Acid and Base Balance

Department of Biochemistry

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 The Body and pH
• Homeostasis of pH is tightly controlled
• Extracellular fluid = 7.4
• Blood = 7.35 – 7.45
• < 7.35: Acidosis (acidemia)
• > 7.45: Alkalosis (alkalemia)
• < 6.8 or > 8.0: death occurs

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 The body produces more acids
than bases
• Acids take in with foods.
• Cellular metabolism produces CO2.
• Acids produced by metabolism of lipids and
proteins. CO2

Volatile acid H2CO3 CO2+ H2O CO2 CO2

(H+ 15 –20 mol /d)

H2SO4 H3PO4
Fixed acid Uric acid
Lactic acid
Ketone body
(H+ < 0.05 –0.10 mol /d) 4
 Maintenance of blood pH

• Three lines of defense to regulate the

body’s acid-base balance
– Blood buffers

– Respiratory mechanism

– Renal mechanism

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 Buffer systems

• Take up H+ or release H+ as conditions

change
• Buffer pairs – weak acid and a base
• Exchange a strong acid or base for a
weak one
• Results in a much smaller pH change

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 Principal buffers in blood

in Plasma in RBC

H2CO3 / HCO3- 35% 18%

HHb / Hb- 35%

HPro / Pro- 7%

H2PO4- / HPO42- 5%
Total 42% 58% 7
 Bicarbonate buffer
• Predominant buffer system
• Sodium Bicarbonate (NaHCO3) and carbonic
acid (H2CO3)
• HCO3- : H2CO3: Maintain a 20:1 ratio
[HCO3－]
pH=pKa+lg
H2CO3 H+ + HCO3- [H2CO3]
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= 6.1+ lg
1.2
20
= 6.1+ lg
1
8
= 6.1+1.3 = 7.4
 Bicarbonate buffer
• HCl + NaHCO3 ↔ H2CO3 + NaCl

• NaOH + H2CO3 ↔ NaHCO3 + H2O

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 Phosphate buffer
• Major intracellular buffer

• NaH2PO4-Na2HPO4

• H+ + HPO42- ↔ H2PO4-

• OH- + H2PO4- ↔ H2O + HPO42-

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 Protein Buffers

• Include plasma proteins and hemoglobin

• Carboxyl group gives up H+

• Amino Group accepts H+

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 2. Respiratory mechanisms
CO2 CO2
• Exhalation of CO2
• Rapid, powerful, but only works with
volatile acids
• H+ + HCO3- ↔ H2CO3 ↔ CO2 + H20
• Doesn’t affect fixed acids like lactic acid
• Body pH can be adjusted by changing rate
and depth of breathing

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 3. Kidney excretion
• Most effective regulator of pH
• The pH of urine is normally acidic (~6.0)
– H+ ions generated in the body are eliminated by
acidified urine.
• Can eliminate large amounts of acid (→H+)
• Reabsorption of bicarbonate (HCO3-) (←HCO3-)
• Excretion of ammonium ions(NH4+) (→NH4+)
• If kidneys fail, pH balance fails

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 Rates of correction
• Buffers function: almost instantaneously
• Respiratory mechanisms: take several
minutes to hours
• Renal mechanisms: may take several
hours to days

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 Acid-Base Imbalances
• pH< 7.35: acidosis
• pH > 7.45: alkalosis
• The body response to acid-base imbalance is
called compensation
– The body gears up its homeostatic mechanism and
makes every attempt to restore the pH to normal level.
– May be complete if brought back within normal limits
– Partial compensation if range is still outside norms.

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 Acid-Base Imbalances
• Acidosis- a decline in blood pH ↓
– Metabolic acidosis: due to a decrease in
bicarbonate. ↓
– Respiratory acidosis: due to an increase in
carbonic acid. ↑
• Alkalosis- a rise in blood pH ↑
– Metabolic alkalosis: due to an increase in
bicarbonate.↑
– Respiratory alkalosis : due to a decrease in
carbonic acid. ↓
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 pH

HCO3－
acidosis alkalosis

metabolic respiretory metabolic respiretory

[HCO3-]↓ PaCO2↑ [HCO3-]↑ PaCO2↓
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 Compensation
• If underlying problem is metabolic,
hyperventilation or hypoventilation can
help: respiratory compensation.
• If problem is respiratory, renal
mechanisms can bring about metabolic
compensation.

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 Metabolic Acidosis
• Bicarbonate deficit (↓) - blood concentrations of
bicarb drop below 22mEq/L (milliequivalents /
liter)
• Causes:
– Loss of bicarbonate through diarrhea or renal
dysfunction
– Accumulation of acids (lactic acid or ketones)
– Failure of kidneys to excrete H+
• Commonly seen in severe uncontrolled DM
(ketoacidosis).
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 Compensation for Metabolic
Acidosis

• Hyperventilation: increased ventilation

• Renal excretion of H+ if possible
• K+ exchanges with excess H+ in ECF
– H+ into cells, K+ out of cells

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 Respiratory Acidosis
• Carbonic acid excess caused by blood
levels of CO2 above 45 mm Hg.
• Hypercapnia – high levels of CO2 in blood
• Causes:
– Depression of respiratory center in brain that
controls breathing rate – drugs or head
trauma
– Paralysis of respiratory or chest muscles
– Emphysema

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 Compensation for Respiratory
Acidosis

• Kidneys eliminate hydrogen ion (H+ and

NH4+) and retain bicarbonate ion

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 Metabolic Alkalosis
• Bicarbonate excess↑ - concentration in
blood is greater than 26 mEq/L
• Causes:
– Excess vomiting = loss of stomach acid
– Excessive use of alkaline drugs
– Certain diuretics
– Endocrine disorders: aldosterone ↑
– Heavy ingestion of antacids

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 Compensation for Metabolic
Alkalosis
• Hypoventilation to retain CO2 (hence
H2CO3↑)
• Renal excretes more HCO3-, retain H+.

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 Respiratory Alkalosis
• Carbonic acid deficit↓
• pCO2 less than 35 mm Hg (hypocapnea)
• Most common acid-base imbalance
• Primary cause is hyperventilation
– Hysteria, hypoxia, raised intracranial pressure,
excessive artificial ventilation and the action
of certain drugs (salicylate) that stimulate
respiratory centre.

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 Compensation of Respiratory
Alkalosis

• Kidneys conserve hydrogen ion

• Excrete bicarbonate ion

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 Mixed acid-base disorders
• Sometimes, the patient may have two or
more acid-base disturbances occurring
simultaneously.
• In such instances, both HCO3- and H2CO3
are altered.

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 Points
• Blood = 7.35 – 7.45;
• < 7.35: Acidosis, > 7.45: Alkalosis
• Three lines of defense to regulate the body’s acid-base
balance
– Blood buffers: Bicarbonate buffer, Phosphate buffer, Protein
Buffers
– Respiratory mechanisms: Exhalation of CO2
– Renal mechanism: eliminate acid, Reabsorption of HCO3-
• Acidosis- blood pH ↓(Causes, Compensation)
– Metabolic acidosis: bicarbonate ↓
– Respiratory acidosis: carbonic acid ↑
• Alkalosis- blood pH ↑ (Causes, Compensation)
– Metabolic alkalosis: bicarbonate↑
– Respiratory alkalosis : carbonic acid ↓
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