Acid Base Balance

Harliansyah, Ph.D
Department of Biochemistry
School of Medicine
Yarsi University
March, 2009
Suggested Reading
• 1. Acid-Base Disorders and Their Treatment.
F.J. Gennari et al. Taylor & Francis, 2005.

• 2. Medical Biochemistry. 2
nd
Edition. J.W.Baynes et al.
Elsevier Mosby, 2005.


Water is an ideal biologic solvent, interaction with water
influences the structure of bio-molecules
pH of Blood
Homeostatic Regulators of H
+

• Carbonic buffer system
• Respiratory mechanisms
• Renal mechanisms
Kidney Hydrogen Ion Balancing: Proximal Tubule
Proximal tubule secretion and reabsorption of filtered HCO
3
-

Step 1: Classify the pH
Normal: 7.35 - 7.45
Acidemia: <7.35
Alkalemia: >7.45
Step 2: Assess PaCO
2

Normal: 35- 45 mm Hg
Respiratory acidosis: >45 mm Hg
Respiratory alkalosis: <35 mm Hg
Step 3: Assess HCO
3
-
Normal: 22-26 mEq/L
Metabolic acidosis: <22 mEq/L
Metabolic alkalosis: >26 mEq/L
Step 4: Determine Presence of Compensation
Compensation present PaCO
2
and HCO
3
-
are abnormal (or
nearly so) in opposite directions; that is, one is acidotic and the
other alkalotic
Step 5: Identify Primary Disorder, If Possible
If pH is clearly abnormal: The acid-base component most consistent with
the pH disturbance is the primary disorder.
If pH is normal or near-normal: The more deviant component is probably
primary. Also note whether pH is on acidotic or alkalotic side of 7.4. The
more deviant component should be consistent with this pH

RESPIRATORY ACIDOSIS
Uncompensated Compensated

pH < 7.35 Normal

PaCO
2 (mmHg)
< 45 > 45

HCO
3
- (mEq/L)
Normal > 26




Causes

Hypoventilation from CNS trauma or tumor that
depresses respiratory center

Neuromuscular diseases that affect respiratory drive

Lung diseases that decrease amount of surface area
available for gas exchange

Airway obstruction

Chest-wall trauma

Certain drugs that depress repiratory center primary hypoventilation



RESPIRATORY ALKALOSIS
Uncompensated Compensated

pH > 7.45 Normal

PaCO
2 (mmHg)
< 35 < 35

HCO
3
- (mEq/L)
Normal < 22




Causes

Any condition that increases respiratory rate & depth

Hyperventilation

Hypercapnia

Hypermetabolic states

Liver failure

Certain drugs

Conditions that affect brain’s respiratory control center

Acute hypoxia 2o to high altitude, pulmonary disease, severe
anemia, pulmonary embolus, & hypotension


METABOLIC ACIDOSIS
Uncompensated Compensated

pH < 7.35 Normal

PaCO
2 (mmHg)
Normal < 35

HCO
3
- (mEq/L)
< 22 <22




Causes

Loss of HCO3-

Accumulation of metabolic acids

Overproduction of ketone bodies

Decreased ability of kidneys to excrete acids

Excessive GI losses from diarrhea, intestinal malabsorption, or
urinary diversion to the ileum

Hyperaldosteronism

Use of K-sparing diuretics

Poisoning or toxic drug reaction
METABOLIC ALKALOSIS
Uncompensated Compensated

pH > 7.45 Normal

PaCO
2 (mmHg)
Normal > 45

HCO
3
- (mEq/L)
> 22 <26




Causes





Excessive acid loss from the GIT

Diuretic therapy

Cushing’s dse.
HCO3- accumulation in the body
Pathophysiology
Chemical buffers bind w/ ions
Excess HCO3 that don’t bind w/
chemical buffers
Elevated serum pH level
Depressed respiratory system
pH >7.45
HCO3
>26
mEq/L
Slow,
shallow
resp.
Excess HCO3- excreted via the
kidneys (>28 mEq/L)
Alkaline
urine &
pH
Near
normal
HCO3 level
Na, H2O, & HCO3- excretion via
the kidneys
Ions shifting ( K and H)
Decreased Ca ionization
Nerve cells’ increased
permeability to Na ions
polyuria
Hypovolemia
tetany
belligerence
irritability
Hypokalemia anorexia,
muscle weakness, etc.
disorientation
seizures
T
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