26.4 Acid-Base Balance - Anatomy and Physiology

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4 Acid-Base Balance – Anatomy and Physiology
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ANATOMY AND PHYSIOLOGY
CONTENTS
Chapter 26. Fluid, Electrolyte, and Acid-Base Balance
184 26.4 Acid-Base Balance
Learning Objectives
By the end of this section, you will be able to:
Identify the most powerful buffer system in the body

Explain the way in which the respiratory system affects
Previous: 26.3 Electrolyte Balance
blood pH
Next: 26.5 Disorders of Acid-Base Balance
https://opentextbc.ca/anatomyandphysiology/chapter/26-4-acid-base-balance/ 1/17
3/29/2019 26.4 Acid-Base Balance – Anatomy and Physiology
Proper physiological functioning depends on a Decrease

very tightFont Size
balance
between the concentrations of acids and bases in the blood. Acid-
balance balance is measured using the pH scale, as shown in Figure
1. A variety of buffering systems permits blood and other bodily
fluids to maintain a narrow pH range, even in the face of
perturbations. A buffer is a chemical system that prevents a radical
change in fluid pH by dampening the change in hydrogen ion
concentrations in the case of excess acid or base. Most commonly,
the substance that absorbs the ions is either a weak acid, which
takes up hydroxyl ions, or a weak base, which takes up hydrogen
ions.

Decrease Font Size
Figure 1. The pH Scale. This chart

shows where many common substances
fall on the pH scale.
Buffer Systems in the Body
The buffer systems in the human body are extremely efficient, and
different systems work at different rates. It takes only seconds for
the chemical buffers in the blood to make adjustments to pH. The
respiratory tract can adjust the blood pH upward in minutes by
exhaling CO2 from the body. The renal system can also adjust
blood pH through the excretion of hydrogen ions (H+) and the
conservation of bicarbonate, but this process takes hours to days to
have an effect. Next: 26.5 Disorders of Acid-Base Balance
The buffer systems functioning in blood plasmaDecrease Font Size

include plasma
proteins, phosphate, and bicarbonate and carbonic acid buffers. The
kidneys help control acid-base balance by excreting hydrogen ions
and generating bicarbonate that helps maintain blood plasma pH
within a normal range. Protein buffer systems work predominantly
inside cells.
Protein Buffers in Blood Plasma and Cells
Nearly all proteins can function as buffers. Proteins are made up of

amino acids, which contain positively charged amino groups and
negatively charged carboxyl groups. The charged regions of these
molecules can bind hydrogen and hydroxyl ions, and thus function
as buffers. Buffering by proteins accounts for two-thirds of the
buffering power of the blood and most of the buffering within cells.
Hemoglobin as a Buffer
Hemoglobin is the principal protein inside of red blood cells and

accounts for one-third of the mass of the cell. During the
conversion of CO2 into bicarbonate, hydrogen ions liberated in the
reaction are buffered by hemoglobin, which is reduced by the
dissociation of oxygen. This buffering helps maintain normal pH.
The process is reversed in the pulmonary capillaries to re-form
CO2, which then can diffuse into the air sacs to be exhaled into the
atmosphere. This process is discussed in detail in the chapter on the
respiratory
Previous:system.
26.3 Electrolyte Balance

Phosphate Buffer Decrease Font Size
Phosphates are found in the blood in two forms: sodium

dihydrogen phosphate (Na2H2PO4−), which is a weak acid, and
sodium monohydrogen phosphate (Na2HPO42-), which is a weak
base. When Na2HPO42- comes into contact with a strong acid,
such as HCl, the base picks up a second hydrogen ion to form the
weak acid Na2H2PO4− and sodium chloride, NaCl. When
Na2HPO42− (the weak acid) comes into contact with a strong base,
such as sodium hydroxide (NaOH), the weak acid reverts back to
the weak base and produces water. Acids and bases are still present,
but they hold onto the ions.
HCl + Na2HPO4→NaH2PO4 + NaCl
(strong acid) + (weak base) → (weak acid) + (salt)
NaOH + NaH2PO4→Na2HPO4 + H2O
(strong base) + (weak acid) → (weak base) + (water)
Bicarbonate-Carbonic Acid Buffer
The bicarbonate-carbonic acid buffer works in a fashion similar to

phosphate buffers. The bicarbonate is regulated in the blood by
sodium, as are the phosphate ions. When sodium bicarbonate
(NaHCO3), comes into contact with a strong acid, such as HCl,
carbonic acid (H2CO3), which is a weak acid, and NaCl are formed.
When carbonic acid comes into contact with a strong base, such as
NaOH, bicarbonate and water are formed.
NaHCO3 + HCl → H2CO3+NaCl
Previous:(sodium
26.3 Electrolyte Balance
bicarbonate) + (strong acid) → (weak acid) + (salt)
H2CO3 + NaOH→HCO3- + H2O
Next:
(weak acid) + (strong 26.5 Disorders of+Acid-Base
base)→(bicarbonate) (water) Balance
As with the phosphate buffer, a weak acid or weakDecrease Font Size

base captures
the free ions, and a significant change in pH is prevented.
Bicarbonate ions and carbonic acid are present in the blood in a
20:1 ratio if the blood pH is within the normal range. With 20 times
more bicarbonate than carbonic acid, this capture system is most
efficient at buffering changes that would make the blood more
acidic. This is useful because most of the body’s metabolic wastes,
such as lactic acid and ketones, are acids. Carbonic acid levels in
the blood are controlled by the expiration of CO2 through the lungs.
In red blood cells, carbonic anhydrase forces the dissociation of the
acid, rendering the blood less acidic. Because of this acid
dissociation, CO2 is exhaled (see equations above). The level of
bicarbonate in the blood is controlled through the renal system,
where bicarbonate ions in the renal filtrate are conserved and
passed back into the blood. However, the bicarbonate buffer is the
primary buffering system of the IF surrounding the cells in tissues
throughout the body.
Respiratory Regulation of Acid-Base Balance
The respiratory system contributes to the balance of acids and bases

in the body by regulating the blood levels of carbonic acid (Figure
2). CO2 in the blood readily reacts with water to form carbonic
acid, and the levels of CO2 and carbonic acid in the blood are in
equilibrium. When the CO2 level in the blood rises (as it does when
you hold your breath), the excess CO2 reacts with water to form
additional carbonic acid, lowering blood pH. Increasing the rate
and/or depth of respiration (which you
Next: 26.5 might feel
Disorders the “urge”
of Acid-Base to do
Balance
after holding your breath) allows you to exhaleDecrease

more COFont Size
2. The loss
of CO2 from the body reduces blood levels of carbonic acid and
thereby adjusts the pH upward, toward normal levels. As you might
have surmised, this process also works in the opposite direction.
Excessive deep and rapid breathing (as in hyperventilation) rids the
blood of CO2 and reduces the level of carbonic acid, making the
blood too alkaline. This brief alkalosis can be remedied by
rebreathing air that has been exhaled into a paper bag. Rebreathing
exhaled air will rapidly bring blood pH down toward normal.
Figure 2. Respiratory Regulation of

Blood pH. The respiratory system
can reduce blood pH by removing
CO2 from the blood.
The chemical reactions that Next:

regulate the levelsofofAcid-Base
26.5 Disorders CO2 andBalance
carbonic
Decrease
acid occur in the lungs when blood travels through Font Size
the lung’s
pulmonary capillaries. Minor adjustments in breathing are usually
sufficient to adjust the pH of the blood by changing how much CO2
is exhaled. In fact, doubling the respiratory rate for less than 1
minute, removing “extra” CO2, would increase the blood pH by
0.2. This situation is common if you are exercising strenuously
over a period of time. To keep up the necessary energy production,
you would produce excess CO2 (and lactic acid if exercising
beyond your aerobic threshold). In order to balance the increased
acid production, the respiration rate goes up to remove the CO2.
This helps to keep you from developing acidosis.
The body regulates the respiratory rate by the use of

chemoreceptors, which primarily use CO2 as a signal. Peripheral
blood sensors are found in the walls of the aorta and carotid
arteries. These sensors signal the brain to provide immediate
adjustments to the respiratory rate if CO2 levels rise or fall. Yet
other sensors are found in the brain itself. Changes in the pH of
CSF affect the respiratory center in the medulla oblongata, which
can directly modulate breathing rate to bring the pH back into the
normal range.
Hypercapnia, or abnormally elevated blood levels of CO2, occurs

in any situation that impairs respiratory functions, including
pneumonia and congestive heart failure. Reduced breathing
(hypoventilation) due to drugs such as morphine, barbiturates, or
ethanol (or even
Previous: just holding
26.3 Electrolyte one’s breath) can also result in
Balance
hypercapnia. Hypocapnia, or abnormally low blood levels of CO2,
Decrease
occurs with any cause of hyperventilation that drives off Font Size
the CO 2,
such as salicylate toxicity, elevated room temperatures, fever, or
hysteria.
Renal Regulation of Acid-Base Balance
The renal regulation of the body’s acid-base balance addresses the

metabolic component of the buffering system. Whereas the
respiratory system (together with breathing centers in the brain)
controls the blood levels of carbonic acid by controlling the
exhalation of CO2, the renal system controls the blood levels of
bicarbonate. A decrease of blood bicarbonate can result from the
inhibition of carbonic anhydrase by certain diuretics or from
excessive bicarbonate loss due to diarrhea. Blood bicarbonate
levels are also typically lower in people who have Addison’s
disease (chronic adrenal insufficiency), in which aldosterone levels
are reduced, and in people who have renal damage, such as chronic
nephritis. Finally, low bicarbonate blood levels can result from
elevated levels of ketones (common in unmanaged diabetes
mellitus), which bind bicarbonate in the filtrate and prevent its
conservation.
Bicarbonate ions, HCO3–, found in the filtrate, are essential to the

bicarbonate buffer system, yet the cells of the tubule are not
permeable to bicarbonate ions. The steps involved in supplying
bicarbonate ions to the system are seen in Figure 3 and are
summarized below:

Decrease
Step 1: Sodium ions are reabsorbed from the filtrateFont
in Size
exchange for H+ by an antiport mechanism in the apical
membranes of cells lining the renal tubule.
Step 2: The cells produce bicarbonate ions that can be shunted
to peritubular capillaries.
Step 3: When CO2 is available, the reaction is driven to the

formation of carbonic acid, which dissociates to form a
bicarbonate ion and a hydrogen ion.
Step 4: The bicarbonate ion passes into the peritubular
capillaries and returns to the blood. The hydrogen ion is
secreted into the filtrate, where it can become part of new
water molecules and be reabsorbed as such, or removed in the
urine.
Figure 3. Conservation of Bicarbonate in the Kidney. Tubular cells are

not permeable to bicarbonate; thus, bicarbonate is conserved rather
than reabsorbed. Steps 1 and 2 of bicarbonate conservation are
indicated.
Next:
It is also possible that salts in the26.5 Disorders
filtrate, suchofasAcid-Base
sulfates,Balance
phosphates, or ammonia, will capture hydrogenDecrease Fontoccurs,

ions. If this Size
the hydrogen ions will not be available to combine with
bicarbonate ions and produce CO2. In such cases, bicarbonate ions
are not conserved from the filtrate to the blood, which will also
contribute to a pH imbalance and acidosis.
The hydrogen ions also compete with potassium to exchange with

sodium in the renal tubules. If more potassium is present than
normal, potassium, rather than the hydrogen ions, will be
exchanged, and increased potassium enters the filtrate. When this
occurs, fewer hydrogen ions in the filtrate participate in the
conversion of bicarbonate into CO2 and less bicarbonate is
conserved. If there is less potassium, more hydrogen ions enter the
filtrate to be exchanged with sodium and more bicarbonate is
conserved.
Chloride ions are important in neutralizing positive ion charges in

the body. If chloride is lost, the body uses bicarbonate ions in place
of the lost chloride ions. Thus, lost chloride results in an increased
reabsorption of bicarbonate by the renal system.
Disorders of the…
Acid-Base Balance: KetoacidosisDiabetic acidosis, or ketoacidosis,

occurs most frequently in people with poorly controlled diabetes
mellitus. When certain tissues in the body cannot get adequate
amounts of glucose, they depend on the breakdown of fatty acids
for Previous: 26.3 Electrolyte
energy. When Balance
acetyl groups break off the fatty acid chains, the
acetyl groups then non-enzymatically combineofto
Next: 26.5 Disorders form ketone
Acid-Base Balance
Decrease
bodies, acetoacetic acid, beta-hydroxybutyric acid, Font Size
and acetone, all
of which increase the acidity of the blood. In this condition, the
brain isn’t supplied with enough of its fuel—glucose—to produce
all of the ATP it requires to function.
Ketoacidosis can be severe and, if not detected and treated

properly, can lead to diabetic coma, which can be fatal. A common
early symptom of ketoacidosis is deep, rapid breathing as the body
attempts to drive off CO2 and compensate for the acidosis. Another
common symptom is fruity-smelling breath, due to the exhalation
of acetone. Other symptoms include dry skin and mouth, a flushed
face, nausea, vomiting, and stomach pain. Treatment for diabetic
coma is ingestion or injection of sugar; its prevention is the proper
daily administration of insulin.
A person who is diabetic and uses insulin can initiate ketoacidosis

if a dose of insulin is missed. Among people with type 2 diabetes,
those of Hispanic and African-American descent are more likely to
go into ketoacidosis than those of other ethnic backgrounds,
although the reason for this is unknown.
Chapter Review
A variety of buffering systems exist in the body that helps maintain

the pH of the blood and other fluids within a narrow range—
between pH 7.35 and 7.45. A buffer is a substance that prevents a
radical change in fluid pH by absorbing excess hydrogen or
hydroxyl ions. Most commonly, the substance that absorbs the ion
is either a weak acid, whichNext:takes26.5
up Disorders of Acid-Base–Balance
a hydroxyl ion (OH ), or a
weak base, which takes up a hydrogen ion (H+). Decrease

Several Font Size
substances
serve as buffers in the body, including cell and plasma proteins,
hemoglobin, phosphates, bicarbonate ions, and carbonic acid. The
bicarbonate buffer is the primary buffering system of the IF
surrounding the cells in tissues throughout the body. The
respiratory and renal systems also play major roles in acid-base
homeostasis by removing CO2 and hydrogen ions, respectively,
from the body.
Review Questions
1. Which of the following is the most important buffer inside

red blood cells?
A. plasma proteins
B. hemoglobin
C. phosphate buffers
D. bicarbonate: carbonic acid buffer
2. Which explanation best describes why plasma proteins

can function as buffers?
A. Plasma proteins combine with bicarbonate to make a

stronger buffer.
B. Plasma proteins are immune to damage from acids.
C. Proteins have both positive and negative charges on

their surface.
D. Proteins are alkaline. Decrease Font Size
3. The buffer that is adjusted to control acid-base balance is

________.
A. plasma protein
B. hemoglobin
C. phosphate buffer
D. bicarbonate: carbonic acid buffer
4. Carbonic acid levels are controlled through the ________.
A. respiratory system
B. renal system
C. digestive system
D. metabolic rate of cells
5. Bicarbonate ion concentrations in the blood are controlled

through the ________.
A. respiratory system
B. renal system
C. digestive system
D. metabolic rate of cells
6. Which reaction is catalyzed by carbonic anhydrase?

A. HPO42- + H+ ↔ HNext:
2PO26.5
4- Disorders of Acid-Base Balance
B. CO2 + H2O ↔ H2CO3 Decrease Font Size
C. H2PO4− + OH− ↔ HPO42− + H2O
D. H2CO3 ↔ HCO3− + H+
Critical Thinking Questions
1. Describe the conservation of bicarbonate ions in the renal

system.
2. Describe the control of blood carbonic acid levels through

the respiratory system.
Glossary
hypercapnia
abnormally elevated blood levels of CO2
hypocapnia
abnormally low blood levels of CO2
Solutions
Answers for Review Questions
1. B
2. C
3. D 26.3 Electrolyte Balance

Previous:
4. A Next: 26.5 Disorders of Acid-Base Balance

5. B Decrease Font Size
6. B
Answers for Critical Thinking Questions
1. Bicarbonate ions are freely filtered through the

glomerulus. They cannot pass freely into the renal
tubular cells and must be converted into CO2 in the
filtrate, which can pass through the cell membrane.
Sodium ions are reabsorbed at the membrane, and
hydrogen ions are expelled into the filtrate. The
hydrogen ions combine with bicarbonate, forming
carbonic acid, which dissociates into CO2 gas and water.
The gas diffuses into the renal cells where carbonic
anhydrase catalyzes its conversion back into a
bicarbonate ion, which enters the blood.
2. Carbonic acid blood levels are controlled through the
respiratory system by the expulsion of CO2 from the
lungs. The formula for the production of bicarbonate
ions is reversible if the concentration of CO2 decreases.
As this happens in the lungs, carbonic acid is converted
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the acid decreases.
The rate of respiration determines the amount of CO2
exhaled. If the rate increases, less acid is in the blood; if
the rate decreases, the blood can become more acidic.
26.4 Acid-Base Balance

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4 Acid-Base Balance – Anatomy and Physiology

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ANATOMY AND PHYSIOLOGY

Chapter 26. Fluid, Electrolyte, and Acid-Base Balance

184 26.4 Acid-Base Balance

By the end of this section, you will be able to:

Identify the most powerful buffer system in the body

Proper physiological functioning depends on a Decrease

Previous: 26.3 Electrolyte Balance

Next: 26.5 Disorders of Acid-Base Balance

Decrease Font Size

Figure 1. The pH Scale. This chart

Buffer Systems in the Body

The buffer systems functioning in blood plasmaDecrease Font Size

Protein Buffers in Blood Plasma and Cells

Nearly all proteins can function as buffers. Proteins are made up of

Hemoglobin is the principal protein inside of red blood cells and

Next: 26.5 Disorders of Acid-Base Balance

Phosphate Buffer Decrease Font Size

Phosphates are found in the blood in two forms: sodium

Bicarbonate-Carbonic Acid Buffer

The bicarbonate-carbonic acid buffer works in a fashion similar to

As with the phosphate buffer, a weak acid or weakDecrease Font Size

Respiratory Regulation of Acid-Base Balance

The respiratory system contributes to the balance of acids and bases

after holding your breath) allows you to exhaleDecrease

Figure 2. Respiratory Regulation of

The chemical reactions that Next:

The body regulates the respiratory rate by the use of

Hypercapnia, or abnormally elevated blood levels of CO2, occurs

Renal Regulation of Acid-Base Balance

The renal regulation of the body’s acid-base balance addresses the

Bicarbonate ions, HCO3–, found in the filtrate, are essential to the

Next: 26.5 Disorders of Acid-Base Balance

Step 3: When CO2 is available, the reaction is driven to the

Figure 3. Conservation of Bicarbonate in the Kidney. Tubular cells are

phosphates, or ammonia, will capture hydrogenDecrease Fontoccurs,

The hydrogen ions also compete with potassium to exchange with

Chloride ions are important in neutralizing positive ion charges in

Acid-Base Balance: KetoacidosisDiabetic acidosis, or ketoacidosis,

Ketoacidosis can be severe and, if not detected and treated

A person who is diabetic and uses insulin can initiate ketoacidosis

A variety of buffering systems exist in the body that helps maintain

weak base, which takes up a hydrogen ion (H+). Decrease

1. Which of the following is the most important buffer inside

D. bicarbonate: carbonic acid buffer

2. Which explanation best describes why plasma proteins

A. Plasma proteins combine with bicarbonate to make a

C. Proteins have both positive and negative charges on

D. Proteins are alkaline. Decrease Font Size

3. The buffer that is adjusted to control acid-base balance is

4. Carbonic acid levels are controlled through the ________.

5. Bicarbonate ion concentrations in the blood are controlled

6. Which reaction is catalyzed by carbonic anhydrase?

B. CO2 + H2O ↔ H2CO3 Decrease Font Size

C. H2PO4− + OH− ↔ HPO42− + H2O