ACID/BASE BALANCE AND

DISORDER
 ACID – BASE BALANCE
• Normal pH of arterial blood is 7.35- 7.45
• Normal Conc. Of H+ = 40 nmol/l
• Definition of pH
– Negative logarithm of H+ concentration (- log H+)
– pH is calculated by HENDERSON-HASSELBALCH
Eq.
pH = pK + log [A-]
[HA]
• Various body fluids and cell organelles have
different pH for their enzyme activity
pH
– Gastric juice - 1.2
– Osteoblast - 9 – 10
– Prostate - 3–5
METABOLIC SOURCE OF ACID & BASES
• Acids:
1. Fixed acids (Non-volatile Acids) - excreted
through kidney
• Phosphoric acid & sulphuric acid – Ptn. & LPs.
• Pyruvic Acid, Lactic acid, uric acid & Keto-acids
(acetoacetic acid & beta hydroxybutyric acid)
2. Volatile acid
• Carbonic Acid
• Bases:
1. Bicarbonate salts from citrate salts of fruit juices
2. NH3 from deamination of amino acids
3. Biphosphate & acetate from different
metabolism
• Average rate of metabolic activity produces
roughly 2000 mEq of acid per day
• Regulatory mechanism of maintenance of pH
of Blood are:
1. Buffer mechanism – 1st line of defence (act
within seconds)
2. Respiratory mechanism – 2nd line of defence (act
within min to hr)
3. Renal meachnism – 3rd line of defence ( act
within few days)
 BUFFER MECHANISM
• Buffer
– Buffer is a mixture of weak acid and a salt of its
conjugate base.
– It can resist change in pH when acid or alkali is
added.
 BLOOD BUFFERS:

Plasma Buffer Buffer of RBC

• NaHCO3 • KHCO3
H2CO3 H2CO3
• K2HPO4
• Na2HPO4 (Alk-PO4) KH2PO4
NaH2PO4 (AcidPO4) • K Hb
H Hb
• Na-Pr
H-Pr • K Hb O2
H. Hb O2
 ROLE OF DIFFERENT BUFFER SYSTEM
1. Bicarbonate buffer system
– NaHCO3/H2CO3 = [salt]/[Acid]
– Normal ratio in blood is 20:1
– Alkali reserve is alkali available for neutralization
of strong acids

a) Na HCO3 + H Cl H2CO3 + NaCl

(strong acid) (weak acid)

H2O + CO2
b) H2CO3 + NaOH NaHCO3 + H2O
(Strong alkali) (weak alkali)

• Bircarbonate buffer system is directly linked up with

respiration
2. Phosphate buffer:
 Na2HPO4/NaH2PO4 = [Alk PO4]/[Acid PO4]

 Normal ratio in plasma is 4:1

 Phosphate buffer system is directly linked up

with kidney
• Eg
– HCl + Na2HPO4 NaH2PO4 + NaCl
(Stong Acid) (Weak acid)

– NaH2PO4 + NaOH H2O + Na2HPO4

(Stong Alkali) (Weak alkali)
• Plasma protein buffer:
– Ptns contain a large no of dissociable acidic and
basic group in their structure.
– Other important buffer is imdizole groups of
histidine
• Hemoglobin buffer of RBC:
– Due to imdizole group of histidine
– Major intra cellular buffer
Tissues
Lungs
 Respiratory mechanism
• Regulation of concentration of carbonic acid
(H2CO3) in the blood and body fluids done by
lungs
• Respiratory centre regulates the removal or
retention of CO2 and thereby H2CO3 from the
extracellular fluid by the lungs
HCO3- + H+ H2CO3 H2O + CO2
Carbonic Anhydrase
(Zn)
 Renal mechanism
• Long term acid base balance control is exerted
by renal mechanism.
• These done by conservation of HCO3- (alkali
reserve) and excretion of acid as the case may
be.
• pH of Glomerular filtrate – 7.4
• pH of urine – 4.5 to 8
• This is maintained by 4 meachnism
1. Exchange of H+ for Na+ of tubular fluid.
2. Reabsorption of bicarbonate from tubular fluid.
3. Formation of ammonia and excretion of
ammonium ion in the urine.
4. Excretion of H+ as NaH2PO4- in urine.
 ACID BASES DISOREDS
• Acidaemia is defined as an arterial blood pH
of less than 7.35
• Alkalaemia is defined as an arterial blood pH
of greater than 7.45
• Acidosis and alkalosis refer to pathological
state that can lead to acidaemia or alkalemia
• Acidosis – (pH less than 7.35)
1. Metabolic acidosis : Decreases in bicarbonate
conc.
2. Respiratory acidosis: Increase in pCO2 or H2CO3
conc.

• Alkalosis - (pH more than 7.45)

1. Metabolic alkalosis: increases in biocarbonate
conc
2. Respiratory alkalosis: decreases in pCO2 or
H2CO3 conc.
 METABOLIC ACIDOSIS
• Symptoms
– Kussmaul’s respiration
– Lethargy, confusion, headache, weakness
– Nausea and Vomiting
– Lab:
• pH below 7.35
• Bicarb less than 22
 METABOLIC ACIDOSIS
Clincal causes
• Diabetes mellitus
(Ketoacidosis)
• Lactic acisdosis
• Renal failure
• Severa dirrhoea
• Renal tubular acidosis due
to loss of HCO3-
Compensatory mechanisms
• Increased elimination of
acid (H2PO4-) in the urine
except in the case of
retention type
• Rise in urinary ammonia
• Increased respiration to
wash out CO2 faster
 RESPIRATORY ACIDOSIS
• Symptoms
– Dyspnea, Disorientation or coma
– Dysrhythmias
– pH < 7.35, PaCO2 > 45mm Hg
– Hyperkalemia or Hypoxemia
 RESPIRATORY ACIDOSIS
Clincal causes Compensatory mechanisms
• Chronic obstructive • Increase in renal
pulmonary diseases, asthma, reabsorption of bicarbonate
emphysema and pneumonia
• Rise in urinary acid (H2PO4-)
• Cardiac arrest, severe
and ammonia.
hypoxia
• Stimulation of respiratory
• Weakness of respiratory
centre by CO2 except in
muscles
depression type
• Chest deformities, thoracic
trauma, pneumothorax
myopathies.
• Administration of respiratory
depression toxic drugs
 METABOLIC ALKALOSIS
• Symptoms
– Hypoventilation (compensatory)
– Dysrhythmias, dizziness
– Paresthesia, numbness, tingling of extremities
– Hypertonic muscles, tetany
– Lab: pH above 7.45, Bicarb above 26
– CO2 normal or increased w/comp
– Hypokalmia, Hypocalcemia
 METABOLIC ALKALOSIS
Clincal causes Compensatory mechanisms
• Loss of gastric juice along • Increased excretion of alkali
with H+ ions (HCO3-) by the kidney
• Nasogastric drainage (loss • Diminished formation of
of H+ ions) ammonia
• Hypokalaemia • Respiration is depressed to
• Therapeutic administration conserve CO2
of alkali
 RESPIRATORY ALKALOSIS
• Symptoms
– Tachypnea or Hyperpnea
– Complaints of SOB, chest pain
– Light-headedness, syncope, coma, seizures
– Numbness and tingling of extremities
– Difficult concentrating, tremors, blurred vision
– Weakness, paresthesias, tetany
– Lab findings
– pH above 7.45
– CO2 less than 35
 RESPIRATORY ALKALOSIS
Clincal causes Compensatory mechanisms
• Hyperventilation (anxiety, • Reduction of urinary
fever) ammonia formation
• Hot baths • Increased excretion of
• High altitudes bicarbonate
• Working in high
temperature
• Salicylate poisoning
 ANION GAP
• The anion gap is the different between
unmeasured anions and unmeasured cations.
• Anion gaps = ([Na+] + [K+]) - (Cl- + HCO3-)]
= (142 + 4) – (103 + 27)
= 146 – 130
= 16 mEq/L
• Clinical significance of anion gap:

– The anion gap is a biochemical tool which

sometimes helps in assessing acid-base problems.

– It is used for the diagnosis of different causes of

metabolic acidosis
• Increased anion gap
– Diabetic ketoacidosis
– Renal failure
– Methonal toxicity
– Alcoholic ketoacidosis
– Paracetamol toxicity
– Lactic acidosis
– Ethylene glycol poisoning
– Saliclate toxicity (present in aspirin)
 BLOOD GAS REPORT
SIEMENS DIAGNOSTICS 348

METABOLIC ACIDOSIS Reference Value

• pH 7.23 • pH 7.35 – 7.45

• pCO2 32.8 mm Hg • pCO2 35 – 45 mm Hg

• pO2 60.4 mm Hg • pO2 80 – 95 mm Hg

• HCO3 14.5 mEq/L • HCO3 22 – 26 mEq/L

• O2 SAT 86.9 % • O2 Saturation 95 – 99 %

• BE (ecf) - 14 mmol/L
 BLOOD GAS REPORT
SIEMENS DIAGNOSTICS 348

Respiratory Acidosis with Metabolic Reference Value

compensation

• pH 7.116 • pH 7.35 – 7.45

• pCO2 132.1 mm Hg • pCO2 35 – 45 mm Hg
• pO2 318.7 mm Hg • pO2 80 – 95 mm Hg
• HCO3 30.6 mEq/L • HCO3 22 – 26 mEq/L
• O2 SAT 99.5 % • O2 Saturation 95 – 99 %
• BE (ecf) 12.2 mmol/L
 BLOOD GAS REPORT
SIEMENS DIAGNOSTICS 348

Metabolic Alkalosis Reference Value

• pH 7.51 • pH 7.35 – 7.45
• pCO2 39.4 mm Hg • pCO2 35 – 45 mm Hg
• pO2 77.3 mm Hg • pO2 80 – 95 mm Hg
• HCO3 31.3 mEq/L • HCO3 22 – 26 mEq/L
• BE (ecf) 7.5 mmol/L • O2 Saturation 95 – 99 %
 BLOOD GAS REPORT
SIEMENS DIAGNOSTICS 348

Respiration Alkalosis Reference Value

• pH 7.53 • pH 7.35 – 7.45

• pCO2 27.0 mm Hg • pCO2 35 – 45 mm Hg

• pO2 65.5 mm Hg • pO2 80 – 95 mm Hg

• HCO3 22 mEq/L • HCO3 22 – 26 mEq/L

• BE (ecf) 2.5 mmol/L • O2 Saturation 95 – 99 %

 BLOOD GAS REPORTS
• Respiratory Acidosis
– pH 7.25, HCO3 24, pCO2 50
• Metabolic Alkalosis
– pH 7.50, HCO3 32, pCO2 38
• Respiratory Alkalosis
– pH 7.48, HCO3 26, pCO2 32
• Metabolic Acidosis
– pH 7.28, HCO3 20, pCO2 39
• Comp. Res Acidosis
pH 7.35, HCO3 32, pCO2 50
• Comp. Met Alkalosis
pH 7.45 , HCO3 32, pCO2 50
• Compensated Res alkal
pH 7.45, HCO3 19, pCO2 32
• Comp. Met Acidosis
pH 7.35, HCO3 20, pCO2 32