Teaching With Problems And Cases What is the ultimate goal in acid-base regulation?

Balakrishnan S, Gopalakrishnan M, Alagesan M, Prakash ES. What is the ultimate goal in acid-base regulation? Adv Physiol Educ 31: 51–54, 2007; doi:10.1152/advan.00010.2006.—It is common to see chapters on acid-base physiology state that the goal of acid-base regulatory mechanisms is to maintain the pH of arterial plasma and not arterial PCO2 (PaCO2) or plasma HCO3. A hypothetical situation in which the PaCO2 of arterial plasma is 80 mmHg and the plasma HCO3 concentration is 48 mM is presented and analyzed to get over this misconception. As per the modified Henderson equation, the pH of arterial plasma would be 7.4; however, we explain that this may be associated with intracellular acidosis due to intracellular hypercapnia and that derangement of homeostasis is evident from the occurrence of respiratory depression and, eventually, coma in the patient described. This suggests that the ultimate goal of acid-base regulatory mechanisms is not just the maintenance of the pH of arterial plasma but the maintenance of the steady-state pH of intracellular fluid as well.