ACID-BASE BALANCE

Muresan Simona
BLOOD pH

Acidity and alkalinity are expressed on the pH scale,

which ranges from 0 (strongly acidic) to 14 (strongly
basic, or alkaline). A pH of 7.0, in the middle of this
scale, is neutral.

Blood is normally slightly basic, with a pH range of
7.35 to 7.45. To function properly, the body
maintains the pH of blood close to 7.40.
The body uses different mechanisms to control the
blood's acid-base balance:
-Role of the Lungs: the release of CO2.
Carbon dioxide, which is mildly acidic, is constantly produced by
cells and it gets excreted into the blood. The blood carries carbon
dioxide to the lungs, where it is exhaled. As carbon dioxide
accumulates in the blood, the pH of the blood decreases (acidity
increases). The brain regulates the amount of carbon dioxide that
is exhaled by controlling the speed and depth of breathing. The
amount of carbon dioxide exhaled, and consequently the pH of
the blood, increases as breathing becomes faster and deeper. By
adjusting the speed and depth of breathing, the brain and lungs
are able to regulate the blood pH minute by minute.
-Role of the Kidneys: the excretion of acids and bases.
The kidneys are able to affect blood pH by excreting excess acids
or bases. The kidneys have some ability to alter the amount of
acid or base that is excreted,but the kidneys make these
adjustments more slowly than the lungs do(several days).
 Buffer Systems:

combinations of the body's own naturally occurring weak acids
and weak bases. (These weak acids and bases exist in balance
under normal pH conditions.) The pH buffer systems work
chemically to minimize changes in the pH of a solution by
adjusting the proportion of acid and base.

Any substance that can reversibly bind hydrogen ions is called
a buffering agent. They function to impede any change in pH.
Hydrogen ions are buffered by extracellular (e.g., bicarbonate,
ammonia) and intracellular buffering agents (including proteins
and phosphate). The buffering ability of plasma acts as an
immediate defense against pH imbalance.

The most important pH buffer system in the blood involves
carbonic acid (a weak acid formed from the carbon dioxide
dissolved in blood) and bicarbonate ion.

CO2+H20 <==> H2CO3 <==> HCO3- + H+

 Acidosis and Alkalosis

There are two abnormalities of acid-base balance.

Acidosis: The blood has too much acid (or too little base), resulting in
a decrease in blood pH.( <7.4)

Alkalosis: The blood has too much base (or too little acid), resulting
in an increase in blood pH.(>7.4)

Acidosis and alkalosis are not diseases but rather are the result of a
wide variety of disorders.

Acidosis and alkalosis are categorized as metabolic or respiratory,

depending on their primary cause:
-Metabolic acidosis and metabolic alkalosis are caused by an imbalance
in the production of acids or bases and their excretion by the
kidneys.
-Respiratory acidosis and respiratory alkalosis are caused primarily by
changes in carbon dioxide exhalation due to lung or breathing
disorders .
Acidosis

Acidosis is excessive blood acidity caused by an overabundance

of acid in the blood or a loss of bicarbonate from the blood
(metabolic acidosis), or by a buildup of carbon dioxide in the
blood that results from poor lung function or slow breathing
(respiratory acidosis).

If an increase in acid overwhelms the body's pH buffering

systems, the blood will become acidic. As blood pH drops, the
parts of the brain that regulate breathing are stimulated to
produce faster and deeper breathing. Breathing faster and deeper
increases the amount of carbon dioxide exhaled.

The kidneys also try to compensate by excreting more acid in the
urine. However, both mechanisms can be overwhelmed if the
body continues to produce too much acid, leading to severe
acidosis and eventually coma.
Major Causes of Metabolic Acidosis

Diabetic ketoacidosis (buildup of ketones)

Drugs and substances such as acetazolamide , alcohol, aspirin ,
iron

Lactic acidosis (buildup of lactic acid as occurs in shock)

Loss of bases, such as bicarbonate, through the digestive tract from
diarrhea, an ileostomy, or a colostomy

Kidney failure

Poisons such as carbon monoxide, cyanide, ethylene glycol,
methanol,

Renal tubular acidosis (a form of kidney malfunction)
Major Causes of Respiratory Acidosis

Lung disorders, such as emphysema, chronic

bronchitis, severe asthma, pneumonia, or
pulmonary edema

Sleep-disordered breathing

Diseases of the nerves or muscles of the chest that
impair breathing, such as Guillain-Barré syndrome
or amyotrophic lateral sclerosis

Overdose of drugs such as alcohol, opioids, and
strong sedatives
Alkalosis

Alkalosis is excessive blood alkalinity caused by an
overabundance of bicarbonate in the blood or a loss of acid from
the blood (metabolic alkalosis), or by a low level of carbon
dioxide in the blood that results from rapid or deep breathing
(respiratory alkalosis).

Metabolic alkalosis

Loss of acid from vomiting or drainage of the stomach

Overactive adrenal gland (Cushing's syndrome)

Use of diuretics ( furosemide , ethacrynic acid )

Respiratory alkalosis

Anxiety

Aspirin overdose (early stages)

Fever

Low levels of oxygen in the blood(altitude)

Pain
Diagnosis

CO2+H20 <==> H2CO3 <==> HCO3- + H+

pH = − log10[H + ]

Normal values:
- pH - 7.4
- pCO2 - 40 mmHg
- HCO3 – 24 mEq/l