Buffers in Relation to Acidosis & Alkalosis

Action of Lungs and Blood Buffers (normal defense mechanisms):

1) in the presence of a weak acid

in the lungs: in the blood:

CO2(g) + H2O H2CO3 [H+] + [HCO3-]
weak acid conjugate base

[H+]

• if there is excess acid [H+], the conjugate base [HCO3-] reacts with the [H+] in the reaction:
H+ + HCO3- → H2CO3
to form the weak H2CO3, favoring an equilibrium shift to the left or backward reaction
• backward reaction decreases blood’s [H+], [HCO3-] and increases pCO2 in the lungs
• to remove excess CO2(g), the lungs then hyperventilate to maintain blood’s pH level

2) in the presence of a weak base

in the lungs: in the blood:

CO2(g) + H2O H2CO3 [H+] + [HCO3-]
weak acid conjugate base

[OH-]

• if there is excess base [OH-], the weak acid H2CO3 reacts with the [OH-] in the reaction:
H2CO3 + OH- → HCO3- + H2O
to form the conjugate base [HCO3-], favoring an equilibrium shift to the right or forward
reaction
• forward reaction decreases pCO2(g) in the lungs and increases blood’s [H+], [HCO3-]
• to conserve CO2(g), the lungs then hypoventilate to maintain blood’s pH level

Acid-Base Balance of the Blood

Respiratory Acidosis: ↑[H+] = ↓pH

in the lungs: in the blood:

CO2(g) + H2O H2CO3 [H+] + [HCO3-]
weak acid conjugate base

lungs cannot hyperventilate (hypoventilation - a symptom):

↑pCO2
↑[HCO3-]

• excess CO2(g) cannot be efficiently removed due to lung disease (hypoventilation),

equilibrium shifts to the right, favoring forward reaction
• forward reaction increases [H+] (blood’s pH ≤ 7.35) and [HCO3-] resulting in respiratory
acidosis
CAUSES: 1) COPD (e.g. emphysema, pneumonia, asthma, pulmonary edema)
2) anesthesia
3) barbiturate overdose (“downers”)

TREATMENT: i.v. NaHCO3; treat the underlying causes (e.g. with antibiotics)

Respiratory Alkalosis: ↓[H+] = ↑pH

in the lungs: in the blood:

CO2(g) + H2O H2CO3 [H+] + [HCO3-]
weak acid conjugate base

lungs hyperventilate (hyperventilation - a symptom):

↓pCO2
↓[HCO3-]

• CO2(g) is being removed rapidly by the lungs (hyperventilation), equilibrium shifts to the
left, favoring backward reaction
• backward reaction decreases [H+] (blood’s pH ≥ 7.35) and [HCO3-] resulting in
respiratory alkalosis

CAUSES: 1) high altitude

2) anxiety; hysteria
3) fever

TREATMENT: rebreathe one’s own exhaled air; administer CO2; treat the underlying causes

Metabolic Acidosis: ↑[H+] = ↓pH

in the lungs: in the blood:

CO2(g) + H2O H2CO3 [H+] + [HCO3-]
weak acid conjugate base

lungs hyperventilate (a defense mechanism):

↓pCO2
↓[HCO3-]

• [H+] increases (blood’s pH ≤ 7.35) thus, equilibrium shifts to the left, favoring backward
reaction
• backward reaction decreases blood’s [HCO3-] and increases pCO2 in the lungs
• to counteract metabolic acidosis, the lungs then hyperventilate to decrease pCO2

CAUSES: 1) diabetes mellitus

2) severe diarrhea

TREATMENT: insulin therapy, hemodialysis, i.v. NaHCO3

Metabolic Alkalosis: ↓[H+] = ↑pH

in the lungs: in the blood:

CO2(g) + H2O H2CO3 [H+] + [HCO3-]
weak acid conjugate base

lungs hypoventilate (a defense mechanism):

↑pCO2
↑[HCO3]

• [H+] decreases (blood’s pH ≥ 7.35) thus, equilibrium shifts to the right, favoring forward
reaction
• forward reaction decreases pCO2 in the lungs and increases blood’s [HCO3-]
• to counteract metabolic alkalosis, the lungs then hypoventilate to increase pCO2

CAUSES: 1) ingestion of large doses of alkali (e.g. antacids)

2) vomiting

TREATMENT: isotonic NH4Cl

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HW

1) Using arrows (↑) or (↓), complete the table below that summarize the changes observed in
respiratory & metabolic acidosis & alkalosis.

Condition pH pCO2 [HCO3-]

Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis

2) Hyperventilation is observed in what two conditions? What treatment goes w/ which condition?
Why?
3) In which condition is hypoventilation part of the problem rather than a cure? Explain.
4) In which condition is hypoventilation the body’s way of helping itself? Explain.
5) In respiratory & metabolic acidosis, in what way are these two conditions the same? In what way
are they different?
6) Explain the ff. situations:
a) hyperventilation in hysterics causes alkalosis
b) emphysema leads to acidosis
c) prolonged vomiting leads to alkalosis
d) uncontrolled diarrhea can cause acidosis