PHASE 1 YEAR 1 BLOCK 1 2009/2010

PHYSIOLOGY LECTURE GUIDELINES

ACID BASE BALANCE

KEY CONCEPTS IN THESE LECTURES

Acid-base balance is critical for maintaining the narrow pH range that is
required for various enzyme systems to function optimally in the
body.Normal blood pH ranges from 7.3-7.4. Decreased pH is termed
acidemia and is caused by an increase in the concentration of hydrogen ions
([H+]). Increased blood pH is termed alkalemia and is caused by a decrease
in the [H+].

The buffer systems that maintain this pH balance are bicarbonate,

phosphates, and proteins. Bicarbonate is the most important extracellular
buffer, while phosphates and proteins contribute mostly to intracellular acid-
base balance. The bicarbonate system is the only buffer measured for the
calculation of acid-base status in patients and is represented by the
equilibrium equation: CO2 + H2O <—> H2CO3 <—> H+ + HCO3-. This
equation allows one to visualize what effects the addition of carbon dioxide
(CO2) or bicarbonate (HCO3-) will have on the buffer system and the blood
pH. Addition of CO2 to the system will cause the equation to shift to the right,
increasing the [H+] and, therefore, lowering the pH. Addition of HCO3- to the
system will cause the equation to shift to the left, lowering the [H+] and
increasing the pH. Another way to conceptualize this information is to simply
think of CO2 as an acid and HCO3- as a base. If CO2 is increased it will tend to
cause acidemia. If HCO3- is increased, then alkalemia is the expected result.

In addition to buffers, the lungs and kidneys play a major role in acid-base
homeostasis. The lungs function in ventilation and they are responsible for
regulating the amount of CO2 present in plasma. The kidneys are responsible
for controlling the amount of HCO3- in the blood by resorbing or excreting it
in the proximal tubule.1 Abnormalities in acid-base status are classified as to
whether the primary abnormality lies with the CO2 concentration or the HCO3-
concentration ([HCO3-]). If CO2 is primarily affected, then a respiratory
disturbance is present. If HCO3- is primarily affected, then a metabolic
disturbance is present.

http://www.vet.uga.edu/VPP/clerk/morse/index.php

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LECTURE OUTLINE

1. BASIC PRINCIPLE OF ACID BASE BALANCE

buffer Bicarbonate

Phosphate

Protein

lung Peripheral chemoreceptors and the mechanism

of breathing

Central chemorecepter and the mechanism of

breathing

kidney H+ secretion in proximal tubule

H+ secretion in distal tubule

Fate of H+ in kidney tubular

2. ACID BASE BALANCE CLINICAL DISORDERS

Respiratory acidosis • definition

Respiratory • example
alkalosis
• compensatory mechanism
Metabolic acidosis

Metabolic alkalosis

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DIAGRAMS THAT ARE HELPFUL IN UNDERSTANDING THE LECTURE

RESPIRATORY

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KIDNEY

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FATE OF HYDROGEN ION

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ACID BASE BALANCE ARTERIAL BLOOD

DISTURBANCES pH [HCO3-] pCO2

 RESPIRATORY ACIDOSIS

Definition

Causes

 RESPIRATORY ALKALOSIS

Definition

Causes

 METABOLIC ACIDOSIS

Definition

Causes

 METABOLIC ALKALOSIS

Definition

Causes

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