Renal 4: ACID BASE

Regulation: according to order of response

1. ECF and ICF buffer (Hgb, Cl-HCO3, HPO4-NaHPO4) first to respond

2. Respiratory
3. Renal/Excretory- most important and major regulatory

Disorders:

blood compensatory
Respiratory Increase CO2 ICF Organ is Renal
acidosis damaged
(COPD)
Respiratory Dec. CO2 ICF Organ is renal
alkalosis damaged
Metabolic INC. HCO3 ICF, Respiratory renal
alkalosis ECF(indirect) (hypoventilate)
Metabolic DEC. HCO3 ICF, Respiratory Renal
acidosis ECF(indirect) (hyperventilate
)

Henderson hasselbach equation= 6.1 + log (HCO3/0.03pCO2)

Acids: titratable: weak acids (HPO4)

Volatile acids: can produce H with H20 (HCl)

Non volatile: does not (Lactic)

Membrane bound carbonic anhydrase: converts HCO3 to CO2 and H (slow reaction) to be
reabsorbed

Case 1: acidosis

Filtrate: increased filtered H

PCT: decrease reabsorbed H, Na is normally reabsorbed

DCT: H is secreted, K is reabsorbed, intercalated cells (population 1) reabsorbs HCO3 as CO2 and
release H

Titratable acid pathway in acidic patient: Na2HPO4 is secreted-> in DCT, dissociates to Na and
NaHPO4-> Na is reabsorbed (active), NaHPO4 binds with H-> forms NaH2PO4, allows H to
dissociate with HCO3 so bicarb can be reabsorbed.

Case 2: acidic patient

Associated with Cl;

PCT: Na, reabsorbed, H not reabsorbed, Cl- follows Na

DCT: H secreted, Cl secreted.. follow pathway in renal 3 transient hypochloremia

If Hypochloremia, then secondary is acidosis follow pathway at renal 3

Associated with hyperkalemia

DCT: H increased secretion, K reabsorbed,

Na reabsorbed (to release K, so that K/H antiport will increase activity)

Addisons dse;

DCT/CD: Na increase reabsorption, H will decrease (Na/H antiport)

Compensation:

pCO2: 35-45mmHg

HCO3: 22-28mEq/L

pH= 7.35-7.45 (arterial more basic) (venous more acidic)

pH pCO2 HCO3
Normal Abnormal Abnormal compensatory
Abnormal Abnormal Abnormal Partial
Abnormal Abnormal or Abnormal or Non Note: one of
normal normal compensatory the pCO2 and
HCO3 must
be normal and
abnormal
Low Low Low All acidosis metabolic
Low High Low acidosis respiratory
High Low High alkalosis metabolic
High High High Partial metabolic alkalosis
High Normal High non Metabolic alkalosis