ACID-BASE PHYSIOLOGY

Julieta Berdon MD XU-JPRSM

Regulation of acid-base balance

This refers to those chemical and physiological processes which maintain the free H+ ion concentration in the body fluids at levels compatible with life and proper function. Narrow range = 36 44 nanomoles per liter pH = 7.35 7.45

The henderson hasselbach equation

Three factors / mechanisms help maintain the free H+ ion concentration

1. Chemical buffer systems: 2. Respiratory mechanism 3. Renal mechanism

Classification of buffer systems

1. Bicarbonate buffer system (BBS) 2. Non-bicarbonate buffer system (NBBS)

PERCENTAGE CONTRIBUTION TO BUFFERING

Buffer systems % Buffering 1. BBS Plasma BBS -------------- 35 % Rbc BBS ------------------- 18 % 53 %

2. NBBS PERCENTAGE CONTRIBUTION TO Hgb and oxyhgb -------------- 35 % (rbc) BUFFERING Organic phosphate ----------- 3 % (rbc) Inorganic phosphate --------- 2 % (rbc, plasma) Plasma proteins -------------7 % (plasma) 47 %

THE PLASMA BICARBONATE BUFFER SYSTEM

Weak acid carbonic acid (H2CO3) Conjugate base bicarbonate (HCO3-) Its equilibrium reaction is: H2CO3 H+ + HCO3 pH = pK + log [HCO3-] [H2CO3]

Properties of the plasma bbs

1. The weak acid component, H2CO3 , is in equilibrium with dissolved carbon dioxide or CO2(d).

CO2(d) + H2O
[800]molecules

H2CO 3
[1]

H+ + HCO3[0.03] [0.03]

pH = pK + log

[HCO3-] [CO2(d) + H2CO3]

Properties of the plasma bbs

2. CO2(d), in a liquid phase in the blood, is in equilibrium with CO2 in a gas phase in the alveolar air, CO2(g). Thus:

CO2(g)
CO2(d)

 CO2 (g) CO2(d) + H2O H2CO3 H+ + HCO3-

[H2CO3 + CO2(D)] PCO2

[CO2(d) + H2CO3] = S. pCO2 pH = pK + log [HCO3-]

S. pCO2

Buffering of plasma bbs to gain of H+ and OH CO2 (g) CO2(d) + H2O H2CO3 H+ + HCO3-

Directional changes of these parameters at the new equilibrium

[HCO3] = [CO2 (d) + H2CO3] = ratio [HCO3-] / [CO2 (d) + H2CO3] = ratio [HCO3- ] / S.PCO2 = pH =

The non-bicarbonate buffer system

Includes all the NBBS Weak acid component Hbuf Conjugate base Buf-

Its equilibrium reaction: Hbuf H+ + Buf

[[

[Buf-] pH Hbuf]

Directional changes of these parameters at the new equilibrium

[Buf -] = [HBuf] = ratio [Buf -] / [HBuf] = pH =

Blood buffer base (BB)

BB - the sum of all the conjugate bases of the two systems (the BBS and NBBS) in one liter of whole blood [BB] = [HCO3-] + [Buf-]

base excess (Be)

BE - the change in [BB] from its normal value [BE] = observed [BB] normal [BB]

Blood buffer base (BB)

Normal [BB] - This is the [BB] of blood having a completely normal acid-base status. There is no single value for a normal BB The value is dependent upon the hemoglobin concentration of the blood

Examples:

Hgb (gms/100ml)

Normal [BB] in

meq/liter 8 --------------------------- 45 13 --------------------------- 47 15 --------------------------- 48

6 general types of acid-base disturbances

1. 2. 3. 4. 5. 6. Gain of strong acid (H+) Gain strong base (OH-) Gain of HCO3Loss of HCO3Gain of CO2 Loss of CO2

buffering of gain of strong acid (H+) and strong base (oH-)

Both the BBS and NBBS respond to gain of H+. Consider now the equilibrium reactions of the two systems:

Buffering by the bbs and nbbs

CO2 (g) CO2(d) + H2O H2CO3 H+ + HCO3-

Hbuf

H+ + Buf-

Directional changes of these parameters at the new equilibrium

[HCO3] = [CO2 (d) + H2CO3] = ratio [HCO3-] / [CO2 (d) + H2CO3] = [Buf-] = [Hbuf] = ratio [Buf-] / [Hbuf] = [BB] = pH = [BE] =

6 general types of acid-base disturbances

Gain or loss of HCO3- & gain or loss of CO2 are buffered exclusively by the NBBS The interaction reaction: H2CO3 + BufHbuf + HCO3-

Buffering of gain or loss of hCO3 gain or loss of co2

CO2 (g) CO2 (d) + H2O H2CO3 + BufHbuf + HCO3-

Directional changes of these parameters at the new equilibrium

[HCO3] = [CO2 (d) + H2CO3] = ratio [HCO3-] / [CO2 (d) + H2CO3] = [Buf-] = [Hbuf] = ratio [Buf-] / [Hbuf] = [BB] = pH = [BE] =

The oxyhemoglobin & reduced hemoglobin buffer systems

HbO2 system: HHbO2 H+ + HbO2 Hb system: HHb H+ + Hb HbO2 (w/o charge) = all forms of oxyhemoglobin Hb (w/o charge) = all forms of reduced hemoglobin

 HbO2 SYSTEM: HHbO2

H+ + HbO2-

HHbO2 = acid form of oxyghemoglobin HbO2- = conjugate base form of oxyhemoglobin

 Hb system: HHb

H+ + H

HHb = acid form of reduced hemoglobin Hb- = conjugate base form of reduced hemoglobin

Buffering by hemoglobin

Buffering by hemoglobin

Role of lungs & kidneys in acid-base balance

[metabolic component] [respiratory component] kidneys

pH pH

lungs

The respiratory component

Represented either by: [CO2d + H2CO3] S.PCO2

Two factors determine the level of pCO2

1. Rate of CO2 production (RCP) 2. Rate of alveolar ventilation (RAV)

pCO2 RCP / RAV

pCO2 1 / RAV

The metabolic component

Is represented either by: [HCO3] plasma [BB] whole blood

Factors affecting metabolic component

1. Tissue metabolism produces acidogenic substances 2. Buffering of these acids cause a mark fall in [BB]

Ways by which kidneys maintain [HCO3-]

1. Variable HCO3- reabsorption 2. Addition of new HCO3- to the plasma

Renal reabsorption of HCO3

Formation of new HCO3

Formation of new HCO3

Process of Compensation
Compensation is defined as the secondary physiological process occurring in response to a primary disturbance in one component of acid-base equilibrium whereby the component not primarily affected changes in such a direction as to restore blood pH towards normal.

process of correction
Correction refers to a secondary, physiological process occurring in response to a primary disturbance in one component of acid-base equilibrium whereby the component that is primarily affected is restored to normal. The process is also mediated by organ or organ systems.

Degrees of compensation
Uncompensated absence of evidence of compensation; no compensatory effect discernable Partially compensated compensatory effect is discernable, but blood pH is NOT normal. Completely compensated compensatory effect is discernable and blood pH is normal.

basic clinical disorders of acid-base balance

1. 2. 3. 4. Metabolic acidosis Metabolic alkalosis Respiratory acidosis Respiratory alkalosis

 Metabolic acidosis is an abnormal physiological process characterized by: A primary gain of strong acid by the ECF A primary loss of HCO3- from the ECF

Body responses to metabolic acidosis

1. Buffer mechanism 2. Compensation 3. Correction

 Metabolic alkalosis is an abnormal physiological process characterized by a primary gain of strong base or primary loss of strong acid by the ECF; or a primary gain of exogenous HCO3 by the ECF

Body responses to metabolic alkalosis

1. Buffer mechanism 2. Compensation 3. Correction

 Respiratory acidosis is an abnormal physiological process in which there is a primary decrease in the rate of alveolar ventilation relative to the rate of CO2 production.

Body responses to respiratory acidosis

1. Buffer mechanism 2. Compensation 3. Correction

 Respiratory alkalosis is an abnormal physiological process in which there is a primary increase in the rate of alveolar ventilation relative to the rate of CO2 production.

Body responses to respiratory alkalosis

1. Buffer mechanism 2. Compensation 3. Correction

 Thank you !