ACID-BASE BALANCE

By: Taufiq RN

Acid-base balance is determined by Hydrogen ion.

Hydrogen ion concentration must be regulated within a
narrow range for the body to function normally.
Slight changes in amounts of hydrogen can significantly
alter biologic processes in cells and tissues.
Hydrogen ion is necessary to maintain membrane integrity
and the speed enzymatic reactions.

H
+

Most pathologic conditions disturb acid-base balance, and

the degree of severity may be more harmful than the
disease process its self.

Concentration of hydrogen ion is commonly expressed as

the pH, the negative logarithm of hydrogen ions in
solution:
1
pH: log
[H+]

pH:
7.4

As the H+ increase, pH decrease acidic solution;

likewise as the H+ decrease, pH increase basic
solution.

In biologic fluids a pH less than 7.4 is

defined as acidic and a pH greater than
7.4 is defined as basic.

Different body fluids have different pH values

Body fluid
Gastric juices
Urine
Arterial blood
Venous blood
Cerebrospinal
fluid
Pancreatic fluid
Sperm

pH
1.0 3.0
5.0 6.0
7.38 7.42
7.37
7.32
7.8 8.0
7.2 8.0

Body acids are formed as end products of cellular

metabolism.
The average person generates acid in the amount of 50
100 mEq/day from the metabolism of protein,
carbohydrates, and fats and from loss of base in the
stools.
maintain a normal pH, an equal amount of acids therefore
must be neutralized or excreted.
The lungs, kidneys, and bone are the major organs
involved in the regulation of acid-base balance.

The systems are interrelated and work together to regulate

short or long term changes in acid-base status.
Body acids exist in two forms: The volatile acids is carbonic
acid (H2CO3) can be eliminated as CO2 gas, and
nonvolatile.

H2CO3 CO2

The volatile acids is carbonic acid (H2CO3) which is formed

from hydration of carbon dioxide:

CO2 + H2O H2CO3 H2CO3 +

H+
Regulated by lung

Regulated by

Carbonic acid is a weak acid, and in the

presence of carbonic anhydrase, it readily
dissociates into carbon dioxide.
Approximately 12.000 to 15.000 milimoles of
CO2 is produced in the human body perday.
The CO2 is then eliminated by pulmonary
ventilation.

Sulfuric, phosphoric, and other organic acids are

nonvolatile strong acids produced from the
metabolism of protein, carbohydrates, and fats.
(strong acids are those that readily give up their
hydrogen; weak acids do not)

Nonvolatile acids are eliminated by the

renal tubules with the regulation of HCO 3

Thus the lungs and kidneys with

the help of buffer systems, are
the prime regulators of acidbase balance !

Buffer Systems

Buffers resist change in pH in solutions

when acids or bases are added. They
are a mixture of a weak acid (HA) and
its conjugate base (A-) or a mixture of a
weak base (B) and its conjugate acid
(HB+).

EXAMPLE

(CH3 COOH) and (H2 CO3) are weak

acids.
(NH3) is a weak base
CH3 COOH and CH3 COO-, H2 CO3/
HCO3
and NH3/ NH4 constitute buffer system

A buffer solution functions in the

following manner to resist changes in
acidity and alkalinity

In acetic acid/sodium acetate buffer

system, the species present solution
are:
CH3 COOH, CH3 COO-, Na+, and H2O.
Amount of H+ and OH- are initially
assumed to be small.

When acid is added to the buffer almost all of the H + ion

react with acetate ion to produce weakly ionized acetic acid:

H+ + CH3COO- CH3COOH,

The H+ ion are thereby prevented from

appreciably changing the pH.

When OH- is added, almost all the hydroxyl

radicals react with acetic acid molecules to
produce more acetate ion and water:

OH- + CH3COOH CH3COO- + H2O

The additional OH- is thus consumed

with little increase in pH
Adding H+ or OH- to a buffer cause only
slight pH changes provided there is
excess salt (CH3COO-) or acid
(CH3COOH)

If all the acid is converted to the salt

form by the addition of a large amount
OH- the solution can longer behave as a
buffer.

100%
CH3COOAdding OH-

PK = 4.76
(CH3 COOH) = (CH3COO-)

pH=pK :

100%
CH3COOH
Adding H+

The maximum buffering capacity exist when The

molarities of salt and acid are equal

Buffer occurs in response to changes in acidbase status.

Buffer can absorb excessive H+ or OH- without
significant change of pH.
The buffer system are located in both in ICF
and ECF compartment, and they function at
different rates.
Buffer system exist as buffer pairs, consisting of
a weak acid and its conjugate base.

Buffer System
Buffer Pairs

HCO3-/H2CO3
Hb /HHb
HPO4- /H2PO4-

Pr-/HPr

Organ
Lung
Ionics shift
Kidney
Bone

Buffer
system
Bicarbonate
Haemoglobin
Phosphate
Plasma
protein

pK
values

Reaction

Rate

6.1

H+ + HCO3 H2O +
CO2

7.3
6.8
6.7

HHb H + Hb
H2PO4- H++HPO4-

HPr H+ + Pr-

Mechanism

Regulates retention or elimination of CO2 and therefore H2CO3

concentration
Exchange of intracellular potassium and sodium for hydrogen
Bicarbonate reabsorption and regeneration, NH3 formation,
phosphate buffering
Exchange of calcium, phosphate, and release of carbonate

Instantaneou
s
Instantaneou
s
instantaneou
s
instantaneou
s Rate
Instantaneous
Instantaneous
instantaneous
instantaneous

The most important plasma buffer system are carbonic

acid-bicarbonate and hemoglobin.
Phosphate and protein are the most important intracellular
buffers.
pK value is an important factor for buffering.
pK value is represent the pH at which a buffer pair is half
dissociated
Buffer pairs can associate and dissociate.
A buffer system is most effective when the pK for the buffer
is close to the pH of the fluid in which the buffer is acting.
The pK of bicarbonatecarbonic acid system is 6.1 is
lowest but it still very effective because carbon dioxide is
rapidly removed from the blood by the lung.

Carbonic acid-Bicarbonate Buffering

This buffer operates in both in the lung and kidney
The greater the carbon dioxide partial pressure (PCO2), the
more carbonic acid is formed.
The relationship that exist between carbonic acid (H2CO3) and
carbon dioxide (PCO2), can be expressed bellow
H2CO3 = 0.03 x PCO2 (mmHg)
The 0.03 represent the solubility coefficient of carbon dioxide in
water.
PCO2 of arterial blood is normally about 40 mmHg, Therefore
the amount of H2CO3 is equal to about 1.2 mmol/l (0,03 x 40)

If CO2 increase or decrease, H2CO3 also changes in

the same direction

The relationship between HCO3- H2CO3 usually

expressed as ratio. This ratio is represent the amount of
HCO3- H2CO3 in arterial blood.
When pH is 7.4 this ratio is 20 : 1 and this always
maintained
HCO3- normally about 24 mEq/L
The lung can decrease the amount of H2CO3 by blowing
off CO2 and leaving water. The kidney can reabsorb
bicarbonate or regenerate new HCO3- from CO2 and
water.
The two systems are very effective together because
acid concentration can be rapidly adjusted by the lung
and bicarbonate is easily reabsorbed or regenerated by
kidney

pH = renal regulation (slow)

Pulmonary regulation (fast)
Or
pH = Metabolic acid-base function
Respiratory acid-base function
Change in either numerator or the denominator will
change the pH.
If the amount of bicarbonate is decrease the pH also
decrease, causing a state of acidosis.
The pH be returned to a normal range if the value of
denominator or amount of carbonic acid also decrease.
(compensation)

The respiratory system compensates for

change in pH by increasing or decreasing
ventilation.
The renal system compensates by producing
more acidic or more alkaline urine.
Correction occur when the value for both
component of the buffer pair return to normal

Maintenance of HCO3-/PCO2 ratio in metabolic acidosis

HCO324 mEq/L

PCO2
40 mmHg
(1.2
mmol)

normal

HCO316 mEq/L
PCO2
40 mmHg
(1.2
mmol)

Uncompensated
Metabolic acidosis

HCO318 mEq/L
PCO2
30 mmHg
(0.9
mmol)

Compensated
Metabolic acidosis
Respiratory buffering response

Protein
Buffering
Both IC and EC
protein have
negative charges
and can serve as
buffer for H+, but
because most
protein are inside
cells, they are
primarily
intracellular
buffer system.

Renal Buffering
The distal tubule of the
kidney regulates acidbase balance by
secreting hydrogen into
urine and reabsorbing
bicarbonate with
maximum acidity of
about 4.4 4.7
Buffer in the tubular fluid
combine with hydrogen
ions allowing more H+ to
be secreted before the
limiting pH value is
reached
Phosphate (HPO4-) and
NH3 are two important
renal buffer

Primary and Compensatory Acid-Base Changes

Primary disturbance
pH

PCO2

HCO3

Compensations
pH

Metacid

-N

Met-alk

-N

Resacid

-N

Res-alk

-N

PCO2

HCO3

Cause of Metabolic acidosis

Increased Noncarbonic
acids (elevated anion
gap)

Bicarbonate Los
(normal anion gap)

Increase H+ load
(Ketoasidosis: DM,
Starvation)
Lactic asidosis: (shock)
Ingestion: salicylate,
ammonium cl, metanol
Decrease H+ excretion
Uremia
Distal renal tubule
acidosis

Diarrhea
Ureterosigmoidescopy
Renal failure
Proximal renal tubule
acidosis

Cause of acidosis/alkalosis Respiratory

Decrease Ventilation
Increase Ventilation
(Increase PCO2 -H2CO3 - H+) (Decrease PCO2 -H2CO3 H+)
Acidosis
(alkalosis)
1.

2.

Damage of central
respiratory system
(medulla oblongata)
Obstruction of
respiratory tract
(pneumonia etc)

Neurosis (Very rare)

Respiratory
regulation
and
AcidIncreasing of CO
ventilation
will
decrease
H+
2
base
ECFBalance
and otherwise

Second regulator of acid-base balance

disturbance is regulation of ECF CO2
concentration by lung
Increasing of PCO2 ECF will increase
pH
Decreasing of PCO2 ECF will decrease
pH
Consequent of PCO2 adjustment will
decrease or increase H+ ECF

Addition of acid

Loss of base
HCO3

H+

Serum pH
Resp
Compensation

Renal correction
Increased acid titration

Hypervent
PCO2
CO2 + H2O
H2CO3
H+

NH3 + H+ NH4
Acid excretion
In urine
Serum pH

HPO4= + H+ H2PO4Bicarbonate
regeneration
Metab acid with com and corr

Sekian Dulu Ya!