Notes on Renal Control in Acid-Base Balance

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Buffering systems:
• Control concentration of H⁺ ions and other elements that affect H⁺ concentration.

Metabolic Disorder:	Plasma pH:	Plasma HCO3-	Arterial PCO2
Metabolic Acidosis	low	low	low
Metabolic Alkalosis	high	high	high
Mixed Acidosis	low	low	high
Mixed Alkalosis	high	high	low
Respiratory Acidosis	low	high	high
Respiratory Alkalosis	high	low	low

Main equation: CO₂ equals H⁺ plus HCO_3-

Respiratory problems (left of above equation):

Respiratory acidosis:
• Hypoventilation.
• Increased CO₂, H⁺.
• Decreased pH.
• Increased bicarbonate ion.
• Uncompensated: increased HCO_3-.
• Completely compensated: increased HCO_3-.

Respiratory alkalosis:
• Hyperventilation.
• Decreased CO₂, H⁺.
• Increased pH.
• Uncompensated: decreased CO₂.
• Decreased bicarbonate ion.

Combined:
• CO₂ depressed, bicarbonate elevated.

Metabolic problems (right of above equation):

Metabolic acidosis:
• Gain in fixed acid.
• Increased H⁺.
• Extremely low bicarbonate ion.
• Compensation: reaction forced to left, consuming H⁺.
• Compensation is hyperventilation: decreased CO₂.
• Compensation is bicarbonate production by kidney.
• Partially compensated: slightly decreased bicarbonate; decreased CO₂.
• Uncompensated: extremely low bicarbonate.

Metabolic alkalosis:
• Decreased H⁺.
• Compensation: reaction forced to right, producing H⁺.
• Extremely high bicarbonate ion.
• Compensation is hypoventilation: increased CO₂.
• Compensation is bicarbonate excretion by kidney.
• Partially compensated: slightly increased bicarbonate.
• Uncompensated: extremely high bicarbonate.

Combined:
• CO₂ and bicarbonate concentrations move in opposite directions.

To differentiate between them, first look at:
• pH, then CO₂.
• Acidic lung = compensatory basic body (and vice versa) (?).

Normal values:
• pH = 7.4 +/- 0.1.
• PCO₂ = 40 mm Hg +/- 10.
• HCO_3- = 24 mmol/L.

Anion gap:
• Due to unmeasured anions.
• Anions are estimated from plasma Cl- and HCO_3-.
• Cations are estimated from plasma Na+.

Additional Readings:

Basic Nephrology

1. Renal Control in Acid-Base Balance
2. Renal Processes
3. Renal Clearance
4. Regional Transport

Related Topics

1. Kidney Disorders
2. Histology of the Urinary System

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