Acid Base Balance..slide

ACID-BASE BALANCE
dr. Winarsi
Acids and bases.
Most biochemical reactions occur in aqueous solution.
 Water (H2O) dissociates to a slight extent to form H+

and OH-.
 The concentration of hydrogen ions determines the
acidity of the solution, which is usually expressed in
terms of pH.
 The pH of a solution is the nagative log of its hydrogen
concentration.
 An acid is a substance that can release hydrogen ions
(proton).
 A base is a substance that can accept hydrogen ions.
 A strong acid/base in solution: almost all molecules
dissociate. (Examples: sulphuric acid/H2SO4, chloride
acid/HCl, Nitric acid/HNO3, etc, NaOH, KOH, etc).
 A strong acid/base in solution: almost all molecules
dissociate. (Examples: sulphuric acid/H2SO4,
chloride acid/HCl, Nitric acid/HNO3, etc, NaOH, KOH,
etc).
 A weak acid/base in solution:
- only small number of the total molecules dissociate.
- a weak acid/base has a characteristic dissociation
constant (Ka/Kb) is defined as the pKa/pKb.
 The relationship between pH, pKa and the
concentration of weak acid and its conyugate base is
described by Henderson-Hasselbalch equation.
 The body produces a number of acid during normal
metabolism.
Buffers
A buffer consists of a weak acid and its

conyugate base or a weak base with its
conyugate acid.
Buffer cause a solution to resist changes on

pH when an acid or a base is added.
If H ions are added, they combine with a
weak base; if H ions are removed (by adding
a base), the weak acid dissociates, replacing
them.
Body fluids must be protected against changes in pH
because most enzymes are very pH sensitive and this
mechanism must be constanly active, because
metabolism involves the production of acids and bases
(especially acids).
In the long run, excess acid or base is eliminated via

the kidney and the lungs.
in the short run, the body is protected against pH
changes by buffering system.
Two main buffers occur in the blood:

- The bicarbonate buffer.
- A buffer involving the oxygen-carrying protein,
hemoglobin.
These mechanism normally act to maintain blood pH
between 7.37 and 7.43.
Acid-base balance
CO2 reacts with water to form carbonic acid

(H2CO3). This reaction is catalyzed by the enzyme
carbonic anhydrase which is located in red blood
cells and other certain cell types (tubule cells, etc).
H2CO3 rapidly ionizes to give H+ and HCO3-, so the
acid-base pair HCO3-/H2CO3 act as a buffer.
The buffers in the blood act in conyunction with

mechanisms in the kidneys for excreting protons as
well as with mechanisms in the lungs for exhaling
CO2 to maintain the pH within the normal range
(acid-base balance).
Although a buffer solution is most effective at mitigating
pH shift when its initial pH (7.35-7.45 in blood) is the same
as its pKa, this limitation for the HCO3-/H2CO3 system,
with a pKa of 6,1, is overridden by the body’s ability to
eliminate CO2 via the lungs.
HCO3- and H2CO3 can be conveniently expressed in a
useful form as the familiar Henderson-Hasselbalch
equation:
pH = pKa + log [HCO3-]/{H2CO3]
or
pH = pKa + log (kidney/lungs), where kidney = [HCO3-]
and lungs = [H2CO3]
7.4 = 6.1 + log [BHCO3] / [H2CO3].  log [BHCO3]/
[H2CO3] = 1.3  antilog 1.3 = 20.
 [BHCO3]/[H2CO3] = 20.
If [BHCO3]/[H2CO3]  pH of the blood is 7.4.
If [BHCO3]/[H2CO3] < 20 acidosis; if [BHCO3]/[H2CO3] > 20 

alkalosis.
If [H2CO3] >>>  ratio : <20  respiratory acidosis; it is

compensated by increased BHCO3 (increased reabsorption of
bicarbonate in kidney).
If [BHCO3] <<<  ratio : < 20  metabolic acidosis; it is

compensated by decreased H2CO3 (increased ventilation in the
lung  hyperventilation).
If [H2CO3] <<<  ratio : > 20  respiratory alkalosis; it is

compensated by decreased BHCO3 (decreased reabsorption of
bicarbonate in kidney).
If [BHCO3] >>>  ratio : > 20  metabolic alkalosis; it is

compensated by increased H2CO3 (decreased ventilation in the
lung  hypoventilation).
The total amount of carbonic acid in the blood can be
reduced or increased by respiration (lungs), expressed
as hipoventilation or hyperventilation respectively.
Kidney modulate HCO3- and excrete H+ by renal

bicarbonate reabsorption.
Respiratory acidosis or alkalosis is initially caused by
carbonic acid concentration.
Metabolic acidosis or alkalosis is initially caused by
bicarbonate concentration.
Lung and kidney play an important role in the
maintenance of pH within the normal range.
Disturbances in acid-base balance
A.Metabolic acidosis
Caused by a decrease in the bicarbonate fraction.
It occurs in uncontrolled diabetes mellitus with
ketosis, in renal disease, in diarrhea, etc.
Compensation by lungs (hyperventilation).
B.Respiratory acidosis
Caused by an increase in carbonic acid fraction.
It occurs in any disease which impaired respiration,
or in morphine poisoning (depression of the
respiratory center).
Compensation by the kidney (increase reabsorption
of bicarbonate)
C. Metabolic alkalosis
Caused by an increase in the bicarbonate fraction.
It occurs in prolonged vomiting, after ingestion of large
quantities of alkali, in Cushing syndrome.
Compensation by the lungs (hypoventilation).
D. Respiratory alkalosis
Caused by a decrease in the carbonic acid fraction.
It occurs in hysterical hyperventilation, in the early stages
of salicylate poisoning (stimulate the respiratory center).
Compensation by the kidney (decrease reabsorption of

bicarbonate).
In the advanced stages of salicylate poisoning resulting
metabolic acidosis because of renal failure (salicylate in
high dosis damage the kidney).
SEKIAN

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ACID-BASE BALANCE

Most biochemical reactions occur in aqueous solution.

 Water (H2O) dissociates to a slight extent to form H+

A buffer consists of a weak acid and its

Buffer cause a solution to resist changes on

In the long run, excess acid or base is eliminated via

Two main buffers occur in the blood:

CO2 reacts with water to form carbonic acid

The buffers in the blood act in conyunction with

If [BHCO3]/[H2CO3] < 20 acidosis; if [BHCO3]/[H2CO3] > 20 

If [H2CO3] >>>  ratio : <20  respiratory acidosis; it is

If [BHCO3] <<<  ratio : < 20  metabolic acidosis; it is

If [H2CO3] <<<  ratio : > 20  respiratory alkalosis; it is

If [BHCO3] >>>  ratio : > 20  metabolic alkalosis; it is

Kidney modulate HCO3- and excrete H+ by renal

Compensation by the kidney (decrease reabsorption of

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