Acid-Base Balance

acid-base balance
- general

acid

any molecule that dissociates in solution to release a hydrogen iron (H+) or proton

base

any molecule capable of accepting a hydrogen iron or proton

buffer system - general -

acid-base balance

buffer : any substance that can reversibly bind hydrogen irons Buffer + H+ HBuffer

buffer system - general

acid-base balance

Three (3) primary systems regulating H+ concentration in body fluids

chemical acid-base buffer systems of body fluids. 2) respiratory center (regulating removal of CO2) 3) kidneys (excreting acid and alkaline urine)
1)

acid-base balance
- buffer system 1)

acid-base buffer systems

a.

bicarbonate buffer

HCO3- + H+

H2CO3

CO2 + H2O

H+ + HCO3- H2CO3 CO2 + H2O excess CO2 will stimulate respiration elimination of CO2

- bicarbonate buffer H+ = K x
CO2 HCO3amount of CO2 in blood is a linear function of Pco2

acid-base balance

most clinical labs measure blood CO2 tension (Pco2)

CO2 = (0.03) x Pco2 H+ = K x

(0.03 )x Pco2
HCO3-

- bicarbonate buffer pH = - log H+

(0.03 )x Pco2

acid-base balance

pH = pK - log

HCO3metabolic factor

pH = pK + log

HCO3(0.03 )x Pco2
respiratory factor

- bicarbonate buffer pH = pK + log

HCO3(0.03 )x Pco2 HCO3- 20 - 26 mEq/L Pco2 35 45 mmHg increase in bicarbonate increase in Pco2 pH pH

acid-base balance

acid-base balance
- buffer system 1)

acid-base buffer systems

b.

phosphate buffer
playing a major role in buffering renal tubular fluid and intracellular fluids

HCl + Na2HPO4 NaH2PO4 + NaCl NaCl + Na2H2PO4 Na2HPO4 + H2O

acid-base balance
- buffer system 1)

acid-base buffer systems

c. d.

to prevent changes in pH of extracellular fluids e. - may take several hours to become maximally effective
f.

proteins - buffer systems within the cells help

hemoglobin

H+ + Hb HHb

acid-base balance
- buffer system 2)

respiratory regulation of acid-base balance

-

increased hydrogen ion concetration (pH) stimulates alveolar ventilation

[H+] alveolar ventilation
(-) Pco2

pulmonary expiration of CO2 balances metabolic formation of CO2 increasing alveolar ventilation decreases extracellular fluid H+ and pH

acid-base balance
- buffer system 3)

renal regulation of pH
body normally consumes more acidproducing foods than base-producing foods kidney tubules secrete (a) hydrogen, (b) ammonium, and (c) phosphate ions into urine when a hydrogen ion is secreted into tubular urine, a sodium ion is simultaneously reabsorbed

acid-base balance
- buffer system

H+-sodium exchange
rids excess H+ into urine 2) conserves sodium 3) preserves ionic equivalence 4) generates sodium bicarbonate for further buffering
1)

acid-base balance
- buffer system renal correction acidosis (1) increased excretion of H+

fluid (2) addition of HCO3- to

extracellular

alkalosis

(1) decreased tubular secretion of H+ (2) increased excretion of HCO3-

clinical causes of acid-base disorders

pH 7.34, Pco2 60mmHg, [HCO3- 31mEq/L]

1.

respiratory acidosis
due to: causes:

[pH, Pco2]

decreased CO2 removal from lungs

a. damage to respiratory centers b. airway obstruction c. pneumonia, chronic bronchitis d. decreased pulmonary membrane surface area e. pulmonary edema

compensatory mechanism:
(1) body fluid buffers (2) kidneys

clinical causes of acid-base disorders

pH 7.50, Pco2 29mmHg, [HCO3- 22mEq/L]

2.

respiratory alkalosis
due to: causes:

[pH, Pco2]

increased loss of CO2 from lungs

a. hyperventilation (i) emotional disturbances (ii) drug overdose (iii) high altitude (low Po2)

compensatory mechanism:
(1) body fluid buffers (2) kidneys

clinical causes of acid-base disorders

pH 7.20, [Pco2 21mmHg], HCO3- 8mEq/L

3.

metabolic acidosis

[pH, HCO3-]

due to:

(1) failure of kidneys to excrete metabolic acids (2) metabolic production of acids (3) addition of acids to body (4) loss of bases

causes:

(1) renal tubular acidosis (i) Addisons disease (ii) Fanconis syndrome (2) chronic renal failure (3) diabetes mellitus

clinical causes of acid-base disorders

pH 7.20, [Pco2 21mmHg], HCO3- 8mEq/L

3.

metabolic acidosis [pH, HCO3]

causes:

(4) acid ingestion (i) aspirin (ii) methanol formic acid (5) diarrhea (6) vomiting from deeper GI tract (7) malnutrition (8) starvation

compensatory mechanism:
(1) lungs (2) kidneys

clinical causes of acid-base disorders

4.

metabolic alkalosis ]

pH 7.50, [Pco2 48mmHg], HCO3- 36mEq/L

[pH, HCO3-

due to:

(1) excess loss of acid (2) uptake of alkaline substances

causes:

H+ secretion HCO3reabsorption (2) excess aldosterone sodium reabsorption H+ secretion (3) vomiting of gastric contents (4) ingestion of alkaline drugs (e.g. antacids)

(1) diuretics

compensatory mechanism:
(1) lungs

systemic effect of alkalosis

alkalosis
overexcitability of central and peripheral nervous system muscle tetany 2) convulsion 3) respiratory arrest death
1)

clinical measurements and analysis of acid-base disorders

acidosis (pH <7.4) alkalosis (pH >7.4) Step 2: check Pco2 (nl: 40 mmHg) HCO3- (nl: 24 mEq/L)

Step 1: examine pH

respiratory acidosis metabolic acidosis respiratory alkalosis metabolic alkalosis

pH

Pco2 HCO3 ( ) ( ) ( ) ( )

Anion-Gap
total concentration of anions and cations in plasma must be equal to maintain electrical neutrality but, only certain cation (Na+) and anions (Cl-, HCO3-) are routinely measured in clinical laboratory

Anion-Gap

anion gap : difference between unmeasured anions and unmeasured cations

Na+
unmeasured cations

Cl-

HCO3-

unmeasured anions

Anion-Gap
Na+
unmeasured cations

Cl-

HCO3-

unmeasured anions

anion gap = [Na+] {[HCO3-] + [Cl-]} = 144 - { 24 + 108} = 10 mEq/L

Anion-Gap
Na+
unmeasured cations

Cl-

HCO3-

unmeasured anions

if unmeasured anions relative amount of Cl- & HCO3 albumin, phosphate, sulfate, other organic anions if unmeasured cation

anion gap
relative amount of Na+

calcium, magnesium, potassium

clinical use of anion-gap

In metabolic acidosis (low HCO3-)

(1)

if plasma Na+ is unchanged,

concentration of anions (Cl- or unmeasured anion) must increase to maintain electroneutrality if Cl- remains unchanged: there must be increased unmeasured anion (= anion gap)
a. b. c. d. e. f.

diabetes mellitus (ketoacidosis) lactic acidosis chronic renal failure aspirin (acetylsalicylic acid) methanol ethylene glycol

clinical use of anion-gap

(2)

if Cl- increases in proportion to the fall of HCO3-: (normal anion gap) (hyperchloremic metabolic acidosis)
a. b.

diarrhea renal tubular acidosis