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ACID AND BASE BALANCE AND
IMBALANCE
PROBLEM BASED LEARNING (PBL)
PREPARED BY: MUHAMMAD ARIFF B.
MAHDZUB
BACHELOR MEDICINE AND SURGERY (MBBS)
UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN
2
pH Review
• pH = - log [H+
]
• H+
is really a proton
• Range is from 0 - 14
• If [H+
] is high, the solution is acidic; pH < 7
• If [H+
] is low, the solution is basic or
alkaline ; pH > 7
3
4
5
• Acids are H+
donors.
• Bases are H+
acceptors, or give up OH-
in
solution.
• Acids and bases can be:
–Strong – dissociate completely in
solution
• HCl, NaOH
–Weak – dissociate only partially in
solution
• Lactic acid, carbonic acid
6
The Body and pH
• Homeostasis of pH is tightly controlled
• Extracellular fluid = 7.4
• Blood = 7.35 – 7.45
• < 6.8 or > 8.0 death occurs
• Acidosis (acidemia) below 7.35
• Alkalosis (alkalemia) above 7.45
7
8
Small changes in pH can produce
major disturbances
• Most enzymes function only with narrow
pH ranges
• Acid-base balance can also affect
electrolytes (Na+
, K+
, Cl-
)
• Can also affect hormones
9
The body produces more acids
than bases
• Acids take in with foods
• Acids produced by metabolism of lipids
and proteins
• Cellular metabolism produces CO2.
• CO2 + H20 ↔ H2CO3 ↔ H+
+ HCO3
-
10
Control of Acids
1. Buffer systems
Take up H+ or release H+ as conditions
change
Buffer pairs – weak acid and a base
Exchange a strong acid or base for a
weak one
Results in a much smaller pH change
11
Bicarbonate buffer
• Sodium Bicarbonate (NaHCO3) and
carbonic acid (H2CO3)
• Maintain a 20:1 ratio : HCO3
-
: H2CO3
HCl + NaHCO3 ↔ H2CO3 + NaCl
NaOH + H2CO3 ↔ NaHCO3 + H2O
12
Phosphate buffer
• Major intracellular buffer
• H+
+ HPO4
2-
↔ H2PO4-
• OH-
+ H2PO4
-
↔ H2O + H2PO4
2-
13
Protein Buffers
• Includes hemoglobin, work in blood and ISF
• Carboxyl group gives up H+
• Amino Group accepts H+
• Side chains that can buffer H+
are present on
27 amino acids.
14
2. Respiratory mechanisms
• Exhalation of carbon dioxide
• Powerful, but only works with volatile
acids
• Doesn’t affect fixed acids like lactic acid
• CO2 + H20 ↔ H2CO3 ↔ H+
+ HCO3
-
• Body pH can be adjusted by changing rate
and depth of breathing
15
3. Kidney excretion
• Can eliminate large amounts of acid
• Can also excrete base
• Can conserve and produce bicarb ions
• Most effective regulator of pH
• If kidneys fail, pH balance fails
16
Rates of correction
• Buffers function almost instantaneously
• Respiratory mechanisms take several
minutes to hours
• Renal mechanisms may take several
hours to days
17
18
19
Acid-Base Imbalances
• pH< 7.35 acidosis
• pH > 7.45 alkalosis
• The body response to acid-base
imbalance is called compensation
• May be complete if brought back within
normal limits
• Partial compensation if range is still
outside norms.
20
Compensation
• If underlying problem is metabolic,
hyperventilation or hypoventilation can
help : respiratory compensation.
• If problem is respiratory, renal
mechanisms can bring about metabolic
compensation.
21
Acidosis
• Principal effect of acidosis is depression of the
CNS through ↓ in synaptic transmission.
• Generalized weakness
• Deranged CNS function the greatest threat
• Severe acidosis causes
–Disorientation
–coma
–death
22
Alkalosis
• Alkalosis causes over excitability of the central
and peripheral nervous systems.
• Numbness
• Lightheadedness
• It can cause :
– Nervousness
– muscle spasms or tetany
– Convulsions
– Loss of consciousness
– Death
23

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Acid and base regulation

  • 1. 1 ACID AND BASE BALANCE AND IMBALANCE PROBLEM BASED LEARNING (PBL) PREPARED BY: MUHAMMAD ARIFF B. MAHDZUB BACHELOR MEDICINE AND SURGERY (MBBS) UNIVERSITY COLLEGE SHAHPUTRA, KUANTAN
  • 2. 2 pH Review • pH = - log [H+ ] • H+ is really a proton • Range is from 0 - 14 • If [H+ ] is high, the solution is acidic; pH < 7 • If [H+ ] is low, the solution is basic or alkaline ; pH > 7
  • 3. 3
  • 4. 4
  • 5. 5 • Acids are H+ donors. • Bases are H+ acceptors, or give up OH- in solution. • Acids and bases can be: –Strong – dissociate completely in solution • HCl, NaOH –Weak – dissociate only partially in solution • Lactic acid, carbonic acid
  • 6. 6 The Body and pH • Homeostasis of pH is tightly controlled • Extracellular fluid = 7.4 • Blood = 7.35 – 7.45 • < 6.8 or > 8.0 death occurs • Acidosis (acidemia) below 7.35 • Alkalosis (alkalemia) above 7.45
  • 7. 7
  • 8. 8 Small changes in pH can produce major disturbances • Most enzymes function only with narrow pH ranges • Acid-base balance can also affect electrolytes (Na+ , K+ , Cl- ) • Can also affect hormones
  • 9. 9 The body produces more acids than bases • Acids take in with foods • Acids produced by metabolism of lipids and proteins • Cellular metabolism produces CO2. • CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3 -
  • 10. 10 Control of Acids 1. Buffer systems Take up H+ or release H+ as conditions change Buffer pairs – weak acid and a base Exchange a strong acid or base for a weak one Results in a much smaller pH change
  • 11. 11 Bicarbonate buffer • Sodium Bicarbonate (NaHCO3) and carbonic acid (H2CO3) • Maintain a 20:1 ratio : HCO3 - : H2CO3 HCl + NaHCO3 ↔ H2CO3 + NaCl NaOH + H2CO3 ↔ NaHCO3 + H2O
  • 12. 12 Phosphate buffer • Major intracellular buffer • H+ + HPO4 2- ↔ H2PO4- • OH- + H2PO4 - ↔ H2O + H2PO4 2-
  • 13. 13 Protein Buffers • Includes hemoglobin, work in blood and ISF • Carboxyl group gives up H+ • Amino Group accepts H+ • Side chains that can buffer H+ are present on 27 amino acids.
  • 14. 14 2. Respiratory mechanisms • Exhalation of carbon dioxide • Powerful, but only works with volatile acids • Doesn’t affect fixed acids like lactic acid • CO2 + H20 ↔ H2CO3 ↔ H+ + HCO3 - • Body pH can be adjusted by changing rate and depth of breathing
  • 15. 15 3. Kidney excretion • Can eliminate large amounts of acid • Can also excrete base • Can conserve and produce bicarb ions • Most effective regulator of pH • If kidneys fail, pH balance fails
  • 16. 16 Rates of correction • Buffers function almost instantaneously • Respiratory mechanisms take several minutes to hours • Renal mechanisms may take several hours to days
  • 17. 17
  • 18. 18
  • 19. 19 Acid-Base Imbalances • pH< 7.35 acidosis • pH > 7.45 alkalosis • The body response to acid-base imbalance is called compensation • May be complete if brought back within normal limits • Partial compensation if range is still outside norms.
  • 20. 20 Compensation • If underlying problem is metabolic, hyperventilation or hypoventilation can help : respiratory compensation. • If problem is respiratory, renal mechanisms can bring about metabolic compensation.
  • 21. 21 Acidosis • Principal effect of acidosis is depression of the CNS through ↓ in synaptic transmission. • Generalized weakness • Deranged CNS function the greatest threat • Severe acidosis causes –Disorientation –coma –death
  • 22. 22 Alkalosis • Alkalosis causes over excitability of the central and peripheral nervous systems. • Numbness • Lightheadedness • It can cause : – Nervousness – muscle spasms or tetany – Convulsions – Loss of consciousness – Death
  • 23. 23