TBL 

2.1. The importance of pH in 
human biology
 Case report
A 45‐year‐old man was admitted with nausea, vomiting, and abdominal pain,
with a pCO2 of 85.5 mmHg, pO2 of 43.5 mmHg, pH of 7.61, and plasma
bicarbonate concentration of 82 mM.

High pCO2  (Normal 35‐45 mmHg)

Low pO2 (Normal 75‐100 mm Hg)

High pH (Normal 7.35‐7.45) 7 7.35 7.45 7.65

Death Acidosis Normal range Alkalosis Death

High bicarbonate (Normal 22‐26 mM)

Javaheri S and Nardell EA. Br Med J 1981

Why a small change in blood pH 
has such a strong impact in 
human health?
 Henderson‐Hasselbalch equation
CH3 COOH + H2O CH3 COO- + H3O+
Acetic acid Acetate

[Base]
pH  pK a  log
[Acid]
 CH3 COOH + H2O CH3 COO- + H3O+
Acetic acid Acetate

[Base]
pH  pK a  log 4.26 = 4.74 + log [Ac‐]/[AcH]
[Acid]
[Ac‐]/[AcH] = 0.33
[Ac‐]/(0.2‐[Ac‐]) = 0.33
[Ac‐] = 0.05 M [AcH] = 0.15 M
 [Base]
CH3 COOH + H2O CH3 COO- + H3O+ pH  pK a  log
Acetic acid Acetate [Acid]

pH [Acetic acid] (M) [Acetate] (M)

1 0.2
1.8 AcH

Concentration
3 0.15
3.76
4.26 0.15 0.05 0.1
5.2 Ac‐
0.05
6
7
8.3
4.26 pH
 [Base]
CH3 COOH + H2O CH3 COO- + H3O+ pH  pK a  log
Acetic acid Acetate [Acid]

pH [Acetic acid] (M) [Acetate] (M)

AcH Ac‐
1 0.19996 0.00004 0.2
1.8 0.1997 0.0002

Concentration
3 0.1964 0.0036
3.76 0.17 0.03
4.26 0.15 0.05 0.1
5.2 0.051 0.149
6 0.013 0.187
7 0.001 0.199
8.3 0.00006 0.199994 ̴4.7 pH
 [Base]
CH3 COOH + H2O CH3 COO- + H3O+ pH  pK a  log
Acetic acid Acetate [Acid]

AcH Ac‐
0.2
[Ac‐]
pH = pKa :              = 1  → [Ac‐] = [AcH]
[AcH]

Concentration
[Ac‐]
pH < pKa :              < 1  → [Ac‐] < [AcH]
[AcH]
0.1
[Ac‐]
pH > pKa :              > 1   → [Ac‐] > [AcH]
[AcH]

̴4.7 pH
 [Base]
pH  pK a  log
[Acid]
+ H2O + H3O+

COOH COO‐

Acid Base

What proportion of the ‐COOH group is 
deprotonated in physiological conditions?
(pKa = 3.6)
 [Base]
pH  pK a  log
[Acid]
N N
+
NH2+ + H2O NH + H3O

Acid Base

What proportion of the  pH [Base] / [Acid] % Base % Acid

imidazole group is  7.4
7.6
deprotonated? 8

(pKa = 7.2) 9
 [Base]
pH  pK a  log
[Acid]
N N
+
NH2+ + H2O NH + H3O

Acid Base

What proportion of the  pH [Base] / [Acid] % Base % Acid

imidazole group is  7.4 1.6 61 39

7.6 2.5 72 28
deprotonated? 8 6.3 86 14

(pKa = 7.2) 9 63 98 2
To avoid health problems, how do I 
keep my pH in such a narrow range?
 Buffer solution
AcH + H2O Ac- + H3O+

CH3COOH pH 4.7 CH3COO‐

H+ CH3COOH CH3COO‐ OH‐

CH3COO‐ CH3COOH

If an acid is added If a base is added

A solution with a mixture of a weak acid and its conjugate base is able 
to neutralize the addition of acids and bases, keeping the pH stable
 Blood is a buffer solution

• To maintain the pH of blood in a normal range, our body uses different 
buffer systems.
• The main buffer system in our blood is the carbonate/bicarbonate buffer.

CO2 + H2O
↔

Carbonic anhydrase

H2CO3 + H2O ↔ HCO3- + H3O+ pKa = 7.2

Can I voluntarily modify my blood pH?
Respiratory control of pH

CO2 + H2O

↔
H2CO3 + H2O ↔ HCO3- + H3O+ pKa = 7.2

Hyperventilation increases blood pH
Hypoventilation reduces blood pH
 Case report
A 45‐year‐old man was admitted with nausea, vomiting, and abdominal pain,
with a pCO2 of 85.5 mmHg, pO2 of 43.5 mmHg, pH of 7.61, and plasma
bicarbonate concentration of 82 mM.

CO2 + H2O
High pCO2 ↔
Low pO2 H2CO3 + H2O ↔ HCO3- + H3O+
High pH The patient was hypoventilating to 
compensate his metabolic alkalosis!
High bicarbonate

Javaheri S and Nardell EA. Br Med J 1981