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Pengaturan Asam Basa Elektrolit
Pengaturan Asam Basa Elektrolit
1
Acid-Base Balance
• Normal pH of body fluids
– Arterial blood is 7.4
– Venous blood and interstitial fluid is 7.35
– Intracellular fluid is 7.0
• Alkalosis or alkalemia – arterial blood pH
rises above 7.45
• Acidosis or acidemia – arterial pH drops
below 7.35
2
Sources of Hydrogen Ions
• Most hydrogen ions originate from cellular
metabolism
– Breakdown of phosphorus-containing proteins
releases phosphoric acid into the ECF
– Anaerobic respiration of glucose produces
lactic acid
– Fat metabolism yields organic acids and
ketone bodies
– Transporting carbon dioxide as bicarbonate
releases hydrogen ions
3
Hydrogen Ion Regulation
• Concentration of hydrogen ions is
regulated sequentially by:
– Chemical buffer systems – act within seconds
– The respiratory center in the brain stem – acts
within 1-3 minutes
– Renal mechanisms – require hours to days to
effect pH changes
4
Acid/Base Homeostasis: Overview
5
Regulation of Blood pH
• The lungs and kidneys play important role in
regulating blood pH.
• The lungs regulate pH through retention or
elimination of CO2 by changing the rate and
volume of ventilation.
• The kidneys regulate pH by excreting acid,
primarily in the ammonium ion (NH4+), and by
reclaiming HCO3- from the glomerular filtrate
(and adding it back to the blood).
6
Carbonic acid/bicarbonate buffer system
CO2 + H2O CA
H2CO3 H+ + HCO3-
7
The Lung Regulation
• Normal, unassisted breathing:
– An increase in arterial PCO2 acts through the
respiratory centre to increase the rate of
pulmonary ventilation
– A decrease in arterial PCO2 reduces the rate
of ventilation
• Assisted breathing:
– A respirator is used to assist breathing by
expelling CO2, thus reducing PCO2 in blood
8
The Lung Regulation
9
10
The Renal Regulation
• Chemical buffers can tie up excess acids
or bases, but they cannot eliminate them
from the body
• The lungs can eliminate carbonic acid by
eliminating carbon dioxide
• Only the kidneys can rid the body of
metabolic acids (phosphoric, uric, and
lactic acids and ketones) and prevent
metabolic acidosis
11
The Renal Regulation
• The most important renal mechanisms for
regulating acid-base balance are:
– Conserving (reabsorbing) or generating new
bicarbonate ions
– Excreting bicarbonate ions
• Losing a bicarbonate ion is the same as
gaining a hydrogen ion; reabsorbing a
bicarbonate ion is the same as losing a
hydrogen ion
12
13
Reabsorption of Bicarbonate
14
Hydrogen Ion Excretion
15
• Sistem Buffer Asam Karbonat – Bikarbonat
- Ginjal mensintesis & reabsorbsi HCO3-
pH turun H+ + HCO3- H2O + CO2 paru
(basa lemah)
pH naik H2CO3 H+ + HCO3-
(asam lemah)
- Tak dapat mengkoreksi pH gangguan respirasi (CO2)
• Sistem Buffer Fosfat
- H2PO4- = dihydrogen fosfat (asam lemah)
- HPO42- = monohydrogen fosfat (basa lemah)
- OH- + H2PO4- H2O + HPO42-
- H+ + HPO42- H2PO4-
• Ekshalasi CO2
- CO2 H+ pH
CO2 + H2O H2CO3 H+ + HCO3-
- Ventilasi CO2 H+ pH
Stimulus
pH ( [H+] )
Diafragma kontraksi
Ekshalasi CO2
H2CO3 , pH
• Alkalosis metabolik
- HCO3- > 26 mEq/ L
- Vomitus, gastric suctioning, diuretik, penyakit-penyakit
endokrin, obat alkalin (antasida), dehidrasi
- Terapi: hipoventilasi, cairan koreksi defisiensi Cl-, K+
• Diagnosis Gangguan Asam – Basa
pH – HCO3- - pCO2
1. pH Alkalosis/ asidosis?
2. pCO2/ HCO3-?
3. pCO2 respiratorik; HCO3- metabolik
Mekanisme Regulasi Keseimbangan
Asam-Basa
Sistem dapar hanya mengatasi ketidakseimbangan
asam-basa sementara
Ginjal: meregulasi keseimbangan ion H+
dengan menghilangkan ketidakseimbangan kadar
H+ secara lambat; terdapat sistem dapar fosfat &
amonia
Paru-paru: berespons scr cepat thd perubahan
kadar H+ dalam darah & mempertahankan
kadarnya sampai ginjal menhilangkan
ketidakseimbangan tersebut
faal_cairan-asam-basa/ikun/2006 23
Regulasi Pernapasan dlm
Keseimbangan Asam-Basa
Kadar CO2 meningkat pH menurun
Kadar CO2 menurun pH meningkat
Kadar CO2 & pH merangsang kemoreseptor yg
kemudian akan mempengaruhi pusat pernapasan
hipoventilasi meningkatkan kadar CO2
dlm darah
hiperventilasi menurunkan kadar CO2
dlm darah
faal_cairan-asam-basa/ikun/2006 24
Regulasi Pernapasan dlm
Keseimbangan Asam-Basa
faal_cairan-asam-basa/ikun/2006 25
Regulasi Ginjal dlm
Keseimbangan Asam-Basa
Sekresi H+ ke dalam filtrat & reabsorpsi HCO3- ke
CES menyebabkan pH ekstrasel meningkat
HCO3- di dlm filtrat diabsorbsi
Laju sekresi H+ meningkat akibat penurunan pH
cairan tubuh atau peningkatan kadar aldosteron
Sekresi H+ dihambat jika pH urin < 4,5
faal_cairan-asam-basa/ikun/2006 26
Gangguan Keseimbangan
Asam-Basa
1. Asidosis respiratori
hipoventilasi retensi CO2 H2CO3H+
2. Alkalosis respiratori
hiperventilasi CO2 banyak yg hilang H2CO3
H+
3. Asidosis metabolik
Diare, DM HCO3- PCO2 H+
4. Alkalosis metabolik
muntah H+ HCO3- PCO2
faal_cairan-asam-basa/ikun/2006 27
faal_cairan-asam-basa/ikun/2006 28
faal_cairan-asam-basa/ikun/2006 29
Kompensasi Sistem Pernafasan
terhadap Asidosis Metabolik
faal_cairan-asam-basa/ikun/2006 30
Kompensasi Ginjal terhadap Asidosis
Respiratorik
faal_cairan-asam-basa/ikun/2006 31
INTERPRETASI AGD
Lihat pH darah
ASIDOSIS ALKALOSIS
faal_cairan-asam-basa/ikun/2006 32
Seorang laki-laki berusia 50 tahun masuk ke UGD
dengan keluhan sesak nafas dan gelisah. pada saat
pengkajian didapatkan pernafasan 33 x/menit, suhu
37oC, nadi 90 x/menit, terdengar suara wheezing, dan
ekspirasi memanjang. Hasil analisa gas darah pH 7.48,
Pa CO2 30 mmHg, HCO3 24 mmHg, SaO2 93%.
Pertanyaan soal:
Apakah hasil interpretasi AGD pada pasien tersebut?
Pilihan jawaban:
A. Normal
B. Alkalosis respiratorik
C. Asidosis respiratorik
D. Asidosis respiratorik terkompensasi
E. Asidosis respiratorik terkompensasi sebagian
33
TERKOMPENSASI atau
TIDAK?
Lihat pH kembali
- jika mendekati kadar normal (7,35-7,45)
terkompensasi
- jika belum mendekati normal
tidak terkompensasi atau terkompensasi
sebagian
Jika asidosis respiratorik dgn HCO - < 24 mM
3
terkompensasi sebagian
Jika asidosis metabolik dgn pCO2 < 40 mmHg
terkompensasi sebagian
Jika alkalosis respiratorik dgn HCO - > 24 mM
3
terkompensasi sebagian
Jika alkalosis metabolik dgn pCO2 > 40 mmHg
terkompensasi sebagian
faal_cairan-asam-basa/ikun/2006 34
LATIHAN
Asidosis metabolik
pH 7.32, PCO2 40, HCO3 19 tdk terkompensasi
pH 7. 55, PCO2 20, HCO3 22 Alkalosis respiratorik
tdk terkompensasi
pH 7.55, PCO2 37, HCO3 30 Alkalosis metabolik
pH 7.49, PCO2 35, HCO3 29 tdk terkompensasi
Alkalosis metabolik
pH 7.30, PCO2 50, HCO3 29 tdk terkompensasi
pH 7.43, PCO2 53, HCO3 30 Asidosis respiratorik
terkompensasi sebagian
pH 7.44, PCO2 38, HCO3 26 Alkalosis metabolik
pH 7.43, PCO2 32, HCO3 20 terkompensasi
normal
Alkalosis respiratorik
terkompensasi
faal_cairan-asam-basa/ikun/2006 35
Sources
1. Achmadi, A., George, YWH., Mustafa, I. Pendekatan “Stewart”
Dalam Fisiologi Keseimbangan Asam Basa. 2007
2. Beaudoin, D. Electrolytes and ion sensitive electrodes. PPT.
2003.
3. Ivkovic, A ., Dave, R. Renal review. PPT
4. Kersten. Fluid and electrolytes. PPT.
5. Marieb, EN. Fluid, electrolyte, and acid-base balance. PPT.
Pearson Education, Inc. 2004
6. Rashid, FA. Respiratory mechanism in acid-base homeostasis.
PPT. 2005.
7. Silverthorn, DU. Integrative Physiology II: Fluid and Electrolyte
Balance. Chapter 20, part B. Pearson Education, Inc. 2004
8. Smith, SW. Acid-Base Disorders. www.acid-base.com
36
pH : 7.6
HCO3: 35
PCO2: 40
BE : 4 - 2 - +2 (nilai normal)
S02 : 90% 95-100%
37