Blood is nearly the same, pH 7.4. But urine is normally pH6, more than 10 times more acid than blood.Blood is held at a pH just abovethat of water by a buffer system consisting of bicarbonate and carbon dioxide (CO 2) gas. The latter is regulated by the brain using the lungs to clear CO 2 from our metabolism at just the rate desired to maintain blood pH. Bicarbonate is a negative ion that can take up a proton – acid radical – or give one off.
So it is a ‘buffer’ – meaning by its donation or uptake of protons it can stabilize the pH of blood.BicarbonateWhen food and metabolism add protons to blood, those protons are ‘buffered’ by blood bicarbonate.
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The lungs carry away any excess, so the partial pressure ofCO2 gas in our blood can be very constant. Given this, when a bicarbonatebuffers a proton It disappears into thin air – CO 2 gas, actually.The arrows point both ways, because these equilibria can move back and forth. If kidneys remove a proton – they do this to make up for what we eat – things simply reverse. Just imagine a tiny tweezers removes the H+ at the left of the equation above. Immediately, the lost proton is replaced by a proton from H 2 CO 3, that then becomes HCO 3 –and the ‘lost’ H 2 CO 3 is replaced from dCO 2 and H 2 O.
Does this mean that new bicarbonate appears in blood out ofthin air?Yes. As kidneys remove acid to make up for our diet, they make newbicarbonate. They make it in the capillaries around the renal tubules that secrete acid into the final urine, and the bicarbonate flows into the renal veins, and thence into the general circulation through the vena cava.Does that mean if we anchored a tiny canoe in the vena cava just at the mouth of a renal vein, and dipped a pH meter into the blood around, us the pH would be higher at the vein’s mouth than in the central parts of that great vein?
Yes.
Total CO 2What we measure in blood is the total of HCO 3 – +H 2 CO 3 + dissolved CO 2 so we call it total CO 2 or just TCO 2. Of these, HCO3 – massively predominated. So when TCO 2 goes down, acid has been retained. When it goes up, acid has been removed – or new alkali added.Lets Use the TermsThe big graph shows serum TCO 2 and urine pH.
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For simplicity I have left out the ‘T’.Common StoneFormersThe tiny blue dots are my data from common calcium stone formers. Mostof the points center between 23 and 30 for total CO 2 . Urine 24 hour pH averages about 5.9 but ranges high and low because these people have normal kidneys that are adjusting for the diet they have chosen to eat.Normal Men and WomenBlue large circles are from normal people we have studied.
They gave us 24 hour urines and let us draw a blood. Nothingmore. Remarkably, their points overlap exactly with those from the common stoneformers.dRTA and Acid Loaded NormalsThe red circles are clinical measurements from my patients with known dRTA. A few could not or would not discontinue their alkali treatments; their points show normal serum CO 2 values and very high urine pH.The red up triangles show dRTA cases given an acid load to force urine pH as low as it can get. I have plotted this low pH against their serum CO 2 values before the acid load – the value one would see clinically.
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