LECTURE 3

UNIT 1: RENAL SYSTEM

ACID-BASE BALANCE

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 LEARNING OUTCOMES
1. State the normal pH of blood.

2. State the sources of acidic production in the blood.

3. State 3 compensatory mechanisms in maintaining

blood pH .

4. Define the acid-base imbalance – acidosis and

alkalosis.

5. Explain the 4 acid-base disturbances in the

body.

6. Explain with a chart of normal acid-base range in 2

plasma.
 RENAL FUNCTIONS
1. Excretion of toxic substances – urea, uric acid,
creatinine
2. Body fluid balance
3. Electrolyte balance
4. Acid-base balance
5. Maintaining blood pressure – renin enzyme
6. Endocrine function:
– erythropoietin hormone → erytropoiesis
– renin enzyme → angiotensin
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 INTRODUCTION
 An important part
of regulating the
chemical balance or
homeostasis of
body fluids is
regulating their
acidity and
alkalinity.
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 CONTD.
 Acid - substance that release hydrogen ions (H+)
in the body.
- proton donors.
- sour taste.
 Base - substance that accept hydrogen ions (H+)
in the body.
- lower hydrogen ion.
- proton acceptors.
- bitter taste and slippery.

Acid –base balance is achieved by chemical buffers,

respiratory regulation and renal regulation of
bicarbonate ion concentration of body fluid. 5
 pH BLOOD SCALE
 pH is a measure of hydrogen ion (H+)
concentration in the blood; a measure of
the acidity or alkalinity of a solution concentration.
 The homeostatic pH range of normal arterial blood is
7.35 - 7.45*.
 Greater number of H+ ion the more acidic the
solution and lower pH reflects as acidosis.
 Fewer H+ ion results as alkaline solution and with
higher pH represents as alkalosis.
 Blood pH must be maintained in order for the
enzymes to function. Any changes in the pH will affect 6

the enzymes systems.

 H+ IONS (ACIDIC) SOURCES
1. Glucose breakdown (Anaerobic glycolysis)
lactic acid.
2. Carbon dioxide reacts with water
carbonic acid (release hydrogen ions and lowers
the blood pH).
3. Fatty acid metabolism acidic ketone bodies.

 All of these products = tend to make the

blood more acidic and to lower the pH.
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COMPENSATORY MECHANISMS OF BLOOD pH

The H+ concentration in blood is regulated by

1. Blood : Chemical buffer (Penampan kimia)

2. Lung : Brain stem respiratory centers –by

respiration regulation, carbon dioxide will be
removed by the lungs.

3. Kidney : Renal mechanism - by renal

regulation, hydrogen ions removed by the
kidneys in order to maintain normal blood pH,9
the cells of the PCT secrete hydrogen ions.
10
 1. CHEMICAL BUFFER
 A buffer solution is a solution that prevents drastic
changes in pH. One such chemical buffer is in our
blood.
 Buffers are substances that act quickly to
temporarily bind H+.
 Has the ability to bind or release H+ ions in
solution.
 A buffer is consist of weak acid(e.g H2CO3) and its
conjugated base (e.g NaHCO3)

 Binding to hydrogen ions when blood pH drops.

 Releasing hydrogen ions when the blood pH rises. 11
 CONTD.
 The 3 major chemical buffer
systems in the body :
a) Bicarbonate buffer system.

b) Phosphate buffer system.

c) Protein buffer system.

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 a) BICARBONATE BUFFER SYSTEM
 Is a mixture of carbonic acid @ hydrogen
carbonate (H2CO3) and it’s salt sodium
bicarbonate (NaHCO3, a weak base) in same
solution.
 Bicarbonate ion (HCO3-) = act as a base.
 Hydrogen carbonate (H2CO3) = act as a weak
acid, does not dissociate to any extent in
neutralization.
 The greater the pH, the lower the concentration
of hydrogen ions, so less acidic the solution is.
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CONTD.

 If shortage of H+ =► need to provide H+

 H2CO3 (hydrogen carbonate) --> HCO3- (bicarbonate ion) + H+ (hidrogen ion)
 If the pH of the blood increase, there are less H+ .
This will drive the equation to the right to produce
more H+ to compensate for the decrease in hydrogen
ions.
 More H+ are produced, decreasing the pH, which
counteracts the initial increase in pH.
 CONTD.
 When CO2 dissolves in our blood:
CO2 (carbon dioxide) + H2O (water) --> H2CO3 (hydrogen carbonate).
H2CO3 (hydrogen carbonate) <--> HCO3- (bicarbonate ion) + H+ (hydrogen ion)
***The double arrow means that the solution can go either way, depending on the
concentrations of the H+. So, if there is less H+, the reaction will go from left to
right. If there is more H+, the reaction will go backwards, from right to left.
 If excess H+ =► need to remove H+
• If the pH of the blood decrease, the increase in [H+] drives the
equation to the left. The excess hydrogen ions combine with the
HCO3-(bicarbonate ion) to form H2CO3 (hydrogen carbonate). The
concentration of hydrogen ions decrease, increasing the pH.

Thus, the bicarbonate buffering system helps prevent dangerous

fluctuations in physiological pH.
 b) PHOSPHATE BUFFER SYSTEM
 Acts via a mechanism similar to the carbonic acid
/hydrogen carbonate (bicarbonate buffer system).

 Components =
 Dihydrogen phosphate (H2PO4ˉ) – is a weak acid.
 Monohydrogen phosphate (HPO42ˉ) – is a weak base.
 NaH2PO4 act as a weak acid and Na2 HPO4ˉ with less
hydrogen atom act as a conjugated weak base.

 If excess strong base = converted to weak base

OH- + H2PO4ˉ → H2O + HPO42-
Hydroxy ion Dihydrogen water Monohydrogen
(strong base) phosphate phosphate
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(weak acid) (weak base)
CONTD.

 If accessive of strong acid = tied up in weak acid

H+ + HPO42ˉ → H2PO4ˉ
Hydrogen ion Monohydrogen Dihydrogen
(strong acid) phosphate phosphate
(weak base) (weak acid)

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 c) PROTEIN BUFFER SYSTEM
 Proteins in body fluids (plasma) comprise the protein buffer
system.
 Proteins = amino acids, and organic molecules (contain carbon).
 Most abundant buffer in intracellular fluid and plasma.
 Contain at least one organic acid -carboxyl group
(-COOH) & least one amino group (-NH2).
 These groups = functional components of the protein buffer
system.
 Carboxyl group release H+ when pH begins to rise .
 Amino group act as base accept H+ when pH begins to drop.

Hemoglobin is an excellent example of a protein

function as an ICF buffer. 18
2. LUNG : RESPIRATORY REGULATION
 Breathing plays an important role in maintaining
the pH of body fluids.
 The respiratory system eliminates carbon
dioxide from the blood while it loads oxygen into
the blood.
 CO2 increase =► H+ concentration increase =►
pH decrease = acidic.
 CO2 decrease =► H+ concentration decrease
=► pH increase = alkaline.
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CONTD.
CO2 + H2O H2CO3 H+ + HCO3ˉ
(Carbon ( Water) (Carbonic acid) (Hydrogen) (Bicarbonate ion)
dioxide)

 Factor that alter the pH of body fluids:

(a) Rate and depth of breathing
(i) Breathing increase =► more CO2 exhaled.
- Reaction goes from right to left.
- H+ concentration falls, blood pH rises =►
ALKALOSIS.
(ii) Breathing decrease =► less CO2 exhaled.
- H+ concentration increase, blood pH
decrease =► ACIDOSIS.
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CONTD.
 When CO2 accumulates
in the blood the
chemoreceptor in the
respiratory control
centers of the brain are
activated = breathing
rate + depth increase =
CO2 removed.

##Chemoreceptor = in
the medulla oblongata,
aortic and carotid
bodies.
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 QUESTION?
 What will happen
if you hold your
breath for 30 ?
seconds, what is
likely will happen
to your blood pH?

________________

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 Answer
CO2 will accumulated in the blood
▼
Chemoreceptor activated in
respiratory control centre
▼
Breathing rate ↑, depth ↑
▼
CO2 removed 23
 3. KIDNEY : RENAL REGULATION)
 The SLOWEST mechanism for removal of acids
and the ONLY way to eliminate most acids in the
body.

 Cells of the renal tubules secrete H+, which then

excreted in urine.

 The kidney maintain acid-base balance by:

(a) Excreting bicarbonate ions through urine.
(b) Conserving (reabsorbing – PCT & DCT) or
generating new bicarbonate ions.
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 CONTD.
 When blood pH falls (acidosis) = H+ ↑

- Bicarbonate ions reabsorbed in peritubular

capillaries and hydrogen ions (H+) are
secreted in the urine.

 When blood pH rises (alkalosis) = H+↓

- Bicarbonate ions are excreted and hydrogen
ions are retained by the tubule cells.
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COMPENSATORY MECHANISMS TO REGULATE ACID BASE STATUS:

ACID-BASE BALANCE

CHEMICAL RESPIRATORY RENAL

BUFFER SYSTEM MECHANISM MECHANISM

BIND @ RELEASE BY REMOVAL BY REABSORTION @

FREE H+ IONS @ RETAIN CO2 EXCERTION
OF H+ AND
HCO3ˉ

BICARBONATE,
PHOSPHATE
AND PROTEIN BUFFER SYSTEM
 ACID-BASE IMBALANCES
Normal arterial blood gases:
 Arterial blood pH = 7.35 - 7.45
 PaCO2 = 35 – 45 mmHg
 HCO3- = 22 –26 mEq/L
Examples:
 Arterial blood pH < 7.35 --- acidemia
 Arterial blood pH > 7.45 --- alkalemia
 PaCO2 > 45 mmHg ---- acidosis
 PaCO2 < 45 mmHg ---- alkalosis

(PaCO2 = Partial Pressure of CO2 in arterial blood , PaO2 = Partial

Pressure of O2 in arterial blood and HCO3- = Bicarbonate ion)
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 CONTD.
(a) Acidosis:
 Arterial blood pH is below than 7.35.
 Depression of central nervous system → confused, coma,
dead.
(b) Alkalosis:
 Arterial blood pH is higher than 7.45.
 Stimulate the central nervous system & peripheral system →
extreme nervousness, muscle stiffness, seizures, dead.
 A change in blood pH that leads to acidosis or alkalosis may
countered by compensation.
 Compensation = acts to normalize arterial blood pH by
respiratory (depth and rate) and renal (by reabsortion @ excertion of H+ ion
and HCO3ˉ) & buffer system.
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TYPES OF ACID-BASE IMBALANCES
1. Respiratory acidosis = pH < 7.35
2. Respiratory alkalosis = pH > 7.45
3. Metabolic acidosis = pH < 7.35
4. Metabolic alkalosis = pH > 7.45

 Respiration – abnormality caused by changes

in CO2 in blood.
 Metabolic – abnormality caused by increased
or decreased HCO3- in artery blood.
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 1. RESPIRATORY ACIDOSIS
 Blood pH < 7.35 (acidic)
 Primary caused – PaCO2 > 45 mmHg –
hypercapnia (CO2 level in blood)
 Hypoventilation

Causes:
1. Impaired lung function :- chronic bronchitis ,
emphysema.
2. Impaires ventilatory movement :- paralysis of
respiratory muscle, chest injury, extreme obesity.
3. Drug eg: narcotic or barbiturate overdose.
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2. RESPIRATORY ALKALOSIS
 Blood artery pH > 7.45 (alkalosis)
 Primary caused --- PaCO2 < 35 mmHg -
hypocapnia
 Hyperventilation

Causes:
1. Strong emotion :- pain, anxiety, fear, panic attack,
hysteria.
2. Hypoxia: asthma, pneumonia, high altititude
septicemia.
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3. Brain tumour / injury.
 3. METABOLIC ACIDOSIS
 Arterial blood pH < 7.35
 Primary cause HCO3---- < 22 mEq/L in the arterial
blood.

Causes :
1. Severe diarrhea - loss of HCO3ˉ
2. Lactic acidosis – glycolysis
3. Untreated diabetic mellitus :- Diabetic
Ketoacidosis.
4. Excess alcohol ingestion.
5. Renal disease. 32
 4. METABOLIC ALKALOSIS
 Arterial blood pH > 7.45
 HCO3- > 26 mEq/L

CAUSES:
1. Vomiting / gastric suctioning.
2. Selected diuretic drugs.
3. Ingestion of excessive sodium bicarbonate (antasid).
4. Excess aldosterone:- Renal loss of hydrogen ions
occurs when excess aldosterone (Conn's syndrome)
increases the activity of a sodium-hydrogen
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exchange protein in the kidney.
 ASID-BASE INDICATOR
pH PCO2 HCO3
Normal 7.35 – 7.45 35 – 45 mmHg 22 – 26mmom/L

Respiratory Normal or
Acidosis If compensated

Respiratory Normal or
Alkalosis If compensated

Metabolic Normal or
Acidosis if compensated

Metabolic Normal or
Alkalosis If compensated
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 SUMMARY:
 Acid-base balance is one of the renal function.
 pH low = acidic
 pH high = alkaline
 3 main contributing in maintaining blood pH;
a) Chemical buffer (Blood)
b) Respiratory regulation (Lung)
c) Renal regulation (Kidney)
□ 4 disturbances & causes in acid-base:
a) Respiratory acidosis
b) Respiratory alkalosis
c) Metabolic acidosis
d) Metabolic alkalosis 35
36
 ABG INTERPRETATION
(Arterial Blood Gases)
 Normal Values:
 pH = 7.35-7.45
 PaCO2 = 35-45 mmHg
 PaO2 = 80-100 mmHg (at 5,000 ft.)
 HCO3 =22-26 mEq/L.
 SaO2 = 94%-97% (at 5,000 ft.)
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 ABG Interpretation
 Assess oxygenation status by checking PaO2 and
SaO2.

 Altitude dependant
 Mild Hypoxemia - PaO2 of 70 -80
mmHg
 Moderate Hypoxemia - PaO2 of 60-70
mmHg
 Severe Hypoxemia - PaO2 below 60
mmHg
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Types of Acid-Base Problems
1. Respiratory Acidosis
 (PaCO2 is high, HCO3- is normal)

2. Respiratory Alkalosis
 (PaCO2 is low, HCO3- is normal)

3. Metabolic Acidosis
 (HCO3- is low, PaCO2 is normal)

4. Metabolic Alkalosis
 (HCO3- is high, PaCO2 is normal) 39
 ABG Interpretation : Exercise 1

pH PaCO2 PaO2 HCO3- SaO2

7.22 55 mmHg 85 mmHg 22 mEq/L 98%

What is your interpretation?

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 CONTD.
pH PaCO2 PaO2 HCO3- SaO2
7.22 55 mmHg 85 mmHg 22 mEq/L 98%

The pH is low (below 7.35) so this is an

acidosis.

What is causing it?

41
 CONTD.
pH PaCO2 PaO2 HCO3- SaO2
7.22 55 mmHg 85 mmHg 22 mEq/L 98%

The CO2 is high and the HCO3- is normal,

so this is a respiratory acidosis.

What about the oxygenation status?

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 Interpretation 1
pH PaCO2 PaO2 HCO3- SaO2
7.22 55 mmHg 85 mmHg 22 mEq/L 98%

The PaO2 normal as is the SaO2 so the patient is

not hypoxemic.

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 ABG Interpretation : Exercise 2

pH PaCO2 PaO2 HCO3- SaO2

7.51 39 mmHg 55 mmHg 30 mEq/L 81%

What is your interpretation?

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 CONTD.

pH PaCO2 PaO2 HCO3- SaO2

7.51 39 mmHg 55 mmHg 30 mEq/L 81%

The pH is high (above 7.45) so this is an

alkalosis.

What is causing it? 45

 CONTD.

pH PaCO2 PaO2 HCO3- SaO2

7.51 39 mmHg 55 mmHg 30 mEq/L 81%

The PaCO2 is normal and the HCO3- is

high so it is a metabolic alkalosis.

What about the oxygenation status? 46

 Interpretation 2.

pH PaCO2 PaO2 HCO3- SaO2

7.51 39 mmHg 55 mmHg 30 mEq/L 81%

The PaO2 is too low, below 60 mmHg and

the SaO2 is below 90%, so the patient is in
severe hypoxemic.
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