Acid Base

Howard Mass, Ph.D. August 2011

Review

Acid any chemical substance that can donate a hydrogen ion

HA H+ + A-

Base any chemical substance that can accept a hydrogen ion

NH3 + H+ NH4+

pH the log measure of the hydrogen ion concentration of a solution

pH = - log 10 [H+]

pK acid dissociation constant or ionization constant

Shows the strength of an acid

The higher the acid dissociation constant, the more an acid is ionized and the greater is its strength. Hydrochloric acid (HCl) is an example of a strong acid. It has a high Ka and is almost completely ionized in aqueous solutions. Other strong acids include sulfuric acid (H2SO4), phosphoric acid (H3PO4), and nitric acid (HNO3). An acid with a low Ka is a weak acid. For example, in a 0.1 M solution of acetic acid (Ka = 1.8 10-5) in water, most (99%) of the acid is nonionized, so that little (1%) is present as acetate- and H+. The acidity (concentration of free H+) of this solution is low. Other weak acids are lactic acid, carbonic acid (H2CO3), ammonium ion (NH4+), and dihydrogen phosphate (H2PO4-).

A strong acid has a high Ka and a low pKa.

A weak acid has a low Ka and a high pKa.

Buffer

A buffer is any substance that reversibly consumes or releases H+. Buffers do not prevent changes in pH, they only minimize the change The most important physiologic buffer pair is CO2 and HCO3 -

Mechanisms of Stabilizing pH

Chemical Buffers Respiratory System

Breathing removes CO2 which in turn lowers H2CO3

Renal Response

Burden of removing H+

HCO3 / CO2 Buffer

The strength of this buffer pair is due to the volatility of CO2, which allows the lungs to maintain stable plasma CO2 concentrations.

The lung excretes over 10,000 mEq of carbonic acid per day (a Volatile acid) Nonvolatile acids produced: lactic acid, ketoacids

Basics

Concentration of CO2 in the blood is governed by Henrys Law:

[CO2]dissolved
s

= s x PCO2

= solubility coefficient, 0.03 mM/mmHg

PaCO2

~ 40 mmHg,

[CO2]diss = (0.03 mM/mmHg) x 40 mmHg = 1.2 mM

CO2 itself, has no effect on pH,

CO2

+ H2O = H2CO3

Reaction is slow, unless catalyzed by Carbonic Anhydrase

 H2CO3
pH

H+ + HCO3

= pKA + log (HCO3-)/(CO2)

Because CO2 obeys Henrys Law,

pH = pKA + log (HCO3-)/0.03*PCO2

Substituting 6.1 for pKA and 24 mmol/L for the normal HCO3- concentration,

Davenport Diagram

Is a graphical tool that depicts the three dimensional relationship between pH, PCO2 and HCO3-

Acid Base Disturbances

Respiratory Acidosis

Caused by an increase in PCO2, which reduces the HCO3-/PCO2 ratio and decreases the pH

Acid Base Disturbances - Terminlogy

Acidemia Acidosis

Alkalemia
Alkalosis Base Excess

Respiratory Alkalosis
Caused by a decrease in PCO2, which in turn increases the HCO3-/PCO2 ratio Hyperventilation

Metabolic Disturbances

Metabolic Acidosis
A primary decrease in HCO3 Caused by accumulation of acids in blood:

Diabetic Ketoacidosis Lactic Acidosis Diarrhea

Metabolic Alkalosis
A primary increase in HCO3 Excess ingestion of alkali, vomiting

pH < 7.4 pH > 7.4 pH = 7.4

Acidosis Alkalosis Normal

pCO2 < 40 pCO2 > 40 pCO2 = 40

alkalosis acidosis Normal

HCO3 < 24 HCO3 > 24 HCO3 = 24

acidosis alkalosis Normal

Look at pH determine if it is acidosis/alkalosis/normal Look at pCO2 determine if it is acidosis/alkalosis/normal Look at HCO3 determine if it is acidosis/alkalosis/normal Whichever one (pCO2 or HCO3) is in the same direction as the pH is the primary problem Whichever one (pCO2 or HCO3) moved in the opposite direction of the pH is the compensation If both PCO2 and HCO3 are in the same direction as the pH, then the patient has two primary problems If the pH is near NORMAL, but the pCO2 and HCO3 are out of the normal range, there are two primary problems. In this case, the PCO2 and HCO3 balance each other to nearly normalize the pH. Compensation does not return pH to 7.4.

An 18-year-old woman has gastroenteritis with nausea and vomiting and is able to ingest only small amounts of water. After 3 days, she develops lightheadedness, especially when sitting or standing. Arterial blood gas analysis is most likely to show which of the following sets of values?

Pco2
pH
A. B.

HCO3(mEq/L) 15 27

(mm Hg) 28 55

7.30 7.30

C.
D. E.

7.40
7.50 7.50

40
30 47

24
22 35

The laboratory provides the following report on arterial blood from a patient: PCO2 32 mm Hg, pH 7.25, HCO3- concentration 25 mmol/L. You conclude that there is: A. Respiratory alkalosis with metabolic compensation.

B.
C.

Acute respiratory acidosis.

Metabolic acidosis with respiratory compensation.

D.
E.

Metabolic alkalosis with respiratory compensation.

A laboratory error.