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Acid-Base Imbalances

Urinary

Ordinarily, chemical and physiological buffer systems maintain the hydrogen ion concentration of body fluids within very narrow pH ranges. Abnormal conditions may disturb the acid-base balance. For example, the pH of arterial blood is normally 7.35-7.45. A value below 7.35 produces acidosis. A pH above 7.45 produces alkalosis. Such shifts in the pH of body fluids may be life threatening. In fact, a person usually cannot survive if the pH drops to 6.8 or rises to 8.0 for more than a few hours.

Acidosis results from an accumulation of acids or a loss of bases, both of which cause abnormal increases in the hydrogen ion concentrations of body fluids. Conversely, alkalosis results from a loss of acids or an accumulation of bases accompanied by a decrease in hydrogen ion concentrations.

The two major types of acidosis are respiratory acidosis and metabolic acidosis. Factors that increase carbon dioxide, also increasing the concentration of carbonic acid (the respiratory acid), cause respiratory acidosis. Metabolic acidosis is due to an abnormal accumulation of any other acids in the body fluids or to a loss of bases, including bicarbonate ions.

Similarly, the two major types of alkalosis are respiratory alkalosis and metabolic alkalosis. Excessive loss of carbon dioxide and consequent loss of carbonic acid cause respiratory alkalosis. Metabolic alkalosis is due to excess loss of hydrogen ions or gain of bases.

Since in respiratory acidosis carbon dioxide accumulates, it can result from factors that hinder pulmonary ventilation. These include the following:

Injury to the respiratory center of the brain stem, decreasing rate and depth of breathing.

Obstructions in air passages that interfere with air movement into the alveoli.

Diseases that decrease gas exchanges, such as pneumonia, or those that reduce surface area of the respiratory membrane, such as emphysema.

Any of these conditions can increase the level of carbonic acid and hydrogen ions in body fluids, lowering pH. Chemical buffers, such as hemoglobin, may resist this shift in pH. At the same time, increasing concentrations of carbon dioxide and hydrogen ions stimulate the respiratory center, increasing breathing rate and depth and thereby lowering carbon dioxide concentration. Also, the kidneys may begin to excrete more hydrogen ions.

Eventually, thanks to these chemical and physiological buffers, the pH of the body fluids may return to normal. When this happens, the acidosis is said to be compensated.

The symptoms of respiratory acidosis result from depression of central nervous system function, and include drowsiness, disorientation, and stupor. Evidence of respiratory insufficiency, such as labored breathing and cyanosis, is usually also evident. In uncompensated acidosis, the person may become comatose and die.

Metabolic acidosis is due to either accumulation of nonrespiratory acids or loss of bases. Factors that may lead to this condition include:

Kidney disease that reduces glomerular filtration and fails to excrete the acids produced in metabolism (uremic acidosis).

Prolonged vomiting that loses the alkaline contents of the upper intestine and stomach contents. (Losing only the stomach contents produces metabolic alkalosis.)

Prolonged diarrhea in which excess alkaline intestinal secretions are lost (especially in infants).

Diabetes mellitus, in which some fatty acids are converted into ketone bodies. These ketone bodies include acetoacetic acid, betahydroxybutyric acid, and acetone.

Normally these molecules are produced in relatively small quantities, and cells oxidize them as energy sources. However, if fats are being utilized at an abnormally high rate, as may occur in diabetes mellitus, ketone bodies may accumulate faster than they can be oxidized. At such times, these compounds may be excreted in the urine (ketonuria); in addition, acetone, which is volatile, may be excreted by the lungs and impart a fruity odor to the breath. More seriously, the accumulation of acetoacetic acid and betahydroxybutyric acid may lower pH (ketonemic acidosis).

These acids may also combine with bicarbonate ions in the urine. As a result, excess bicarbonate ions are excreted, interfering with the function of the bicarbonate acid-base buffer system.

In each case, the pH tends to shift toward lower values. However, the following factors resist this shift: chemical buffer systems, which accept excess hydrogen ions; the respiratory center, which increases the breathing rate and depth; and the kidneys, which excrete more hydrogen ions.

Respiratory alkalosis develops as a result of hyperventilation. Hyperventilation is accompanied by too great a loss of carbon dioxide and consequent decreases in carbonic acid and hydrogen ion concentrations.

Hyperventilation may occur during periods of anxiety, although it may also accompany fever or poisoning from salicylates, such as aspirin. At high altitudes, hyperventilation may be a response to low oxygen pressure. Also, musicians, such as bass tuba players, who must provide a large volume of air when playing sustained passages, sometimes hyperventilate. In each case, rapid, deep breathing depletes carbon dioxide and the pH of body fluids increases.

Chemical buffers, such as hemoglobin, that release hydrogen ions resist this pH change. Also, the lower concentrations of carbon dioxide and hydrogen ions stimulate the respiratory center to a lesser degree. This inhibits hyperventilation, thus reducing further carbon dioxide loss. At the same time, the kidneys decrease their secretion of hydrogen ions, and the urine becomes alkaline as bases are excreted.

The symptoms of respiratory alkalosis include lightheadedness, agitation, dizziness, and tingling sensations. In severe cases, impulses may be triggered spontaneously on peripheral nerves, and muscles may respond with tetanic contractions.

Metabolic alkalosis results from a great loss of hydrogen ions or from a gain in bases, both of which are accompanied by a rise in the pH of the blood (alkalemia).

This condition may occur following gastric drainage (lavage), prolonged vomiting in which only the stomach contents are lost, or the use of certain diuretic drugs. Because gastric juice is very acidic, its loss leaves the body fluids with a net increase of basic substances and a pH shift toward alkaline values. Metabolic alkalosis may also develop as a result of ingesting too much antacid, such as sodium bicarbonate, medication to relieve the symptoms of indigestion. The symptoms of metabolic alkalosis include a decrease in the breathing rate and depth, which, in turn, results in an increased concentration of carbon dioxide in the blood.

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