40 PHYSUOClir.MICAI; BASIS OF PHYSIOLOGICAL PROCESSES 



containing an excess of CO, — a true acidosis, but one for which no place 

 is found in the above definition. 



Nevertheless, Van Slyke's definition has a veal value, because it em- 

 phasizes the importance of a determination of the bicarbonate as a cri- 

 terion of the degree of the forms of acidosis usually met with in disease. 

 The bicarbonate under such conditions may become reduced either be- 

 cause of the appearance of improperly oxidized fatty acids, like /?-oxy- 

 butyric and acetoacetic, when carbohydrate metabolism is upset as in 

 diabetes or starvation, or because the acids produced by a normal 

 metabolism are inadequately eliminated by the kidneys, as in nephritis. 



Accordingly, if the respiratory mechanism and increased mass move- 

 ment of the blood (for an increase in C H accelerates this also) should 



IT CO, 

 fail to eliminate CO, quickly enough so as to keep the T jr^ ratio at 



one twentieth, then C H will rise. This is not likely to happen until a 



large part of the NaHC0 3 has been used up, so that an estimation of that 



actually present must be a reliable index of the proximity to this 



condition. 



A sustained increase in C H is incompatible with life. The NaHC0 3 is 



the buffer, the factor of safety which prevents its occurrence. Although 



it is only in arterial blood (i. e., after elimination of excess of CO, by 



TT Co 

 the lungs has been accomplished) that constancy in the ratio tt<^a ~ 



NaHCOo 

 can be expected, it is fortunate, for practical reasons, that venous blood 



collected during muscular rest and without stasis should be only slightly 



different. 



"When acids are added to the blood, they will first of all be neutralized 



by the "buffers" of the plasma — namely, NaHC0 3 and protein, as Ave 



have seen. But this is only the first line of defense against acidosis, for 



buffer substances present in the corpuscles may also be used. This intra- 



corpuscular reserve of alkali is mobilized partly by transference of K 



and Na from corpuscle to plasma, but mainly by that of HC1 from the 



plasma into the corpuscle, so releasing base in the former to combine 



with the added acid (e. g., H,C0 3 ), according to the equation: 



H,C0 3 + NaCl +± NaHCO, f HC1. The HC1 on entering the corpuscle 



reacts with phosphates according to the equation: HC1 + NaJTPO, ^± 



NaH,P0 4 + NaCl. This is a particularly important detail of the buffer 



action of the blood, for it shows us how the phosphates of the corpuscles 



are rendered available for neutralizing acids added to the plasma, where 



there are practically no phosphates. Indeed the transference of acid 



through the corpuscular envelope indicates that the same sort of thing 



must go on with the oilier cells of the body, so that the plasma, itself 



rather poor in buffer substances, has all those of the body at its disposal. 



