pH

The negative logarithm of the hydrogen ion concentration pH = - log [ H+ ] or pH = log 1 [ H+ ]

BLOOD pH NORMAL VALUE : 7.4 0.05 Compatible with life = 6.8 7.8 Low pH high [ H+ ] Acidic High pH low [ H+ ] Basic
KIDNEYS AND LUNGS major organs that maintain physiologic pH

3 MAJOR BODY WATER COMPARTMENTS

EXTRACELLULAR FLUID: 1. PLASMA: cation: Na+ anion: HCO3-, Cl 2. INTERSTITIAL FLUID

INTRACELLULAR FLUID: cation: K+ anion: organic phosphates and proteins

CHEMICALS IN THE FLUID COMPARTMENTS:

SIGNIFICANCE OF Na+ and Cl ANION GAP represents the other plasma anions which are not routinely measured. - used to establish a differential

diagnosis for metabolic acidosis.

A = (Na+ + K+) (Cl- + HCO3-) Normal value = 12-16 meq L-1 or = 8-12 meq L-1 (w/o K+)

BUFFER
BUFFERING the tendency of a solution to resist more effectively a change in pH after addition of a strong acid or base than does an equal volume of water

Consists of: weak acid

conjugate base

BUFFER SYSTEMS

BICARBONATE BUFFER SYSTEM

Carbonic Acid-Bicarbonate (H2CO3-HCO3-) / Carbon Dioxide-Bicarbonate (CO2 -HCO3- ) Buffer System

Major buffering system of the blood

Maintains a balance between CO2 and H+

Components:

H2O + CO2 H2CO3 H+ + HCO3H2O + CO2 H+ + HCO3-

pH-BICARBONATE DIAGRAM

pH-BICARBONATE DIAGRAM

BICARBONATE BUFFER SYSTEM

Open system: excellent blood buffer
CO2 (gas in the lungs) CO2 (dissolved in the blood)

pK = 6.1: normally, not a good blood buffer Normal ratio of HCO3 to CO2 = 20:1

HENDERSON-HASSELBALCH EQUATION
Expresses the degree of ionization of a weak acid depending on the concentration of free hydrogen ions Identifies the optimal ratio of CO2 to HCO3- required to maintain blood pH at 7.4 pH = pK + log conjugate base acid pH = pK + log HCO3CO2 States that there is a direct relationship between the pH and the ratio of [conjugate base] / [acid]

SAMPLE COMPUTATION:
What is the pH of an individual having an abnormal ratio of HCO3- to CO2 of 10:1?
pH = pK + log HCO3CO2

pH = 6.1 + log 10
1

ph = 6.1 + 1

pH = 7.1

ACIDOSIS
Lower than normal blood pH Causes: excess acid deficiency of base Conditions: 1. RESPIRATORY ACIDOSIS

2. METABOLIC ACIDOSIS

RESPIRATORY ACIDOSIS
occurs when the lungs are unable to remove excess CO2 (hypoventilation)

Common Causes: acute: obstruction of the airway, neuromuscular diseases, diseases of CNS, inhalation of gas mixture with high pCO2 chronic: COPD emphysema

RESPIRATORY ACIDOSIS

METABOLIC ACIDOSIS
occurs when excess acid is produce in the body or abnormal loss of base

EXCESS ACID: Ketoacidosis

LOSS OF BASE: Renal tubular acidosis Severe diarrhea Treatment: Sodium lactate

ALKALOSIS
Higher than normal blood pH Causes: excess base deficiency of acid Conditions: 1. RESPIRATORY ALKALOSIS 2. METABOLIC ALKALOSIS

RESPIRATORY ALKALOSIS
decrease alveolar pCO2, occurs when the lungs remove too much CO2 (hyperventilation)
Causes: anxiety (most common), CNS injury to the respiratory center, salicylate poisoning, fever, artificial ventilation chronic: high altitudes

RESPIRATORY ALKALOSIS

METABOLIC ALKALOSIS
CAUSES: excess acid is lost through nonrespiratory mechanisms (loss of gastric acid, diuresis) intake of excess alkali (sodium bicarbonate) HCO3- elimination is prevented at a time when Na+ conservation is needed

MIXED ACID-BASE DISTURBANCE

Mixed respiratory and metabolic acidosis

Mixed respiratory and metabolic alkalosis

Patient has a plasma pH, [HCO3-], and pCO2 consistent with an acute metabolic imbalance Impaired compensatory mechanisms

ROLE OF LUNGS
varies the amount of CO2 extracted from the blood during respiration

HYPERVENTILATION reduces blood CO2 concentration

HYPOVENTILATION increases blood CO2 concentration

NEPHRON

ROLE OF KIDNEYS
controls the composition of the urine

controls HCO3- reabsorption and by secreting acid

3 FATES of H+:

1. Reabsorption of NaHCO3- - H+ can react with HCO3- to form CO2 and H2O 2. Formation of Titratable Acidity of Urine - H+ can be excreted as part of the buffering system
3. Neutralization by NH3 - H+ can be excreted by reacting with ammonia to form ammonium

ROLE OF KIDNEYS
3 IMPORTANCE OF AMMONIUM IN ACIDOSIS:

1. Acid can be excreted as ammonium without lowering the pH of urine 2. Enormous amounts of acids can be excreted in this form.
3. Spares the bodys stores of Na+ and K+ ALKALOSIS: Kidneys allow HCO3- to escape

KIDNEY REABSORPTION OF BICARBONATE

ROLE OF BONE
Average adult skeleton: 50,000 meq of Ca+ Chronic acidosis: bones helps control plasma pH

Patients develop: Rickets or Osteomalacia - prolonged administration of sodium bicarbonate or citrate showed bone healing

COMPENSATORY MECHANISMS
COMPENSATION a secondary alteration in either [HCO3-] or [CO2] that has the effect of counteracting the primary alteration in the other resulting to a pH that is readjusted toward normal.

General principle: since an abnormal condition has directly altered one of the terms of the [HCO3-] / [CO2] ratio, the plasma pH can be readjusted back toward normal by a compensatory alteration of the other term.

COMPENSATORY MECHANISMS
RULE:

If [HCO3-] changes, the only way to restore the original [HCO3-] / [CO2] ratio is to change pCO2 in the same direction.
If the primary change is in pCO2, the original ratio can be restored only by altering [HCO3-] in the same direction.

STAGES OF COMPENSATION
1. Acute State 2. Intermediate State / Partially Compensated State

3. Compensated / Uncompensated State

ACUTE RESPIRATORY ACID-BASE IMBALANCE

ACUTE METABOLIC ACID-BASE IMBALANCE

OTHER BIOCHEMICAL BUFFERS

Proteins (free amine groups on amino acids) HEMOGLOBIN second most important blood buffer Inorganic phosphates and organic phosphate esters (HPO42- and H2PO4- ) - important physiologic buffers inside cells

ALTERNATIVE MEASURES
1. TOTAL PLASMA CO2 sum of HCO3- and dissolved CO2

2. BASE EXCESS amount of acid that would have to be added to the blood to titrate it to pH 7.4 at a pCO2 of 40mmHg at 37C