ACID BASE BALANCE

By:
Dr. Samraa Abdalwhab khider
 Normal pH
 - pH = - log [H] = 7.4 ± 0.05.
 - [H+] = 40 nmol/L or 0.00004 mmol/L (in arterial

blood).
 - pH less than 7.35 = Acidosis & more than 7.45 =

Alkalosis.
 - pH above 7.7 or below 7.0 is incompatible with life

(the parson may be die).

 Sources of acid in the body
- The body produces large amount of H+ every day.
Sources of H+ include:
1- Carbon dioxide :
2- Fixed acids (H2SO4 , H3PO4)
3- Organic acids (acetoacetic acid, lactic acid,...)
4- Ingestion of acidifying salts (NH4Cl, CaCl2)
5- Failure of diseased kidneys to excrete normal amount
of acid
 Sources of alkali
 1- Loss of gastric acid
 2- Ingestion of alkali eg, (drugs)
CONTROL OF pH

 Control of ECF pH is important for:

  Normal enzyme function
  Normal neuronal function
 Mechanisms for control of pH include
 Buffers (act immediately for very rapid control)
  The respiratory system (acts in seconds to minutes

for less rapid control)

  The renal system (acts in hours to days for long term

control)
The buffers

 A chemical substance that has the ability to bind or

release H+ in solution, thus keeping the pH of the
solution relatively constant
 A chemical substance formed of weak acid & alkali,

acts to resist changes in pH.

 Examples of Buffers in body fluids
 In the blood
 –Bicarbonate
 –Proteins
 –Hemoglobin

 In the interstitium
 –Bicarbonate
 Inthe cells
 –Proteins
 –Phosphate

 In urine
 –Bicarbonate
 –Ammonia
 –Phosphate
The respiratory system

 - Acts within seconds to minutes.

 - There are 2 types of chemoreceptors:
 o Peripheral: Stimulated by low Po2, high P co2 & low

pH (in plasma)
 o Central: Stimulated by high Pco2 & low pH (in CSF)
 - Stimulation of the chemoreceptors (e.g. by the low
pH) results in stimulation of the respiratory center
which causes hyperventilation. This results in washout
of CO2 and correction of the low pH.
 - On the other hand, high pH decreases stimulation of

the chemoreceptors and this eventually causes

hypoventilation resulting in accumulation of CO2 and
correction of the high pH.
The renal system

 - The kidney participates in acid base balance by:

 1- Reabsorption of HCO3-
 2- Synthesis of new HCO3-
 3- Secretion of H+
ACID BASE DISTURBANCES

 Low pH (acidosis) is caused by:

 o High CO2 (Due to a respiratory problem)
 o Low HCO3- (Due to a metabolic cause)

 High pH (alkalosis) is caused by:

 o Low CO2 (Due to a respiratory problem)
 o High HCO3- (Due to a metabolic problem)
 Therefore there are 4 types of acid base disturbances:
 a- Metabolic acidosis (due to low HCO3-)
 b- Metabolic alkalosis (due to high HCO3-)
 c- Respiratory acidosis (due to high CO2)
 d- Respiratory alkalosis (due to low CO2)
1- Metabolic acidosis

- Causes:
 o Failure to excrete acids (renal failure)
 o Formation of high amounts of acids (diabetic

ketoacidosis, lactic acidosis)

 o Loss of base (diarrhea)

- Characterized by:
 o Low pH & low bicarbonate

- Compensation:
 o Buffers
 o Respiratory system (hyperventilation)= low PCO2
2- Metabolic alkalosis

- Causes:
 o Loss of gastric acid: (vomiting or naso-gastric tube suction)

 o Ingestion of alkali

 o Diuretics

- Characterized by:
 o High pH & high bicarbonate

- Compensation:
 o Buffers

 o Respiratory system (hypoventilation)= high PCO2

 o Renal system
3- Respiratory acidosis

- Causes:
 o Respiratory center depression by drugs or trauma
 o Paralysis of respiratory muscles
 o Diseases of the lung

- Characterized by:
 o Low pH & high PCO2

- Compensation:
 o Buffers & renal system (the respiratory system is the

cause)
4- Respiratory alkalosis

- Causes:
 o Hys (hyperventilation)

- Characterized by:
 o High pH & low PCO2

- Compensation:
 o Buffers & renal system (the respiratory system is the

cause)
EVALUATION OF ACID BASE STATUS

 [1] Measurement of the following in the plasma:

 o pH
 o PCO2

NR : arterial = 40
venous = 46
Momken n7seba by gehas esmo puls oximeter .
 o HCO3-
 [2] Measurement of the anion gap
bgme3o al + & - charge in the body wa bteaho
mgmo3 al – men mgmo3 al + charge eza al + akter
7ykon 3endana low anion gap wa eza al – akter 7ykon
3endana high anoin gap .