Objectives

Basics of Acid-base balance:

• Define: acid and base.
• Explain what is meant by strong and weak acids and bases
• List and identify the names/formulas for the common strong acids and strong bases.
• To explain the role of Henderson-Hasselbalch equation in acid-base regulation

Buffer systems:
• To define buffer system and discuss the role of blood buffers and to explain their relevant roles
in the body
• To describe the role of kidneys in the regulation of acid-base balance
• To describe the role of lungs in the regulation of acid-base balance
Basics of Acid Base Balance
What pH represent?
H+ concentration in the blood

What is the normal range of pH?

- in general: 0-14
- in the blood: 7.35-7.45
- Extracellular fluid (ECF): 7.4

What is the type of blood sample should be

taken to measure pH and Why?
Arterial blood sample (not venous),
because it represents the actual contents of
blood such as Oxygen, nutrients.. Etc.

Does pH in the body change?

Yes, like exercise body will add some hydrogen What is the survival range of pH in the blood?
to blood through lactic acid and change pH. Between 6.8 and 8. More or less will lead to death
How can we calculate the pH?
pH= 1/H+ concentration log When we said it is acidosis or alkalosis?
OR -pH less than 7.35 (acidosis)
pH= - log [H+] -pH more than 7.45 (alkalosis)
 What acids and bases? Why pH tightly regulated and small changes
-Acids are H+ donors in pH is a serious condition?
-Bases are H+ acceptors
Why acids more than bases in our bodies? -Most enzymes work only in specific pH
1.Food that contain proteins and lipids are rich in (change in pH → enzymes become inactive)
acids
-Change in pH cause disturbance in electrolytes -
2.The end cellular metabolism in mitochondria Can affect some hormones
produced CO2 which source of H+ from the -Acidosis can cause depression of synaptic ending
following reaction: and lead to coma such as a patient with diabetes
CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3 ketoacidosis and Hypercalcaemia
Why venous blood is more acidic than arterial? -Alkalosis can cause convulsion , muscle twitching,
Because it has higher CO2 concentration tetany and hypocalcemia
than arterial blood

Strong and weak acids and bases

•Strong acid = HCL (complete dissociation)
•Weak acid = Lactic acid,CO2,H2CO3 “Carbonic acid” (Partial dissociation)
•Strong base = NaOH (complete dissociation)
•Weak base = NaHCO3,HCO3 (Partial dissociation)
Contact us: [email protected]
Buffer systems
 Systems that regulate pH
-Chemical buffer system: (first line)
Buffer system (immediately)
-Physiological buffer system: (second line)
1.Respiratory system (from minutes to hours)
2.Renal system (from hours to days) The most
effective regulator of pH

The component of chemical buffer system

1. Bicarbonate buffer (intracellular and extracellular)

2. Phosphate buffer (intracellular and renal tubule fluid)
3. Protein buffer (the most important intracellular)

What is the goal of chemical buffer systems?

Convert strong acids and bases to weak acids

and bases to maintain blood pH

The most important feature of chemical buffers

pH of buffer must be the same or very close to
the pH of sites that buffer work in. to observe
the changes in pH.
• Bicarbonate buffer
What are the components of bicarbonate buffer How bicarbonate buffer work?
system? We must have acid and base to react with each
-Sodium bicarbonate: NaHCO3 regulated by kidney other. Then:
-Carbonic acid: H2CO3 regulated by lungs through
equation:
CO2 + H2O → H2CO3

Why it is the most important extracellular buffer How can we calculate blood pH through
system? bicarbonate buffer?
Because it regulated by kidney and lungs By Handerson-Hasselbalch equation:

What is the concentration of HCO3 in the blood

and what it is called?
Its concentration in blood equals = 27mEq/L and is Note that 6.1 represent pH of the buffer not the
called alkali reserve. blood
 • Phosphate buffer
What are the components of bicarbonate buffer system?
-Hydrophosphate: HPO4 which bind to H+ to Increase pH
-Dihydrophosphate: H2PO4 which bind to OH to Decrease pH
pH of phosphate is
around 5 (acidosis)
Why it is the most important kidney or renal tubules buffer system? because of that it works
Because it has pH that so close to the pH of fluid in the tubules inside the cell

• Proteins buffer
-Hemoglobin:
the most important
Carboxyl group gives H+ “Decrease pH” intracellular buffer as follow
Amino group accept H+ “Increase pH” 1)Intracellular proteins buffer
2)Phosphate buffer
-Plasma proteins 3) Bicarbonate buffer
-Intracellular proteins (the most important intracellular buffer)
 Respiratory mechanism
What are the components of system?
The only component regulated here is CO2 (carbon dioxide) which is volatile acids.
It cannot deal with fixed acids such lactic acids that accumulate in skeletal muscles.
(Fixed acids is regulated by kidneys)

What is the general mechanism?

pH can be adjusted by changing RATE and DEPTH of breathing.
Patient with acidosis → Hyperventilation → wash out CO2 → increase pH
Patient with alkalosis → Hypoventilation → retain CO2 → Decrease pH

What happened if a healthy person has FAST hyperventilation?

He will stop ventilation after 15 seconds because amount of CO2 reduced and
chemoreceptors in the brain will observe this reduction. Therefore, it will inhibit ventilation.

What happened if a healthy person has chronic hyperventilation?

Patient with Anorexia will develop alkalosis due to reduction in CO2.
 Renal mechanism
What is the normal secretion of H+ and reabsorbation of HCO3 per day?
Secretion H+ = 4400 mEq/day
Filtration HCO3 = 4320 mEq/day
So, the 80 that remains must be titers by ammonia and phosphate buffer systems

What is the general mechanism?

Secretion of H+:
1.Sodium/H+ counter transport (PCT, Thick ascending loop and early DCT)
2.H+ pump (Late DCT and collecting ducts) “phosphate buffer”
3.Secretion of H+ with ammonia “ammonia buffer”

Reabsorbation of HCO3:
1.Reabsorbation of 99% of filtered HCO3 (PCT, Thick ascending loop and early DCT)
2.Generate a new one HCO3 by intercalated cells (Late DCT and collecting ducts) “phosphate buffer”
3.Generate new two HCO3 from glutamine “ammonia buffer”
 H+ secretion and HCO3- reabsorption occur in all parts of tubules EXCEPT:
1- descending and
2- thin ascending loop of Henle.
Keep in mind that for each HCO3- reabsorption, a H+ must be secreted.

Carbonic
Bicarbonate is anhydrase
filtered in
Cl-
glomeruli

tubules secrete H+ by
H+ is excreted into the lumen (step 1) Na-H Counter-transport
and HCO3- backs into the circulation
by counter-transport with Cl. (secondary active
transport) - Carbonic anhydrase is an enzyme that combines HCO3- with H+
to make H2CO2. And dissociates H2CO3 to H+ and HCO3-
- Carbonic anhydrase inhibitors will create alkaline urine > body
won’t be able to excrete H+ and reabsorbed H2CO3. (Will be
discussed in 1st pharmacology lecture)
- In renal failure the body won’t be able to do this function, which
result of acidosis.
CO2 diffuses into the cell passively and
H+ is combined with HCO3-
i- combines again with H2O by to form Carbonic acid which
carbonic anhydrase to form carbonic In circulation : reabsorption of HCO3- by counter – transport with Cl.
acid which is converted to Co2 + H2O by In the tubules lumin : reabsorption of HCO3- by counter – transport
ii- dissociates to H+ and HCO3- carbonic anhydrase with Na.
Why there is a buffer system for tubules by ammonia and phosphate?
Because H+ reduced tubular pH 4.5. This is the lower limit that can be achieved in normal
kidneys. Further decrease will cause tubular acidosis.

What is the most important buffer of renal tubules? Ammonia or phosphate?

Ammonia because excreted two H+ and formation two HCO3

• No filtrated Bicarbonate in tubules

• CO2 binds to H2O to form H2CO3

• H2CO3 dissociates to bicarbonate and H+

• Bicarbonate is secreted back to blood as “new

bicarbonate synthesized by metabolism”

• H+ is pumped into the tubular fluid. And it will bind

to monohydrate phosphate (buffer of tubules)
 Ammonia buffers H+ and form Ammonium

Acidosis → metabolize of
glutamine into Two NH3
(ammonia) and Two HCO3
→ Two H+ will bind with
two NH3 to form two NH4
(ammonium) → Secreted of
H++NH3
NH4 to tubules → NH4 bind
with Cl to form ammonium
chloride → excreted with Two “New” HCO3-
urine
 Ans: 1-C, 2-B, 3-A, 4-A, 5-D, 6-D, 7-C. 8-D,
1-What pH represent?
A-CO2 concentration 6-generation of new HCO3 take place in:
B-HCO3 concentration A- PCT
C-H+ concentration B- DCT
D-OH- concentration C- Collecting ducts
D- Intercalate cells
2-Which of the following is a strong base?
A-HCl
B- NaOH 7-Which of the following is a part of mechanism of phosphate buffer?
C-HCO3 A- generation of two HCO3
D-H2CO3 B- generation of two HPO4
C- generation of one HCO3
3-A patient with acidosis. He may develop: D- generation of one HPO4
A-Coma
B-Convlusion 8-Ammonia will excreted in the urine as:
C-Tetany A-Ammonium
D-muscle twitching B-Ammonia
C-Ammonium phosphate
4-Venous blood is more acidic than arterial blood due to: D-Ammonium chloride
A-CO2 concentration
B-HCO3 concentration
C-H+ concentration
D-OH- concentration

5- Which of the following is a protein buffer:

A-Albumin
B-Myosin
C-Actin
D-Hemoglobin