Acid-Base Balance

M. Rasjad Indra
Laboratorium Ilmu Faal
FK. UNIBRAW
Seorang wanita 34 tahun hamil 32 minggu datang ke rumah
sakit dengan keluhan muntah-muntah selama dua hari terakhir.

Penderita adalah peminum alkohol berat. Awal muntah terjadi

setelah meneguk alkohol dalam jumlah besar, tetapi segera
berhenti minum setelah mengalami muntah.

Hasil pemeriksaan darah:

pH : 7,17 (7,35 – 7,45)
PCO2 : 14 mm Hg (23 – 33)
HCO3 : 7 mmol/L (35 – 45)
W ha t is Aci d and Base ?

 Acid is proton (H+) donor

 Base is proton (H+) acceptor
 The most important acid in the blood is
H2CO3
 The most important base is HCO3-
 H2CO3 <=> HCO3-+H+
 Henderson-Hasselbalch
Equation
 pH=pK + log kidneys
lungs

 pH=pK + log [HCO3-]

PCO2

 pH=6,1 + log [HCO3-]

0.03 * P CO2
 [ HCO 3] [ HCO 3] 20
1. pH = 6,1 + log =
[ H 2CO3] 1
PCO 2
PCO 2 ( mmHg )
2. [ H + ]( nmol / L ) = 24 x
HCO 3mEq / L

pH 7.70  [H+] = 20 nmol/L pH7.20 [H+]=60

nmol/L
7.60 25 7.10 80
7.50 30 7.00 100
7.40 40 6.90 125
7.30 50 6.80 160
 ACID
 Result of metabolism and
digestion
 Consist of: volatile and nonvolatile
 Volatile
– HCl, H2SO4, HNO3, H3PO4, NH4+,
H2CO3
 H2CO3 (primary)<=>H20 + CO2
 Eliminated as CO2 gas via lungs.
 Nonvolatile:
– Small amount.
– Lactic acid, acetic acid
– Removed via the kidney
 •NaOH: Sodium hydroxide
Base : •KOH: Potasium hydroxide
•NH3+: Ammonia
•HCO3-: Bicarbonate

Amphoteric Substance:
Can function as both an acid and a base.
•Glycine( +H3N-CH2-COO-):
•NaOH++H3N-CH2-COO-=>H2N-CH2-COO-Na+ + H2O
•HCl + +H3N-CH2-COO- => Cl-+H3N-CH2-COOH
Buffer: Minimize the change & promote
stability
1. Acid <=> Conjugate base :
H2PO4- <=> HPO42- + H+
H2CO3 <=> HCO3- + H+
NH4+ <=> NH3 + H+
2. Protein :
Albumin; Globulin
Hemoglobin
3. Lung and Kidney
 [H2CO3 ]~PaCO2= Respiratory
component

 [H2CO3]<=>PaCO2 x (0.03)
 PaCO2 :
– Provides a measure of H2CO3
– The respiratory component.
 Normal:
– PaCO2 = 40 mm Hg.
– H2CO3 = 40 x 0.03 = 1.2 mEq/L
HC O 3 - =Met abolic component

 Regulated by the kidney.

 By modulating the rate of re-absorption
 Metabolic acid-base imbalance:
 Kidney-related
 Non-kidney-related
 Electrolite Disturbance
(Chloride depletion)
Three Process in Urinary Acidification

1.Reabsorption of filtered bicarbonate

2.Formation of titrable acid
3.Excretion of ammonium
 REABSORPTION OF FILTERED BICARBONATE

Blood Plasma Tubular Epithelium Tubular Urine

Na+ Na+
HCO3- H+
HCO3 -
H+ + HCO3-

H2CO3

CA
H2CO3
H2 O
+

CO2 CO2 CO2 H2 O

 FORMATION OF TITRATABLE ACID

Blood Plasma Tubular Epithelium Tubular Urine

Na+ Na+
HCO3- H+
HCO3 -
H+ + HPO42-2Na

H2CO3

CA
H2PO4-2Na
H2 O
+

CO2 CO2
 EXCRETION OF AMMONIUM [NH4]
Blood Plasma Tubular Epithelium Tubular Urine

Glutamine
Na+

α-ketoglutarate2- 2NH4+ NH4+

NH3 NH3
Glucose NH4+
2H +
+
or CO2
H+
H+

2Na+ Na+
2H2CO3
HCO3-
2HCO3-
CA

2H2O

2CO2 2CO2
 The acidity of blood
 Depend on [H+]
 Expressed by pH
• The [H+] increase -> the pH decrease
• pH = -log[H+]
• pH = pK + log [HCO3- / H2CO3]
 Henderson Hasselbalch equation
 Arterial Blood Gas (ABG):
• pH = measured - HCO3- = calculated
• PaCO2 = measured
 Normal Range

• PaCO2 = 38 to 42 mmHg
• HCO3- = 22 to 26 mEq/L
• pH = 7.38 to 7.42
• HCO3- / H2CO3 = 20 : 1
• Acid-base disturbance (blood):
– Acidemia: pH< 7.38
– Alkalemia: pH> 7.42
 Acid-Base Disturbance
Simple :
• Respiratory acidosis: PaCO2 high / HCO3- normal
or slightly high
• Respiratory alkalosis: PaCO2 low /HCO3- normal or
low
• Metabolic acidosis: HCO3- low / PaCO2 normal or
low
• Metabolic alkalosis: HCO3- high / PaCO2 normal or
high
Mixed / Combination:
• (Respiratory + Metabolic)
 Physiologic compensation
Primary disorder Physiol. compensation
Respiratory acidosis Kidney – retention of HCO3-
; excretion of H+
Respiratory alkalosis Kidney – excretion of
HCO3-; retention of H+
Metabolic acidosis Lung – excretion of H+
(CO2).
Metabolic alkalosis Lung – possible retention of
H+ (CO2)
 Exercise
► pH = 7.33 ► pH = 7.55
► PaCO2 = 50 mmHg ► PaCO2 = 30 mmHg
► HCO3- =25.8 mEq/L ► HCO3- = 23.4
Answer: mEq/L
► Acidemia Answer:
► Primary respiratory ► Alkalemia

► Acute ► Primary respiratory

► Acute
 Exercise
pH = 7.31 pH = 7.59
PaCO2 = 29.5 mmHg PaCO2 = 46.5 mmHg
HCO3- = 14.5 mEq/L HCO3- = 45 mEq/L
Answer: Answer:
Acidemia Alkalemia
Primary metabolic Primary metabolic
Respiratory Respiratory
compensation compensation