Module 17: Fluid, Electrolyte, and Acid-Base Balance

Lesson 4: Acid-Base Balance

Cân Bằng Toan-Kiềm

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Mỗi bài học (lesson) bao gồm 4 phần chính: Thuật ngữ, Luyện Đọc, Luyện Nghe, và Bàn Luận.
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Dưới đây là danh sách những thuật ngữ Y khoa của module Fluid, Electrolyte, and Acid-Base Balance.
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Medical Terminology: Fluid, Electrolyte, and Acid-Base Balance

antidiuretic hormone (ADH)
also known as vasopressin, a hormone that increases the volume of water reabsorbed from the collecting tubules of the kidney
state of containing insufficient water in blood and other tissues
dihydroxyvitamin D
active form of vitamin D required by the intestinal epithelial cells for the absorption of calcium
excess production of urine
extracellular fluid (ECF)
fluid exterior to cells; includes the interstitial fluid, blood plasma, and fluids found in other reservoirs in the body
fluid compartment
fluid inside all cells of the body constitutes a compartment system that is largely segregated from other systems
hydrostatic pressure
pressure exerted by a fluid against a wall, caused by its own weight or pumping force
abnormally increased blood levels of calcium
abnormally elevated blood levels of CO2
higher-than-normal blood chloride levels
higher-than-normal blood potassium levels
abnormal increase in blood sodium levels
abnormally increased blood phosphate levels
abnormally low blood levels of calcium
abnormally low blood levels of CO2
lower-than-normal blood chloride levels
abnormally decreased blood levels of potassium
lower-than-normal levels of sodium in the blood
abnormally low blood phosphate levels
interstitial fluid (IF)
fluid in the small spaces between cells not contained within blood vessels
intracellular fluid (ICF)
fluid in the cytosol of cells
metabolic acidosis
condition wherein a deficiency of bicarbonate causes the blood to be overly acidic
metabolic alkalosis
condition wherein an excess of bicarbonate causes the blood to be overly alkaline
plasma osmolality
ratio of solutes to a volume of solvent in the plasma; plasma osmolality reflects a person’s state of hydration
respiratory acidosis
condition wherein an excess of carbonic acid or CO2 causes the blood to be overly acidic
respiratory alkalosis
condition wherein a deficiency of carbonic acid/CO2 levels causes the blood to be overly alkaline
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Proper physiological functioning depends on a very tight 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.
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.

The buffer systems functioning in blood plasma 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.

A. 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.

B. 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 system.

C. Phosphate Buffer

Phosphates are found in the blood in two forms: sodium dihydrogen phosphate (NaH2PO4), which is a weak acid, and sodium monohydrogen phosphate (Na2HPO4), which is a weak base. When Na2HPO4 comes into contact with a strong acid, such as HCl, the base picks up a second hydrogen ion to form the weak acid NaH2PO4 and sodium chloride, NaCl. When NaHPO4 (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)

D. 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

(sodium bicarbonate) + (strong acid) → (weak acid) + (salt)

H2CO3 + NaOH→NaHCO3 + H2O

(weak acid) + (strong base)→(sodium bicarbonate) + (water)

As with the phosphate buffer, a weak acid or weak 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 ketone bodies, 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.
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 might feel the “urge” to do after holding your breath) allows you to exhale more CO2. 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.

The chemical reactions that regulate the levels of CO2 and carbonic acid occur in the lungs when blood travels through 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 just holding one’s breath) can also result in hypercapnia. Hypocapnia, or abnormally low blood levels of CO2, occurs with any cause of hyperventilation that drives off the CO2, such as salicylate toxicity, elevated room temperatures, fever, or hysteria.
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:

  • Step 1: Sodium ions are reabsorbed from the filtrate in 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.

It is also possible that salts in the filtrate, such as sulfates, phosphates, or ammonia, will capture hydrogen ions. If this occurs, 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.

OpenStax. (2022). Anatomy and Physiology 2e. Rice University. Retrieved June 15, 2023. ISBN-13: 978-1-711494-06-7 (Hardcover) ISBN-13: 978-1-711494-05-0 (Paperback) ISBN-13: 978-1-951693-42-8 (Digital). License: Attribution 4.0 International (CC BY 4.0). Access for free at

This chart shows where many common substances fall on the pH scale.

The respiratory system can reduce blood pH by removing CO2 from the blood.

Tubular cells are not permeable to bicarbonate; thus, bicarbonate is conserved rather than reabsorbed. Steps 1 and 2 of bicarbonate conservation are indicated.

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  1. 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.
  2. A buffer is a substance that prevents a radical change in fluid pH by absorbing excess hydrogen or hydroxyl ions.
  3. Most commonly, the substance that absorbs the ion is either a weak acid, which takes up a hydroxyl ion, or a weak base, which takes up a hydrogen ion.
  4. Several substances serve as buffers in the body, including cell and plasma proteins, hemoglobin, phosphates, bicarbonate ions, and carbonic acid.
  5. The bicarbonate buffer is the primary buffering system of the interstitial fluid surrounding the cells in tissues throughout the body.
  6. The respiratory and renal systems also play major roles in acid-base homeostasis by removing carbon dioxide and hydrogen ions, respectively, from the body.
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