Acid-base imbalance is an abnormality of the human body's normal balance of acids and bases that

causes the plasma pH to deviate out of the normal range (7.35 to 7.45). It can exist in varying levels of
severity, some life-threatening.

Classification

An excess of acid is called acidosis (pH less than 7.35) and an excess in bases is called alkalosis
(pH greater than 7.45). The process that causes the imbalance is classified based on the etiology
of the disturbance (respiratory or metabolic) and the direction of change in pH (acidosis or
alkalosis). This yields the following four basic processes:

process pH carbon dioxide compensation

metabolic acidosis down down respiratory
respiratory acidosis down up renal
metabolic alkalosis up up respiratory
respiratory alkalosis up down renal

Meaning of pH

pH is a measure of the acidity or basicity of a solution. It is defined as the cologarithm of the

activity of dissolved hydrogen ions (H+). Hydrogen ion activity coefficients cannot be measured
experimentally, so they are based on theoretical calculations. The pH scale is not an absolute
scale; it is relative to a set of standard solutions whose pH is established by international
agreement.[1]

The concept of pH was first introduced by Danish chemist Søren Peder Lauritz Sørensen at the
Carlsberg Laboratory in 1909. It is unknown what the exact definition of p is. Some references
suggest the p stands for “Power”[2], others refer to the German word “Potenz” (meaning power in
German)[3], still others refer to “potential”. Jens Norby published a paper in 2000 arguing that p
is a constant and stands for “negative logarithm”[4]; which has also been used in other works[5]. H
stands for Hydrogen. Sørensen suggested the notation "PH" for convenience, standing for "power
of hydrogen",[2] using the cologarithm of the concentration of hydrogen ions in solution, p[H][6]
Although this definition has been superseded p[H] can be measured if an electrode is calibrated
with solution of known hydrogen ion concentration.

Pure water is said to be neutral. The pH for pure water at 25 °C (77 °F) is close to 7.0. Solutions
with a pH less than 7 are said to be acidic and solutions with a pH greater than 7 are said to be
basic or alkaline. pH measurements are important in medicine, biology, chemistry, food science,
environmental science, oceanography and many other applications.

pH is defined as minus the decimal logarithm of the hydrogen ion activity in an aqueous solution.

where aH is the (dimensionless) activity of hydrogen ions.

pOH

pOH is sometimes used as a measure of the concentration of hydroxide ions, OH−, or alkalinity.
pOH is not measured independently, but is derived from pH.

pOH

pOH is sometimes used as a measure of the concentration of hydroxide ions, OH−, or alkalinity.
pOH is not measured independently, but is derived from pH.
In medicine, metabolic acidosis is a process which if unchecked leads to acidemia, i.e. blood pH is
low (less than 7.35) due to increased production of H+ by the body or the inability of the body to form
bicarbonate (HCO3-) in the kidney. Its causes are diverse, and its consequences can be serious, including
coma and death. Together with respiratory acidosis, it is one of the two general causes of acidemia.

Signs and symptoms

Symptoms are aspecific, and diagnosis can be difficult unless the patient presents with clear
indications for arterial blood gas sampling. Symptoms may include chest pain, palpitations,
headache, altered mental status such as severe anxiety due to hypoxia decreased visual acuity,
nausea, vomiting, abdominal pain, altered appetite (either loss of or increased) and weight loss
(longer term), muscle weakness and bone pains. Those in metabolic acidosis may exhibit deep,
rapid breathing called Kussmaul respirations which is classically associated with diabetic
ketoacidosis. Rapid deep breaths increase the amount of carbon dioxide exhaled, thus lowering
the serum carbon dioxide levels, resulting in some degree of compensation. Over compensation
via respiratory alkalosis to form an alkalemia does not occur.

Extreme acidemia leads to neurological and cardiac complications:

 Neurological: lethargy, stupor, coma, seizures.

 Cardiac: arrhythmias (ventricular tachycardia), decreased response to epinephrine; both
lead to hypotension (low blood pressure).

Physical examination occasionally reveals signs of disease, but is otherwise normal. Cranial
nerve abnormalities are reported in ethylene glycol poisoning, and retinal edema can be a sign of
methanol (methyl alcohol) intoxication. Longstanding chronic metabolic acidosis leads to
osteoporosis and can cause fractures.

Diagnosis

Arterial blood gas sampling is essential for the diagnosis. The pH is low (under 7.35) and the
bicarbonate levels are decreased (<24 mmol/l). Due to respiratory compensation
(hyperventilation), carbon dioxide is decreased and conversely oxygen is increased. An ECG can
be useful to anticipate cardiac complications.

Other tests that are relevant in this context are electrolytes (including chloride), glucose, renal
function and a full blood count. Urinalysis can reveal acidity (salicylate poisoning) or alkalinity
(renal tubular acidosis type I). In addition, it can show ketones in ketoacidosis.

To distinguish between the main types of metabolic acidosis, a clinical tool called the anion gap
is considered very useful. It is calculated by subtracting the chloride and bicarbonate levels from
the sodium.

Anion gap = ( [Na+] ) - ( [Cl-]+[HCO3-] )

As sodium is the main extracellular cation, and chloride and bicarbonate are the main anions, the
result should reflect the remaining anions. Normally, this concentration is about 8-16 mmol/l
(12±4). An elevated anion gap (i.e. > 16 mmol/l) can indicate particular types of metabolic
acidosis, particularly certain poisons, lactate acidosis and ketoacidosis.

As the differential diagnosis is made, certain other tests may be necessary, including
toxicological screening and imaging of the kidneys. It is also important to differentiate between
acidosis-induced hyperventilation and asthma; otherwise, treatment could lead to inappropriate
bronchodilation.[1]

Causes

[edit] Disease

The other main causes are best grouped by their influence on the anion gap:

[edit] Increased anion gap

Main article: High anion gap metabolic acidosis

Causes include:

 lactic acidosis
 ketoacidosis
 chronic renal failure (accumulation of sulfates, phosphates, uric acid)
 intoxication:
o organic acids (salicylates, ethanol, methanol, formaldehyde, ethylene glycol,
paraldehyde, INH)
o sulfates, metformin (Glucophage)
 massive rhabdomyolysis

[edit] Normal anion gap

Main article: Normal anion gap acidosis

Causes include:[1]

 longstanding diarrhea (bicarbonate loss)

 pancreatic fistula
 uretero-sigmoidostomy
 Renal tubular acidosis (RTA)
 intoxication:
o ammonium chloride
o acetazolamide (Diamox)
o bile acid sequestrants
o isopropyl alcohol
  renal failure (occasionally)
 Glue sniffing
 tolulene

It bears noting that the anion gap can be spuriously normal in sampling errors of the sodium
level, e.g. in extreme hypertriglyceridemia. The anion gap can be increased due to relatively low
levels of cations other than sodium and potassium (e.g. calcium or magnesium).

[edit] Pathophysiology

[edit] Compensatory mechanisms

Metabolic acidosis is either due to increased generation of acid or an inability to generate

sufficient bicarbonate. The body regulates the acidity of the blood by four buffering mechanisms.

 bicarbonate buffering system

 Intracellular buffering by absorption of hydrogen atoms by various molecules, including
proteins, phosphates and carbonate in bone.
 Respiratory compensation
 Renal compensation

[edit] Buffer

The decreased bicarbonate that distinguishes metabolic acidosis is therefore due to two separate
processes: the buffer (from water and carbon dioxide) and additional renal generation. The buffer
reactions are:

The Henderson-Hasselbalch equation mathematically describes the relationship between blood

pH and the components of the bicarbonate buffering system:

Using Henry's Law, we can say that [CO2]=0.03xPaCO2

(PaCO2 is the pressure of CO2 in arterial blood)

Adding the other normal values, we get

 = 6.1 + 1.3

= 7.4

[edit] Treatment

A pH under 7.1 is an emergency, due to the risk of cardiac arrhythmias, and may warrant
treatment with intravenous bicarbonate. Bicarbonate is given at 50-100 mmol at a time under
scrupulous monitoring of the arterial blood gas readings. This intervention however, is not
effective in case of lactic acidosis.

If the acidosis is particularly severe and/or there may be intoxication, consultation with the
nephrology team is considered useful, as dialysis may clear both the intoxication and the
acidosis.

Metabolic alkalosis is a primary increase in serum bicarbonate (HCO3 -) concentration. This occurs as a
consequence of a loss of H+ from the body or a gain in HCO3 -. In its pure form, it manifests as alkalemia
(pH >7.40). As a compensatory mechanism, metabolic alkalosis leads to alveolar hypoventilation with a
rise in arterial carbon dioxide tension (PaCO2), which diminishes the change in pH that would otherwise
occur. (See image below and Image 1.)

Summary of causes of metabolic alkalosis

 Chloride-responsive alkalosis (urine chloride <20 mEq/L)

o Loss of gastric secretions - Vomiting, NG suction
o Loss of colonic secretions - Congenital chloridorrhea, villous adenoma
o Thiazides and loop diuretics (after discontinuation)
o Posthypercapnia
o Cystic fibrosis
 Chloride-resistant alkalosis (urine chloride >20 mEq/L)
o With hypertension
 Primary hyperaldosteronism - Adrenal adenoma, bilateral adrenal
hyperplasia, adrenal carcinoma, glucocorticoid-remediable
hyperaldosteronism
 11B-HSD2 - Genetic, licorice, chewing tobacco, carbenoxolone
 CAH - 11-Hydroxylase or 17-hydroxylase deficiency
 Current use of diuretics in hypertension
 Cushing syndrome
 Exogenous mineralocorticoids or glucocorticoids
 Liddle syndrome
 Renovascular hypertension
o Without hypertension
  Bartter syndrome
 Gitelman syndrome
 Severe potassium depletion
 Current use of thiazides and loop diuretics
 Hypomagnesemia
 Other causes
o Exogenous alkali administration - Sodium bicarbonate therapy in the presence of
renal failure, metabolism of lactic acid or ketoacids
o Milk-alkali syndrome
o Hypercalcemia
o Intravenous penicillin
o Refeeding alkalosis
o Massive blood transfusion

Electrolyte

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Jump to: navigation, search

This article is about the ionic solution. For the R.E.M. song, see Electrolite.

In chemistry, an electrolyte is any substance containing free ions that make the substance
electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes
and solid electrolytes are also possible.
Contents
[hide]

 1 Principles
 2 Physiological importance
o 2.1 Measurement
o 2.2 Sports drinks
 3 Electrochemistry
 4 Dry electrolyte
 5 See also
 6 References

[edit] Principles

Electrolytes commonly exist as solutions of acids, bases or salts. Furthermore, some gases may
act as electrolytes under conditions of high temperature or low pressure. Electrolyte solutions can
also result from the dissolution of some biological (e.g., DNA, polypeptides) and synthetic
polymers (e.g., polystyrene sulfonate), termed polyelectrolytes, which contain charged functional
group.

Electrolyte solutions are normally formed when a salt is placed into a solvent such as water and
the individual components dissociate due to the thermodynamic interactions between solvent and
solute molecules, in a process called solvation. For example, when table salt, NaCl, is placed in
water, the salt (a solid) dissolves into its component elements, according to the dissociation
reaction

NaCl(s) → Na+(aq) + Cl−(aq).

It is also possible for substances to react with water when they are added to it, producing ions,
e.g., carbon dioxide gas dissolves in water to produce a solution which contains hydronium,
carbonate, and hydrogen carbonate ions.

Note that molten salts can be electrolytes as well. For instance, when sodium chloride is molten,
the liquid conducts electricity.

An electrolyte in a solution may be described as concentrated if it has a high concentration of

ions, or dilute if it has a low concentration. If a high proportion of the solute dissociates to form
free ions, the electrolyte is strong; if most of the solute does not dissociate, the electrolyte is
weak. The properties of electrolytes may be exploited using electrolysis to extract constituent
elements and compounds contained within the solution.
[edit] Physiological importance

In physiology, the primary ions of electrolytes are sodium(Na+), potassium (K+), calcium (Ca2+),
magnesium (Mg2+), chloride (Cl−), hydrogen phosphate (HPO42−), and hydrogen carbonate
(HCO3−). The electric charge symbols of plus (+) and minus (−) indicate that the substance in
question is ionic in nature and has an imbalanced distribution of electrons, which is the result of
chemical dissociation.

All known higher lifeforms require a subtle and complex electrolyte balance between the
intracellular and extracellular milieu. In particular, the maintenance of precise osmotic gradients
of electrolytes is important. Such gradients affect and regulate the hydration of the body, blood
pH, and are critical for nerve and muscle function. Various mechanisms exist in living species
that keep the concentrations of different electrolytes under tight control.

Both muscle tissue and neurons are considered electric tissues of the body. Muscles and neurons
are activated by electrolyte activity between the extracellular fluid or interstitial fluid, and
intracellular fluid. Electrolytes may enter or leave the cell membrane through specialized protein
structures embedded in the plasma membrane called ion channels. For example, muscle
contraction is dependent upon the presence of calcium (Ca2+), sodium (Na+), and potassium (K+).
Without sufficient levels of these key electrolytes, muscle weakness or severe muscle
contractions may occur.

Electrolyte balance is maintained by oral, or in emergencies, intravenous (IV) intake of

electrolyte-containing substances, and is regulated by hormones, generally with the kidneys
flushing out excess levels. In humans, electrolyte homeostasis is regulated by hormones such as
antidiuretic hormone, aldosterone and parathyroid hormone. Serious electrolyte disturbances,
such as dehydration and overhydration, may lead to cardiac and neurological complications and,
unless they are rapidly resolved, will result in a medical emergency.

[edit] Measurement

Measurement of electrolytes is a commonly performed diagnostic procedure, performed via

blood testing with ion selective electrodes or urinalysis by medical technologists. The
interpretation of these values is somewhat meaningless without analysis of the clinical history
and is often impossible without parallel measurement of renal function. Electrolytes measured
most often are sodium and potassium. Chloride levels are rarely measured except for arterial
blood gas interpretation since they are inherently linked to sodium levels. One important test
conducted on urine is the specific gravity test to determine the occurrence of electrolyte
imbalance.

[edit] Sports drinks

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 discussion may be found on the talk page.
This article has been tagged since October 2009.

Electrolytes are commonly found in sports drinks. In oral rehydration therapy, electrolyte drinks
containing sodium and potassium salts replenish the body's water and electrolyte levels after
dehydration caused by exercise, diaphoresis, diarrhea, vomiting, intoxication or starvation.
Athletes exercising in extreme conditions (for three or more hours continuously e.g. marathon or
triathlon) who do not consume electrolytes, risk dehydration (or hyponatremia)[1].

The regular and frequent use of sports drinks by men and women can potentially lead to
increased dental decay and erosion. [2]

A simple electrolyte drink can be home-made by using the correct proportions of water, sugar,
salt, salt substitute for potassium, and baking soda.[3] However, effective electrolyte
replacements should include all electrolytes required by the body, including sodium chloride,
potassium, magnesium, and calcium that can be either obtained in a sports drink or a solid
electrolyte capsule.[4]

[edit] Electrochemistry
Main article: electrolysis

When electrodes are placed in an electrolyte and a voltage is applied, the electrolyte will conduct
electricity. Lone electrons normally cannot pass through the electrolyte; instead, a chemical
reaction occurs at the cathode consuming electrons from the anode, and another reaction occurs
at the anode producing electrons to be taken up by the cathode. As a result, a negative charge
cloud develops in the electrolyte around the cathode, and a positive charge develops around the
anode. The ions in the electrolyte move to neutralize these charges so that the reactions can
continue and the electrons can keep flowing.

For example, in a solution of ordinary salt (sodium chloride, NaCl) in water, the cathode reaction
will be

2H2O + 2e− → 2OH− + H2

and hydrogen gas will bubble up; the anode reaction is

2H2O → O2 + 4H+ + 4e−

and oxygen gas will be liberated. The positively charged sodium ions Na+ will react towards the
cathode neutralizing the negative charge of OH− there, and the negatively charged chlorine ions
Cl− will react towards the anode neutralizing the positive charge of H+ there. Without the ions
from the electrolyte, the charges around the electrode would slow down continued electron flow;
diffusion of H+ and OH− through water to the other electrode takes longer than movement of the
much more prevalent salt ions.
In other systems, the electrode reactions can involve the metals of the electrodes as well as the
ions of the electrolyte.

Electrolytic conductors are used in electronic devices where the chemical reaction at a
metal/electrolyte interface yields useful effects.

 In batteries, two metals with different electron affinities are used as electrodes; electrons flow
from one electrode to the other outside of the battery, while inside the battery the circuit is
closed by the electrolyte's ions. Here the electrode reactions convert chemical energy to
electrical energy.
 In some fuel cells, a solid electrolyte or proton conductor connects the plates electrically while
keeping the hydrogen and oxygen fuel gases separated.
 In electroplating tanks, the electrolyte simultaneously deposits metal onto the object to be
plated, and electrically connects that object in the circuit.
 In operation-hours gauges, two thin columns of mercury are separated by a small electrolyte-
filled gap, and, as charge is passed through the device, the metal dissolves on one side and
plates out on the other, causing the visible gap to slowly move along.
 In electrolytic capacitors the chemical effect is used to produce an extremely thin 'dielectric' or
insulating coating, while the electrolyte layer behaves as one capacitor plate.
 In some hygrometers the humidity of air is sensed by measuring the conductivity of a nearly dry
electrolyte.
 Hot, softened glass is an electrolytic conductor, and some glass manufacturers keep the glass
molten by passing a large current through it.

[edit] Dry electrolyte

Dry electrolytes are essentially gels in a flexible lattice framework.[5]