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Topic

Acid-Base Homeostasis
BY

Rashid Hussain
Post R.N Bsc Nursing

Khyber Medical University

Post Graduate Nursing College Hayatabad


Peshawar. 1
OBJECTIVES

At the end of the session the learner will be able


to:

 Overview the Acid-Base Homeostasis.


 Describe acids and bases and types acids in the
body.
 Explain different types of Acid-Base balance systems.
 Discuss Acidosis and Alkalosis.

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Acid-Base Homeostasis
 Acid-base homeostasis is the part of human homeostasis
concerning the proper balance between acids and bases, in
other words, the pH. The body is very sensitive to its pH level,
so strong mechanisms exist to maintain it. Outside the
acceptable range of pH, proteins are denatured and digested,
enzymes lose their ability to function, and death may occur.

 acid-base balance  a normal balance between production and


excretion of acid or alkali by the body, resulting in a stable
concentration of H+ in body fluids.

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Conti…

 When the body is in a state of acid-base balance, it maintains a stable


hydrogen ion concentration in body fluids; specifically, blood pH
remains relatively constant between 7.35 and 7.45

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ACIDS BASES

 Molecules that can  Molecule that accept H+ called


base
release H+ in solution
 HCO3- + H+ ---> H2CO3
called acids  HPO4 - + H+  H2PO4
 HCl  H+ + Cl-  Bases may be strong or weak
Strong base reacts rapidly and
 H2Co3  HCO3- + H+ 

strongly with H+ (HCO3-)


 Acid may be strong  Proteins also function as base
acid which completely  Hemoglobin Hb + H+ HHb

dissociates
 While weak acids have
less tendency to
dissociate
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There are two types of acids
formed:
 Volatile acids can be  Non-Volatile acids Cannot be
excreted from the body as eliminated by the lungs and
must be eliminated by the
gas. Carbonic acid produced
kidneys
by the hydration of carbon
 All metabolic acids except
dioxide is a volatile acid carbolic are non-volatile acids
 Normally carbon dioxide is  These include sulfuric acid,
excreted by the lungs as fast phosphoric acid, lactic acid,
as metabolism produces it, so ketoacids like acetoacetic acid
carbonic acid is not allowed to and beta hydroxybutyric acid,
and small amounts of other
accumulate and alter pH
inorganic and organic acids

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A Review of Important Terms
Relating to Acid-Base Balance

 pH: The negative exponent (negative log) of the


hydrogen ion concentration.
 Neutral: A solution with a pH of 7, which
contains equal numbers of hydrogen and
hydroxyl ions.
 Acidic: A solution with a pH below 7, in which
hydrogen H+ ions predominate.
 Basic or Alkaline: A solution with a pH above 7,
in which hydroxyl OH- ions predominate.
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Conti

 Acids: A substance that dissociates to release hydrogen
ions, shifting the pH towards acidity.

 Base: A substance that dissociates to release hydroxyl


ions or tie up hydrogen ions and shifting the pH towards
alkalinity

 Salt: An ionic compound consisting of a cation other than


hydrogen ions and anion other then a hydroxide ion.

 Buffers: A substance that tends to oppose changes in


the pH of solution by removing or replacing H+ ions in the
body fluids, Buffers maintain pH within normal limits
(7.35-7.45)

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Acid Base Balance
 Three primary system to maintain H+
concentration:
• Chemical Buffers: - chemical system, act
with in seconds to neutralize H+ excess

• Respiratory System– Activate with in


minutes to remove CO2

• Kidneys:- response slowly to remove acid or


alkali from body, only way to eliminate acids
other than H2CO3. (minutes to hours)

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Buffer Systems in Body Fluids

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3 Major Chemical Buffer
Systems
 Protein buffer systems:
• Help regulate pH in ECF and ICF
• Interact extensively with other buffer
systems

 Carbonic acid–bicarbonate buffer


system:
• Most important in ECF

 Phosphate buffer system:


• Buffers pH of ICF and urine
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1: Protein Buffer system
 Is the most abundant buffer in intracellular fluid and blood plasma:

a) Albumin in the blood plasma.


 Protein are composed of amino acids, that contain at least
one carboxyl group (--COOH) an at least one amino group
(NH2).
 The free carboxyl group at one end of a protein acts like
an acid by releasing H+ ions, when pH rises.
 The free amino group at the other en of a protein can act
as a base by combining H+, when pH falls.
 So protein can buffer both acids and bases.

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Amino Acids in
Protein Buffer Systems

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b) Hemoglobin within RBCs.

 As blood flow through the systemic capillaries,


CO2 passes from tissues cells into RBCs, here it
combine with H2O to form H2CO3,

 Once formed H2CO3 dissociate into H+ and HCO3-

 At the same time CO2 entering the RBCs and O2


to the tissue cells.

 Deoxyhemoglobin picks up most of the H+,


written as Hb-H.

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CARBON DIOXIDE DIFFUSION
Systemic Circulation
Red Blood Cell
Plasma

Cl-
carbonic (Chloride Shift)
anhydrase
CO2 + H2O H+ + HCO3-

HCO3-

CO2 diffuses into plasma and into RBC Within


CO2 RBC, the hydration of CO2 is catalyzed by
carbonic anhydrase
Bicarbonate thus formed diffuses into plasma
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CO2 Tissues
CARBON DIOXIDE DIFFUSION
Systemic Circulation
Red Blood Cell
Plasma
carbonic
anhydrase
Cl-

+ H + + HCO3-

H+ is buffered by
Hemoglobin
Hb
H2O
Click for Carbon
Dioxide diffusion

CO CO2 CO2 Tissues


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2 CO2 CO2 CO2 CO2 CO2
BICARBONATE DIFFUSION

Red Blood Cell Pulmonary Circulation


Plasma

Cl-
HCO3-
CO2 + H2O H+ + HCO3-

CO2 Bicarbonate diffuses back into RBC in


pulmonary capillaries and reacts with hydrogen
ions to form carbonic acid

The acid breaks down to CO2 and water


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Alveolus
BICARBONATE DIFFUSION

Red Blood Cell Pulmonary Circulation


Plasma

Cl-

CO2+ H2O + HCO3-

CO2 H+

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Alveolus
2: Bicarbonate-Carbonic Acid
Buffer System
 Bicarbonate buffer system is the most
powerful ECF buffer
 Blood Buffer systems act instantaneously
and thus constitute the body’s first line of
defense against acid-base imbalance
 HCO3- and CO2 are regulated by kidney and
lung
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2: Bicarbonate-Carbonic Acid
Buffer System
 Is based on the concentration of HCO3- ions, which
acts as a weak base and H2CO3, which acts as weak
acid.
 HCO3- is a significant anion in both ICFs & ECFs
 If there is an excess of H+ ions, the HCO3- can
function as weak base an remove the excess H+.

• H+ + HCO3- H2CO3 CO2 + H2O


 Then H2CO3 dissociate into water and carbon dioxide
and CO2 is exhaled from the lungs.
 Conversely, if there is a shortage of H+, the H2CO3 can
function as a weak acid and provide H+ .

• H2CO3  HCO3- + H+ 20
3: Phosphate buffer system
 Main elements are H2 PO4- and HPO4=

 Buffer in renal tubular fluid and ICF.

 When HCl is added to buffer


HCl +Na2HPO4 NaH2PO4 + NaCl

 Strong acid HCl is replaced by weak acid


NaH2PO4 and change in pH minimized

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Phosphate Buffer

 Concentration of Phosphate is less in ECF


 So Phosphate buffer system act much less in
ECF.
 Main site of action are ICF and renal tubular
fluids, where Phosphate is in abundant and
pH is less as compared to ECF

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Respiratory regulation of Acid
base balance
 Lungs 2nd line of defense in maintaining acid base balance

 CO2 continuously forming in cellular metabolism

 It than diffuses into interstitial fluid and blood, transported to


lungs and out of body

 Increased ventilation decreases CO2 and reduces H+,

decreased ventilation increases CO2 and H+

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Respiratory Buffer
 Normal CO2 in ECF is 1-2 ml/L equals to PCO2 of 40
mmHg

 Change in pulmonary ventilation or rate of CO2

formation can change ECF PCO2

 So rate of metabolic formation of CO2 decreases,


Rate of ventilation decreases

 Rate of metabolic formation of CO2 increases, rate of


ventilation increases

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Effect of H+ Concentration on
Alveolar Ventilation
 Respiratory compensation in not as effective in
case of increase in pH, as it is effective in reduction
in pH.
 If pH decreases from 7.4 to 7.0, alveolar ventilation
rate will increase 04-05 times.
 Change in alveolar ventilation rate will be more in
case of increase in H+ as compared to decrease in
H+
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Respiratory Buffer

 Over all buffering power of respiratory system is


one to two times as great as the buffering power of
all other chemical buffers in ECF

 H+ concentration is regulated by negative feed back


with alveolar ventilation

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Respiratory Buffer

 Respiratory control of pH is only effective


up to 50% -70%

 If pH is suddenly falls from 7.4 to 7.0


respiratory system will bring it up to 7.2 to
7.3

 Response occur in 3-12 minutes

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ACIDOSIS
 Acidosis is a decrease in pH below 7.35

• Which means a relative increase of H ions


+

• pH may fall as low as 7.0 without irreversible damage


but any fall less than 7.0 is usually fatal

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H +
= pH
ACIDOSIS
 May be caused by:

• An increase in H2CO3

• A decrease in HCO 3
-

 Both lead to a decrease in the ratio of 20:1

H2CO3 HCO 3
-
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ALKALOSIS
 Alkalosis is a increase in pH above 7.45

• Which means a relative decrease of H+ ions


+

• pH may rise as high as 8.0 without irreversible


damage but any rise more than 8.0 is usually fatal

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H +
= pH
ALKALOSIS
 May be caused by:

• An increase in HCO3-

• A decrease in H2CO3
 Both lead to a increase in the ratio of 20:1

H2CO3 HCO 3
-
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Acid-Base Imbalances

 pH < 7.35 acidosis


 pH > 7.45 alkalosis

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ACIDOSIS
decreased failure of metabolic production absorption of prolonged
removal of kidneys to acid of keto acids metabolic acids diarrhea
CO2 from excrete from GI tract
lungs acids

accumulation accumulation excessive loss


of CO2 in blood of acid in blood of NaHCO3
from blood

deep
vomiting
from
respiratory metabolic GI tract
increase in
acidosis plasma H+ acidosis
concentration kidney
disease
(uremia)

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depression of
nervous system
ALKALOSIS
anxiety overdose high prolonged ingestion of excess
of certain altitudes vomiting excessive aldosterone
drugs alkaline drugs

hyperventilatio
hyperventilation loss of acid accumulation
n 2 and
loss of CO of base
Hloss CO2 and
2CO3 from
H2CO 2 from
blood

respiratory metabolic
alkalosis alkalosis
decrease
in plasma H+
concentration

overexcitability
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system
Normal Blood Gas Values
 pH – 7.35 - 7.45
 PCO2 - 35 – 45 mmHg
 HCO3 – 22 – 26 meq/liter
 PO2 – 90-100 mmHg
 O2 Saturation 94-97%
 BE – base excess = + 2 meq/liter
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ACIDOSIS AND ALKALOSIS

 Metabolic Acidosis:- Primary decrease in HCO3-

 Metabolic alkalosis:- Primary increase in HCO3-

 Respiratory acidosis:- Increase in PCO2

 Respiratory Alkalosis:- Decrease in PCO2

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Don’t see others doing
better than you…
Beat your own records
everyday!!
Because success is a
fight between YOU and
YOURSELF…
Victory is not the property of
the brilliants…
It is the crown for those who
believe in hard work.
Winners never quit
and quitters never wins…
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