Acid-Base Balance

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.

Most pathologic conditions disturb acid-base balance, and

the degree of severity may be more harmful than the
disease process.
Concentration of hydrogen ion is commonly expressed as
the pH, the negative logarithm of hydrogen ions in
solution.

1
pH: log
[H+]

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

define as acidic and a pH greater than 7.4
is define as basic.
Different body fluids have different pH values

Body fluid pH

Gastric juices 1.0 3.0

Urine 5.0 6.0
Arterial blood 7.38 7.42
Venous blood 7.37
Cerebrospinal fluid 7.32
Pancreatic fluid 7.8 8.0
Sperm 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.

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
Carbon dioxide is a weak acid, and in the
presence of carbonic anhydrase, it readily
dissociates into carbon dioxide.

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 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.
 100%
CH3COO-
Adding OH-

PK = 4.76
pH=pK :
(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 acid-base 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 pK
Buffer Pairs Reaction Rate
system values

HCO3-/H2CO3 Bicarbonate 6.1 H+ + HCO3 H2O + Instantaneous

CO2
Hb-/HHb Haemoglobin 7.3 HHb H + Hb- Instantaneous
HPO4- Phosphate 6.8 H2PO4- H++HPO4- instantaneous
Pr-/HPr Plasma protein 6.7 HPr H+ + Pr- instantaneous

Organ Mechanism Rate

Lung Regulates retention or elimination of CO2 and therefore H2CO3 Instantaneous
concentration
Ionics shift Exchange of intracellular potassium and sodium for hydrogen Instantaneous
Kidney Bicarbonate reabsorption and regeneratiodn, NH3 formation, phosphate instantaneous
buffering
Bone Exchange of calcium, phosphate, and release of carbonate 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 emmost 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

HCO3-
HCO3-
24 mEq/L HCO3-
16 mEq/L
18 mEq/L

PCO2 PCO2
PCO2
40 mmHg 40 mmHg
30 mmHg
(1.2 mmol) (1.2 mmol)
(0.9 mmol)

Compensated
normal Uncompensated Metabolic acidosis
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.
Renal Buffering

The distal tubule of the

kidney regulates acid-
base 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 Compensations

pH PCO2 HCO3 pH PCO2 HCO3

Met-acid N -N

Met-alk N -N

Res-acid N -N

Res-alk N -N
 Cause of Metabolic acidosis
Increased Noncarbonic Bicarbonate Los
acids (elevated anion gap) (normal anion gap)

Increase H+ load Diarrhea

(Ketoasidosis: DM, Ureterosigmoidescopy
Starvation) Renal failure
Lactic asidosis: (shock) Proximal renal tubule
Ingestion: salicylate, acidosis
ammonium cl, metanol
Decrease H+ excretion
Uremia
Distal renal tubule acidosis
Loss of base Addition of acid

HCO3 H+

Serum pH
Resp Renal correction
Compensation
Increased acid titration
Hypervent

PCO2 HPO4= + H+ H2PO4-

NH3 + H+ NH4

CO2 + H2O Bicarbonate

Acid excretion
In urine regeneration
H2CO3
Serum pH Metab acid with com and corr
H+