Acid-base regulation during hypothermia. a brief review

Acid-base physiology has mainly focused on mechanisms that maintain normal, extracellular pH at a constant temperature. Usually it is the arterial blood which is considered. As reliable pH meters became generally available in the 1950s it was observed that an arterial pH of about 7.39-7.42 was maintained remarkably constant in normal man and in mammals in general. This moderate degree of blood alkalosis is maintained by chemical buffering, by appropriate adjustment of the lung ventilation and by the kidneys. To measure pH intracellularly was more difficult, but not impossible, and over some time it became apparent that intracellular fluid was close to neutrality. pH values around 6.8 was found. This is a favorable state for retention of metabolites inside the cells. From an analysis by Davis (1) of the ionization constants of several hundred watersoluble biosynthetic intermediates one may argue that the ideal intracellular pH would occur near the neutrality of water where most of these compounds are ionized and thus captured within the cells, with little tendency to escape across the cell membrane. Apparently, if cells are to defend their neutrality and also to eliminate their acid metabolites and CO2, there must be a considerable transmembrane H+ gradient: The hydrogen ion concentration at neutrality is 160 nmol/L (pH 6.8) and that of blood 40 nmol/l (pH 7.4).