2. a.

Describe the sources of hydrogen ion, buffering system and compensatory mechanisms for acid base
disorders.

SOURCE OF H+ IN THE BODY

1. Carbonic acid formation

Major source of H+ is from metabolically produced CO2. Cellular oxidation of nutrient yields energy, with CO2
and H2O as end products. With no catalyst, CO2 dan H2O slowly fornm H2CO3  rapid partially dissociates to
liberate free H+ and HCO3-
The slow rx : rate – limiting step in the plasa, the hydration(gabung dgn H2O) of CO2: accelerated by enzyme
carbonic anhydrase (in RBC), some special secretory cell of the stomach and pancreas, and kidney tubular cells. 
lgsg dari co2 dan h2o jadi h+ dan hco3-
Step 1. Carbonic anhydrase catalyzes the formation of HCO3- from metabolically produced CO2.
Step 2. Water dissociates, forming more OH- that can be used in Step 1
These reactions are reversible, depending on the concentrations of the substances involved as dictated by the
law of mass action. Within the systemic capillaries, the CO2 level in the blood increases as metabolically produced
CO2 enters from the tissues  rx to the acid side, generating H+ as well as HCO3-. In the lungs, the reaction is
reversed: CO2 diff uses from the blood flowing through the pulmonary capillaries into the alveoli (air sacs), from
which it is expired to the tmosphere.  reaction toward the CO2 side. Hydrogen ion and HCO3- form CO2 and
H2O onceagain. The CO2 is exhaled while the hydrogen ions generated at
the tissue level are incorporated into H2O molecules.
When the rate of CO2 removal by the lungs does not match the rate of CO2 production at the tissue level
 accumulation or deficit of CO2 leads to an excess or shortage of free H+ in body fluid.

2. Inorganic acids produced during breakdown of nutrients.

Dietary proteins found abundantly in meat contain a large quantity of sulfur and phosphorus  sulfuric acid
and phosphoric acid are produced as by-products. Being moderately strong acids, these two inorganic acids largely
dissociate, liberating free H+ into the body fluids. In contrast, breakdown of fruits and vegetables produces bases
 neutralize acids derived from protein metabolism. Generally, more acids than bases are produced during
breakdown of ingested food  excess of these acids.

3. Organic acids resulting from intermediary metabolism.

Numerous organic acids are produced during normal intermediary metabolism. For example, fatty acids (fat
metabolism), and lactic acid (lactate by muscles during heavy exercise). These acids partially dissociate to yield free
H+. Hydrogen ion generation therefore normally goes on continuously  ongoing metabolic activities. In certain
disease states additional acids may be produced that further contribute to the total body pool of H+. For example,
in diabetes mellitus large quantities of keto acids may be produced by abnormal fat metabolism.
Some types of acid-producing medications may also add to the total H+ load that the body must handle.

BUFFERING SYSTEM

Most buffer  consist of a weak acid and the salt of that acid - a weak base. Buffers prevent rapid, drastic changes
in the pH of body fluids by converting strong acids and bases into weak acids and weak bases within fractions of a
second.

 Protein Buffer System

Most abundant buffer in intracellular fluid and blood plasma. For example, the protein hemoglobin
is an especially good buffer within red blood cells, and albumin is the main protein buffer in blood plasma. Proteins
- composed of amino acids, organic molecules that contain at least one carboxyl group (-COOH) and at least one
amino group (-NH2); these groups are the functional components of the protein buffer system.
The free carboxyl group at one end of a protein acts like an acid by releasing H+ when pH rises  H+ then able to
react with any excess OH-  form water. The free amino group at the other end of a protein can act as a base by
combining with H+ when pH falls. Proteins can buffer both acids and bases.
The protein hemoglobin is an important buffer of H+ in red blood cells. As blood flows through the systemic
capillaries, carbon dioxide (CO2) passes from tissue cells into red blood cells, where it combines with water (H2O)
to form carbonic acid (H2CO3). Once formed, H2CO3 dissociates into H+ and HCO3-. At the same time that CO2 is
entering red blood cells, oxyhemoglobin (Hb-O2) is giving up its oxygen to tissue cells. Reduced hemoglobin
(deoxyhemoglobin) picks up most of the H+. For this reason, reduced hemoglobin usually is written as Hb-H.

 Carbonic Acid–Bicarbonate Buffer System

Based on the bicarbonate ion (HCO3-), which can act as a weak base, and carbonic acid (H2CO3), which can act as a
weak acid. HCO3- is a significant anion in both intracellular and extracellular fluids. Because the kidneys also
synthesize new HCO3- and reabsorb filtered HCO3-, this important buffer is not lost in the urine. If there is an
excess of H+, the HCO3- can function as a weak base and remove the excess H+.
Then, H2CO3 dissociates into water and carbon dioxide, and he CO2 is exhaled from the lungs.
Conversely, if there is a shortage of H+, the H2CO3 can function as a weak acid and provide H+. At a pH of 7.4,
HCO3- concentration is about 24 mEq/liter and H2CO3 concentration is about 1.2 mmol/liter, so bicarbonate ions
outnumber carbonic acid molecules by 20 to 1. Because CO2 and H2O combine to form H2CO3, this buffer system
cannot protect against pH changes due to respiratory problems in which there is an excess or shortage of CO2.

 Phosphate Buffer System

The components of the phosphate buffer system are the ions dihydrogen phosphate (H2PO4-) and monohydrogen
phosphate (HPO42-). The dihydrogen phosphate ion acts as a weak acid and is capable of buffering strong bases
such as OH-, The monohydrogen phosphate ion is capable of buffering the H+ released by a strong acid such as
hydrochloric acid (HCl) by acting as a weak base. Because the concentration of phosphates is highest in
intracellular fluid, the phosphate buffer system is an important regulator of pH in the cytosol. It also acts to a
smaller degree in extracellular fluids and buffers acids in urine. H2PO4 2- is formed when excess H+ in the kidney
tubule fluid combines with HPO42-. The H+ that becomes part of the H2PO4- passes into the urine. This reaction is
one way the kidneys help maintain blood pH by excreting H+ in the urine.

b. Describe the role of the lungs, plasma buffering systems in an acid load

Exhalation of Carbon Dioxide

An increase in the carbon dioxide (CO2) concentration in body fluids increases H+ concentration and thus
lowers the pH (makes body fluids more acidic). Because H2CO3 can be eliminated by exhaling CO2, it is called a
volatile acid. Conversely, a decrease in the CO2 concentration of body fluids raises the pH (makes body fluids more
alkaline). Changes in the rate and depth of breathing can alter the pH of body fluids within a couple of minutes.
With increased ventilation, more CO2 is exhaled. When CO2 levels decrease, the reaction is driven to the left (blue
arrows), H+ concentration falls, and blood pH increases.
If ventilation is slower than normal, less carbon dioxide is exhaled. When CO2 levels increase, the
reaction is driven to the right (red arrows), the H+ concentration increases, and blood pH decreases. The pH of
body fluids and the rate and depth of breathing interact via a negative feedback loop. When the blood acidity
increases, the decrease in pH (increase in concentration of H+) is detected by central chemoreceptors in the
medulla oblongata and peripheral chemoreceptors in the aortic and carotid bodies, both of which stimulate the
inspiratory area in the medulla oblongata. As a result, the diaphragm and other respiratory muscles contract more
forcefully and frequently, so more CO2 is exhaled. As less H2CO3 forms and fewer H+ are present, blood pH
increases. When the response brings blood pH (H+ concentration) back to normal, there is a return to acid–base
homeostasis. The same negative feedback loop operates if the blood level of CO2 increases.
MECHANISM FOR ACID BASE DISORDERS