodstream otherwise). Without it, the reaction converting CO2 come HCO3- would be painfully slow. Through massive quantities of erythcyte carbonic anhydrase, we can instead counting on these molecular transactions to be complete in the an are of one circulatory time. In fact, since all the compelled proteins are obtainable in substantial concentrations, the reaction is exceptionally fast. Wieth & Brahm (1980) had figured out that 99% the the chloride shift process is complete within about 700 milliseconds.

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Yes, those potato-looking things are erythrocytes. The numbers came from west & Prange (2003), whose experiments are disputed below.

Magnitude that the chloride shift

With every this speak of shifting, how much chloride in reality shifts? This effect is not specifically seismic. Because that instance, after identify what electrolyte movements should occur utilizing quantitative physicochemical analysis, west & Prange (2003) drained blood from healthy volunteers and also subjected it come "venous-ification" by exposure to a hypoxic and hypercapnic atmosphere. In ~ a simulated venous gas concentration, the median chloride transition of the samples was around 2.4 mmol/L. With a greater haematocrit, closer come 0.55 (they cheated through centrifuge yet there really are world out there through such haematocrit values) the investigators were able to measure up a chloride shift of about 4.3 mmol/L. 

Significance that the chloride shift:

Why is this phenomenon important? Well:

Mitigation that pH adjust in the peripheral circulation: pH of the peripheral blood would change significantly much more if deoxygenated RBCs were not there to buffer the acid and sequester the chloride.Increase in the CO2 delivering capacity the the blood:  the impact of shuttling chloride into the red cells and also bicarbonate the end of them rises the complete potential bicarbonate carriage by the venous blood, i m sorry is great because most CO2 is brought as bicarbonate.

Westen, Edward A., and Henry D. Prange. "A reexamination of the mechanisms basic the arteriovenous chloride shift."Physiological and Biochemical Zoology76.5 (2003): 603-614.

Klocke, Robert A. "Velocity that CO2 exchange in blood."Annual review of physiology50.1 (1988): 625-637.

Hamburger, H. J. "Anionenwanderungen in Serum und Blut unter dem Einfluss von CO2, Säure und Alkali."Biochem Z86 (1918): 309-324.

Fairbanks, G., Theodore L. Steck, and D. F. H. Wallach. "Electrophoretic analysis of the major polypeptides of the person erythrocyte membrane."Biochemistry10.13 (1971): 2606-2617.

Wieth, J. O., and also J. Brahm. "Kinetics of bicarbonate exchange in human being red cells—physiological implications."Membrane transport in erythrocytes. Munksgaard, Copenhagen(1980): 467-487.

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Brix, Ole, et al. "The chloride shift may facilitate oxygen loading and also unloading to/from the hemoglobin from the brown bear (Ursus arctos L.)."Comparative biochemistry and physiology. B, to compare biochemistry95.4 (1990): 865-868.