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During diabetic ketoacidosis the pH of blood decreases. How does the body respond and why? (has...

During diabetic ketoacidosis the pH of blood decreases. How does the body respond and why? (has to do with the CO2- carbonic acid- bicarb buffer system)

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Complicated mechanism involving lungs, kidneys and bicarbonate buffering system in blood working in synergy to keep the delicate balance of pH of blood (ECF)between 7.35 -7.45. During metabolism inside the body produce Hydrogen ions continuously tend to reduce the pH in blood level which is prevented by bicarbonate (ECF) in blood that reacts with hydrogen ions (H+) and forms carbonic acid

H+ + HCO3- ---------> H2CO3

   (bicarbonate) ( Carbonic acid)

Then it is converted into CO2 and water.

H2CO3 -----------> CO2 and H2

CO2 is removed from the body by expiration through lungs and kidneys regenerate bicarbonate.

By this balancing act, the production of Hydrogen ions is being converted into Carbonic acid then CO2 and water thus maintaining the pH of blood constant.

During diabetic ketoacidosis the production of ketoacids will be high and thus collapsing this buffering system.

Both acetoacetic acid and beta hydroxy butyric acid are strong keto acids and dissociate fully in physiological pH.This results in higher concentration of H+ ions and regeneration of bicarbonate from the kidneys cannot match the pace of production of Hydrogen ions to buffer the same.

CH3 CO CH2 COOH ----------------> CH3 CO CH2 COO- + H+

Aceto acetic acid Aceto acetate

CH3 CH (OH) CH2COOH ------------> CH3 CH(OH)CH2 COO - + H+

Beta- Hydroxy butyric acid    Beta- Hydroxy butyrate

Due to increase in H+ ions and failure of bicarbonate to make buffering mechanism due to less regeneration of bicarbonate causes the pH of blood falls below optimum level. Patients suffer from metabolic acidosis with reduced pH in blood and less concentration of bicarbonate observed in blood gas analysis.

In more acute cases of DKA the pH of blood falls below 7.00 and bicarbonate 10mmol/L ( Normal range (22-28mmol/L)

Maintaining normal pH in blood is essential for life and the body responds in such a way to bring back the normal pH value in blood that changed due to acid -base imbalance. Before understanding the compensatory mechanism of body we must look into the relationship between concentration of bicarbonate and carbon di oxide that defines pH

pH directly proportional to [HCO3] / pCO2 where pH is directly proportional to the concentration of bicarbonate and partial pressure of CO2. In severe DKA conditions the concentration of bicarbonate is greatly reduced and effectively stopping buffering system resulting in pH of blood falls.

In the same way, if pCO2 is reduced by removal of the same from the body by exasperation through lungs then the pH of blood will be back to normal level. Concentration of CO2 can be reduced by lungs through respiration. This deep and rapid sighing respiration observed in patients suffering from severe DKA called Kussmaul's respiration. This is a compensatory mechanism by body in response to lowering of pH in blood. This mechanism helps the patient gets back to near normal pH level of blood. But we cannot say that this can aid complete recovery of normal pH level in blood.

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