| Hydrogen ion is also buffered by the intracellular buffers, mainly proteins and phosphates
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| The hydrogen ion enters cells in exchange for potassium, therefore buffering of hydrogen ion may result in an increase in plasma potassium concentration. Conversely, low concentration of hydrogen ion in plasma, and an excess of bicarbonate, can be buffered by cell-derived hydrogen ion. In this case, hydrogen ion enters plasma in exchange for potassium, and the plasma potassium concentration decreases.
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| Thus, and this is important to recall again, the excess of hydrogen ions in plasma (acidemia, low plasma pH) may be associated with efflux of potassium from cells and therefore hyperkalemia. On the other hand, a low hydrogen ion concentration in plasma (alkalemia, high blood pH), is often associated with an entry of potassium into cells and thus hypokalemia (Fig. 23.2).
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