SEMINAR ON ACID

BASE IMBALANCES
SUBMITTED TO,

MRS, SHALY ULAHANNAN

ASSITANT. PROFESSOR

HOLY FAMILY COLLEGE OF NURSING

SUBMITTED BY

MRS. DANI THOMAS

S T
1 YEAR M.Sc NURSING

HOLY FAMILY COLLEGE OF

NURSING

SUBMITTED ON6/03/2019
 INTRODUCTION
Normal function of body cell depends on regulation of hydrogen ion concentration
within very narrow limits. Acid-base imbalance occur when these limits exceeded and are
recognized clinically as abnormalities of serum Ph. Because acid base imbalances may results
from diseases of any body system and their incidence in clinical setting is very high. The
nurse is responsible with other health professionals, for the prevention detection, and
interventions in acid base disorders.
Three physiologic systems act independently to maintain normal serum pH, excretion of acid
by lungs, excretion of acid or reclamation of base by kidneys and buffering of excess acid or
base by the blood buffer system.
KEY WORDS
• pH- it is a negative log of hydrogen ion concentration
• NORMAL pH-7.35-7.45
• ACIDOSIS-pH of the body fluid is less than 7.35
• ALKALOSIS-pH of the body fluid is more than 7.35
• ACIDEMIA-plasma pH less than 7.35
• ALKALAEMIA-plasma pH more than 7.45
• ACID- Any compound which forms H+ ion in solution. Eg. Carbonic acid releases
H+ ion
• BASE- any compound which accepts H+ ion. Eg. Bicarbonate accepts H+
• BUFFERING- regulate the pH by binding or releasing H ion. Mainly bicarbonate and
non bicarbonate –Hb, protein and phosphate.
• ARTERIAL OXYGEN PARTIAL PRESSURE(PAO2)
A low PaO2 indicates that the person is not oxygenating properly, and is hypoxemic. (Note
that a low PaO2 is not required for the person to have hypoxia. At a PaO2 of less than 60 mm
Hg, supplemental oxygen should be administered)
• ARTERIAL CARBON DIOXIDE PARTIAL PRESSURE(PACO2)
The carbon dioxide partial pressure (PaCO2) is an indicator of CO2 production and
elimination: for a constant metabolic rate, the PaCO2 is determined entirely by its elimination
through ventilation. A high PaCO2 (respiratory acidosis, alternatively hypercapnia) indicates
underventilation (or, more rarely, a hypermetabolic disorder), a low PaCO2 (respiratory
alkalosis, alternatively hypocapnia) hyper- or overventilation
• HCO3–
The HCO3– ion indicates whether a metabolic problem is present (such as ketoacidosis). A
low HCO3– indicates metabolic acidosis, a high HCO3– indicates metabolic alkalosis. As
this value when given with blood gas results is often calculated by the analyzer, correlation
should be checked with total CO2 levels as directly measured
• BASE EXCESS
The base excess is used for the assessment of the metabolic component of acid-base
disorders, and indicates whether the person has metabolic acidosis or metabolic alkalosis.
Contrasted with the bicarbonate levels, the base excess is a calculated value intended to
completely isolate the non-respiratory portion of the pH change
• Anion gap (AG)
Anion gap is a quantity which is almost equal to the sum of concentrations of “un
measurable” anions (albumin – plasma proteins, phosphates, sulphates, organic anions). Un
measurable is not accurate term, more precise is commonly non-measured.

REGULATION OF ACID BASE BALANCE

The symbol of pH stands for the negative log of hydrogen ion. It is used to
express the degree of acidity and alkalinity of solution. A pH of 7.0 is neutral, having an
equal number of acid and base. An acidic solution has a pH below 7.0 and an alkaline
solution has a pH above 7.0. pH is a negative log , a rise in pH reflects a fall in H + and vice
versa.
Normal serum pH is 7.35-7.45. Cell function is seriously impaired when pH falls to
7-2 or lower or rises to 7.55 or higher. Serum pH below 6.8 or above 7.8 may be compatible
to life

BODY SYSTEMS PARTICIPATES IN REGULATION OF pH

 Excretion of acids by lungs
 Excretion of acids or reclamation of base by kidneys.
 Buffering of excessive acids and base by the blood buffer system

EXCRETION OF ACIDS BY LUNGS

CO2 is produced in the body cells as an end product of aerobic carbohydrate
metabolism, diffuses in to the blood, where combined with water to form carbonic acid. This
carbonic acid then dissociate , releasing free H+ ion. The reaction is shown as
H2 O +CO2 ↔ H2 CO3 ↔ H CO3- + H+
 The bicarbonate formed within the RBC diffuse out in to the plasma and chloride ion
enters in to the RBC for electron neutralization. This process is called chloride shift. The
hydrogen ion buffer with Hb to form hydrogen buffered Hb.
In the lungs when the O2 enters in to the RBC that combined with buffered hydrogen
Hb that combined with buffered hydrogen Hb to separate the H+ ion and HbO2.. As soon as
the re-entry of HCO3 in to RBC and Cl- will move back in to the plasma. This HCO3
combines with H+ ion to form H2 CO3 that again separate to form CO2 + H2 O. This CO2
enters in to alveoli and expel out.

EXCRETION OF ACIDS OR RECLAMATION OF BASE BY KIDNEYS.

Kidney plays an important role in maintenance of acid-base balance by excreting H+ ions and
retaining bicarbonate ions by Urine Acidification:

The two main functions in Urine Acidification includes:

1- H+ Secretion.
2- Bicarbonate ions Reabsorption.

Renal H+ Secretion:
Excretion of H+ occurs by three mechanisms:
1. Phosphate Mechanism.
2. Bicarbonate Mechanism.
3. Ammonia Mechanism.

Phosphate Mechanism
Step-1:
sodium-potassium pump on the baso-lateral membrane. low-sodium in the cell and high
potassium in the cytoplasm.
Step-2:
The concentration of sodium in the lumen of proximal convoluted tubule is high and the
concentration of H+ ions is low in the tubular cell. Thus Na+ moves inside the cell, extruding
H+ ions in the Tubular Fluid and this phenomenon is known as Sodium-hydrogen counter
transport

Step-3:
The concentration gradient of H+ ions in the cell being low indicates that the H+ ions are
transported through Primary active transport. This step is also called Secretion of H+ ions.
Carbonic Acid (Bicarbonate Mechanism)
Step-4:
The secreted H+ ions combines with Bicarbonate ions HCO3 that are already in the Tubular
Fluid. H+ ions and HCO3 together will allow to form Carbonic Acid- H2CO3.
Step-5: Carbonic Acid goes to the border of cell and dissociates into Carbon dioxide and
Water in the presence of Carbonic Anhydrase Enzyme.
Step-6: Carbon dioxide moves inside the cell and combines with the water molecules that are
already present inside. Carbon dioxide and water molecules once again forms carbonic Acid.
Step-7:
Carbonic Acid further breaks down into H+ ions and Bicarbonate ions.
Step-8:
Bicarbonate from the tubular cell enters the interstitium. Simultaneously, Na+ is reabsorbed
from the renal tubule under the influence of aldosterone.
Step-9: bicarbonate being re-absorbed by using Chloride transporter. Chloride ions moves
inside the cell while bicarbonate moves in the interstitial space. This step is also called
Chloride-Bicarbonate Counter-Transport.
Step-10:
Bicarbonate combines with Sodium to form Sodium Bicarbonate. Now the H+ is secreted
into the tubular lumen from the cell in exchange for Na+.

Ammonia Mechanism
Step-11:
Ammonia in tubular cell is formed when the amino acid Glutamine is converted into
Glutamic Acid in the presence of the enzyme Glutaminase. Ammonia (NH3) formed in
tubular cells is secreted into tubular lumen in exchange for sodium ion.
Step-12: it combines with H+ to form Ammonium (NH4). Thus, H+ is added to urine in the
form of Ammonium Compounds resulting in acidification of urine.

REABSORPTION OF BICARBONATE
For each NH4 excreted one HCO3 is added to interstitial fluid. Thus, by excreting H+ and
conserving HCO3, kidneys produce acidic urine and help to maintain the acid-base balance of
body fluids
 Peritubular space
Tubular fluid Cell (interstitium)

Glutamine
NH3 + H + NH4 11
12
Na NH3
NH3 ++

4 10
1
H+ + HCO3- Na+ + HCO3
Na
H2CO3 aa NaHCO3

K aa
2 a

Na

H+

3 HCO3-

H+ Cl
+ 8
5
Na
CA
7
H+ + HCO3-

H2O + CO2

6 H2O + CO2 H2CO3

BUFFER SYSTEM

A buffer is a compound that limits the change in hydrogen ion concentration, when hydrogen
ions are added or removed from the solution. All buffers are in fact weak acids or base.

Common buffers are:- Protein, haemoglobin, bicarbonate and phosphates.

Buffers are act as a sponge that soak up extra hydrogen ion and can be squeezed to release
extra hydrogen ion.