Acid /Base Balance

• Because maintaining the pH of body fluids

within a narrrow range there are three main
mechanisms for maintaining this balance by
compensating for any changes
• 1. Blood buffers- the most immediate to
act but having limited capacity
• 2. Respiratory compensations- the next
fastest to act but also with limited capacity
• 3. Renal compensations- the slowest to act
but with the greatest capacity to correct1
 1. Blood Buffers
The main blood buffer is the carbonic acid
/bicarbonate buffer which can be expressed in this
equation
H20 + CO2  H2CO3  H+ + HCO3-
in other words water combines with carbon dioxide to form ccarbonic acid which
then can dissociate to form free Hydrogen ions and bicarbonate ions , ( that is
wheb you read the equation from left to right – but the equation can also go in the
opposite direction in which case bicarbonate ions will combine with hydrogen ions
to form carbonic acid which can then dissociate to form water and carvon dioxide.
When the equation shifts to the right it produces more H+ and so lowers the pH
When the equation shifts to the left it decreases the H+ concentration and raises
the pH

2
 H
• Blood buffers continued

There are other blood buffers including protein buffers

– remember that a protein is a chain of amino acids
– each of which can be H+ donor ( release H+ ) or
an H+ acceptor ( ie. receive an H+ to lower the
blood [H+]. Hemoglobin is one of many proteins in
the blood that can accept or donate hydrogen ions

3
2. Respiratory Compensations
• This compensation involves increasing or
decreasing the rate and depth of breathing.
• For acidosis you would increase rate and depth
and thus decrease the level of CO2 in the blood-
this would cause the cause the bicarb/carbonic
acid buffer to shift to the left and form more
carbonic acid from bicarb and H+- lowering the
[H+]
• For alkalosis , you slow your breathing to
increase blood [CO2] – thus shifting the equation
to the right , leading to increased carbonic acid
which dissociates in H+ and bicarb
4
 Renal Compensations
• As stated previously the buffers and the resp. comps. are
faster but limited in capacity and in the end the kidneys
have to step in.
• The kidneys can do two different things to
respond;
• 1. increase or decrease the rate of hydrogen ion
secretion, This occurs in the distal tubules and is
regulated by aldosterone in cation exchange. By
increasing Na reabsorption, in exchange you can
secrete either H+ or K+
• 2. increase or decrease the rate of bicarbonate
ion reabsorption from the proximal tubules back
into the blood ( in the peritubular capillaries 5
 Renal response continued;
• When compensating for acidosis your kidneys
would;
• Increase the rate of H+ secretion and
• Increase the rate of bicarbonate reabsorption

• When compensating for alkalosis your kidneys

would:
• Decrease the rate of H+ secretion and
• Decrease the rate of bicarbonate reabsorption

An important consideration though is that if you

secrete H+ you will not secrete K+ and vice versa –
6
so adjustments for pH will affect potassium balance
Reminder of Kidney structure

7
 Other important considerations
• In order to maintain a Ph of 7.35-7.45 you
must maintain a blood ratio of
Bicarbonate : Carbonic Acid of
20 : 1
All the time the ration is 20:1 the PH will be in
the normal range.
In acidosis the ratio will be less than 20:1
either because the bicarbonate level dropped
(metabolic acidosis) or the carbonic increased
ie. respiratory acidosis 8
• In Alkalosis the ratio will be greater than 20:1
either because;
Bicarbonate levels rise ( metabolic alkalosis)
or Carbonic acid levels fall ( respiratory
alkalosis
To compensate any PH change your body will
try to restore the ratio eg. If bicarb rises then
you try to raise the carbonic acid to match.Or
If bicarb falls then you try to lower the
carbonic acid levels to maintain the ratio
and vice versa 9
 Compensated vs decompensated or not
compesated
If you are compensated then your body has succeeded
in maintaining the 20:1 ratio and your pH is in the normal
range – so for example if you have compensated
acidosis it means challenges were causing a pH
decrease but you have managed to maintain 20:1 and
though your pH may be closer to the 7.35 end it is still in
the normal range
Decompensated means that you have gone outside the
normal ratio and outside the normal pH range
Decompensated acidosis means your pH is less than
7.35 and the ratio is less than 20:1
Decompensated alkalosis, pH > 7.45, ratio > 20:1 10