sensor

Biochemistry departement of medical faculty

lampung university
[H ]
+

pH
 Acid Base

Notasi pH diciptakan oleh seorang ahli kimia dari Denmark yaitu

Soren Peter Sorensen pada thn 1909, yang berarti log negatif dari
konsentrasi ion hidrogen. Dalam bahasa Jerman
disebutWasserstoffionenexponent (eksponen ion hidrogen) dan
diberi simbol pH yang berarti: potenz (power) of Hydrogen.
 Syazili Mus

Maintenance of relatively constant blood pH value is essential

for health, since changes in blood pH will affect intracell pH

alter : - metabolism
- protein conformation
- enzyme activity
- equilibria of reaction that consume / generate H+
(oxidation - reduction reaction)
Maintenance of a constant blood pH is, in part, achieved by

- buffer system in the blood control short - term

changes in acid - base metab.
- in long term : balancing proton loss & proton gain

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 Syazili Mustofa

pH value of plasma may be affected by :

- malfunctioning of buffer system or

- disturbance of acid base balance

e.g. due to - kidney disease or

- altered breathing frequency ( hypo

/ hyperventilation)

Normal alterial plasma pH : 7.40 0.05

- pH < 7.35 acidosis

- pH > 7.45 alkalosis

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 Syazili Mustofa

3 major body water components :

- plasma : within circulating system
- interstitial fluid : fluid that bathes cells
- intracellular fluid
Composition :
- plasma : - major kation : Na+
- small amounts : K+, Ca2+, Mg2+
- dominant anions : HCO3-, Cl-
- small amount anion : protein, HPO42-, SO42-
- mixture organic anions
- interstitial fluid : - similar
- contain less protein
plasma & interst. fluid extracell. Fluid

- intracell fluid : - major kation : K+

- major anions : - organic P (ATP, BPG, glycolitic intrmd)
- protein

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 Syazili Mustofa
Each fluid makes a different contribution to buffering
* Major buffer of extracell fluid : HCO3- / CO2 system
- not very effective in resisting pH changes from
changes in pCO2
- effective in controlling pH changes caused by other
than pCO2 changes
* Intracell fluid : responsible for buffering pCO2 changes
( Hb buffering within RBC)
* Extracell fluid & intracell fluid : equal in buffering strong

organic / inorganic acids

Plasma : excellent indicator to handle additional loads of
acids

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 Syazili Mustofa

Every buffer consist of : - a weak acid : H A

- conjugate base : A-
e.g. acetate-/acetic acid, NH3 / NH4+, HPO42- / H2PO4-
- weak acid : neutral, (+) charged, (-) charged
- conjugate base : 1 less (+) charge / 1 more (-) charge
than weak acid
Henderson - Hesselbalch equation :

[conj. base ]
pH = pK + log
[acid]

direct relationship between pH & ratio .

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 Syazili Mustofa

[HCO3-] / [CO2] buffer system :

Blood pH : 7,4

p.k. : 6,1 7,4 = 6,1 + log 20/1

[HCO3-] / [CO2] ratio = 20/1 at normal blood pH = 7,4

Every changes in [HCO3-] or [CO2] changes the ratio

changes pH compensation to normalize blood pH.

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 Syazili Mustofa

Blood plasma is a mixed buffer system :

HCO3- / CO2 , HPO42- / H2PO4-, protein / H protein

Major buffer of plasma : bicarbonate buffer system

an open system : pCO2 is adjusted to meet the

bodys needs

If respiration can not accomplish this adjustment

pCO2 changes strikingly bicarbonate syst. would

be ineffective.

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 Syazili Mustofa

Acidosis : excess acid or def. of alkali in the body

Alkalosis : excess alkali or def. of acid in the body
There exist mechanisms where the body normally rids itself of
excess acid or alkali

Individuals produce large amounts of acids

* Major acid : CO2 volatile : normally excreted by the lungs

Inability of the lungs respiratory acidosis or alkalosis

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 Syazili Mustofa

* Respiratory acidosis : result of hypoventilation of alveoli

CO2 accumulates

Alv. hypoventilation : occur when depth or rate of respiration

- airway obstruction

- neuromuscular disorders Acute resp. acidosi

- diseases of CNS

- chronic resp. acidosis : chronic obstructive lung

disease (emphyema)

- inhalation of gas mixture with high pCO2 resp. acidosis

Increase the PCO2 ------> the pH goes down. Hypoventilation.

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 Syazili Mustofa

* Respiratory alkalosis : arises from decreased alv. pCO2

Hyperventilation : - anxiety : most common cause

- CNS injury involving resp. center

- salicylate poisoning

- fever

- artificial ventilation

High altitude alv. pCO2 chronic resp. alkalosis

Decrease the PCO2 ------> the pH goes up. Hyperventilation.

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 Syazili Mustofa

* Metabolic acidosis

The body produced nonvolatile acids H+ + SO42-

- hydrolysis of phosphate- esters phosphoric acid

- metabolism - lactic acid

produced in excess
- acetoacetic acid
accumulation
- - hydr. butyric acid
acidosis
- administration of : NH4Cl / Arg hydrochloride / Lys

hydrochloride urea + HCl

Decrease the HCO3------> the pH goes down

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 Syazili Mustofa

- ingestion of salicylate, methyl alcohol, ethylene glycol

production of strong organic acid

accumulation of nonvolatile acids metabolic acidosis

- abnormal loss of base ;
- renal tubular acidosis : abnormal amount of HCO3-
escape from blood into urine

- severe diarrhea HCO3-

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 Syazili Mustofa
* Metabolic alkalosis
- intake excess alkali :
- NaHCO3

- salt of organic acid : Na - lactate NaHCO3

- fruits & vegetables : contain mixture of organic acids

- metabolized to CO2 + H2O

no long term. effect on acid
base balance

- salt of organic acids [HCO3-]

- abnormal loss of acids : vomiting, gastric lavage (Lose enough stomach acid to

produce alkalosis)

- rapid loss of body water :diuresis temporary [HCO3-]

Increase the HCO3------> the pH goes up
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 Syazili Mustofa

Causes of acid base imbalance

Acidosis :
Respiratory : alveolar hypoventilation
Metabolic : - H+ overproduction
- HCO3- overexcretion

Alkalosis :

Respiratory : alveolar hyperventilation

Metabolic : - alkali ingestion
- H+ overexcretion

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 Syazili Mustofa

Blood Urine [HCO3- ]/ Cause

pH pH [H2CO3

7,4 6 7 20/1
Normal

Acidosis 20 / > 1 Hypoventilation

- Respiratory < 20 / 1 H+ production
- Metabolic or HCO3- excretion

Alkalosis 20 / < 1 Hyperventilation

- Respiratory >20 / 1 Alkali ingestion
- Metabolic or H+ excretion

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Kardiovaskular Respirasi
Gangguan kontraksi otot jantung Hiperventilasi
Penurunan kekuatan otot nafas dan
Dilatasi Arteri,konstriksi vena, dan menyebabkan kelelahan otot
sentralisasi volume darah Sesak
Metabolik
Peningkatan tahanan vaskular paru Peningkatan kebutuhan
metabolisme
Penurunan curah jantung, tekanan Resistensi insulin
darah arteri, dan aliran darah Menghambat glikolisis anaerob
hati dan ginjal Penurunan sintesis ATP
Hiperkalemia
Sensitif thd reentrant arrhythmia dan Peningkatan degradasi protein
penurunan ambang fibrilasi
ventrikel Otak
Penghambatan metabolisme dan
regulasi volume sel otak
Menghambat respon kardiovaskular
terhadap katekolamin Koma

Management of life-threatening Acid-Base Disorders, Horacio J. Adrogue, And Nicolaos EM:

Review Article;The New England Journal of Medicine;1998
 Kardiovaskular
Konstriksi arteri
Penurunan aliran darah koroner
Penurunan ambang angina
Predisposisi terjadinya supraventrikel dan ventrikel
aritmia yg refrakter
Respirasi
Hipoventilasi yang akan menjadi hiperkarbi dan
hipoksemia
Metabolic
Stimulasi glikolisis anaerob dan produksi asam
organik
Hipokalemia
Penurunan konsentrasi Ca terionisasi plasma
Hipomagnesemia and hipophosphatemia
Otak
Penurunan aliran darah otak
Tetani, kejang, lemah delirium dan stupor

Management of life-threatening Acid-Base Disorders, Horacio J. Adrogue, And Nicolaos EM:

Review Article;The New England Journal of Medicine;1998
 Essentially, the difference between the
concentrations of cations (Na+ primarily)
and anions (Cl-, HCO3-) in the blood.

Anion gap = ( Na + K ) ( Cl + HCO)

= 4-17 mmol l
High Anion Gap: It is high in any condition with
reduced clearance or excess production of any
unmeasured anions. Metabolic Acidosis. It
indicates that you have added acids to the
blood: salicylic acid, formic acid, lactic acid,
oxalic acid, sulfuric acid.
Normal Anion Gap: Respiratory Acidosis. It
occurs when you ultimately become acidotic
because of losing HCO3
It is low in hyperalbuminaemia, liver disease and
paraproteinaemias
 Inget
Item value brho.
pH 7,4
[HCO3-] 22 - 28 mEq / L
PaCO2 33 - 44 mEq / L
PaO2 90 - 100 mEq / L
Rapid regulation Chronic control
(short-term) (long-term)
 pH n pH PCO2
Kompensasi

SID
Sintesis Alb <<..? PPOK

NH4
Absorpsi Cl
Cl

NH4Cl Hipokloremi
Hipoalbumin..
?