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Acid-Base Balance: Overview

Reman A. Alingasa, RMT


Terms
 Acid
 Any substance that can yield a hydrogen ion
(H+) or hydronium ion when dissolved in water
 Release of proton or H+

 Base
 Substance that can yield hydroxyl ions (OH-)

 Accept protons or H+
Terms
 pK/ pKa
 Negative log of the ionization constant of an acid

 Strong acids would have a pK <3

 Strong base would have a pK >9

 pH
 Negative log of the hydrogen ion concentration
 pH= pK + log([base]/[acid])
 Represents the hydrogen concentration
Terms

 Buffer
 Combination of a weak acid and /or a
weak base and its salt
 What does it do?
 Resists changes in pH

 Effectiveness depends on
 pK of buffering system
 pH of environment in which it is placed
Terms
 Acidosis
 pH less than 7.35

 Alkalosis
 pH greater than 7.45

 Note: Normal pH is 7.35-7.45


Acid-Base Balance
 Function
 Maintains pH homeostasis

 Maintenance of H+ concentration

 Potential Problems of Acid-Base balance


 Increased H+ concentration yields decreased pH

 Decreased H+ concentration yields increased


pH
Regulation of pH
 Direct relation of the production and retention of acids and
bases
 Systems
 Respiratory Center and Lungs
 Kidneys
 Buffers
 Found in all body fluids
 Weak acids good buffers since they can tilt a reaction
in the other direction
 Strong acids are poor buffers because they make the
system more acid
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Blood Buffer Systems

 Why do we need them?


 If the acids produced in the body from the
catabolism of food and other cellular
processes are not removed or buffered,
the body’s pH would drop
 Significant drops in pH interferes with cell
enzyme systems.
Blood Buffer Systems

 Four Major Buffer Systems


 Protein Buffer systems
 Amino acids
 Hemoglobin Buffer system
 Phosphate Buffer system
 Bicarbonate-carbonic acid Buffer system
Blood Buffer Systems

 Protein Buffer System


 Originates from amino acids
 ALBUMIN- primary protein due to high
concentration in plasma
 Buffer both hydrogen ions and carbon
dioxide
Blood Buffering Systems

 Hemoglobin Buffer System


 Roles

 Binds CO2

 Binds and transports hydrogen and


oxygen
 Participates in the chloride shift

 Maintains blood pH as hemoglobin


changes from oxyhemoglobin to
deoxyhemoglobin
Oxygen Dissociation Curve

Curve B: Normal
curve

Curve A: Increased
affinity for hgb, so
oxygen keep close

Curve C: Decreased
affinity for hgb, so
oxygen released to
tissues
Bohr Effect

 It all about
oxygen
affinity!
Blood Buffer Systems
• Phosphate Buffer System
• Has a major role in the elimination of H+
via the kidney
• Assists in the exchange of sodium for
hydrogen
• It participates in the following reaction
• HPO-24 + H+ H2PO – 4

• Essential within the erythrocytes


Blood Buffer Systems

 Bicarbonate/carbonic acid buffer


system
 Function almost instantaneously
 Cells that are utilizing O2, produce CO2, which
builds up. Thus, more CO2 is found in the tissue
cells than in nearby blood cells. This results in a
pressure (pCO2).
 Diffusion occurs, the CO2 leaves the tissue
through the interstitial fluid into the capillary
blood
Bicarbonate/Carbonic Acid Buffer

Excreted
Carbonic by lungs
acid
Conjugate
base

Bicarbonate

Excreted in
urine
Bicarbonate/carbonic acid buffer system

 How is CO2 transported?


 5-8% transported in dissolved form

 A small amount of the CO2 combines directly


with the hemoglobin to form
carbaminohemoglobin
 92-95% of CO2 will enter the RBC, and under
the following reaction
 CO2 + H20 H+ + HCO3-
 Once bicarbonate formed, exchanged for
chloride
Henderson-Hasselbalch Equation

 Relationship between pH and the


bicarbonate-carbonic acid buffer
system in plasma

 Allows us to calculate pH
Henderson-Hasselbalch Equation

 General Equation

 pH = pK + log A-
HA

 Bicarbonate/Carbonic Acid system

o pH= pK + log HCO3


H2CO3 ( PCO2 x 0.0301)
Henderson-Hasselbalch Equation
1. pH= pK+ log H
HA
2. The pCO2 and the HCO3 are read or derived from the blood gas analyzer
pCO2= 40 mmHg
HCO3-= 24 mEq/L

3. Convert the pCO2 to make the units the same


pCO2= 40 mmHg * 0.03= 1.2 mEq/L

3. Lets determine the pH:


4. Plug in pK of 6.1

5. Put the data in the formula


pH = pK + log 24 mEq/L
1.2 mEq/L
pH = pK + log 20
pH= pK+ 1.30
pH= 6.1+1.30
pH= 7.40
The Ratio….
Normal is : 20 = Bicarbonate = Kidney = metabolic
1 carbonic acid Lungs respiratory

 The ratio of HCO3- (salt/bicarbonate) to H2CO3


(acid/carbonic acid) is normally 20:1

 Allows blood pH of 7.40


 The pH falls (acidosis) as bicarbonate
decreases in relation to carbonic acid
 The pH rises (alkalosis) as bicarbonate
increases in relation to carbonic acid
Physiologic Buffer Systems

 Lungs/respiratory
 Quickest way to respond, takes minutes
to hours to correct pH by adjusting
carbonic acid
 Eliminate volatile respiratory acids such
as CO2
 Doesn’t affect fixed acids like lactic acid
 Body pH can be adjusted by changing
rate and depth of breathing “blowing off”
 Provide O2 to cells and remove CO2
Physiologic Buffer Systems

 Kidney/Metabolic
 Can eliminate large amounts of acid
 Can excrete base as well
 Can take several hours to days to correct pH
 Most effective regulator of pH

 If kidney fails, pH balance fails


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References

 Bishop, M., Fody, E., & Schoeff, l. (2010). Clinical


Chemistry: Techniques, principles, Correlations. Baltimore:
Wolters Kluwer Lippincott Williams & Wilkins.
 Carreiro-Lewandowski, E. (2008). Blood Gas Analysis and
Interpretation. Denver, Colorado: Colorado Association for
Continuing Medical Laboratory Education, Inc.
 Sunheimer, R., & Graves, L. (2010). Clinical Laboratory
Chemistry. Upper Saddle River: Pearson .

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