• Ammonium is an important route by which H+ is excreted from the body. By excreting nitrogen in the form of ammonium rather than urea, the bicarbonate that would have been consumed to produce urea is spared.
The pH of extracellular fluids is normally maintained very near to 7.40 with minor deviations due to diet and fluctuations in respiratory minute volume. Under pathologic conditions, plasma pH may be as low as 7.0 or as high as 7.7, which represents a wide range of hydrogen ion concentration from 100 nmol/L (100 • 10—9 mol/L) to 20 nmol/L, respectively. In the Western hemisphere, the normal diet contains an excess of fixed acids because of the metabolic conversion of sulfur-containing amino acids to sulfuric acid and of nucleic acids and phospho-lipids to phosphoric acid. This is equivalent to a daily proton (H+) production of about 1 mmol/kg body weight per day or, for convenience, on the order of 100 mmol/day in a normal adult.
As with all the solutes taken in and produced in the body, homeostasis demands a rate of excretion equal to this daily rate of intake and production of H+. The kidney is responsible for excreting this acid load. It does so by conserving all of the bicarbonate filtered at the glomerulus and secreting hydrogen ions into the urine while generating ''new'' bicarbonate in the renal tubules. However, the kidney can also compensate for a net base input or acid loss from the body by failing to reabsorb all of the filtered bicarbonate. The loss of bicarbonate in the urine is equivalent to the loss of base from the body and causes a fall in the pH of the extracellular fluid.
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