General Principles
- The normal ECF pH is 7.40 ± 0.03. Perturbations in pH can occur with changes in the ratio of
to partial pressure of carbon dioxide (pCO2) as described by the Henderson–Hasselbalch equation:
- Maintenance of pH is essential for normal cellular function. Three general mechanisms exist to keep it within a narrow window:
- Chemical buffering is mediated by
in the ECF and by protein and phosphate buffers in the ICF. The normal
is 24 ± 2 mEq/L.
- Alveolar ventilation minimizes variations in the pH by altering the pCO2. The normal pCO2 is 40 ± 5 mm Hg.
- Renal H+ handling allows the kidney to adapt to changes in acid–base status via
reabsorption and excretion of titratable acid (e.g.,
) and
.
- Chemical buffering is mediated by
- Acidemia and alkalemia refer to processes that lower and raise pH regardless of mechanism. They can be caused by metabolic or respiratory disturbances:
- Metabolic acidosis is characterized by a decrease in the plasma
due to either
loss or the accumulation of acid.
- Metabolic alkalosis is characterized by an elevation in the plasma
due to either H+ loss or
gain.
- Respiratory acidosis is characterized by an elevation in pCO2 resulting from alveolar hypoventilation.
- Respiratory alkalosis is characterized by a decrease in pCO2 resulting from hyperventilation.
- Metabolic acidosis is characterized by a decrease in the plasma
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Citation
Bhat, Pavat, et al., editors. "General Principles." Washington Manual of Medical Therapeutics, 35th ed., Wolters Kluwer Health, 2016. The Washington Manual, www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602785/all/General_Principles.
General Principles. In: Bhat PP, Dretler AA, Gdowski MM, et al, eds. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602785/all/General_Principles. Accessed September 29, 2023.
General Principles. (2016). In Bhat, P., Dretler, A., Gdowski, M., Ramgopal, R., & Williams, D. (Eds.), Washington Manual of Medical Therapeutics (35th ed.). Wolters Kluwer Health. https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602785/all/General_Principles
General Principles [Internet]. In: Bhat PP, Dretler AA, Gdowski MM, Ramgopal RR, Williams DD, editors. Washington Manual of Medical Therapeutics. Wolters Kluwer Health; 2016. [cited 2023 September 29]. Available from: https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602785/all/General_Principles.
* Article titles in AMA citation format should be in sentence-case
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BT - Washington Manual of Medical Therapeutics
UR - https://www.unboundmedicine.com/washingtonmanual/view/Washington-Manual-of-Medical-Therapeutics/602785/all/General_Principles
PB - Wolters Kluwer Health
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DB - The Washington Manual
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