"If One Advances Confidently in The Direction of His Dreams, He Will Meet With A Success Unexpected in Common Hours

“If one advances confidently in
the direction of his dreams, he

will meet with a success
unexpected in common hours
--Henry David Thoreau
"Shoot for the moon. Even if you miss

it, you will land among the stars….!"
- Les Brown
Acid-Base Balance
 A hydrogen ion is a single free proton
released from a hydrogen atom
 Acids.. Molecules containing hydrogen
atoms that can release hydrogen ions in
solutions
-hydrochloric acid (HCl) ,carbonic acid
(H2CO3)
 A base…. an ion or a molecule that can
accept an H+
-HCO3-,HPO4=,The proteins ,hemoglobin
Strong and Weak Acids and Bases
 A strong acid ..rapidly dissociates and releases
large amounts of H+ in solution….HCl
 Weak acids ..less tendency to dissociate their
ions … is H2CO3
 A strong base … reacts rapidly and strongly with
H+ and quickly removes these from a solution…
OH-
 A typical weak base is HCO3-
 Most of the acids and bases in the extracellular
fluid that involved in normal acid-base regulation
are weak acids and bases
Types of Acids in the body
 Volatile acids:
– Can leave solution and enter the atmosphere.
– H2C03 (carbonic acid).
– Pco2 is most important factor in pH of body
tissues.
 Fixed Acids:
– Acids that do not leave solution.
– Sulfuric and phosphoric acid.
– Catabolism of amino acids, nucleic acids, and
phospholipids.
 Organic Acids:
– Byproducts of aerobic metabolism, during
anaerobic metabolism and during starvation,
diabetes.
– Lactic acid, ketones.
Normal Hydrogen Ion Concentration and
pH of Body Fluids
 the blood H+ concentration is normally
maintained within tight limits around a
normal value of about 0.00004 mEq/L (40
nEq/L)
Ph= log 1/H= -log [H]
Ph=7.4
pH = pK + log HCO3
CO2
Defenses Against Changes in Hydrogen Ion
Concentration
There are three primary systems that regulate the
H+ concentration
(1)the chemical acid-base buffer systems of the

body fluids
(2) the respiratory center
(3) the kidneys

Buffer Systems
 a buffer system is a combination of two
compounds that minimizes pH changes when
acid or base is added to a solution
 A pair of substance is involved: one substance

yield H+ ion when PH is increased the other
binds with H+ ion when pH is decreased.
 Chemical buffer system
– Combination of weak acid and weak base
– Binds to H+ as H+ concentration rises
– Releases H+ as H+ concentration falls
– Can restore normal pH almost immediately
– Three major chemical buffer systems
• Bicarbonate system
• Phosphate system
• Protein system
buffers
 Accomplished by converting:
– Strong acid  Weak acid
– Strong base  Weak base
BODY BUFFER SYSTEMS
– bicarbonate/carbonic acid
• major plasma buffer
– phosphate: H2PO4- / HPO42-

• major urine buffer
– ammonium: NH3 / NH4+

• also used to buffer the urine
– proteins: important in ICF
– Hb: is the main buffer against CO2 changes

BICARBONATE BUFFER SYSTEM
 Carbonic acid (H2CO3)
– Weak acid
 Bicarbonate ion (HCO3-)
– Weak base
 CO2 + H20  H2CO3  H+ + HCO3-
 Works along with respiratory and urinary
system
– These systems remove CO2 or HCO3-
NaOH + H2CO3 H2O + Na HCO3
HCl + Na HCO3 NaCl + H2CO3

 pK 6.1
 the concentrations of CO2 and HCO3 not

great.
 the most powerful extracellular buffer in

the body
 the two elements of the buffer system are

regulated by the kidneys and the lungs
PHOSPHATE BUFFER SYSTEM
• Dihydrogen phosphate ion (H2PO4-)
– Weak acid
• Monohydrogen phosphate ion (HPO42-)
– Weak base
• H2PO4-  H+ + HPO42-
• More important in buffering kidney filtrate
than in tissue
Phosphate Buffer System
The main elements of the phosphate buffer
system are H2PO4- and HPO4
NaOH + NaH2PO4 H2O+ Na2HPO4
HCl + Na2HPO4 NaCl + NaH2PO4
 pK 6.8
 8 % of the concentration of the bicarbonate

buffer
 the total buffering power less than that of the

bicarbonate buffering system.
 the phosphate buffer is important in the
tubular fluids of the kidney for two reasons
(1) phosphate concentrated in the tubules
(2) the tubular fluid has lower pH than the
extracellular fluid does
- bringing the operating range of the buffer closer
to the pK (6.8) of the system
 important in buffering intracellular fluid because
the concentration of phosphate in this fluid is
many times that in the extracellular fluid
PROTEIN BUFFER SYSTEM
 Proteins are more concentrated than
bicarbonate and phosphate buffers
 Accounts for ~75% of all chemical

buffering of body fluids
 Buffering ability due to certain functional

groups of amino acid residues
 except for the red blood cells, the slowness with
which H+ and HCO3 move through the cell
membranes often delays the maximum ability of
the intracellular proteins to buffer extracellular
acid-base abnormalities.
 the pKs of many of these protein systems close

to 7.4.
Isohydric buffer system
The buffer system buffers each other by

shifting hydrogen from buffer to other
Respiratory mechanisms .2
 Exhalation of carbon dioxide
 Powerful, but only works with volatile
acids
 Doesn’t affect fixed acids like lactic acid
 CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3-
 Body pH can be adjusted by changing rate
and depth of breathing
 the overall buffering power of the
respiratory system is one to two times as
great as the buffering power of all other
chemical buffers in the ECF combined
Renal Control of Acid-Base Balance
• Alkalosis
→↑urinary HCO3-
• Acidosis
→↓urinary HCO3-
new HCO3- production
Acid-Base Imbalances
• pH< 7.35 acidosis
• pH > 7.45 alkalosis
Compensation for Metabolic Acidosis
• Increased ventilation
• Renal excretion of hydrogen ions if
possible
• K+ exchanges with excess H+ in ECF
• ( H+ into cells, K+ out of cells)
Changes in Arteial Concentrations
of H+, HCO3- & CO2 in Acid-Base Disorders
Primary Cause of HCO3- Cause of CO2

H + HCO3- CO2
Disorder Change Change
Respiratory
Acidosis ↑ ↑ ↑
Renal Primary
Compensation Abnormality
Respiratory
Alkalosis ↓ ↓ ↓
Metabolic
Acidosis ↑ ↓ ↓ Reflex
Primary
Ventilatory
Abnormality
Metabolic Compensations
Alkalosis ↓ ↑ ↑
Clinical Causes of
Acid-Base Disorders
 Respiratory Acidosis; ↑PCO2 & [H+]
 Respiratory Alkalosis; ↓PCO2 & [H+]
 Metabolic Acidosis
; compensatory reflex hyperventilation ⇒ ↓ PCO2
1. Tubular acidosis; ↓HCO3- reabsorption & H+ secretion
2. Diarrhea & Vomiting(intestinal); ↓HCO3-
3. Diabetes Mellitus; ↑acetoacetic acid (ketone body)
4. Ingestion of acids; aspirin, methyl alcohol
5. Chronic renal failure; ↓acid excretion
6. Hypoxia (severe exercise); ↑lactic acid
 Metabolic Alkalosis
; compensatory reflex hypoventilation ⇒ ↑PCO2
1. Diuretics; ↑distal tubule flow
⇒↑Na+ reabsorption & H+ secretion
2. Excess Aldosterone; ↑H+ secretion
3. Vomiting; ↓H+ (upper gastric content)
4. Ingestion of alkaline drugs; sodium bicarbonate
Summary of Acid-Base Disturbances

Uncompensated Compensated

pH [HCO3-] PCO2 pH [HCO3-] PCO2
24 40
Normal

7.4
mEq/L mmHg
Respiratory
Acidosis ↓ - ↑ ↓ ↑ ↑
Respiratory
Alkalosis ↑ - ↓ ↑ ↓ ↓
Metabolic
Acidosis ↓ ↓↓ - ↓ ↓↓ ↓
Metabolic
Alkalosis ↑ ↑↑ - ↑ ↑↑ ↑
Analysis of Acid-Base Disorders

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“If one advances confidently in

the direction of his dreams, he

"Shoot for the moon. Even if you miss

(1)the chemical acid-base buffer systems of the

(2) the respiratory center

(3) the kidneys

 A pair of substance is involved: one substance

– phosphate: H2PO4- / HPO42-

– ammonium: NH3 / NH4+

– proteins: important in ICF

– Hb: is the main buffer against CO2 changes

HCl + Na HCO3 NaCl + H2CO3

 the concentrations of CO2 and HCO3 not

 the most powerful extracellular buffer in

 the two elements of the buffer system are

 8 % of the concentration of the bicarbonate

 the total buffering power less than that of the

 Accounts for ~75% of all chemical

 Buffering ability due to certain functional

 the pKs of many of these protein systems close

The buffer system buffers each other by

Primary Cause of HCO3- Cause of CO2

 Respiratory Alkalosis; ↓PCO2 & [H+]

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