Liver and Bone

The liver plays additional roles in acid-base balance that may be underestimated. For example, the liver metabolizes lactate and keto acids; the rate of metabolism is dependent on pH (e.g., ketogenesis is suppressed at low pH) and may be exceeded at higher concentrations of lactate or in liver disease. The synthesis of urea from ammonium and carbon dioxide (above) results in the genesis of two protons, and is reduced in the presence of acidosis. Some buffering also occurs in bone due to the slow exchange of bone calcium carbonate for extracellular phosphate.

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