Pathophysiology of Acid Base Regulation

  • H. J. Adrogué
Conference paper


The need for the existence of multiple mechanisms involved in acid-base regulation stems from the critical importance of the hydrogen ion (H+) concentration on the operation of many cellular enzymes and function of vital organs, most prominently the brain and the heart [1]. The task imposed on the mechanisms that maintain acid-base homeostasis is large since metabolic pathways are continuously consuming or producing H+, and the daily load of waste products for excretion in the form of volatile (carbonic acid) and fixed acids is substantial. The equilibrium reaction of water and CO2, the end product of oxidative metabolism, results in the daily formation of large amounts of carbonic acid, approximately 15,000 mEq/day [2]. The acceptance of the H+ derived from carbonic acid by haemoglobin results in the transformation of carbonic acid into bicarbonate, and this ion transports ∼ 80% of the CO2 added to the blood from the peripheral tissues to the lungs. As red cells reach the lungs and oxygen is taken up by haemoglobin, H+ is released decomposing bicarbonate into CO2 that diffuses into the alveoli for final excretion. The presence of carbonic anhydrase in red cells facilitates bicarbonate generation in peripheral tissues and decomposition in the lungs, speeding up the mechanisms of blood CO2 loading and unloading.


Metabolic Acidosis Lactic Acidosis Metabolic Alkalosis Urea Synthesis Fixed Acid 
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Copyright information

© Springer-Verlag Italia 1999

Authors and Affiliations

  • H. J. Adrogué
    • 1
  1. 1.Dept. of Medicine and Renal SectionVeterans Affairs Medical CentreHoustonUSA

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