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Acid-base Balance:- Part 1 – Introduction to the Acid-Base Balance

May 30, 2022Chemical pathologyLab Tests

Table of Contents

  • Acid-base Balance
      • Definition of acid-base balance:
      • H+ ions are needed for:
      • Body acids are formed from end products of:
      • Body acids are of two types:
      • Buffer systems of the acid-base balance:
      • Functions of the buffer system:
      • Summary of the different buffer systems in acid-base balance:
      • Renal buffering system:
      • Carbonic acid-bicarbonate buffering system:
      • Protein buffering system:
      • Pulmonary role in the acid-base balance:
      • Summary of the parameters needed for the acid-base balance:

Acid-base Balance

Definition of acid-base balance:

  1. This regulation of the extracellular fluid environment involves the ratio of acid to base, measured clinically as pH.
    1. Physiologically all positively charged ions are called acids, and all negatively charged ions are called bases.
      Acid-base definition and explanation

      Acid-base definition and explanation

      Distribution of the various anions/cations in body fluids:

      Anions Extracellular fluid (ECF) Intracellular fluid (ICF)
      Chloride 104 meq/L 4 meq/L
      Bicarbonate 24 meq/L 12 meq/L
      Phosphate 2 meq/L 40 to 95 meq/L
      Protein 16 meq/L 54 meq/L
      Other anions 8 meq/L 31 to 85 meq/L
      Cations
      Potassium 5 meq/L 156 meq/L
      Sodium 142 meq/L 10 meq/L
      Calcium 5 meq/L 4 meq/L
      Magnesium 2 meq/L 26 meq/L
    2. The regulation of intracellular and extracellular electrolytes concentration depends on the following factors:
      1. There is a balance between the intake of substances in a diet containing electrolytes and the electrolytes’ output in feces, urine, and sweating.
      2. It also depends upon the transport of fluids and electrolytes between ECF and ICF.
  2. Acid-base balance is essential for life.
  3. Physiological changes in the concentration of H+ ions in the blood lead to acid-base balance.
  4. A systemic increase in the H+ ions concentration is called acidosis (acidemia).
    Acid-base Imbalance and acidemia

    Acid-base Imbalance and acidemia

  5. A systemic decrease in the H+ ions is called alkalosis (alkalemia).
    Acid-base imbalance and alkalemia

    Acid-base imbalance and alkalemia

  6. Must regulate acid-base balance within a narrow range for the body to function normally.
    1. A very slight change in the pH will affect the body.
    2. A very slight change in the H+ ions can bring changes in the cell and tissue.

For normal body functions, the pH range is very narrow and needs to be maintained within these limits.
pH significance in our life:

pH value  Effects on the body
<6.8 This is incompatible with life.
<7.2 The cell’s functions are seriously impaired.
<7.35 This indicate acidosis
7.37 to 7.43 This indicates a normal range
>7.45 This indicates alkalosis
>7.55 The cell functions are seriously affected
>7.8 This is incompatible with the life

The pH of different body fluids:

Body fluids pH range Explanation 
Arterial blood 7.38 to 7.42 pH is higher due to less amount of carbonic acid
Venous blood 7.37 pH is lower due to more carbonic acid
Gastric juice 1.0 to 3.0 This is due to HCL acid
Pancreatic juice 7.8 to 8.0 Exocrine glands produce bicarbonate (HCO3–)
Cerebrospinal fluid 7.32 There is decreased HCO3- and increased CO2 contents.
Urine 5.0 to 6.0 There is H+ ions excretion from waste products through kidneys.

H+ ions are needed for:

  1. To maintain the integrity of the membrane.
  2. Speed of the metabolic reactions.
  3. Any change in the pH will lead to more harmful effects than other diseases.
  4. The symbol pH represents the power of H+.
  5. When pH changes one unit like 7.0 to 6.0 = [H+] [H+] = H+ ions concentration changes 10 folds.

Body acids are formed from end products of:

  1. Metabolism of proteins.
  2. Metabolism of Carbohydrates.
  3. Metabolism of fats.
  4. This must be balanced by the number of basic substances in the body to maintain the normal pH.
    1. Lungs, kidneys, and bones are the major organs involved in the regulation of acid-base balance.

Body acids are of two types:

  1. Volatile acids:
    1. Carbonic acid (H2CO3) is a weak acid, and it does not easily release the H+ ions.
    2. The presence of carbonic anhydrase enzyme can eliminate CO 2 gas and water H2O.
    3. CO 2 is eliminated through the lungs.
  2. Nonvolatile acids:
    1. These are sulfuric acid, phosphoric acid, and other organic acids that are eliminated through the kidneys.
    2. These are strong acids and readily give up their H+ ions.
    3. Nonvolatile acids are secreted into the urine by the renal tubules.
    4. These acids are about 150 meq/L of H+ ions per day or about 1 meq/kg body weight.

Buffer systems of the acid-base balance:

The buffer systems become active in response to changes in the pH of the body as acid-base balance.

Functions of the buffer system:

  1. Prevent the significant change in pH.
  2. Buffer can absorb the excess of the H+ ions (acid).
  3. Buffer system can absorb OH– ions, Hydroxyl (base).
  4. The buffer system is present in the intracellular fluid (ICF) and extracellular fluid (ECF).
  5. The most common buffer systems are:
    1. Carbonic acid-bicarbonate system.
    2. Hemoglobin-oxyhemoglobin system.
    3. Phosphate and protein are the most important intracellular buffers (ICF).

Summary of the different buffer systems in acid-base balance:

Renal buffering system:

  1. The distle tubule of the kidneys regulates acid-base balance by secreting the H+ ions in the urine and reabsorbs the HCO3–.
  2. Dibasic phosphate (HPO4—) and ammonia (NH3) are two important renal buffer.
  3. The renal buffering of H+ ions requires CO2 and water (H2O) to form the H2CO3.
  4. The enzyme carbonic anhydrase catalyzes the reaction.
  5. H+ ions are secreted from the tubular cells and buffer in the lumen by PO4— and NH3 = H2PO–3 + NH4+.
  6. The rest of HCO3– is reabsorbed.
    Kidneys role in the acid-base balance

    Kidneys role in the acid-base balance

  7. If a respiratory Disease causes acidosis or alkalosis, then the kidney becomes active and responds by changing H+ and HCO3– ions to return the pH to normal.
    1. Renal compensation starts in hours to days after respiratory alteration in the pH.
    2. There is a delay, but the renal buffer system is powerful.
    3. In acidemia (acidosis) Kidney excrete an excess of the H+ ions, and these may combine with PO4 (phosphate) or NH3 (ammonia) to form titratable acids in the urine.
    4. The net outcome is to raise the concentration of the HCO3– ions in the ECF and restore the acid-base balance.
    5. In alkalemia (alkalosis), kidneys excrete HCO3–  ions, usually with Na+ ions.
    6. The net result is to decrease the concentration of the HCO3- ions in the ECF and restore the acid-base balance.

Carbonic acid-bicarbonate buffering system:

  1. This buffer system operates both in the lungs and kidneys.
  2. This is the major extracellular buffer system.
  3. Lungs can decrease the carbonic acid by blowing out the CO2 and leaving water behind.
  4. Kidneys can reabsorb HCO3- or regenerate new HCO3- from CO 2 and water.
  5. Normal bicarbonate (24 meq/L) and normal carbonic acid (1.2 meq/L), produce a 20:1 relation and maintain the pH of 7.4
  6. Both the systems are very efficient because:
    1. HCO3– is easily reabsorbed or regenerated by the kidneys.
    2. The lungs adjust acid concentration.
  7. Compensation for the pH is done as:
    1. The respiratory system compensates for pH by decreasing or increasing CO2 by changing the rate of respiration.
    2. The renal system produces more acidic or more alkaline urine.

Protein buffering system:

  1. Hemoglobin (Hb) is the best intracellular buffer system, and it combines with H+ and forms HHb and CO2, forming the HHbCO2 complex.
  2. When Hb combines with H+ ions becomes weak acid.
  3. Venous blood Hb is a better to buffer system than arterial blood Hb.
Acid base control by the various organs of the body

Acid-base control by the various organs of the body

Pulmonary role in the acid-base balance:

  1. In case of acidosis or alkalosis resulting from metabolic or renal diseases, the respiratory system regulates the respiratory rate to restore the pH to normal.
  2. In acidemia (acidosis), there is an increased respiratory rate and depth to eliminate CO2.
  3. In alkalemia (alkalosis), there is decreased respiratory rate and depth to retain the CO2.

Various Buffer systems and their role in the acid-base system:

Buffer system (pairs) Buffer system anions Buffer reaction Mechanism
Hb-/HHb Hemoglobin in the RBCs HHb ↔H+ + Hb–
  1. Hb binds with H+ and CO2.

HCO3– / H2CO3

(Carbonic acid/bicarbonate buffer system)

Bicarbonate (HCO3–) H+ + HCO3–   =  H2O + CO2
  1. Lungs will regulate retention or elimination of CO2 and H2CO3 concentration.
  2. Kidneys play a role in bicarbonate reabsorption and regeneration, ammonia formation.
  3. Kidneys play a role in phosphate buffering.
Protein– (Pr–) / hydrogenated protein (HPr) Plasma proteins HPr ↔H– + Pr–
  1. The main role is Hb which combines with H+ ions.
  2. Hb also combines with CO2.
HPO4– / H2PO4– Phosphate in the blood H2PO4 + H+ + HPO4– The bone will exchange calcium and phosphate and release carbonate.

Role of various organs as a buffer and their role in acid-base balance:

Role of organs Mechanism of these organ’s role in acid-base balance
Kidneys
  1. There is the reabsorption of HCO3– 
  2. There is ammonia formation.
  3. There is a role of PO4— as a buffer.
Lungs
  1. There is retention or elimination of CO2.
  2. Regulate H2CO3 concentration
Ionic shift
  1. There is an exchange ICF of  K+ and Na+ for H+.
Bones
  1. There is an exchange of Ca++.
  2. There is an exchange of PO4—
  3. There is the release of HCO3–

Role of various anions in the acid-base balance:

Anions of acid-base balance Signs and symptoms Diagnostic test
Potassium   Hyperkalemia (K+)
  1. There may be nausea.
  2. There may be abdominal pain.
  3. Patients may have diarrhea.
  4. There are muscle weakness and flaccid paralysis.
  5. There are tachycardia and changes to bradycardia.
  6. There are ECG changes.
  7. There is a possibility of cardiac arrest.
  1. Serum K+ is >5 meq/L
  2. ECG changes are:
    1. Elevated T-waves
    2. Wide QRS complex
    3. Prolonged PR interval
    4. Flattened or absent P waves
    5. Depressed ST segment
    6. Metabolic acidosis
Potassium   Hypolalemia
  1. There is nausea, vomiting, and anorexia.
  2. There may be diarrhea, abdominal distension, and decreased peristalsis.
  3. The patient will have muscle weakness, fatigue, and cramps.
  4. The patient may have hypotension and dizziness.
  5. The patient will have arrhythmias and ECG changes.
  6. There may be cardiac arrest.
  1. Serum K+ <3.5 meq/L
  2. Metabolic alkalosis
  3. Low serum Ca++ and Mg++
  4. ECG changes show:
    1. Flattened T-wave
    2. Depressed ST-segment
    1. Elevated U-wave
Sodium   Hypernatremia (Na+)
  1. There is thirst, increased viscosity of saliva, and rough tongue.
  2. The patient will have agitation, restlessness, and decreased level of consciousness.
  3. The patient will have a fever.
  4. There is pitting edema.
  5. Excessive weight gain
  6. There are hypertension and tachycardia.
  7. The patient will be dyspneic, have respiratory arrest, and ultimately die.
  1. Serum Na+ is >145 meq/L
  2. Urine Na+ <40 meq/day
  3. There is high osmolality.
Sodium  Hyponatremia (Na+)
  1. There are nausea, vomiting, and abdominal cramps.
  2. There is oliguria or anuria
  3. There is lethargy, muscle weakness, and twitching.
  4. There are confusion and seizures.
  5. There are hypotension and tachycardia.
  1. Serum Na+ is < 135 meq/L
  2. Urine Na+ >100 meq/L
  3. Increased RBC count
  4. Decreased urine specific gravity
  5. Decreased serum osmolality
Hyperchloremia (Cl–)
  1. There is weakness
  2. There is rapid, deep breathing.
  3. There is decreased cognitive ability, which may lead to coma.
  1. Serum Cl– =  >108 meq/L
  2. Serum pH = <7.35
  3. Serum CO2 = <22 meq/L
Hypochloremia (Cl–)
  1. There is shallow depressed breathing.
  2. There are muscle hypertonicity and tetany.
  3. Usually hyponatremia
  4. Muscle weakness and twitching
  1. Serum Cl– =  <98 meq/L
  2. Serum pH = >7.45
  3. Serum CO2 = >32 meq/L

Panic values:

Clinical parameter Panic value
pH <7.25   or  >7.55
pO2 <50 mm Hg
pCO2 >60 mm Hg

Summary of the parameters needed for the acid-base balance:

Lab test Importance
pH This will tell:

  1. Increased pH value indicates alkalosis
  2. Decreased value of pH indicates acidosis
pCO2 This is the partial pressure of CO2, and it will tell:

  1. The respiration modulates this pCO2
  2. This is the index of ventilation
pO2 This is the partial pressure of the O2 in the arterial blood and tell:

  1. Low values indicate hypoxia
  2. pO2 is the indirect measure of O2 contents of arterial blood.

 

 

Possible References Used
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