Acid-Base Balance

M. Rasjad Indra Laboratorium Ilmu Faal FK. UNIBRAW

Seorang wanita 34 tahun hamil 32 minggu datang ke rumah sakit dengan keluhan muntah-muntah selama dua hari terakhir. Penderita adalah peminum alkohol berat. Awal muntah terjadi setelah meneguk alkohol dalam jumlah besar, tetapi segera berhenti minum setelah mengalami muntah. Hasil pemeriksaan darah: pH : 7,17 (7,35 7,45) PCO2 : 14 mm Hg (23 33)

HCO3 : 7 mmol/L (35 45)

What is Acid and Base ?

Acid is proton (H+) donor Base is proton (H+) acceptor The most important acid in the blood is H2CO3 The most important base is HCO3 H2CO3 <=> HCO3-+H+

pH
Simbol kadar ion H+ Besarnya = -log [H+]

HCO logH logK log H CO

3 2 3

HCO logH logK log S.pCO

3 2

HCO pH pK log
3

S.pCO2

pH pK log

0,03xS.PCO 2

HCO
3

Henderson-Hasselbalch Equation

pH=pK + log kidneys lungs pH=pK + log [HCO3-]

PCO2

pH=6,1 + log [HCO3-]

0.03 * P CO2

[ HCO 3] 1. pH 6,1 log PCO 2

2. [ H ]( nmol / L ) 24 x

[ HCO 3] 20 [ H 2CO3] 1

PCO 2 ( mmHg ) HCO 3mEq / L

pH 7.70 [H+] = 20 nmol/L pH7.20 [H+]=60 nmol/L 7.60 25 7.10 80 7.50 30 7.00 100 7.40 40 6.90 125 7.30 50 6.80 160

ACID
Result of metabolism and digestion Consist of: volatile and nonvolatile Volatile

HCl, H2SO4, HNO3, H3PO4, NH4+, H2CO3

Nonvolatile:

H2CO3 (primary)<=>H20 + CO2 Eliminated as CO2 gas via lungs.

Small amount. Lactic acid, acetic acid Removed via the kidney

Base :

NaOH: Sodium hydroxide KOH: Potasium hydroxide NH3+: Ammonia HCO3-: Bicarbonate

Amphoteric Substance:
Can function as both an acid and a base. Glycine( +H3N-CH2-COO-):
NaOH++H3N-CH2-COO-=>H2N-CH2-COO-Na+ + H2O HCl + +H3N-CH2-COO- => Cl-+H3N-CH2-COOH

Buffer: Minimize the change & promote stability

1. Acid <=> Conjugate base : H2PO4- <=> HPO42- + H+ H2CO3 <=> HCO3- + H+ NH4+ <=> NH3 + H+ 2. Protein : Albumin; Globulin Hemoglobin 3. Lung and Kidney

[H2CO3 ]~PaCO2= Respiratory component

[H2CO3]<=>PaCO2 x (0.03) PaCO2 :

Provides a measure of H2CO3 The respiratory component.

Normal:
PaCO2 = 40 mm Hg. H2CO3 = 40 x 0.03 = 1.2 mEq/L

HCO3-=Metabolic component
Regulated by the kidney.
By modulating the rate of re-absorption

Metabolic acid-base imbalance:

Kidney-related Non-kidney-related
Electrolite Disturbance
(Chloride depletion)

Three Process in Urinary Acidification

1.Reabsorption of filtered bicarbonate 2.Formation of titrable acid 3.Excretion of ammonium

REABSORPTION OF FILTERED BICARBONATE

Blood Plasma Tubular Epithelium Tubular Urine

Na+

Na+
-

HCO3-

HCO3

H+

H+

HCO3-

H2CO3

CA
H2O + CO2 CO2 CO2

H2CO3

H2O

FORMATION OF TITRATABLE ACID

Blood Plasma

Tubular Epithelium
Na+

Tubular Urine
Na+

HCO3-

HCO3

H+

H+

HPO42-2Na

H2CO3 CA H2O H2PO4-2Na

+
CO2 CO2

EXCRETION OF AMMONIUM [NH4]

Blood Plasma Tubular Epithelium Tubular Urine

Glutamine Na+ -ketoglutarate22NH4+ NH3 2H+ + NH4+ NH3 NH4+ H+

Glucose or CO2

H+ 2Na+
HCO32HCO3CA 2H2O + 2CO2 2CO2 2H2CO3

Na+

The acidity of blood

Depend on [H+] Expressed by pH

The [H+] increase -> the pH decrease pH = -log[H+] pH = pK + log [HCO3- / H2CO3]

Henderson Hasselbalch equation

Arterial Blood Gas (ABG):

pH = measured - HCO3- = calculated PaCO2 = measured

Normal Range
PaCO2 = 38 to 42 mmHg HCO3- = 22 to 26 mEq/L pH = 7.38 to 7.42 HCO3- / H2CO3 = 20 : 1 Acid-base disturbance (blood):
Acidemia: pH< 7.38 Alkalemia: pH> 7.42

Acid-Base Disturbance
Simple :
Respiratory acidosis: PaCO2 high / HCO3- normal or slightly high Respiratory alkalosis: PaCO2 low /HCO3- normal or low Metabolic acidosis: HCO3- low / PaCO2 normal or low Metabolic alkalosis: HCO3- high / PaCO2 normal or high

Mixed / Combination:
(Respiratory + Metabolic)

Physiologic compensation
Primary disorder Respiratory acidosis Physiol. compensation Kidney retention of HCO3; excretion of H+ Respiratory alkalosis Kidney excretion of HCO3-; retention of H+ Metabolic acidosis Lung excretion of H+ (CO2). Metabolic alkalosis Lung possible retention of H+ (CO2)

Exercise
pH

= 7.33 PaCO2 = 50 mmHg HCO3- =25.8 mEq/L Answer: Acidemia Primary respiratory Acute

pH

= 7.55 PaCO2 = 30 mmHg HCO3- = 23.4 mEq/L Answer: Alkalemia Primary respiratory Acute

Exercise
pH = 7.31 PaCO2 = 29.5 mmHg HCO3- = 14.5 mEq/L Answer: Acidemia Primary metabolic Respiratory compensation pH = 7.59 PaCO2 = 46.5 mmHg HCO3- = 45 mEq/L Answer: Alkalemia Primary metabolic Respiratory compensation