ACID BASE

BALANCE
BY
DR.ABUBAKKAR
SIDDIQUE

ACID BASE HOMEOSTASIS

Every day, metabolic reactions in the body produce and

consume many moles of hydrogen ions (H+s). Yet, the

[H+] level of most body fluids is low (in the nanomolar
range) and is kept within narrow limits.
For example, the [H+] level of arterial blood is normally
35 to 45 nmol/L (pH 7.45 to 7.35).
Normally, the body maintains acidbase balance; inputs
and outputs of acids and bases are matched so that the
[H+] level stays relatively constant both outside and
inside cells.
Abnormalities in pH have profound effects on all
systems in the body and can have fatal consequences

ACID BASE HOMEOSTASIS

Acid-Base homeostasis involves

chemical and physiologic processes

responsible for the maintenance of the
acidity of body fluids at levels that
allow optimal function of the whole
individual

ACID BASE HOMEOSTASIS

The chemical processes represent the

first line of defense to an acid or base
load and include the extracellular and
intracellular buffers
The physiologic processes modulate
acid-base composition by changes in
cellular metabolism and by adaptive
responses in the excretion of volatile
acids by the lungs and fixed acids by
the kidneys

ACID BASE HOMEOSTASIS

The need for the existence of multiple

mechanisms involved in Acid-Base

regulation stems from the critical
importance of the hydrogen ion (H+)
concentration on the operation of
many cellular enzymes and function of
vital organs, most prominently the
brain and the heart

ACID BASE HOMEOSTASIS

The task imposed on the mechanisms

that maintain Acid-Base homeostasis is

large
Metabolic pathways are continuously
consuming or producing H+
The daily load of waste products for
excretion in the form of volatile and
fixed acids is substantial

EFFECTS OF pH

The most general effect of pH changes

are on enzyme function
Also affect excitability of nerve and
muscle cells

p
H
p

Excitabilit
y
Excitabilit
7

ACID-BASE BALANCE

ACID-BASE BALANCE

Acid - Base balance is primarily

concerned with two ions:
Hydrogen (H+)
Bicarbonate (HCO3- )

HCO

ACID-BASE BALANCE

Derangements

of hydrogen and
bicarbonate
concentrations
in body fluids
are common in
disease
processes

10

ACID-BASE
BALANCE

H+ ion has

special
significance
because of the
narrow ranges
that it must be
maintained in
order to be
compatible with
living systems
11

ACID-BASE BALANCE

Primarily

rm
No
al

controlled by
regulation of
H+ ions in the
body fluids
Especially
extracellular
fluids

12

ACIDS

13

ACIDS

Acids can be defined as a proton (H+) donor

Hydrogen containing substances which
dissociate in solution to release H+

Click Here

14

ACIDS

Acids can be defined as a proton (H+) donor

Hydrogen containing substances which
dissociate in solution to release H+

Click Here

15

ACIDS

Acids can be defined as a proton (H+) donor

Hydrogen containing substances which
dissociate in solution to release H+

OH
-

H+

H+

OH-

H+

O
H-

OH

H+

16

ACIDS

Many other substance (carbohydrates)

also contain hydrogen but they are not
classified as acids because the
hydrogen is tightly bound within their
molecular structure and it is never
liberated as free H+
OH
-

H+

H+

OH-

H+

O
HH+

OH

17

ACIDS

Physiologically important acids include:

Carbonic acid (H2CO3)
Phosphoric acid (H3PO4)
Pyruvic acid (C3H4O3)
Lactic acid (C3H6O3)
These acids are dissolved in body fluids
Lactic
acid
Pyruvic
acid

Phosphoric
acid

18

BASES

19

BASES

Bases can be defined as:

A proton (H+) acceptor
Molecules capable of accepting a
hydrogen ion (OH-)

Click Here

20

BASES

Bases can be defined as:

A proton (H+) acceptor
Molecules capable of accepting a
hydrogen ion (OH-)

Click Here

21

BASES

Bases can be defined as:

A proton (H+) acceptor
Molecules capable of accepting a
hydrogen ion (OH-)

OH
-

H+

H+

OH-

H+

O
H-

OH

H+

22

BASES

Physiologically important bases include:

Bicarbonate (HCO3- )
Biphosphate (HPO4-2 )

Biphosphat
e

23

The Acid Dissociation Constant

Ka Shows the Strength of an
Acid

At equilibrium, the rate of dissociation of an

acid to form H+ + A- and the rate of

association of H+ and base A- to form HA are
equal. The equilibrium constant (Ka), which
is also called the ionization constant or acid
dissociation constant, is given by the
expression

24

25

26

27

pH SCALE

28

pH SCALE

pH refers to Potential Hydrogen

Expresses hydrogen ion concentration in
water solutions
Water ionizes to a limited extent to form
equal amounts of H+ ions and OH- ions

H2O

H+ + OH-

H+ ion is an acid
OH- ion is a base

29

pH SCALE

H+ ion is an acid

30

pH SCALE

OH- ion is a base

31

pH SCALE

H+ ion is an acid
OH- ion is a base

32

pH SCALE

Pure water is Neutral

( H+ = OH- ) ACIDS, BASES OR NEUTRAL???
pH = 7
H
OH H
H OH
H
Acid
H OH
OH
H H
H
H
+
( H > OH ) OH OH
OH H
OH H
H
OH H
OH OH
pH
<
7

H OH
3
1
H OH
Base
OH
+
( H < OH )
2
pH > 7
Normal blood pH is 7.35 - 7.45
pH range compatible with life is 6.8 - 8.0
+

33

pH SCALE

pH equals the logarithm (log) to the

base 10 of the reciprocal of the
hydrogen ion (H+) concentration

pH = log 1 / H+ concentration

H+ concentration in extracellular fluid

(ECF)

4 X 10

-8

(0.00000004)
34

35

pH SCALE

Low pH values = high H+ concentrations

H+ concentration in denominator of
formula

pH = log 1 / H+ concentration

Unit changes in pH represent a tenfold

change in H+ concentrations
Nature of logarithms

4 X 10

-8

(0.00000004)

36

pH SCALE

pH = 4 is more acidic than pH = 6

pH = 4 has 10 times more free H+

concentration than pH = 5 and 100 times

more free H+ concentration than pH = 6
ACIDOSIS

NORMAL

DEATH

DEATH
6.8

ALKALOSIS

7.3
Venou
s
Blood

7.4

7.5
Arteria
l Blood

8.0

37

38

pH SCALE

39

pH SCALE

40

ACID-BASE
REGULATION

41

ACID-BASE REGULATION

Maintenance of an acceptable pH range

in the extracellular fluids is

accomplished by three mechanisms:
1) Chemical Buffers
React very rapidly
(less than a second)
2) Respiratory Regulation
Reacts rapidly (seconds to minutes)
3) Renal Regulation
Reacts slowly (minutes to hours)

42

ACID-BASE REGULATION

Chemical Buffers

The body uses pH buffers in the blood to

guard against sudden changes in acidity

A pH buffer works chemically to minimize
changes in the pH of a solution

Buffe
43

ACID-BASE REGULATION

Respiratory Regulation

Carbon dioxide is an important by-product

of metabolism and is constantly produced
by cells
The blood carries carbon dioxide to the
lungs where it is exhaled

CO
Cell
2CO2CO
CO2 CO 2
CO2 2
Metabolis

m
44

ACID-BASE REGULATION

Respiratory Regulation

When breathing is increased,

the blood carbon dioxide level

decreases and the blood
becomes more Base
When breathing is decreased,
the blood carbon dioxide level
increases and the blood becomes more
Acidic
By adjusting the speed and depth of
breathing, the respiratory control centers
and lungs are able to regulate the blood
pH minute by minute
45

ACID-BASE REGULATION

Kidney Regulation

Excess acid is excreted

by the kidneys, largely

in the form of ammonia
The kidneys have some
ability to alter the
amount of acid or base
that is excreted, but this
generally takes several
days

46

ACID-BASE REGULATION

Enzymes, hormones and ion

distribution are all affected by

Hydrogen ion concentrations

47

ACIDOSIS /
ALKALOSIS

48

ACIDOSIS / ALKALOSIS

An abnormality in one or more of the pH

control mechanisms can cause one of two

major disturbances in Acid-Base balance
Acidosis
Alkalosis

49

ACIDOSIS / ALKALOSIS

Acidosis

A condition in which the blood has too

much acid (or too little base), frequently

resulting in a decrease in blood pH

Alkalosis

A condition in which the blood has too

much base (or too little acid), occasionally

resulting in an increase in blood pH

50

ACIDOSIS / ALKALOSIS

Acidosis and alkalosis are not diseases

but rather are the results of a wide
variety of disorders
The presence of
acidosis or
alkalosis provides
an important clue
to physicians that
a serious
metabolic
problem exists

51

ACIDOSIS / ALKALOSIS

pH changes have dramatic effects on

normal cell function
1) Changes in excitability of nerve
and muscle cells
2) Influences enzyme activity
3) Influences K+ levels

52

CHANGES IN CELL
EXCITABILITY

pH decrease (more acidic) depresses

the central nervous system
Can lead to loss of consciousness
pH increase (more basic) can cause
over-excitability
Tingling sensations, nervousness,
muscle twitches

53

INFLUENCES ON ENZYME
ACTIVITY

pH increases or decreases can alter

the shape of the enzyme rendering it

non-functional
Changes in enzyme structure can
result in accelerated or depressed
metabolic actions within the cell

54

INFLUENCES ON K+ LEVELS

When reabsorbing Na+ from the

filtrate of the renal tubules K+ or H+ is

secreted (exchanged)
Normally K+ is
secreted in much
greater amounts
than H+
K+

Na+

H+
K+

55

INFLUENCES ON K+ LEVELS

If H+ concentrations are high (acidosis)

than H+ is secreted in greater amounts

This leaves less K+ than usual excreted
The resultant K+ retention can affect
cardiac function and other systems

K+

Na+

H+

56

ACIDOSIS

A relative increase in hydrogen ions

results in acidosis

OH

57

ALKALOSIS

A relative increase in bicarbonate

results in alkalosis

OH

58

ACIDOSIS / ALKALOSIS
Acidosis

OH

OH

Alkalosis

59

ACIDOSIS / ALKALOSIS
BASE

ACID

Normal ratio of HCO3- to H2CO3 is 20:1

H2CO3 is source of H+ ions in the body
Deviations from this ratio are used to
identify Acid-Base imbalances

H2CO

HCO3

60

ACIDOSIS / ALKALOSIS

Acidosis and Alkalosis can arise in two

fundamentally different ways:
1) Excess or deficit of CO2
(Volatile Acid)
Volatile Acid can be eliminated by
the respiratory system
2) Excess or deficit of Fixed Acid
Fixed Acids cannot be
eliminated by the
respiratory system

61

ACIDOSIS / ALKALOSIS

Normal values of bicarbonate

(arterial)
pH = 7.4
PCO2 = 40 mm Hg
HCO3- = 24 meq/L

62

ACIDOSIS

A decrease in a normal 20:1 base to

acid ratio
An increase in the number of
hydrogen ions
(ex: ratio of 20:2 translated to 10:1)
A decrease in the number of
bicarbonate ions (ex: ratio of 10:1)
Caused by too much acid or too little base

ACI

BASE
63

ALKALOSIS

An increase in the normal 20:1 base

to acid ratio
A decrease in the number of
hydrogen ions
(ex: ratio of 20:0.5 translated to 40:1)
An increase in the number of
bicarbonate ions (ex: ratio of 40:1)
Caused by base excess or acid deficit

ACI

BASE
64

SOURCES OF
HYDROGEN IONS
H

C
H

C
H

65

SOURCES OF HYDROGEN
IONS
1) Cell Metabolism (CO )

1) Cell Metabolism (CO2 )

2) Food Products
3) Medications
4) Metabolic Intermediate by-products
5) Some Disease processes

66

SOURCES OF HYDROGEN
IONS

1) Cellular Metabolism of

carbohydrates release CO2 as a waste

product
Aerobic respiration

C6H12O6 CO2 + H2O + Energy

67

SOURCES OF HYDROGEN
IONS
CO diffuses into the bloodstream

where the reaction:

CO2 +
H2O
H2CO3
H+ + HCO3This process occurs in red blood cells
H2CO3 (carbonic acid)
Acids produced as a result of the
presence of CO2 is
referred to as a
Volatile acid
68

SOURCES OF HYDROGEN
IONS

Dissociation of H2CO3 results in the

production of free H+ and HCO3The respiratory system removes CO2

thus freeing HCO3- to recombine with H+
Accumulation or deficit of CO2 in blood
leads to respective H+ accumulations or
deficits
CO2
H+ p
H

CO2

H+

p
H

69

CARBON DIOXIDE DIFFUSION

Plasma

Red Blood Cell

carbonic
anhydrase

CO2 +H2O

Systemic
Circulation

Cl(Chloride
Shift)
-

H+ +HCO3

HCO3CO2

CO2

CO2 diffuses into plasma and into RBC

Within RBC, the hydration of CO2 is
catalyzed by carbonic anhydrase
Bicarbonate thus formed diffuses into
plasma Tissues
70

CARBON DIOXIDE DIFFUSION

Red Blood Cell

Plasma

Systemic Circulation

carbonic
anhydrase

Cl-

H + + HCO3-

H+ is buffered
by HemoglobinHb

H2O

CO2

CO2

CO2 CO TissuesCO2 CO2

2

Click for
Carbon
Dioxide
diffusion

CO2

CO2

71

SOURCES OF HYDROGEN
IONS
2) Food products
Sauerkraut
Yogurt
Citric acid in fruits

72

SOURCES OF HYDROGEN
IONS
3) Medications
May stimulate
HCl production
by parietal cells
of the stomach

73

SOURCES OF HYDROGEN
IONS
4) Metabolic
Intermediate
by-products
Lactic acid
Pyruvic acid
Acetoacetic acid
Fatty acids

C6H12O6

74

SOURCES OF HYDROGEN
IONS

Inorganic acids can also be produced

during breakdown of nutrients
Proteins (meat products)
Breakdown leads to
productions of sulfuric
acid and phosphoric acid
Fruits and Vegetables
Breakdown produces
bases which can help
to equalize acid
production

75

SOURCES OF HYDROGEN
IONS
5) Some disease processes
Ex: diabetes causes improper
metabolism of fats which results
in the generation of a waste
product called a Keto Acid

76

SOURCES OF
BICARBONATE IONS

77

SOURCES OF BICARBONATE
IONS

1) CO2 diffusion into red blood cells

2) Parietal cell

secretion of the
gastric mucosa

78

1) CO2 DIFFUSION

Hemoglobin buffers H+
Chloride shift insures electrical
neutrality

+
H
H+ +
+H
H H+
H+
H+ +
H

Red Blood
Cell

Cl-

Hb

Cl-

ClCl-

ClClCl
Cl79

CARBON DIOXIDE DIFFUSION

Plasma

Red Blood Cell

Systemic Circulation

carbonic
anhydrase

CO2 +H2O

Cl(Chloride
Shift)

H+ +HCO3HCO3-

CO2 diffuses into the plasma and into

the RBC
CO2
CO2

Within the RBC, the hydration of CO2 is

catalyzed by carbonic anhydrase
Tissues
Bicarbonate
thus formed diffuses into 80

BICARBONATE DIFFUSION
Plasma

Red Blood Cell

Pulmonary Circulation
ClHCO3-

CO2 +H2O

CO2

H+ +HCO3-

Bicarbonate diffuses back into RBC in

pulmonary capillaries and reacts with
hydrogen ions to form carbonic acid
The acid breaks down to CO2 and water
Alveolus

81

BICARBONATE DIFFUSION
Plasma

Pulmonary Circulation

Red Blood Cell

ClCO2+ H2O
CO2

HCO3-

H+

Alveolus

82

2) PARIETAL CELL SECRETION

Secrete hydrogen ions into the lumen of

the stomach

Bicarbonate

Bloo
d

ions diffuse into

the bloodstream
to maintain
electrical
neutrality in the
parietal cell
Click to see
ion
movement

Parieta
l Cells

CO2 +
H2O

H+
HCO3

Lumen
of
Stomac
h

ClHCl

83

PANCREATIC CELL
SECRETION

In pancreatic cells the direction of ion

movement is reversed

H+ ions are

secreted into
the blood and
bicarbonate
ions diffuse into
pancreatic juice

Bloo
d

HCO3
-

Click to see
ion
movement

Pancreatic
Cells

Pancreati
c
duct

H+
HCO3
-

84

PARIETAL CELL SECRETION

If the two processes are balanced,

there is no net change in the amount

of bicarbonate in blood
Loss of gastric or pancreatic juice
can change that balance

HCO3

HCO3

HCO3

HCO3
-

HCO3
HCO3

85

BICARBONATE SECRETION
Parietal cells of
gastric mucosa
H+

blood

HCO3-

lumen of
stomach

Pancreatic
epithelial cells
HCO3blood

H+

Cells of the gastric

mucosa secrete H+
ions into the lumen
of the stomach in
exchange for the
diffusion of
bicarbonate ions
into blood

The direction of the

diffusion of these
pancreatic
ions is reversed in
juice
pancreatic
epithelial cells

86

ACIDOSIS /
ALKALOSIS

87

ACIDOSIS / ALKALOSIS

Deviations from normal Acid-Base

status are divided into four general

categories, depending on the source
and direction of the abnormal change
in H+ concentrations
Respiratory Acidosis
Respiratory Alkalosis
Metabolic Acidosis
Metabolic Alkalosis
88

ACIDOSIS / ALKALOSIS

Acidosis and Alkalosis are categorized

as Metabolic or Respiratory
depending on their primary cause
Metabolic Acidosis and Metabolic
Alkalosis
caused by an imbalance in the
production and excretion of acids
or bases by the kidneys
Respiratory Acidosis and
Respiratory Alkalosis
caused primarily by lung or
breathing disorders
89

ACIDOSIS

A pH of 7.4 corresponds to a 20:1 ratio

of HCO3- and H2CO3

Concentration of HCO3- is 24

meq/liter and H2CO3 is 1.2 meq/liter

Bicarbonat Bicarbonat
Bicarbonat
eBicarbonat eBicarbonat Bicarbonat
e
e
Bicarbonat
Bicarbonat
e
e
Carbonic
e
eBicarbonat Bicarbonat
e Bicarbonat Acid Bicarbonat
e
Bicarbonat
e
e
eBicarbonat Bicarbonat
Bicarbonat
eBicarbonat eBicarbonat e Bicarbonat
e
e
Bicarbonat
90

7.

ACIDOSIS

Acidosis is a decrease in pH below 7.35

Which means a relative increase of H+
ions
pH may fall as low as 7.0 without
irreversible damage but any fall less
than 7.0 is usually fatal

p
91

ACIDOSIS

May be caused by:

An increase in H2CO3
A decrease in HCO3Both lead to a decrease in the ratio
of 20:1

H2CO3

HCO

3
92

ACIDOSIS

H+

1) Respiratory Acidosis+
H
+
2) Metabolic Acidosis
H
+
H
+

H
+
H
+
+
+
+
H
H H +
H
+
H
H
+
+
H
+
+
H
H
H
+
+
+
H
+
H H
H
+
+
H
H
+
+
H
H
+
H+
H
+
H
H+
H+
H+ H+

93

ALKALOSIS

1) Respiratory alkalosis H+
2) Metabolic alkalosis
H+

+
H
H+

H+
H+
H+

H+
H+

H+

H+
+

H+ H+
H+

H+

94

RESPIRATORY
ACIDOSIS

95

RESPIRATORY ACIDOSIS

Caused by hyperkapnia due to

hypoventilation
Characterized by a pH decrease
and an increase in CO2
CO2
CO2
CO CO2
2

CO2

COCO
2
2

p
H

CO2
CO2

p
COH
2

CO2
CO2

CO2
96

HYPOVENTILATION

Hypo = Under

Elimination of
CO2
+
H
pH

97

RESPIRATORY ACIDOSIS

Hyperkapnia is defined as an

accumulation of carbon dioxide in

extracellular fluids

CO2
CO2
CO CO2
2

CO2

COCO
2
2

p
H

CO2
CO2

p
COH
2

CO2
CO2

CO2
98

RESPIRATORY ACIDOSIS

Hyperkapnia is the underlying cause of

Respiratory Acidosis
Usually the result of decreased CO2
removal from the lungs
CO2
CO2
CO CO2
2

CO2

COCO
2
2

p
H

CO2
CO2

p
COH
2

CO2
CO2

CO2
99

RESPIRATORY ACIDOSIS

The speed and depth of breathing control

the amount of CO2 in the blood

Normally when CO2 builds up, the pH of the
blood falls and the blood becomes acidic
High levels of CO2 in the blood stimulate the
parts of the brain that regulate breathing,
which in turn stimulate faster and deeper
breathing

100

RESPIRATORY ACIDOSIS

Respiratory acidosis

develops when the

lungs don't expel CO2
adequately
This can happen in
diseases that severely
affect the lungs, such
as emphysema, chronic
bronchitis, severe
pneumonia, pulmonary
edema, and asthma
101

RESPIRATORY ACIDOSIS

Respiratory acidosis can also develop when

diseases of the nerves or muscles of the

chest impair the mechanics of breathing
In addition, a person can develop respiratory
acidosis if overly sedated from narcotics and
strong sleeping medications that slow
respiration

102

RESPIRATORY ACIDOSIS

The treatment of respiratory acidosis

aims to improve the function of the lungs

Drugs to improve breathing may help
people who have lung diseases such as
asthma and emphysema

103

RESPIRATORY ACIDOSIS

Decreased CO2 removal

can be the result of:

1) Obstruction of air
passages
2) Decreased respiration
(depression of
respiratory centers)
3) Decreased gas
exchange between
pulmonary capillaries
and air sacs of lungs
4) Collapse of lung
104

RESPIRATORY ACIDOSIS

1) Obstruction of air passages

Vomit, anaphylaxis, tracheal cancer

105

RESPIRATORY ACIDOSIS

2) Decreased Respiration
Shallow, slow breathing
Depression of the respiratory centers in
the brain which control breathing rates
Drug overdose

106

RESPIRATORY ACIDOSIS

3) Decreased

gas exchange
between
pulmonary
capillaries and
air sacs of
lungs
Emphysema
Bronchitis
Pulmonary
edema
107

RESPIRATORY ACIDOSIS

4) Collapse of lung
Compression injury, open thoracic
wound

Left lung
collapsed

108

RESPIRATORY ACIDOSIS
-metabolic balance before onset
of acidosis
-pH = 7.4

-respiratory acidosis
-pH = 7.1
-breathing is suppressed holding
CO2 in body

40

-bodys compensation
-kidneys conserve HCO3- ions to
restore the normal 40:2 ratio
-kidneys eliminate H+ ion in acidic
urine
- therapy required to restore
metabolic balance
- lactate solution used in therapy
is converted to bicarbonate ions in
the liver

109

RESPIRATORY ACIDOSIS
H2CO3 : Carbonic Acid
H2CO

HCO3

HCO3- : Bicarbonate Ion

(Na+) HCO3-

(K+) HCO3-

20

(Mg++) HCO3(Ca++) HCO3-

- metabolic balance before onset of acidosis

- pH = 7.4
110

RESPIRATORY ACIDOSIS
CO

HCO

CO

CO
2

O
C
H2

CO
2

20

-breathing is suppressed holding CO2 in body

-pH = 7.1
111

RESPIRATORY ACIDOSIS
H2CO
3

HCO

H 2CO

HCO3HCO3
+
H
+

30
acidic
urine

BODYS COMPENSATION
-kidneys conserve HCO3- ions to restore the
normal 40:2 ratio (20:1)
-kidneys eliminate H+ ion in acidic urine

112

RESPIRATORY ACIDOSIS

H2CO

HCO3-

LIVE
R
Lactat
e
HCO3-

Lactate

40

- therapy required to restore metabolic balance

- lactate solution used in therapy is converted to
bicarbonate ions in the liver

113

RESPIRATORY
ALKALOSIS

114

RESPIRATORY ALKALOSIS

Normal 20:1 ratio is increased

pH of blood is above 7.4
H2HCO
2 CO
3

HCO3HCO 3

0.1
5

20

=
= 7.4
115

RESPIRATORY ALKALOSIS

Cause is Hyperventilation
Leads to eliminating excessive

amounts of CO2
Increased loss of CO2 from the lungs
at a rate faster than it is produced
Decrease in H+

CO
2

CO
2

CO

CO
2

CO
2

CO
2

CO
CO
CO2
2

CO
2 CO
2

CO
2

116

HYPERVENTILATION

Hyper = Over

Elimination of
CO2
+
H
pH

117

RESPIRATORY ALKALOSIS

Can be the result of:

1) Anxiety, emotional

disturbances
2) Respiratory center
lesions
3) Fever
4) Salicylate poisoning
(overdose)
5) Assisted respiration
6) High altitude (low
P O2)
118

RESPIRATORY ALKALOSIS

Anxiety is an emotional

disturbance
The most common cause
of hyperventilation, and
thus respiratory
alkalosis, is anxiety

119

RESPIRATORY ALKALOSIS

Usually the only treatment needed is

to slow down the rate of breathing

Breathing into a paper bag or holding
the breath as long as possible may
help raise the blood CO2 content as the
person breathes carbon dioxide
back in after breathing it out

120

RESPIRATORY ALKALOSIS

Respiratory center
lesions
Damage to brain
centers responsible
for monitoring
breathing rates
Tumors
Strokes

121

RESPIRATORY ALKALOSIS

Fever
Rapid shallow

breathing blows off

too much CO2

122

RESPIRATORY ALKALOSIS

Salicylate poisoning

(Aspirin overdose)
Ventilation is
stimulated without
regard to the status of
O2, CO2 or H+ in the
body fluids

123

RESPIRATORY ALKALOSIS

Assisted Respiration
Administration of CO2 in the exhaled
air of the care - giver

Your insurance wont

cover a ventilator any
longer, so Bob here
will be giving you
mouth to mouth for
the next several days

124

RESPIRATORY ALKALOSIS

High Altitude
Low concentrations of O2 in the arterial
blood reflexly stimulates ventilation in
an attempt to obtain more O2
Too much CO2 is blown off in the
process

125

RESPIRATORY ALKALOSIS

Kidneys compensate by:

Retaining hydrogen ions
Increasing bicarbonate excretion
HCO3HCO3+
H
H+
HCO3 HCO 3
H+
+
H H+
HCO3+
HCO3- H
+ HCO3
H
H+
HCO3HCO3+
H
+
HCO - H
3

H+

126

RESPIRATORY ALKALOSIS

Decreased CO2 in the lungs will

eventually slow the rate of breathing

Will permit a normal amount of
CO2 to be retained in the lung

127

RESPIRATORY ALKALOSIS
-metabolic balance before
onset of alkalosis
-pH = 7.4

-respiratory alkalosis
-pH = 7.7
- hyperactive breathing blows
off CO2
- bodys compensation
- kidneys conserve H+ ions and
eliminate HCO3- in alkaline urine
- therapy required to restore
metabolic balance
- HCO3- ions replaced by Cl- ions

128

RESPIRATORY ALKALOSIS
H2CO3 : Carbonic Acid
H2CO

HCO3

HCO3- : Bicarbonate Ion

(Na+) HCO3-

(K+) HCO3-

20

(Mg++) HCO3(Ca++) HCO3-

-metabolic balance before onset of alkalosis

-pH = 7.4
129

RESPIRATORY ALKALOSIS
CO2
CO2 + H2O

H2 C
O

HCO

0.5

20

-respiratory alkalosis
-pH = 7.7
-hyperactive breathing blows off CO2
130

RESPIRATORY ALKALOSIS
HCO3H2 CO

HCO 3

0.5

15
Alkaline
Urine

BODYS COMPENSATION
- kidneys conserve H+ ions and eliminate HCO3- in
alkaline urine
131

RESPIRATORY ALKALOSIS

H2CO

HCO3-

Cl

0.5

10

Chloride
containin
g solution

- therapy required to restore metabolic balance

- HCO3- ions replaced by Cl- ions

132

RESPIRATORY
ACIDOSIS / ALKALOSIS

CO2 + H2O

H2CO3

H+ +
HCO3-

Respiratory
Acidosis
Respiratory
Alkalosis
133

METABOLIC ACIDOSIS

134

METABOLIC ACIDOSIS

Occurs when there is a decrease in

the normal 20:1 ratio
Decrease in blood pH and
bicarbonate level
Excessive H+ or decreased HCO33 3

CO
HHCO

H2CO
O
H32C
3

10
20

== 7.4
7.4
135

METABOLIC ACIDOSIS

Any acid-base imbalance not

attributable to CO2 is classified as

metabolic
Metabolic production of Acids
Or loss of Bases

136

METABOLIC ACIDOSIS

If an increase in acid overwhelms the

body's pH buffering system, the blood

can become acidic
As the blood pH drops,
breathing becomes
deeper and faster as the
body attempts to rid the
blood of excess acid by
decreasing the amount
of carbon dioxide
137

METABOLIC ACIDOSIS

Eventually, the kidneys

also try to compensate
by excreting more acid
in the urine
However, both
mechanisms can be
overwhelmed if the
body continues to
produce too much acid,
leading to severe
acidosis and eventually
a coma

138

METABOLIC ACIDOSIS

Metabolic acidosis is always

characterized by a reduction in plasma

HCO3- while CO2 remains normal

HCO3-

Plasma
Levels

CO2

139

METABOLIC ACIDOSIS

Acidosis results from excessive loss of

HCO3- rich fluids from the body or from an

accumulation of acids
Accumulation of non-carbonic plasma
acids uses HCO3- as a buffer for the
additional H+ thus reducing HCO3- levels

Muscle
Cell

tic
d

140

METABOLIC ACIDOSIS

The causes of metabolic acidosis can

be grouped into five major categories

1) Ingesting an acid or a substance
that is metabolized to acid
2) Abnormal Metabolism
3) Kidney Insufficiencies
4) Strenuous Exercise
5) Severe Diarrhea

141

METABOLIC ACIDOSIS

1) Ingesting An Acid
Most substances that cause acidosis
when ingested are considered
poisonous
Examples include
wood alcohol
(methanol) and
antifreeze
(ethylene glycol)
However, even an overdose
of aspirin (acetylsalicylic acid)
can cause metabolic acidosis

142

METABOLIC ACIDOSIS

2) Abnormal Metabolism
The body can produce excess acid

as a result of several diseases

One of the most significant is Type
I Diabetes Mellitus

143

METABOLIC ACIDOSIS

Unregulated

diabetes mellitus
causes ketoacidosis
Body metabolizes
fat rather than
glucose
Accumulations of
metabolic acids
(Keto Acids)
cause an increase
in plasma H+
144

METABOLIC ACIDOSIS

This leads to excessive production of

ketones:
Acetone
Acetoacetic acid
B-hydroxybutyric acid
Contribute excessive numbers of
hydrogen ions to body fluids
Acetone

H
H
Acetoacetic
+
+
acid
H
H H
Hydroxybutyric
+
+
+
acid
H

145

METABOLIC ACIDOSIS

2) Abnormal Metabolism
The body also produces excess acid
in the advanced stages of shock,
when lactic acid is formed through
the metabolism of sugar

146

METABOLIC ACIDOSIS

3) Kidney

Insufficiencies
Even the production
of normal amounts of
acid may lead to
acidosis when the
kidneys aren't
functioning normally

147

METABOLIC ACIDOSIS

3) Kidney Insufficiencies
Kidneys may be unable

to rid the plasma of even

the normal amounts of H+
generated from metabolic
acids
Kidneys may be also
unable to conserve an
adequate amount of
HCO3- to buffer the
normal acid load
148

METABOLIC ACIDOSIS

3) Kidney Insufficiencies
This type of kidney malfunction is

called renal tubular acidosis or

uremic acidosis and may occur in
people with kidney failure or with
abnormalities that affect the kidneys'
ability to excrete acid

149

METABOLIC ACIDOSIS

4) Strenuous Exercise
Muscles resort to anaerobic glycolysis

during strenuous exercise

Anaerobic respiration leads to the
production of large amounts of lactic acid
Enzymes

C6H12O6
(energy)

2C3H6O3 + ATP

Lactic Acid

150

METABOLIC ACIDOSIS

5) Severe Diarrhea
Fluids rich in HCO3- are released and

reabsorbed during the digestive process

During diarrhea this HCO3- is lost from
the body rather than reabsorbed

151

METABOLIC ACIDOSIS

5) Severe Diarrhea
The loss of HCO3- without a

corresponding loss of H+ lowers the pH

Less HCO3- is available for buffering H+

Prolonged deep (from duodenum)

vomiting can result in the same
situation

152

METABOLIC ACIDOSIS

Treating the underlying cause of metabolic

acidosis is the usual course of action
For example, they may control diabetes
with insulin or treat poisoning by
removing the toxic substance
from the blood
Occasionally
dialysis is needed
to treat severe
overdoses and
poisonings

153

METABOLIC ACIDOSIS

Metabolic acidosis may

also be treated directly

If the acidosis is mild,
intravenous fluids and
treatment for the
underlying disorder may
be all that's needed

154

METABOLIC ACIDOSIS

When acidosis is severe,

bicarbonate may be
given intravenously
Bicarbonate provides
only temporary relief
and may cause harm

155

METABOLIC ACIDOSIS
- metabolic balance before
onset of acidosis
- pH 7.4
- metabolic acidosis
- pH 7.1
- HCO3- decreases because of
excess presence of ketones,
chloride or organic ions
- bodys compensation
- hyperactive breathing to
blow off CO2
- kidneys conserve HCO3- and
eliminate H+ ions in acidic urine

0.5

10

- therapy required to restore

metabolic balance
- lactate solution used in therapy
is
converted to bicarbonate ions 156

METABOLIC ACIDOSIS
H2CO3 : Carbonic Acid
H2CO

HCO3

HCO3- : Bicarbonate Ion

(Na+) HCO3-

(K+) HCO3-

20

(Mg++) HCO3(Ca++) HCO3-

-metabolic balance before onset of

acidosis
-pH 7.4

157

METABOLIC ACIDOSIS

HCO

O
H 2C

10

= 7.4

-HCO3- decreases because of excess

presence of ketones, chloride or organic
ions

158

METABOLIC ACIDOSIS
CO2

CO2 +
H2O

HCO3- +
H+
O
H 2C

HCO

H+

0.75 :

HCO3+

10

Acidic
BODYS COMPENSATION
urine
- hyperactive breathing to blow off
2
-CO
kidneys
conserve HCO3- and eliminate
H+ ions in acidic urine
159

METABOLIC ACIDOSIS

H2CO

HCO3-

0.5

10

Lactat
e
Lactate
containin
g solution

- therapy required to restore metabolic

balance
- lactate solution used in therapy is
converted to bicarbonate ions in the

160

METABOLIC ALKALOSIS

161

METABOLIC ALKALOSIS

Elevation of pH due to an increased 20:1

ratio
May be caused by:
An increase of bicarbonate
A decrease in hydrogen ions
Imbalance again cannot be due to CO2
Increase in pH which has a nonrespiratory origin

7.4

162

METABOLIC ALKALOSIS

A reduction in H+ in the case of metabolic

alkalosis can be caused by a deficiency of

non-carbonic acids
This is associated with an increase in HCO3-

163

METABOLIC ALKALOSIS

Treatment of metabolic alkalosis is most

often accomplished by replacing water and

electrolytes (sodium and potassium)
potassium
while treating the underlying cause
Occasionally when metabolic alkalosis is
very severe, dilute acid in the form of
ammonium chloride is given by IV

164

METABOLIC ALKALOSIS

Can be the result of:

1) Ingestion of Alkaline

Substances
2) Vomiting ( loss of HCl )

165

METABOLIC ALKALOSIS

1) Ingestion of Alkaline Substances

Influx of NaHCO3

166

METABOLIC ALKALOSIS

Baking soda (NaHCO3) often used as a

remedy for gastric hyperacidity

NaHCO3 dissociates to Na+ and HCO3-

167

METABOLIC ALKALOSIS

Bicarbonate neutralizes high

acidity in stomach (heart

burn)
The extra bicarbonate is
absorbed into the plasma
increasing pH of plasma as
bicarbonate binds with free H+

168

METABOLIC ALKALOSIS

Commercially prepared alkaline products

for gastric hyperacidity are not absorbed
from the digestive tract and do not alter
the pH status of the plasma

169

METABOLIC ALKALOSIS

2) Vomiting (abnormal loss of HCl)

Excessive loss of H+

170

METABOLIC ALKALOSIS

Gastric juices contain large amounts of HCl

During HCl secretion, bicarbonate is added
to the plasma

HCl

K+

H+

HCO3Cl-

Click to
View Animation

171

METABOLIC ALKALOSIS

The bicarbonate is neutralized as HCl

is reabsorbed by the plasma from the
digestive tract

HCl

H Cl
+

K+

HHCO
3
2CO

Click to
View Animation

172

METABOLIC ALKALOSIS

During vomiting H+ is lost as HCl and the

bicarbonate is not neutralized in the plasma

Loss of HCl increases the plasma
bicarbonate and thus results in an
increase in pH of the blood

HCl

K+
Bicarbonate not
neutralized

HCO3-

Click to
View Animation

173

METABOLIC ALKALOSIS

Reaction of the body to alkalosis is to

lower pH by:
Retain CO2 by decreasing breathing
rate
Kidneys increase the retention of H+
H+
CO2

CO2

H+
H+
H+
174

METABOLIC ALKALOSIS
- metabolic balance before onset
of alkalosis
- pH = 7.4
- metabolic alkalosis
- pH = 7.7
- HCO3- increases because of loss
of chloride ions or excess
ingestion of NaHCO3
- bodys compensation
- breathing suppressed to hold
CO
2
- kidneys
conserve H+ ions and
eliminate HCO3- in alkaline urine
- therapy required to restore
metabolic balance
1.2
5

25

- HCO3- ions replaced by Cl- ions

175

METABOLIC ALKALOSIS
H2CO3 : Carbonic Acid
H2CO

HCO3

HCO3- : Bicarbonate Ion

(Na+) HCO3-

(K+) HCO3-

20

(Mg++) HCO3(Ca++) HCO3-

- metabolic balance before onset of

alkalosis
- pH = 7.4

176

METABOLIC ALKALOSIS

H2 C
O

HCO

40

- pH = 7.7
- HCO3- increases because of loss of
chloride ions or excess ingestion of

177

METABOLIC ALKALOSIS
HCO3- +
H+
H2CO

CO2 +
H2O

HCO3 -

1.25 :

H+
+
HCO3-

30

Alkaline
BODYS COMPENSATION
urine
- breathing suppressed to hold CO2
- kidneys conserve H+ ions and
eliminate HCO3- in alkaline urine

178

METABOLIC ALKALOSIS

H2CO

HCO3-

1.25 :

25

ClChloride
containin
g solution

- Therapy required to restore metabolic

balance
- HCO - ions replaced by Cl- ions
3

179

ACIDOSIS
decreased
removal of
CO2 from
lungs

failure of metabolic production absorption of prolonged

kidneys to
of keto acids metabolic acids diarrhea
acid
excrete
from GI tract
acids

accumulation
of CO2 in blood

respiratory
acidosis

accumulation
of acid in blood

increase in
plasma H+
concentrati
on
depression of
nervous system

excessive loss
of NaHCO3
from blood

metabolic
acidosis

deep
vomiting
from
GI tract
kidney
disease
(uremia)

180

ALKALOSIS
anxiety

overdose
of certain
drugs

high
altitudes

hyperventilat
ion
loss of CO2
and
H2CO2 from
blood

prolonged
vomiting

loss of acid

ingestion of
excess
excessive
aldosterone
alkaline drugs

accumulation
of base

metabolic
alkalosis

respiratory
alkalosis
decrease
in plasma
H+
concentrati
on
overexcitability
of nervous
system

181

ACID BASE DISORDERS

Clinical State

Acid-Base
Disorder

Pulmonary Embolus

Respiratory Alkalosis

Cirrhosis

Respiratory Alkalosis

Pregnancy

Respiratory Alkalosis

Diuretic Use

Metabolic Alkalosis

Vomiting

Metabolic Alkalosis

Chronic Obstructive Pulmonary Disease

Respiratory Acidosis

Shock

Metabolic Acidosis

Severe Diarrhea

Metabolic Acidosis

Renal Failure

Metabolic Acidosis

Sepsis (Bloodstream Infection)

Respiratory Alkalosis,
Metabolic Acidosis

182

RESPONSES TO:
ACIDOSIS AND ALKALOSIS

Mechanisms protect the body

against life-threatening changes in

hydrogen ion concentration
1) Buffering Systems in Body
Fluids
2) Respiratory Responses
3) Renal Responses
4) Intracellular Shifts of Ions
183

1) Buffer Systems

2) Respiratory Responses
3) Renal Responses
4) Intracellular Shifts of Ions

184

BUFFERS

Buffering systems provide an immediate

response to fluctuations in pH
1) Phosphate
2) Protein
3) Bicarbonate Buffer System

185

BUFFERS

A buffer is a combination of chemicals

in solution that resists any significant
change in pH
Able to bind or release free H+ ions

186

BUFFERS

Chemical buffers are able to react

immediately (within milliseconds)

Chemical buffers are the first line of
defense for the body for fluctuations in pH

187

PHOSPHATE BUFFER SYSTEM

1) Phosphate buffer system

Na2HPO4 + H+
Na+

NaH2PO4 +

Most important in the intracellular

system

+Na2HPO

4
Click to
animate

+
+
Na
NaH2PO
4

188

PHOSPHATE BUFFER SYSTEM

Na2HPO4 + H+
NaH2PO4 + Na+

Alternately switches Na+ with H+

Disodium hydrogen
phosphate

+Na2HPO

4
Click to
animate

+
+
Na
NaH2PO
4

189

PHOSPHATE BUFFER SYSTEM

Na2HPO4 + H+
NaH2PO4 + Na+

Phosphates are more abundant within the

cell and are rivaled as a buffer in the ICF by

even more abundant protein

Na2HPO
4

Na2HPO

Na42HPO
190

PHOSPHATE BUFFER SYSTEM

Regulates pH within the cells and the

urine
Phosphate concentrations are higher
intracellularly and within the kidney
tubules
Too low of a
concentration in
extracellular fluid
to have much
HPO4
importance as an
2
ECF buffer system
191

PROTEIN BUFFER SYSTEM

2) Protein Buffer System

Behaves as a buffer in both plasma
and cells
Hemoglobin is by far the most
important protein buffer

192

PROTEIN BUFFER SYSTEM

Most important

intracellular buffer
(ICF)
ICF
The most plentiful
buffer of the body

193

PROTEIN BUFFER SYSTEM

Proteins are excellent buffers because

they contain both acid and base groups

that can give up or take up H+
Proteins are extremely abundant in the
cell
The more limited number of proteins in
the plasma reinforce the bicarbonate
system in the ECF

194

PROTEIN BUFFER SYSTEM

Hemoglobin buffers H+ from metabolically

produced CO2 in the plasma only
As hemoglobin releases O2 it gains a
great affinity for H+

O2

O2

O2

H
b

O2
195

PROTEIN BUFFER SYSTEM

H+ generated at the tissue level from

the dissociation of H2CO3 produced by

the addition of CO2
Bound H+ to Hb (Hemoglobin) does
not contribute to the acidity of blood
O2

O2

O2

H
b

O2
196

PROTEIN BUFFER SYSTEM

As H+Hb picks up O2 from the lungs the Hb

which has a higher affinity for O2 releases
H+ and picks up O2

Liberated H+ from H2O combines with

HCO3-

HCO3-

H2CO3

O2

O2

CO2 (exhaled)

H+

H
b

O2
197

PROTEIN BUFFER SYSTEM

Venous blood is only slightly more acidic

than arterial blood because of the
tremendous buffering capacity of Hb
Even in spite of the large volume of H+
generating CO2 carried in venous blood

198

PROTEIN BUFFER SYSTEM

Proteins can act as a buffer for both acids

and bases
Protein buffer system works
instantaneously making it the most
powerful in the body
75% of the bodys buffer capacity is
controlled by protein
Bicarbonate and phosphate buffer
systems require several hours to be
effective

Pr

added H+ + Pr

199

PROTEIN BUFFER SYSTEM

Proteins are very large, complex

molecules in comparison to the size

and complexities of acids or bases
Proteins are surrounded by a multitude
of negative charges on the outside and
numerous positive charges in the
crevices of the molecule
- - -+ + - + - - - +
++ +
+ +
+
+
- -+
+
+
-+
+
+
+++
+
+
+
+ +
-- - -- - 200

PROTEIN BUFFER SYSTEM

H+ ions are attracted to and held from

chemical interaction by the negative
charges
H
H
H
H
H
H
+

H+

- - -+ + - + - - - +
++ +
+ +
++
+
+
-- ++
+
+
+++
+
+
+
+ +
-- - -- - -

H+

H+

H+

H+

H+

H+
H+
H+
H+
H+

H+

H+

201

PROTEIN BUFFER SYSTEM

OH- ions which are the basis of

alkalosis are attracted by the positive

charges in the crevices of the
protein
OH
OH
-

OHOH-

OH-

OH-

OH-

- - -+ + - + - - - +
++ +
+ +
+
+
- -+
+
+
-+
+
+
+++
+
+
+
+ +
-- - -- - -

OH-

OH-

OH-

OH-

OH-

202

PROTEIN BUFFER SYSTEM

H+
H+
OH-

H+OH

H+
OH-

H+

H+

H+

OH-

OH-

H+ OH- H+

H+

OH
+
H

- - -+ + - + - - - +
++ +
+ +
+
+
- -+
+
+
-+
+
+
+++
+
+
+
+ +
-- - -- - -

OHH+

H+

+
OH
H

H+
OH- H+

H+
OHH+
H

OH-

H+

203

BICARBONATE BUFFER
SYSTEM

3) Bicarbonate Buffer System

ECF
Predominates in extracellular fluid (ECF)
HCO3- + added H+
H2CO3

H2CO3

HCO3
-

204

BICARBONATE BUFFER
SYSTEM

This system is most

important because
the concentration of both components
can be regulated:
Carbonic acid by the respiratory
system
Bicarbonate by the renal system

205

BICARBONATE BUFFER
SYSTEM

H2CO3

H+ + HCO3-

Hydrogen ions generated

by metabolism or
by ingestion react with bicarbonate base to
form more carbonic acid

H2CO3 HCO

206

BICARBONATE BUFFER
SYSTEM
Equilibrium shifts toward the formation of
acid
Hydrogen ions that are lost (vomiting)
causes carbonic acid to dissociate
yielding replacement H+ and
bicarbonate
H CO

H2 CO3
HCO
+
3
H
-

207

BICARBONATE BUFFER
SYSTEM

CO2 + H2
O
Vomitin
g

H2CO3

H+ + HCO3
-

Addition of lactic
acid
Loss of HCl

Exercis
e

208

1) Buffer Systems

2) Respiratory
Responses

3) Renal Responses
4) Intracellular Shifts of Ions

209

RESPIRATORY RESPONSE

Neurons in the medulla oblongata and

pons constitute the Respiratory Center

Stimulation and limitation of respiratory
rates are controlled by the respiratory
center
Control is
accomplished by
responding to CO2
and H+
concentrations in
the blood
210

RESPIRATORY
CENTER

Pons
Respiratory centers
Medulla oblongata
211

CHEMOSENSITIVE AREAS

Chemosensitive areas of the respiratory

center are able to detect blood
concentration levels of CO2 and H+

Increases in CO2 and H+ stimulate the

respiratory center
The effect is to raise
respiration rates
But the effect
diminishes in
1 - 2 minutes

Click to increase
CO2

CO
2
CO
CO
22
CO
2
CO
CO
2 CO
2
2
CO

212

CHEMOSENSITIVE AREAS

The effect of

stimulating the
respiratory centers
by increased CO2
and H+ is weakened
in environmentally
increased CO2 levels

Symptoms may

persist for several

days
213

CHEMORECEPTORS

Chemoreceptors are also present in

the carotid and aortic arteries which

respond to changes in partial
pressures of O2 and CO2 or pH

Increased levels of

CO2 (low pH)

pH or
decreased levels of
O2 stimulate
respiration rates
to increase
214

CHEMORECEPTORS

Overall compensatory response is:

Hyperventilation in response to
increased CO2 or H+ (low pH)
pH
Hypoventilation in response to
decreased CO2 or H+ (high pH)
pH

215

RESPIRATORY CONTROL OF pH
cell production of CO2 increases
CO2 + H2O
H2CO3
H+

H2CO3

H+ + HCO3acidosis; pH drops

H+ stimulates respiratory center in medulla oblongata

rate and depth of breathing increase

CO2 eliminated in lungs

pH rises toward normal

216

1) Buffer Systems
2) Respiratory Responses

3) Renal Responses
4) Intracellular Shifts of Ions

217

RENAL RESPONSE

The kidney compensates for Acid -

Base imbalance within 24 hours and is

responsible for long term control
The kidney in response:
To Acidosis
Retains bicarbonate ions and
eliminates hydrogen ions
To Alkalosis
Eliminates bicarbonate ions and
retains hydrogen ions
218

ACIDIFICATION
OF URINE BY
EXCRETION OF
AMMONIA

219

ACIDIFICATION OF URINE BY EXCRETION OF

AMMONIA
Capillary

NH2

Distal Tubule
Cells

NH
NH33

H
+

WHAT
HAPPENS
NEXT?
Tubular
urine to be
excreted

220

ACIDIFICATION OF URINE BY EXCRETION OF

AMMONIA
Notice the
Distal Tubule
Capillary
Cells
H+ - Na+
exchange
NH3
to maintain
electrical
neutrality
Dissociation
of carbonic
acid

H2CO
HCO
3 +H

Na
+ ClNaCl
+

3
NaHCO
3

NH3ClNH4Cl
Click
ClickMouse
Mouseto
to
SeeStart
Animation
Animation
Again

Tubular
Urine

221

ACIDIFICATION OF URINE BY EXCRETION OF

AMMONIA
Notice the
Distal Tubule
Capillary
Cells
H+ - Na+
exchange
NH3
to maintain
electrical
neutrality
H2CO
HCO
3 +H

Na
+ ClNaCl
+

3
NaHCO
3

NH3ClNH4Cl
Click
ClickMouse
Mouseto
to
SeeStart
Animation
Animation
Again

Tubular
Urine

222

RESPIRATORY / EXCRETORY
RESPONSE
CO2 + H2O

yperventilation removes
H+ ion concentrations

ypoventilation increases
H+ ion concentrations

H2CO3

H+ + H

Kidneys eliminate or retai

H+ or bicarbonate ions

223

1) Buffer Systems
2) Respiratory Responses
3) Renal Responses

4) Intracellular Shifts of
Ions

224

HYPERKALEMIA

Hyperkalemia is generally associated

with acidosis
Accompanied by a shift of H+ ions
into cells and K+ ions out of the cell
to maintain electrical neutrality

+
225

HYPERKALEMIA

Hyperkalemia is an elevated serum K+

H+ ions are buffered in cell by
proteins
Acidosis may cause Hyperkalemia
and Hyperkalemia may cause
Acidosis

H
+

226

HYPOKALEMIA

Hypokalemia is generally associated

with reciprocal exchanges of H+ and K+ in

the opposite direction
Associated with alkalosis
Hypokalemia is a depressed serum K+

+
227

ELECTROLYTE SHIFTS
Acidosis
Compensatory Response
H+
K+

Result

- H+ buffered intracellularly
- Hyperkalemia

cell

Alkalosis
Compensatory Response
H+
K+
cell

Result

- Tendency to correct alkalo

- Hypokalemia
228

END
ACID - BASE BALANCE

229