6.acid Base Balance

ACID BASE
BALANCE
Dr Wairimu Mwaura
OBJECTIVES
• Define pH, acid and alkali
• Buffer system
• Role of the respiratory system in acid base balance
• Respiratory acidosis
• Respiratory alkalosis
• Metabolic acidosis
• Metabolic alkalosis
DEFINITIONS
• Acid :molecule that can donate a H+ ion
• Example :H2CO3  H+ + HCO3
• Strong acid: completely dissociates into separate ions, pH is closer to 1
• HCL→H+ +Cl-
• Weak acid releases H+ into a solution but does not completely
dissociate into separate ions, pH is closer to 7
• H2CO3  H+ + HCO3
DEFINITIONS
• Base :molecule that can accept a H+ ion
• Example: H+ + HCO3-  H2CO3
• Strong base completely dissociates into its separate ions, pH
closer to 14
• NaOH ⇄Na+ + OH-
• Weak base: NH3++H+=NH4+ , pH closer to 7
DEFINITIONS
• Buffer :substance that contains a weak acid and its

conjugate base
• Buffers can absorb excess H+ ions or OH– ions,
thereby maintaining a stable pH
DEFINITIONS
• pH: represents the free H+ concentration
• Measurement of how alkaline or acid a substance is
• Neutral ph = 7
• The more acidic a solution the lower the pH. pH < 7 is acid
• The more alkaline the solution the higher the pH. pH > 7 is
alkaline
• Normal pH of arterial blood is 7.35 – 7.45
pH
• The more hydrogen ions a solution contains, the

more acidic it is and the lower the pH
• The lower the hydrogen concentration, the more
alkaline the solution and the higher the pH
REGULATION OF ACID BASE BALANCE
• Three major mechanisms for regulation of acid base

balance:
i. Buffer systems
ii. Respiratory system
iii.Kidneys
ACID BASE BALANCE
1.BUFFER SYSTEM
• Buffers within body fluids regulate the pH by binding to
excess H+ or by releasing H+
• Three buffer systems function together to prevent major
changes in the pH of body fluids:
i. Carbonic acid/ bicarbonate buffer system
ii. Protein buffer system: haemoglobin &plasma proteins
iii. Phosphate buffer system
CARBONIC ACID/HCO3 SYSTEM
• CO2+H20⇄H2CO3 ⇄HCO3-+H+
• Depends on the equilibrium that is quickly established
between H2CO3 and HCO3-+H+
• When H+ are added to a solution- a large proportion of the H+
binds to HCO3- to form H2CO3
• When H+ is removed from a solution H2CO3 dissociates to form
HCO3-&H+
CARBONIC ACID/HCO3 SYSTEM
• Plays an important role in regulating extracellular pH
• It quickly responds to:
i. The addition of CO2/lactate produced by increased metabolism
during exercise
ii. Increased fatty acid and ketone body production during periods of
elevated lipid metabolism
iii. Addition of basic substances e.g. large amounts off NaHCO3
consumed as an antacid
PROTEIN BUFFER SYSTEM
• Components of the protein buffer system are:
i. Plasma proteins and intracellular proteins
ii. Haemoglobin
• Proteins function as effective buffers due to their free carboxyl
(COOH) and amino (NH3+) groups which can act as weak acids or
bases
RCOOH ⇄RCOO-+ H+
RNH3+⇄ RNH2+H+
PROTEIN BUFFER SYSTEM
HAEMOGLOBIN BUFFER SYSTEM
• Imidazole groups of histidine residues on Hb act as a buffer
• CO2 diffuses across the RBC membrane combines with H2O to form
H2CO3
• Carbonic acid dissociates : HCO3- diffuse into plasma
• H+ are buffered by Hb molecules
• DeoxyHb is a better buffer than oxyHb
• Hb buffer system prevents major changes in pH when plasma PCO2 levels
are rising or falling
HAEMOGLOBIN BUFFER SYSTEM
PHOSPHATE BUFFER SYSTEM
• Important intracellular buffer
• Phosphate containing molecules (ATP, DNA,RNA, phosphate
ions) act as buffers
H+ + HPO4-2 ⇄H2PO4⇄ H++HPO4-
• When the pH decreases : HPO4- binds H+ to form H2PO4-
• Increase in pH H2PO4- releases H+ into solution
2. RESPIRATORY REGULATION OF ACID
BASE BALANCE
• The respiratory system regulates acid base balance
by eliminating or retaining CO2
• pH is regulated by altering the rate and depth of
respiration
• Changes in pH are rapid- occur within a few minutes
• Normal arterial CO2 levels=35-45 mmHg
2.RESPIRATORY REGULATION OF ACID
BASE BALANCE
• Hyperventilation – breathing faster & deeper
eliminates more CO2 leading to an increase in pH
• Hypoventilation- slow and shallow breathing leads
to accumulation of CO2 causing a decrease in pH
3.RENAL REGULATION OF ACID BASE
BALANCE
• Kidneys make long term adjustment to pH
• Slower to respond- may take hours/days/ weeks
• Maintain acid base balance by excreting or
conserving bicarbonate and hydrogen ions
• Normal bicarbonate level in blood is 22-26 meq/L
ACIDOSIS AND ALKALOSIS
• Normal pH of arterial blood is between 7.35-7.45

• Acidosis results when pH falls below 7.35
• Alkalosis occurs when pH rises above 7.45
• Major effect of acidosis is depression of the CNS
• Major effect of alkalosis is hyperexcitability of the
CNS
• Categorised according to their cause

• Respiratory acidosis and alkalosis : abnormalities in
the respiratory system
• Metabolic acidosis/ alkalosis: results from abnormal
metabolism
RESPIRATORY ACIDOSIS
• Occurs due to inadequate ventilation and CO2 retention

• Characterised by :
i. pH < 7.35
ii. PaCO2 > 45 mmHg
iii.Compensatory increase in HCO3-
RESPIRATORY ACIDOSIS
• ↑ concentration of CO2 in the body
• CO2 reacts with H2O to form carbonic acid
• Carbonic acid dissociates into H+ + HCO3-
CO2+H20 ⇄H2CO3 ⇄ H++HCO3-
• Increase in H+ causes body pH to decrease
• Buffers help resist the decrease in pH
• Kidneys ↑ H+ secretion and reabsorb HCO3-
SIGNS& SYMPTOMS OF RESPIRATORY
ACIDOSIS
• Causes :
• Impaired ventilation
• Airway obstruction
• Paralysis of respiratory muscles
• Anaesthesia
• Drug overdose: narcotics
• Respiratory arrest
RESPIRATORY ALKALOSIS
• Decrease in PaCO2 caused by increase in alveolar

ventilation
• Characterised by:
i. pH >7.45
ii. PaCO2 < 35mmHg
iii.Compensatory decrease in HCO3-
• Hyperventilation=↑ CO2 elimination from the body

• As CO2 levels decrease H+ reacts with HCO3- to form H2CO3
• H2CO3 breaks down into CO2+H20
• CO2+H20 ⇄H2CO3 ⇄ H++HCO3-
• The resulting decrease in H+ causes the pH of the body
fluids to increase
• Causes:
• Fever
• Hypoxia
• Anxiety
• Fear
• Anger
• Mechanical ventilation
METABOLIC ACIDOSIS
• Occurs when acids accumulate in blood or

bicarbonate is lost from the body
• Characterised by:
i. pH <7.35
ii. HCO3- < 22 meq/L
iii.Compensatory decrease in PaCO2
METABOLIC ACIDOSIS CAUSES
• Loss of HCO3-: diarrhoea , intestinal fistulae
• Decreased elimination of acids: renal failure
• Excess production of acids:
i. Diabetic ketoacidosis
ii. Lactic acidosis
iii. Anaerobic metabolism
iv. Starvation
v. Aspirin overdose
METABOLIC ACIDOSIS
• Acidic metabolites /HCO3- loss cause a decrease in pH
• As H+ accumulates – buffers resist the decline in pH
• If the buffers cannot compensate for the increase in H+ the
respiratory center is stimulated→ hyperventilation
• Hyperventilation causes ↑ CO2 elimination
• Elimination of CO2 also eliminates excess H+ and helps
maintain normal body ph
METABOLIC ACIDOSIS
• The kidneys can compensate for metabolic acidosis by:

i. Secreting H+ at a greater rate
ii. Increasing the rate of HCO3- secretion
• Symptoms of metabolic acidosis appear if the
respiratory and renal systems are not able to maintain
the pH within its normal range
METABOLIC ACIDOSIS
METABOLIC ALKALOSIS
• Results from an increase in bicarbonate

• It is characterised by:
i. pH > 7.45
ii. HCO3- > 26 meq/L
iii.Compensatory increase in PaCO2
METABOLIC ALKALOSIS CAUSES
• Excess of base or loss of acid
• Acute H+ ion loss
i. Vomiting
ii. Gastric suction
iii. Diuretics e.g. furosemide
• Excess intake of alkali: antacid
• Intravenous NAHCO3 administration
METABOLIC ALKALOSIS
• H+ decrease
• Buffers form the 1st line of defense against the increase in
pH
• If the buffers cannot compensate for increased pH the
respiratory center inhibits respiration
• Reduced respiration allows CO2 to accumulate→H2CO3
• Kidneys reduce the rate of H+ secretion
METABOLIC ALKALOSIS
VENTILATION AND ACID BASE
BALANCE
• Ventilation controls the respiratory component of acid
base balance
• Hypoventilation results in↑CO2 &↑H2CO3= ↓pH,
respiratory acidosis occurs
• Hyperventilation ↓CO2 , less carbonic acid is formed =↑
pH, respiratory alkalosis occurs
VENTILATION AND ACID BASE
BALANCE
• Ventilation can compensate for metabolic acid base
imbalance
CO2+H20 ⇄H2CO3 ⇄ H++HCO3-
• Patient with metabolic acidosis, hyperventilates eliminating
increased CO2 and H+
• Patient with metabolic alkalosis, will hypoventilate resulting
in CO2 retention and H2CO3 formation
THANK YOU

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ACID BASE

• Buffer :substance that contains a weak acid and its

• The more hydrogen ions a solution contains, the

• Three major mechanisms for regulation of acid base

• Normal pH of arterial blood is between 7.35-7.45

• Categorised according to their cause

• Occurs due to inadequate ventilation and CO2 retention

• Decrease in PaCO2 caused by increase in alveolar

• Hyperventilation=↑ CO2 elimination from the body

• Occurs when acids accumulate in blood or

• The kidneys can compensate for metabolic acidosis by:

• Results from an increase in bicarbonate

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