Acid-Base Balance

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Objectives

 Explain how the pH of the blood is stabilized by

bicarb buffer and define the terms acidosis and
alkalosis.
 Explain how the acid-base balance of the blood is
affected by C02 and HC03-, and describe the roles of
the lungs and kidneys in maintaining acid-base
balance.
 Explain how C02 affects blood pH, and
hypoventilation and hyperventilation affect acid-base
balance.
 Explain how the interaction between plasma K+ and
H+ concentrations affects the tubular secretion of
these.
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pH

 pH of blood is 7.35 to 7.45

 pH = 6.1 + log [HCO3-]

0.03 x Pco2
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Types of Acids in the Body

 Volatile acids:
 Can leave solution and enter the
atmosphere.
 H2C03 (carbonic acid).
 Pco2 is most important factor in pH of
body tissues.
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Types of Acids in the Body

 Fixed Acids:
 Acids that do not leave solution.
 Sulfuric and phosphoric acid.
 Catabolism of amino acids, nucleic
acids, and phospholipids.
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Types of Acids in the Body

 Organic Acids:
 Byproducts of aerobic metabolism,
during anaerobic metabolism and
during starvation, diabetes.
 Lactic acid, ketones.
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Buffer Systems

 Provide or remove H+ and stabilize

the pH.
 Include weak acids that can donate
H+ and weak bases that can absorb
H+ .
 Does NOT prevent a pH change.
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Chemical Buffers

 Act within fraction of a second.

 Protein.
 HCO3-.
 Phosphate.
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Proteins

 COOH or NH2.
 Largest pool of buffers in the body.
 pk. close to plasma.
 Albumin, globulins such as Hb.
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HCO3-

 pk. = 6.1.
 Present in large quantities.
 Open system.
 Respiratory and renal systems act
on this buffer system.
 Most important ECF buffer.
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HCO3- Limitations

 Cannot protect ECF from

respiratory problems.
 Cannot protect ECF from elevated
or decreased CO2.
 Limited by availability of HCO3-.
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Phosphates

 pk. = 6.8.
 Low [ ] in ECF, better buffer in ICF,
kidneys, and bone.
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Respiratory System

 2nd line of defense.

 Acts within min. maximal in 12-24 hrs.
 H2CO3 produced converted to CO2, and
excreted by the lungs.
 Alveolar ventilation also increases as
pH decreases (rate and depth).
 Coarse , CANNOT eliminate fixed acid.
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Urinary Buffers

 Nephron cannot produce a urine pH

< 4.5.
 IN order to excrete more H+, the
acid must be buffered.
 H+ secreted into the urine tubule
and combines with HPO4-2 or NH3.
 HPO4-2 + H+ H2PO4-2
 NH3 + H+ NH4+
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Renal Acid-Base Regulation

 Kidneys help regulate blood pH by

excreting H+ and reabsorbing HC03-.
 Most of the H+ secretion occurs across
the walls of the PCT in exchange for Na+.
 Antiport mechanism.
 Moves Na+ and H+ in opposite directions.
 Normal urine normally is slightly acidic
because the kidneys reabsorb almost all
HC03- and excrete H+.
 Returns blood pH back to normal range.
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Reabsorption of HCO3-
 Apical membranes of tubule cells are
impermeable to HCO3-.
 Reabsorption is indirect.
 When urine is acidic, HCO3- combines with
H+ to form H2C03-, which is catalyzed by ca
located in the apical cell membrane of
PCT.
 As [C02] increases in the filtrate, C02 diffuses
into tubule cell and forms H2C03.
 H2C03 dissociates to HCO3- and H+.
 HCO3- generated within tubule cell
diffuses into peritubular capillary.
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Acidification of Urine

Insert fig. 17.28

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Urinary Buffers

 Nephron cannot produce a urine pH

< 4.5.
 In order to excrete more H+, the
acid must be buffered.
 H+ secreted into the urine tubule
and combines with HPO4-2 or NH3.
 HPO4-2 + H+ H2PO4-
 NH3 + H+ NH4+
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Metabolic Acidosis

 Gain of fixed acid or loss of HCO3-.

 Plasma HCO3- decreases.

PCO2 decreases.
 pH decreases.
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Metabolic Alkalosis

 Loss of fixed acid or gain of

HCO3-.
 Plasma HCO3- increases.
 PCO2 increases.
 pH increases.
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Respiratory Acidosis

 PCO2 increases.
 Plasma HCO3- increases.
 pH decreases.
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Respiratory Alkalosis

 PCO2 decreases.
 Plasma HCO3- decreases.
 pH increases.
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Anion Gap

 The difference between [Na+] and the

sum of [HC03-] and [Cl-].
 [Na+] – ([HC03-] + [Cl-]) =
 140 - (24 + 105) = 11
 Normal = 12 + 2

 Clinicians use the anion gap to identify

the cause of metabolic acidosis.
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Anion Gap

 Law of electroneutrality:
 Blood plasma contains an =
number of + and – charges.
 The major cation is Na+.
 Minor cations are K+, Ca2+ , Mg2+ .
 The major anions are HC03- and Cl-.
 (Routinely measured.)
 Minor anions include albumin,
phosphate, sulfate (called
unmeasured anions).
 Organic acid anions include lactate
and acetoacetate,.
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Anion Gap

 In metabolic acidosis, the

strong acid releases
protons that are buffered
primarily by [HC03].
 This causes plasma [HC03-]
to decrease, shrinking the
[HC03-] on the ionogram.
 Anions that remain from
the strong acid, are
added to the plasma.
 If lactic acid is added, the
[lactate] rises.
 Increasing the total [unmeasured
anions].
 If HCL is added, the [Cl-]
rises.
 Decreasing the [HC03-].
Anion Gap in Metabolic
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Acidosis

 Salicylates raise the gap to 20.

 Renal failure raises gap to 25.
 Diabetic ketoacidosis raises the gap to
35-40.
 Lactic acidosis raises the gap to > 35
(>50).
 Largest gaps are caused by ketoacidosis
and lactic acidosis.