Acid-base homeostasis pathways

Acid-base homeostasis pathways represent the complex physiological systems responsible for maintaining the body's pH within a narrow range, typically 7.35 to 7.45, which is critical for protein function and cellular metabolism (StatPearls, 2023). These pathways involve a coordinated effort between chemical buffering systems, respiratory regulation of carbon dioxide, and renal regulation of bicarbonate and hydrogen ions (NIH, 2022). Key molecular players within these pathways include carbonic anhydrases, sodium-hydrogen exchangers (NHEs), and various bicarbonate transporters such as those in the SLC4 family (Hamm et al., 2015). Dysregulation of these pathways leads to clinical conditions such as metabolic or respiratory acidosis and alkalosis, which are frequently observed in chronic kidney disease or respiratory failure. Pharmacological intervention focuses on specific components of the pathway, such as carbonic anhydrase inhibitors for glaucoma or altitude sickness, and oral alkali or acid binders for chronic metabolic acidosis. Maintaining this balance is essential for preventing systemic complications, including bone loss and muscle wasting associated with chronic acid retention.

Other names

pH regulationAcid-base balanceAcid-base regulationAcid-base physiology

Drugs targeting these pathways typically inhibit specific enzymes like carbonic anhydrase to promote bicarbonate excretion, block ion exchangers like NHE3 to modulate sodium and proton flux, or act as buffers to neutralize excess acid in the blood or gastrointestinal tract (StatPearls, 2023; Hamm et al., 2015).