Buffer System Group

1. Discuss how it works?

Buffers act chemically to change strong acids into weaker acids or to bind acids to neutralize their effect.
All body fluids contain buffers. The major buffer system in ECF is carbonic acid–bicarbonate. Other buffers
include phosphate, protein, and hemoglobin. The cell itself can act as a buffer by the shifting of H+ in and
out of the cell.

A buffer consists of a weakly ionized acid or a base and its salt. Buffers function to minimize the effect of
acids on blood pH until they can be excreted from the body. The carbonic acid (H2CO3)–bicarbonate
(HCO3 −) buffer system neutralizes hydrochloric acid (HCl) in the following manner:

In this way, combining a strong acid with a base prevents the acid from causing a large decrease in pH.
The carbonic acid is broken down to H2O and CO2. The lungs excrete CO2, either combined with
insensible H2O as carbonic acid or alone as CO2.
2. Why can acidosis cause hyperkalemia?
3. Why can alkalosis cause hypokalemia?
When ECF levels of H+ are increased, H+ enters the cell in exchange for potassium. This may result in
hyperkalemia. Conversely, with decreased H+ levels, H+ enters plasma in exchange for potassium. This is
referred to as an intracellular buffering response and the reason why alkalosis can cause hypokalemia and
acidosis can cause hyperkalemia.
**the cell itself can act as a buffer by the shifting of H+ in and out of the cell. With an accumulation of H+
in the ECF, the intracellular compartment can accept hydrogen in exchange for another cation (e.g., K+)

Respiratory Buffer Systems

1. How does the respiratory system buffer?
Because carbonic acid forms when CO2 is dissolved in blood, high CO2 levels indicate acidosis,
and low CO2 levels indicate alkalosis.
The lungs help maintain a normal pH by excreting CO2 and water, which are byproducts of
cellular metabolism. When released into circulation, CO2 enters RBCs and combines with H2O to
form H2CO3. The carbonic acid dissociates into hydrogen ions and bicarbonate. The free
hydrogen is buffered by hemoglobin molecules, and the bicarbonate diffuses into the plasma. In
the pulmonary capillaries, this process is reversed, and CO2 is formed and excreted by the lungs.
The overall reversible reaction is expressed as the following:

2. What role does the respiratory center in the medulla play?

The rate of excretion of CO2 is controlled by the respiratory centre in the medulla in the brainstem. If
increased amounts of CO2 or H+ are present, the respiratory centre stimulates an increased rate and
depth of breathing. Respirations are inhibited if the centre senses low H+ or CO2 levels.
 As a compensatory mechanism, the respiratory system acts on the CO2 + H2O side of the reaction by
altering the rate and depth of breathing to “blow off” (through hyperventilation) or “retain” (through
hypoventilation) CO2. If a respiratory problem is the cause of an acid–base imbalance (e.g., respiratory
failure), the respiratory system cannot play its usual role to correct a pH alteration.
3. How does the respiratory system respond to metabolic acidosis and metabolic alkalosis?

Metabolic acidosis: Compensatory response of CO2 excretion by lungs

Metabolic alkalosis: Compensatory response of CO2 retention by lungs

Renal System

1. How does the renal system aid in PH balance?

Under normal conditions, the kidneys reabsorb and conserve the bicarbonate they filter. The kidneys can generate
additional bicarbonate and eliminate excess H+ as compensation for acidosis. The three mechanisms of acid
elimination include (1) secretion of small amounts of free hydrogen into the renal tubule, (2) combination of H+
with ammonia (NH3) to form ammonium (NH4 −), and (3) excretion of weak acids.

Complete this chart

Common Causes Pathophysiology Lab Findings

Resp Acidosis

Resp Alkalosis

Metabolic Acidosis

Metabolic Alkalosis
 Acid–base imbalances are classified as respiratory or metabolic. Respiratory imbalances affect carbonic
acid concentrations; metabolic imbalances affect the base bicarbonate. Therefore, acidosis can be
caused by an increase in carbonic acid (respiratory acidosis) or a decrease in bicarbonate (metabolic
acidosis). Alkalosis can be caused by a decrease in carbonic acid (respiratory alkalosis) or an increase in
bicarbonate (metabolic alkalosis). Imbalances may be further classified as acute or chronic. Chronic
imbalances allow greater time for compensatory changes

Respiratory Acidosis--- hypoventilation- retaining CO2.. carbonic acid acculumates and dissociates, increase in
Hydrogen ions floating around therefore PH decrease. Renal system responds by conserving the bicarbonate,
and release Hydrogen ions into the urine.

Respiratory Alkalosis

The primary cause of respiratory alkalosis is hypoxemia from acute pulmonary disorders (e.g., pneumonia,
pulmonary embolus). Hyperventilation can occur as a physiological response to metabolic acidosis and increased
metabolic demands (e.g., in a state of fever). Pain, anxiety, and some CNS disorders can cause an increase in
respirations without a physiological need. The decrease in the arterial CO2 level leads to a decrease in carbonic
acid concentration in the blood and an increase in pH.

Compensated respiratory alkalosis is uncommon unless the patient has been maintained on a ventilator or has a
CNS condition. If the respiratory alkalosis is caused by panic or pain, rebreathing CO2 from a closed system (e.g.,
paper bag) can assist in the compensatory process. A decreased bicarbonate level differentiates compensated
respiratory alkalosis from acute or uncompensated respiratory alkalosis.

Metabolic Acidosis

Metabolic acidosis (base bicarbonate deficit) occurs when an acid other than carbonic acid accumulates in the
body or when bicarbonate is lost from body fluids (see Table 19.12 and Figure 19.17, B). In both cases, a
bicarbonate deficit results. Ketoacid accumulation in diabetic ketoacidosis and lactic acid accumulation with
shock are examples of accumulation of acids. Severe diarrhea results in loss of bicarbonate. In renal disease, the
kidneys lose their abilities to reabsorb bicarbonate and secrete H+.

The compensatory response to metabolic acidosis is to increase CO2 excretion by the lungs. Many affected
patients develop Kussmaul’s respiration (deep, rapid breathing). In addition, the kidneys attempt to excrete
additional acid.

Metabolic Alkalosis

Metabolic alkalosis (base bicarbonate excess) occurs when acid is lost (as a result of prolonged vomiting or
gastric suction) or when bicarbonate increase (from ingestion of baking soda) occurs (see Table 19.12 and Figure
19.17, B). The compensatory mechanism is a decreased respiratory rate to increase plasma CO2. However, once
hypoxemia occurs or plasma CO2 reaches a certain level, stimulation of chemoreceptors increases respirations.
Renal excretion of bicarbonate also occurs.