ACID-BASE BALANCE

DESAK MADE WIHANDANI

 pH Review
 pH = - log [H+]
 H+ is really a proton
 Range is from 0 - 14
 If [H+] is high, the solution is acidic; pH < 7
 If [H+] is low, the solution is basic or alkaline ;
pH > 7
 Acids are H+ donors.
 Bases are H+ acceptors, or give up OH- in
solution.
 Acids and bases can be:
 Strong – dissociate completely in solution

 HCl, NaOH

 Weak – dissociate only partially in solution

 Lactic acid, carbonic acid

3
 The Body and pH
 Homeostasis of pH is tightly controlled
 Extracellular fluid = 7.4
 Blood = 7.35 – 7.45
 < 6.8 or > 8.0 death occurs
 Acidosis (acidemia) below 7.35
 Alkalosis (alkalemia) above 7.45

4
5
The body produces more acids than
bases
 Acids take in with foods
 Acids produced by metabolism of lipids and
proteins
 Cellular metabolism produces CO2.
 CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3-
 ACID-BASE BALANCE
 Acid - Base balance is primarily concerned
with two ions:
 Hydrogen (H+)

 Bicarbonate (HCO3- )

H+ HCO3-
 Hydrogen Ion Regulation
The body maintains a narrow pH range by 3
mechanisms:
1. Chemical buffers (extracellular and intracellular)
react instantly to compensate for the addition or
subtraction of H+ ions.
2. CO2 elimination is controlled by the lungs
(respiratory system). Decreases (increases) in pH
result in decreases (increases) in PCO2 within
minutes.
3. HCO3- elimination is controlled by the kidneys.
Decreases (increases) in pH result in increases
(decreases) in HCO3-. It takes hours to days for the
renal system to compensate for changes in pH.
 ACID-BASE
REGULATION
 ACID-BASE REGULATION
 Maintenance of an acceptable pH range in the
extracellular fluids is accomplished by three
mechanisms:
 1) Chemical Buffers

 React very rapidly

(less than a second)
 2) Respiratory Regulation

 Reacts rapidly (seconds to minutes)

 3) Renal Regulation

 Reacts slowly (minutes to hours)

1.Buffer systems

 A buffer is a solution which has the ability to

minimize changes in pH when an acid or base is
added.
 Take up H+ or release H+ as conditions change
 A buffer typically consists of a solution which
contains a weak acid mixed with the salt of that
acid & a strong base.
 Results in a much smaller pH change
 Phosphate buffer
 Major intracellular buffer
 H+ + HPO42- ↔ H2PO4-

 OH- + H2PO4- ↔ H2O + H2PO42-

 Protein Buffers
 Includes hemoglobin
 Carboxyl group gives up H+
 Amino Group accepts H+
 Bicarbonate buffer
 Sodium Bicarbonate (NaHCO3) and carbonic
acid (H2CO3)
 Maintain a 20:1 ratio : HCO3- : H2CO3

HCl + NaHCO3 ↔ H2CO3 + NaCl

NaOH + H2CO3 ↔ NaHCO3 + H2O

14
2. Respiratory mechanisms
Carbon dioxide is an important by-product of
metabolism and is constantly produced by cells
The blood carries carbon dioxide to the lungs where
it is exhaled
Exhalation of carbon dioxide
Doesn’t affect fixed acids like lactic acid
CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3-
Body pH can be adjusted by changing rate and
depth of breathing
15
 Respiratory Regulation
 When breathing is increased,
the blood carbon dioxide level
decreases and the blood
becomes more Base
 When breathing is decreased,
the blood carbon dioxide level
increases and the blood becomes more Acidic
 By adjusting the speed and depth of breathing, the
respiratory control centers and lungs are able to
regulate the blood pH minute by minute
3. Kidney excretion
 Can eliminate large amounts of acid
 Can also excrete base
 Can conserve and produce bicarbonate ions
 Most effective regulator of pH
 If kidneys fail, pH balance fails
 Kidney Regulation
 Excess acid is excreted by the
kidneys, largely in the form of
ammonia
 The kidneys have some ability
to alter the amount of acid or
base that is excreted, but this
generally takes several days
 Acid-Base Imbalances
 pH< 7.35 acidosis
 pH > 7.45 alkalosis
 The body response to acid-base imbalance is
called compensation
 May be complete if brought back within normal
limits
 Partial compensation if range is still outside
norms.
 ACIDOSIS / ALKALOSIS
 Acidosis
A condition in which the blood has too much
acid (or too little base), frequently resulting in a
decrease in blood pH
 Alkalosis
A condition in which the blood has too much
base (or too little acid), occasionally resulting in
an increase in blood pH

20
 ACID BASE DISORDERS
 RESPIRATORY: pCO2
pCO2 : respiratory acidosis
pCO2 : respiratory alkalosis
 METABOLIC: [HCO3_]
[HCO3_] : metabolic alkalosis
[HCO3_] : metabolic acidosis
23
 Diagnosis of Acid-Base Imbalances
1. Note whether the pH is low (acidosis) or high
(alkalosis)
2. Decide which value, pCO2 or HCO3- , is
outside the normal range and could be the
cause of the problem. If the cause is a change
in pCO2, the problem is respiratory. If the
cause is HCO3- the problem is metabolic.
 Compensation
 If underlying problem is metabolic,
hyperventilation or hypoventilation can help :
respiratory compensation.
 If problem is respiratory, renal mechanisms can
bring about metabolic compensation.
Respiratory Compensation
A metabolic acidosis excites the chemoreceptors
and initiates a prompt increase in ventilation and
a decrease in arterial PCO2.

A metabolic alkalosis silences the

chemoreceptors and produces a prompt
decrease in ventilation and increase in arterial
PCO2.
PRIMARY AND SECONDARY ACID-BASE DERANGEMENTS

End-Point: A Constant PCO2/[HCO3- ] Ratio

Acid-Base Disorder Primary Change Compensatory Change

Respiratory acidosis PCO2 up HCO3 up

Respiratory alkalosis PCO2 down HCO3 down
Metabolic acidosis HCO3 down PCO2 down
Metabolic alkalosis HCO3 up PCO2 up
 The clinical cause of acid base disorders

Metab.acid Resp.acid Metab alk Resp. Alk

DM (keto acidos Chronic Vomiting( loss of Hyperventilation
Lactic acidosis obstructive airway hydrogen ion) (anxiety, fever)
Renal failure diseases Nasogastric
Severe diarrhe Severe asthma suction Lung diseases
Surgical drainage Cardiac arrest assosiated with
of intestine Depression of Hypokalemie hyperventilation
Renal loss of respiratory center
bicarb.(renal (drugs, eg opiate) Intravenous Anemia
tubular acid type- Weakness of resp administration of
2) muscle (polio bicarbonate (e.g Salysilate
Impairment of myelitis, multiple after cardiac poisoning
renal H+ slerosis arrest)
excretion (renal Chst deformities
tubulus acidosis Airway obstruct.
 Blood gas measurement
 Is important Laboratory investigation.
 When there are suspicion of respiratory failure, acid base
disorder, e.g diabetic keto acidosis
 In resp failure, the result of the measurement may indicate a
need for oxygen treatment.
 In more severe condition, artificial ventilation may be required.
 From radial artery in the forearm or femoral artery in the leg.
 The measurement include : pCO2, pO2, pH. Bicarbonate
concentration, is calculated using H-H equation.
 Normal value : on the table
Getting an
arterial blood
gas sample
 Blood Gas Report

 Acid-Base Information
• pH
• PCO2
• HCO3 [calculated vs
measured]
 Oxygenation
Information
• PO2 [oxygen tension]
• SO2 [oxygen saturation]
Pulse Oximeter Measures SaO2
Pulse Oximeter Measures SaO2
 Normal value gas measurement
--------------------------------------------------------------------------------------------------------
Arterial Venous
---------------------------------------------------------------------------------------------------------
[H+] 36-43 mmol/L 35-45 mmol/L

pH 7.37- 7.44 7.35-7.45

pCO2 4.6-6.0 kPa 4.8-6.7 kPa

pO2 10.5-13.5 kPa 4.0-6.7 kPa

Bicarbonate 23-30 mmol/L