Keseimbangan Asam Basa

Acid Base Balance - ARL 1

 Asam = H+ donor
Basa = H- akseptor

Keseimbangan asam basa diatur oleh :

•Paru-paru
•Ginjal
•Buffer sistem
- Bikarbonat 65% (darah, paru, ginjal)
- Fosfat 1% (filtrat urine, ICF)
- Protein 5%
- Hemoglobin 29%
(berat sama kekuatan buffernya 3x protein)
(total tubuh -------- 6x protein total tubuh)

Acid Base Balance - ARL 2

PARU-PARU

Produksi CO2 oleh metabolisme intra seluler

C6H12O6 6CO2 + 6H2O

H2O + CO2 H2CO3 H+ + HCO3-

Hiperventilasi Hipoventilasi
-pCO2 alveoli - pCO2 alveoli
-CO2 Plasma - CO2 Plasma
-Keseimbangan kearah H2CO3 - kearah H+
-H+ (pH ) - H+ (pH )
-Buffer lain kearah H+ - kearah H2CO3
-pH normal kembali - pH normal kembali

TOTAL BUFFER BASE TIDAK BERUBAH

Acid Base Balance - ARL 3

Acid/Base Homeostasis: Overview

Figure 20-18: Hydrogen balance in the body

Acid Base Balance - ARL 4
The Central Role of the Carbonic Acid-Bicarbonate Buffer
System in the Regulation of Plasma pH

Acid Base Balance - ARL 5

 The Central Role of the Carbonic Acid-Bicarbonate
Buffer System in the Regulation of Plasma pH

Acid Base Balance - ARL 6

Kidney Hydrogen Ion Balancing: Proximal Tubule

Acid Base Balance - ARL 7

Kidney Hydrogen Ion Balancing: Collecting Duct

Acid Base Balance - ARL 8

Figure 20-22: Role of the intercalated cell in acidosis and alkalosis
Kidney tubules and pH Regulation

Acid Base Balance - ARL 9

Kidney tubules and pH Regulation

Acid Base Balance - ARL 10

Buffer Systems in Body Fluids

Acid Base Balance - ARL 11

Respiratory Acid-Base Regulation

Acid Base Balance - ARL 12

Respiratory Acid-Base Regulation

Acid Base Balance - ARL 13

Acid Base Balance - ARL 14
Gangguan Keseimbangan
Asam Basa
Respiratory Acidosis Metabolic Acidosis
H2CO3 berlebihan Kekurangan HCO3
Ok hipoventilasi Sering pada Peny. Ginjal
dan Diabetes

Respiratory Alkalosis Metabolic Alkalosis

Kekurangan H2CO3 Excess HCO3 berlebihan
Ok hiperventilasi Ok
Diare, Steroid, Diuretic

Acid Base Balance - ARL 15

Gangguan Keseimbangan
Asam Basa

Acid Base Balance - ARL 16

Bicarbonate buffer system.

Acid Base Balance - ARL 17

 Keseimbangan Asam Basa
[OH -]
[H+]

Acidic Alkaline (Basic)

Neutral
pH
0 7 14
Venous Blood Arterial Blood

Acidosis 7.4 Alkalosis

Normal 8.0
6.8 7.35-7.45
Acid Base Balance - ARL 18
 Respiratory acidosis.

16
HCO3

3
H2CO3

Acid Base Balance - ARL 19

 Hypoventilating
pH
Decrease ventilations

Respiratory Acidosis

H2CO3
PaCO2

Acid Base Balance - ARL 20

 Respiratory alkalosis.

25
HCO3-

1
H2CO3
Acid Base Balance - ARL 21
Metabolic acidosis.

Acid Base Balance - ARL 22

Metabolic alkalosis.

Acid Base Balance - ARL 23

Nilai Normal Analisa Gas darah
• pH:
– 7.40 (7.35-7.45)
• pO2:
– 80-100mmHg
• pCO2:
– 35-45mmHg
• SaO2:
 >/= 95%
• HCO3:
– 22-26 mmol/L
Acid Base Balance - ARL 24
Faktor yang mempengaruhi
sekresi H+ di tub. Proksimalis :

•pCO2 intrasesuler (pCO2 H+ sekresi )

•Konsentrasi K+ (K+ H+ sekresi )
•Jlh enzym c a CAI sekresi
•Hormon ACTH (meningkatkan reabsorbsi Na+ )
•Parathormon (sekresi H+ dan K+ meninggi)
•Reabsorbsi anion yang berguna
•Functional ECF volume
•pH lumen (urine)
•Metabolisme H+

Acid Base Balance - ARL 25

Faktor yang mempengaruhi
sekresi H+ di tub. distalis :

•Keadaan asam basa di ICF

•pH lumen (urine)
•Aktifasi mineralokortikoid
•Konsentrasi K+

Acid Base Balance - ARL 26

Contoh

•K+ ICF menurun

•Asidosis ICF
•Sekresi H+ urine naik
•Reabsorbsi HCO3- naik
•Alkalosis ECF

Jadi pH urine tergantung pada

•Kecepatan proses sekresi H+

•Ekskresi HCO3-
•Produksi NH4+
Acid Base Balance - ARL 27
Kidney Hydrogen Ion Balancing: Proximal Tubule

Proximal tubule secretion and reabsorption of filtered HCO3-

Acid Base Balance - ARL 28
Kidney Hydrogen Ion Balancing: Collecting Duct

Role of the intercalated cell in acidosis and alkalosis

Acid Base Balance - ARL 29
Acid Base Balance - ARL 30
Asidemia = pH turun ( H+ naik) tendensi peningkatan asam
Alkalemia = pH naik (H+ turun) tendensi peningkatan basa

Asidosis = pH turun (asidemia) Uncompensated

pH tetap Compensated

Alkalosis = pH naik (alkalemia) Uncompensated

pH tetap Compensated

Gangguan asam basa

•Metabolik : perubahan pertama H+ dan / atau HCO3

kompensasi oleh respirasi (pCO2)
•Respiratorik: perubahan pertama pCO2
kompensasi oleh metabolik (HCO3-)

Acid Base Balance - ARL 31

ASIDOSIS METABOLIK

PENYEBAB

EXCRESI ASAM MENURUN

KEHILANGAN ALKALI

MANIFESTASI KLINIK

PERNAFASAN KUSSMAUL/ CEPAT DALAM

TERAPI

LART.NAT.BIKARBONAS 50 - 100 meq/l iv

Acid Base Balance - ARL 32

ASIDOSIS RESPIRATORIK

PENYEBAB

KEMAMPUAN VENTILASI BERKURANG

OBSTRUKSI JALAN NAFAS

MANIFESTASI KLINIK

SOMNOLEN, BINGUNG, KOMA.

TERAPI

MEMPERBAIKI VENTILASI

Acid Base Balance - ARL 33

ALKALOSIS METABOLIK

PENYEBAB

PEMBERIAN ALKALI BERLEBIHAN

KEHILANGAN ION H SEPERTI MUNTAH

MANIFESTASI KLINIK

LEMAH. HIPO REFLEK, TETANI

TERAPI

ATASI PENYEBAB.
PEMB. HCl 0.1 mol/l
Acid Base Balance - ARL 34
ALKALOSIS RESPIRATORIK

PENYEBAB

HIPERVENTILASI , PC02 MENURUN

MANIFESTASI KLINIK
ANXIETAS. SAKIT KEPALA

TERAPI
MENYUNGKUP KEPALA DENGAN KANTONGAN
KERTAS -----> p CO2 MENINGKAT

Acid Base Balance - ARL 35

A Diagnostic Chart for Acid-Base Disorders

Acid Base Balance - ARL 36

Terapi

Kebutuhan H2CO3 (NaHCO3)

= (AR - 24) x ½ Berat Badan

AR = Alkali Reserve = HCO3-

= (24 - BE) x 1/3 Berat Badan

BE = Base Excess

Acid Base Balance - ARL 37

 Acid Base Practice
• ABG Values
• pH = 7.37

• PaCO2 = 38

• HCO3 = 24 Normal

• PaO2 = 98

Acid Base Balance - ARL 38

 Acid Base Practice
• ABG Values
• pH = 7.16

• PaCO2 = 70

Respiratory
• HCO3 = 25
Acidosis
88
• PaO2 =

Acid Base Balance - ARL 39

 Acid Base Practice
• ABG Values
• pH = 7.21

• PaCO2 = 68
Respiratory
• HCO3 = 22 Acidosis

• PaO2 = 86

Acid Base Balance - ARL 40

 Acid Base Practice
• ABG Values
• pH = 7. 13

• PaCO2 = 35
Metabolic acidosis
• HCO3 = 20

• PaO2 = 80

Acid Base Balance - ARL 41

 Acid Base Practice
• ABG Values
• pH = 7.47

• PaCO2 = 45
Metabolic
• HCO3 = 34
Alkalosis

• PaO2 = 90

Acid Base Balance - ARL 42

TERIMA KASIH
Acid Base Balance - ARL 43