Lesson - 7

Alteration of acid-base balance

PHATOPHYSIOLOGY
Prof. Javier Pereda
 Contents
Physiologicar review and important concepts
1- Types of pH disorders
2- Metabolic acidosis
3- Respiratory acidosis
4- Manifestations of acidosis
5- Metabolic alkalosis
6- Respiratory alkalosis
7- Manifestations of alkalosis

Prof. J. Pereda
 Review: pH

Is the concentration of (H3O+) in solution.

Gives us the knowledge of acidity or basicity
pH = -log10[H3O+]
In water solution
→ H O+ + OH-
H 2O ← 3

Acid Neutral Basic

0 7 14

Prof. J. Pereda
 Review: Concept of buffer

Buffer system:
Mix of a weak acid and conjugate base pair.
Prevents large changes in pH: helps in maintaining pH value more stable.
In our body fluids:

Extracelular fluid Intracelular fluid

Buffer: Bicarbonate Phosphate

(H2CO3 & HCO3- ) (H2PO4- & HPO42-)

[HCO3-]
pH = pK + log = 7,4 (rel 20:1)
Henderson-Hasselbach equation
[H2CO3]
Prof. J. Pereda
 Review: pH homeostasis
Eliminates HCO3- or
H+
Intake (acids or  slow
bases)  Definitive

[HCO3-]
pH = pK + log = 7,4
[H2CO3]
Internal
Eliminates CO2
Production (metabolism)
 Quick
Acids products!  limited
Volatile acids: from CO2
H3O+ + HCO3- → → H O + CO
← H2CO3 ← 2 2

Nonvolatile acids: Phosphate, sulfuric, ketones, lactic…

Prof. J. Pereda
 1- Types of pH disorders

-osi & -emia

A) Acidosis.
 Metabolic acidosis (compensated or not compensated).
 Respiratory acidosis (compensated or not compensated).

B) Alkalosis.
 Metabolic alkalosis (compensated or not compensated).
 Respiratory alkalosis (not compensated).

C) Mixed processes.
Prof. J. Pereda
 2- Metabolic acidosis

Accumulation of nonvolatile acids (no carbonic acid)

[HCO3-]
Causes log
Endogenous acid overload (diabetes, lactic acidosis).
[H2CO3]
Exogenous acid overload (intoxication).
Decreased “renal acid elimination” (renal failure)
Loss of alkali fluids (diarrhea).

Pulmonary ventilation increases.

Compensated: increased H2CO3 elimination (CO2) (to maintain ratio)
Decompensated: no balance. pH decreases

At the end, kidneys have to balance [HCO3-] levels

Prof. J. Pereda
 3- Respiratory acidosis

Accumulation of carbonic acid [HCO3-]

log
Causes [H2CO3]
Alveolar Hypoventilation (total respiratory failure)

Pulmonary ventilation fails and accumulates CO2.

Kidneys will compensate but with time
Compensated: Chronic total respiratory failure. There is time.
Decompensate: Acute total respiratory failure. There is no time and pH
decreases.

Prof. J. Pereda
 4- Acidosis manifestation

Process leading to acidosis + compensatory mechanisms +

accumulation of H3O+
Metabolic acidosis
• Deep and slow respiratory pattern
(Kussmaul)
• Decreased PCO2? and bicarbonate
Respiratory acidosis
• total respiratory failure.
• Increased PCO2 and bicarbonate?.
Accumulation of H3O+
• Decreased heart rate
• Risk of arrhythmias
• Hypotension.
• Acute confusion and coma
• Bone problems in chronic
situations.
• Hyperkalemia in general
• Leukocytosis.
• More oxygen release by Hb.

Prof. J. Pereda
 4.1- Consecuencias de la insuf. respiratoria.

A) Hipoxia Hipoxémica
Aumento
 Trastornos funcionales lactato
Disminución de O2
Eritropoyesis

Hiperventilación
Vasodilatación Vasoconstricción
Taquicardia
cerebral pulmonar
y sistémica
 Manifestaciones
Cerebrales:
Cefalea, euforia o embotamiento, alteraciones sensoriales, astenia, coma
Otras:
Policitemia e hipertensión pulmonar, taquicardia, taquipnea, hiperlactacidemia
NECROSIS TISULAR CIANOSIS DISNEA
Prof. J. Pereda
4.1- Consecuencias de la insuf. respiratoria (II).

B) Cianosis (ver cianosis)

C) Hipercapnia (insuficiencia total)
Aumento de CO2

Acidosis respiratoria Alteración secreciones

Sialorrea
Alteraciones
Alteraciones Sudoración
Neurológicas
Circulatorias: Hipersecreción bronquial
Parecidas a hipoxia
Igual que hipoxia
Deprime contracción miocárdica

Prof. J. Pereda
 5- Metabolic alkalosis

Decrease of nonvolatile acids(no carbonic acid)

[HCO3-]
Causes log [H2CO3]
Exogenous alkali overload (intoxication).
Loss of acids (vomiting, hyperaldosteronisms, hypokalemia).

Decrease of respiratory rate

Compensated: increased H2CO3 concentration (to balance ratio)
Little compensation by associated hypoxia
Decompensated: no balance. pH increases

At the end, kidneys have to balance [HCO3-] levels

Prof. J. Pereda
 6- Respiratory alkalosis

Decrease of carbonic acid. [HCO3-]

log
Causes [H2CO3]
Alveolar Hyperventilation (anxiety, fever, beginning of sepsis)

Hyperventilation eliminates CO2.

kidneys have to balance but they don’t have time.
Compensada: Hay tiempo.
Decompensated: No time and increase of pH.

Prof. J. Pereda
 7- Alkalosis manifestations

TETANY (Ca2+ and K+ reduction ), arrhythmias, hypoxia

because of no release of Oxygen by Hb, mental confusion ,
vasoconstriction in general….
Metabolic alkalosis
Increase of PCO2 ? and bicarbonate
Hypoventilation not easy noticeable.

Respiratory alkalosis
Decrease of PCO2 (and bicarbonate is variable).

Prof. J. Pereda