Acid-Base Balance

By: Taufiq RN

 Acidbase homeostasis is the part of human homeostasis:

concerning the proper balance between acids and bases, (body pH) Outside the acceptable range of pH, proteins are denatured and digested, enzymes lose their ability to function, and death may occur.

Enzyme activity

7.4 pH

Acid-base balance is determined by Hydrogen ion. Hydrogen ion concentration must be regulated within a narrow range for the body to function normally. Slight changes in amounts of hydrogen can significantly alter biologic processes in cells and tissues. Hydrogen ion is necessary to maintain membrane integrity and the speed enzymatic reactions.

H+
Most pathologic conditions disturb acid-base balance, and the degree of severity may be more harmful than the disease process its self.

Concentration of hydrogen ion is commonly expressed as the pH, the negative logarithm of hydrogen ions in solution: pH: log 1 [H+]

pH: 7.4

As the H+ increase, pH decrease acidic solution; likewise as the H+ decrease, pH increase basic solution.

In biologic fluids a pH less than 7.4 is defined as acidic and a pH greater than 7.4 is defined as basic.

Acid-Base Balnce in Blood

Different body fluids have different pH values

Body fluid Gastric juices Urine Arterial blood Venous blood Cerebrospinal fluid Pancreatic fluid Sperm pH 1.0 3.0 5.0 6.0 7.38 7.42 7.37 7.32 7.8 8.0 7.2 8.0

Body acids are formed as end products of cellular metabolism.

The average person generates acid in the amount of 50 100 mEq/day from the metabolism of protein, carbohydrates, and fats and from loss of base in the stools.
Maintain a normal pH, an equal amount of acids therefore must be neutralized or excreted. The lungs, kidneys, and bone are the major organs involved in the regulation of acid-base balance.

The systems are interrelated and work together to regulate short or long term changes in acid-base status. Body acids exist in two forms: The volatile acids is carbonic acid (H2CO3) can be eliminated as CO2 gas, and nonvolatile.

H2CO3 CO2

The volatile acids is carbonic acid (H2CO3) which is formed from hydration of carbon dioxide:

CO2 + H2O H2CO3 H2CO3 + H+

Regulated by lung Regulated by kidney

Carbonic acid is a weak acid, and in the presence of carbonic anhydrase, it readily dissociates into carbon dioxide, (exhaled) Approximately 12.000 to 15.000 milimoles of CO2 is produced in the human body perday. The CO2 is then eliminated by pulmonary ventilation.

Sulfuric, phosphoric, and other organic acids are nonvolatile strong acids produced from the metabolism of protein, carbohydrates, and fats. (strong acids are those that readily give up their hydrogen; weak acids do not)

Nonvolatile acids are eliminated by the renal tubules with the regulation of HCO3
Thus the lungs and kidneys with the help of buffer systems, are the prime regulators of acid-base balance !

Buffer Systems
Buffers resist change in pH in solutions when acids or bases are added. They are a mixture of a weak acid (HA) and its conjugate base (A-) or a mixture of a weak base (B) and its conjugate acid (HB+).

EXAMPLE
(CH3 COOH) and (H2 CO3) are weak acids. (NH3) is a weak base CH3 COOH and CH3 COO-, H2 CO3/ HCO3
and NH3/ NH4 constitute buffer system

A buffer solution functions in the following manner to resist changes in acidity and alkalinity
In acetic acid/sodium acetate buffer system, the species present solution are: CH3 COOH, CH3 COO-, Na+, and H2O. Amount of H+ and OH- are initially assumed to be small.

When acid is added to the buffer almost all of the H+ ion react with acetate ion to produce weakly ionized acetic acid: H+ + CH3COO- CH3COOH, The H+ ion are thereby prevented from appreciably changing the pH.

When OH- is added, almost all the hydroxyl radicals react with acetic acid molecules to produce more acetate ion and water:

OH- + CH3COOH CH3COO- + H2O The additional OH- is thus consumed with little increase in pH Adding H+ or OH- to a buffer cause only slight pH changes provided there is excess salt (CH3COO-) or acid (CH3COOH)
If all the acid is converted to the salt form by the addition of a large amount OH- the solution can longer behave as a buffer.

Examples of Buffering

 If a strong acid is added slowly to a buffer solution and the hydrogen ion concentration [H+] is measured then a plot similar to the one in figure 4 will be generated. Notice that during the highlighted portion of the curve a large volume of acid is added with little change in [H+] or pH.

100% CH3COOAdding OH-

pH=pK :

PK = 4.76 (CH3 COOH) = (CH3COO-)

100% CH3COOH Adding H+

The maximum buffering capacity exist when The molarities of salt and acid are equal

Buffer occurs in response to changes in acidbase status. Buffer can absorb excessive H+ or OH- without significant change of pH. The buffer system are located in both in ICF and ECF compartment, and they function at different rates. Buffer system exist as buffer pairs, consisting of a weak acid and its conjugate base.

Buffer System
Buffer Pairs
HCO3-/H2CO3 Hb-/HHb HPO4- /H2PO4Pr-/HPr

Buffer system
Bicarbonate Haemoglobin Phosphate Plasma protein

pK values
6.1 7.3 6.8 6.7

Reaction
H+ + HCO3 H2O + CO2 HHb H + HbH2PO4- H++HPO4HPr H+ + Pr-

Rate
Instantaneous Instantaneous instantaneous instantaneous

Organ
Lung

Mechanism
Regulates retention or elimination of CO2 and therefore H2CO3 concentration Exchange of intracellular potassium and sodium for hydrogen Bicarbonate reabsorption and regeneration, NH3 formation, phosphate buffering Exchange of calcium, phosphate, and release of carbonate

Rate
Instantaneous

Ionics shift Kidney

Bone

Instantaneous instantaneous
Instantaneous

The most important plasma buffer system are carbonic acid-bicarbonate and hemoglobin. Phosphate and protein are the most important intracellular buffers. pK value is an important factor for buffering. pK value is represent the pH at which a buffer pair is half dissociated Buffer pairs can associate and dissociate. A buffer system is most effective when the pK for the buffer is close to the pH of the fluid in which the buffer is acting. The pK of bicarbonatecarbonic acid system is 6.1 is lowest but it still very effective because carbon dioxide is rapidly removed from the blood by the lung.

Carbonic acid-Bicarbonate Buffering

This buffer operates in both in the lung and kidney The greater the carbon dioxide partial pressure (PCO2), the more carbonic acid is formed. The relationship that exist between carbonic acid (H2CO3) and carbon dioxide (PCO2), can be expressed bellow H2CO3 = 0.03 x PCO2 (mmHg) The 0.03 represent the solubility coefficient of carbon dioxide in water. PCO2 of arterial blood is normally about 40 mmHg, Therefore the amount of H2CO3 is equal to about 1.2 mmol/l (0,03 x 40)

If CO2 increase or decrease, H2CO3 also changes in the same direction

The relationship between HCO3- H2CO3 usually expressed as ratio. This ratio is represent the amount of HCO3- H2CO3 in arterial blood. When pH is 7.4 this ratio is 20 : 1 and this always maintained

HCO3- normally about 24 mEq/L

The lung can decrease the amount of H2CO3 by blowing off CO2 and leaving water. The kidney can reabsorb bicarbonate or regenerate new HCO3- from CO2 and water. The two systems are very effective together because acid concentration can be rapidly adjusted by the lung and bicarbonate is easily reabsorbed or regenerated by kidney

pH = renal regulation (slow) Pulmonary regulation (fast)

Or pH = Metabolic acid-base function Respiratory acid-base function

Change in either numerator or the denominator will change the pH. If the amount of bicarbonate is decrease the pH also decrease, causing a state of acidosis. The pH be returned to a normal range if the value of denominator or amount of carbonic acid also decrease. (compensation)

The respiratory system compensates for change in pH by increasing or decreasing ventilation. The renal system compensates by producing more acidic or more alkaline urine. Correction occur when the value for both component of the buffer pair return to normal

Maintenance of HCO3-/PCO2 ratio in metabolic acidosis

HCO324 mEq/L

HCO316 mEq/L PCO2 40 mmHg (1.2 mmol)

HCO318 mEq/L
PCO2 30 mmHg (0.9 mmol)

PCO2 40 mmHg (1.2 mmol)

normal

Uncompensated Metabolic acidosis

Compensated Metabolic acidosis Respiratory buffering response

Protein Buffering
Both IC and EC protein have negative charges and can serve as buffer for H+, but because most protein are inside cells, they are primarily intracellular buffer system.

CO2 Transport in the Blood & Haemoglobin Buffering

Renal Buffering
The distal tubule of the kidney regulates acidbase balance by secreting hydrogen into urine and reabsorbing bicarbonate with maximum acidity of about 4.4 4.7 Buffer in the tubular fluid combine with hydrogen ions allowing more H+ to be secreted before the limiting pH value is reached Phosphate (HPO4-) and NH3 are two important renal buffer

Primary and Compensatory Acid-Base Changes

Primary disturbance pH
Met-acid
Met-alk Res-acid Res-alk

Compensations pH PCO2 HCO3

PCO2

HCO3

N
N N N

-N
-N -N -N

Cause of Metabolic acidosis

Increased Noncarbonic acids (elevated anion gap)
Increase H+ load (Ketoasidosis: DM, Starvation) Lactic asidosis: (shock) Ingestion: salicylate, ammonium cl, metanol Decrease H+ excretion Uremia Distal renal tubule acidosis

Bicarbonate Los (normal anion gap)

Diarrhea Ureterosigmoidescopy Renal failure Proximal renal tubule acidosis

Cause of acidosis/alkalosis Respiratory

Decrease Ventilation (Increase PCO2 -H2CO3 - H+) Acidosis
1.

Increase Ventilation (Decrease PCO2 -H2CO3 - H+) (alkalosis) Neurosis (Very rare)

2.

Damage of central respiratory system (medulla oblongata) Obstruction of respiratory tract (pneumonia etc)

Increasing of CO2 ventilation will decrease H+ ECF and otherwise

Respiratory regulation and Acid-base Balance

Second regulator of acid-base balance disturbance is regulation of ECF CO2 concentration by lung Increasing of PCO2 ECF will increase pH Decreasing of PCO2 ECF will decrease pH Consequent of PCO2 adjustment will decrease or increase H+ ECF

Loss of base HCO3

Addition of acid

H+

Serum pH Resp Compensation Hypervent PCO2 CO2 + H2O H2CO3 H+ Renal correction Increased acid titration

NH3 + H+ NH4 Acid excretion In urine Serum pH

HPO4= + H+ H2PO4Bicarbonate regeneration

Metab acid with com and corr

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