ACID/ BASE BALANCE

Outline
• An overview of acids, bases, and maintenance of homeostasis

• Outline the processes involved in the secretion of H+ into the tubules

• Discuss the significance of these processes in the regulation of acid–base

balance.
• Understand acidosis and alkalosis

• Describe the principal buffers in blood, interstitial fluid, and intracellular

fluid

• Describe acid- base imbalance and compensation mechanisms

 INTRODUCTION
• An important property of blood is its degree of acidity and alkalinity :
indicated on a pH scale
• The kidneys play a key role in the maintenance of acid–base:
• excrete acid in the amount equivalent to the production of nonvolatile acids in the
body.
• filter and reabsorb plasma bicarbonate, and thus prevent the loss of bicarbonate in
the urine
Both processes are linked physiologically, due to the nephron’s ability to
secrete H+ ions into the filtrate

The production of nonvolatile acids will vary with diet, metabolism, and
disease.
Acid-base balance
• Acids: Electrolytes that ionize in water and release H + ions
• Bases: Substances that accept H+ ions
• Maintenance of homeostasis depends on controlling the conc. of acids
& bases in the body fluid
• Solutions turn into acids when concentration of hydrogen ions rises
and turns to a base when it falls.
• pH- The concentration of hydrogen ions
• Normal pH values are 7.35- 7.45
• <7.35 pH indicates an acid
• >7.45 pH indicates a base (Alkalosis)
• A neutral solution such as water has a pH of 7.0
• Blood has a pH of 7.4 with a variance of .05
Types of acids in the body
• Volatile acid
• Can leave solution and enter the atmosphere (e.g. carbonic acid)
• H+ + HCO3– H2CO3  CO2 + H2O

• Non-volatile acids
• Acids that do not leave solution (e.g. sulfuric and phosphoric acids)
sources
sources of acids Sources of alkali
• Exercise- lactic acid • Diet
• Diet • Loss of acid- vomiting
• Drugs • Drugs
• Disease processes
• Loss of alkali eg diarrhoea
• Impaired removal- renal ds
• Diabetes mellitus
Sources of hydrogen ion
H+ in the body fluids originate as by-products of metabolism
Small quantities of H+ may be directly absorbed thro the GIT
Strengths of Acids and Bases
• Strong acids ionize more completely and release more H +
• Weak acids ionize less completely and release fewer H +
• Strong bases ionize more completely and release more OH -
• Weak bases ionize less completely and release fewer OH -
Regulation of hydrogen Ion Concentration
• acid-base buffer systems
• respiratory excretion of carbon dioxide
• renal excretion of hydrogen ions
Secretion of hydrogen ion

• The cells of the proximal and distal tubules collecting ducts.

• Na–H exchanger
.
• The apical membrane of epithelial cells lining the proximal tubule
is permeable to CO2 and H2O, and they enter the tubule rapidly.

• 80% of the filtered load of HCO3– is reabsorbed in the proximal

tubule.
• Inside the cell, carbonic anhydrase is also present and can catalyze
the formation of H2CO3 from CO2 and H2O.
• H2CO3 dissociates into H+ ions and HCO3– ,the H+ is secreted into
the tubular lumen
• HCO3– diffuses into the interstitial fluid.
• For each H+ ion secreted, one Na+ ion and one HCO3– ion
enter the interstitial fluid.
NB: Because carbonic anhydrase catalyzes the formation of
H2CO3, drugs that inhibit carbonic anhydrase depress both
secretion of acid by the proximal tubules and the reactions that
depend on it.
Acid-Base Buffer Systems

• Systems that resist abrupt and large swings in the pH

of body fluids

• Buffer is a solution able to resist changes in pH when

considerable amount of acid or base is added
• Operates in plasma, lungs and kidneys
• Types:
• Chemical buffers
• Physiological buffers
• Bicarbonate, carbon dioxide and carbonic Acid are always present in
the balance of blood.

• Carbonic Acid is formed in extracellular fluid when CO 2 unites with

H2O.

• There are three chemical buffer systems:

 Types of chemical buffers
Carbonic acid/ Bicarbonate buffering System

• CO2, a by-product of cellular respiration, is dissolved in the

blood, where it is taken up by RBC and converted to carbonic
acid by carbonic anhydrase.
• Most of the carbonic acid then dissociate to bicarbonate and
hydrogen ions

• CO2 + H2O  H2CO3  H+ + HCO3–

limitations

• Only functions when respiratory system and control centers

are working normally
• It is limited by availability of bicarbonate ions (bicarbonate
reserve)
• Cannot protect the ECF from pH changes due to increased or
depressed CO2 levels
Carbonic Acid-Bicarbonate Buffer in the
Regulation of pH
Carbonic Acid-Bicarbonate Buffer in the
Regulation of pH
The Carbonic Acid-Bicarbonate Buffer
System
The Basic Relationship between PCO2 and
Plasma pH
 Phosphate buffer system
• Monohydrogen phosphate (HPO4-2)ion converts a strong acid to a weak acid
• Dihydrogen phosphate(H2PO4) ion converts a strong base to a weak base

• When pH decreases, monohydrogen phosphate ion acts as H + acceptor

H+ + HPO4-2  H2PO4-  H+ + HPO4-2

• When pH increases, dihydrogen phosphate ion donates H +

H2PO4-  HPO4-2 and H+

• Phosphates are major ions in intracellular fluid &urine buffer

• Found in collecting tubules of kidneys where they buffer urine
• Intracellular and Urine buffer helps “keep” H+ in the urine
Protein Buffer System

• Depend upon proteins which act as buffers and consume small

amounts of acid or base
• Protein haemoglobin can bind to small amounts of acid in blood,
helping to remove that acid before it changes the blood’s pH
• Amino (NH3+)group releases a hydrogen ion in the presence of excess
base
• Carboxyl (COO- )group accepts a hydrogen ion in the presence of
excess acid
Physiological buffers
• Respiratory system

• Renal system
Respiratory system
H+ + HCO3–  H2CO3  H2O + CO2 blown out

Effect of respiration on pH
 Rise in ventilation lead to fall in CO2
 Fall in ventilation lead to rise in CO2
Effect of pH on ventilation
 Ventilation rate is proportional to the amount of H+
 Fall in pH lead to rise in ventilation
Respiratory Excretion of Carbon Dioxide

.
Renal System
• H+ excretion
• HCO3- reabsorption
• NH4+ excretion
Renal Excretion of Hydrogen Ions
Summary of Acid-Base Balance
Clinical Application

Acid base imbalances

• If the pH of arterial blood drops to 6.8 or rises to 8.0 for more than a
few hours, the person usually cannot survive
 Acid-Base Disorders
• Respiratory disorders
Result when abnormal respiratory function causes rise or fall in CO2 in ECF
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic disorders
Generation or accumulation of organic or fixed acids
• Metabolic acidosis
• Metabolic alkalosis
Acidosis versus Alkalosis
Factors that lead to acid base imbalance
RESPIRATORY ACIDOSIS RESPIRATORY ALKALOSIS

.
.

• METABOLIC ACIDOSIS • METABOLIC ALKALOSIS

METABOLIC ACIDOSIS
• Results from an accumulation of acid or loss of a base
• 4 most common pre-hospital encounters are
• lactic acidosis
• diabetic ketoacidosis
• acidosis from renal failure
• acidosis from ingestion of toxins
• Treatment of metabolic acidosis varies and may include
• IV administration of Bicarbonate
METABOLIC ALKALOSIS
• Results from loss of Hydrogen ions
including IV injection of a base, diuretics
vomiting
• Treatment involves
• Correcting underlying problem
• Isotonic IV solutions
• hypokalemia treated with Potassium supplementation
Respiratory acidosis
• Results from reduction in ventilation
• Trauma e.g head injury
• depression of respiratory centre - Neurological
Respiratory alkalosis
• Associated with hyperventilation
• Increased ventilation
• Excessive exercises
Respiratory Acid-Base Regulation
Respiratory Acid-Base Regulation
Compensated Metabolic Acidosis
Compensated Metabolic Alkalosis
Plasma pH, HCO3–, and Pco2 values in various typical disturbances of acid–base balance
 TAKE AWAY CAT
• Read and write an essay on Renal regulation of blood pressure.(20
marks)
• To be submitted on 6th

• 2023.
References
• 1. Barrett, K. E.,& Ganong, W. F. (2012). Ganong's review of medical
physiology. New York: McGraw-Hill Medical.

• 2. Hall, J. E., Guyton, A. C., & Hall, J. E. (2012). Pocket companion to

Guyton and Hall textbook of medical physiology. Philadelphia:
Elsevier/Saunders