THE RENAL REGULATION OF ACID-BASE BALANCE IN MAN. II. FACTORS AFFECTING THE EXCRETION OF TITRATABLE ACID BY THE NORMAL HUMAN SUBJECT 1

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Abstract
The rate of excretion of titratable acid in man as in the dog is largely detd. by 3 factors, namely: (1) the rate of excretion of buffer; (2) the acid strength of the buffer; and (3) the extent of the reduction in the plasma concn. of bicarbonate. For phosphate and p-aminohippurate the relationship between buffer and titratable acid excretion is essentially a linear one within the range of buffer excretion studied. For creatinine the relationship is curvi-linear because urine pH increases slightly at high rates of buffer excretion. At any given molar rate of excretion of buffer, the rate of elimination of titratable acid is highest for the buffer of lowest acid strength. The accepted normal range of 24-26 m[image] of bicarbonate/l, of plasma constitutes a state of mild acidosis so far as the kidneys are concerned, and titratable acid elimination proceeds at a nearly maximal rate when a buffer of favorable acid strength is presented to the kidney. Further reduction of plasma bicarbonate of 20 m[image]/l. maximally stimulates the acid excretory mechanism. The results presented are in accord with the view that the urine is acidified by the exchange of hydrogen ions formed within the tubular cells for ions of fixed base in the tubular urine.

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