Regulasi asam-basa.ppt

7/22/2019 Regulasi asam-basa.ppt

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Oleh: Ardi Pramono



Seorang anak 3 tahun dibawa oleh neneknyake IGD rumah sakit karena diketahui sedangmakan beberapa butir tablet aspirin. Kondisianaknya masih baik-baik saja, tetapi neneknyasangat ketakutan akan kondisi cucunya danterlihat hiperventilasi. Si nenek mengeluhpusing dan mulutnya seperti ditusuk jarum.Setelah diberitahu agar tenang dan bernapas

dengan menggunakan rebreathing mask,keluhannya berkurang



Seorang perempuan 26 tahun dibawa ke IGDrumah sakit karena penurunan kesadaran.Diketahui bahwa penderita adalah pengguna

insulin karena diabetes mellitus sejak usia 12tahun. Dari pemeriksaan didapat tensi turun,turgor kulit menurun, napas cepat dan dalamberbau aseton, nadi juga cepat.



Asma bronkial asam-basa ?

COPD asam-basa ?

Diare asam-basa ?

Muntah-muntahasam-basa ?

Histeria asam-basa ?

Makanan asam/pahit asam-basa ?



pH = logaritma negatif ion H+ (Henderson-Hasselbalch)

Asam = donor proton atau donor ion H

Basa = akseptor proton atau akseptor ion H pH plasma 7,36-7,44

Diperankan oleh [HCO3-] dan pCO2 [H+]

Dikenalkan oleh Henderson-Hasselbalch



Respiratorik

Paru-paru CO2

Metabolik

Ginjal HCO3-, pembuangan asam ttt,pembentukan ammonia (NH4+)





Acidemia: blood pH < 7.35

Acidosis: a primary physiologic process that, occurring alone, tends tocause acidemia, e.g.: metabolic acidosis from decreased perfusion (lacticacidosis); respiratory acidosis from hypoventilation. If the patient alsohas an alkalosis at the same time, the resulting blood pH may be low,normal or high.

Alkalemia: blood pH > 7.45

Alkalosis: a primary physiologic process that, occurring alone, tends tocause alkalemia. Examples: metabolic alkalosis from excessive diuretictherapy; respiratory alkalosis from acute hyperventilation. If the patientalso has an acidosis at the same time, the resulting blood pH may be high,normal or low.



Primary acid-base disorder: One of the four acid-base disturbancesthat is manifested by an initial change in HCO3

- or PaCO2. They are:metabolic acidosis (MAc), metabolic alkalosis (MAlk), respiratoryacidosis (RAc), and respiratory alkalosis (RAlk). If HCO3

- changes first,the disorder is either MAc (reduced HCO3

- and acidemia) or MAlk(elevated HCO3

- and alkalemia). If PaCO2 changes first, the problem is

either RAlk (reduced PaCO2 and alkalemia) or RAc (elevated PaCO2 andacidemia).

Compensation: The change in HCO3- or PaCO2 that results from the

primary event. Compensatory changes are not classified by the termsused for the four primary acid-base disturbances. For example, a patient

who hyperventilates (lowers PaCO2) solely as compensation for MAcdoes not have a RAlk, the latter being a primary disorder that, alone,would lead to alkalemia. In simple, uncomplicated MAc the patient willnever develop alkalemia.



Metabolic acidosis is conveniently divided

into elevated and normal anion gap

(AG) acidosis. AG is calculated as

AG = Na+ - (Cl- + CO2)



METABOLIC ACIDOSIS 9HCO3- & 9pH

Increased anion gap

lactic acidosis; ketoacidosis; drug poisonings (e.g., aspirin,ethyelene glycol, methanol)

Normal anion gap

diarrhea; some kidney problems, e.g., renal tubular acidosis,intersititial nephritis

METABOLIC ALKALOSIS 8HCO3- & 8pH

Chloride responsive (responds to NaCl or KCl therapy):contraction alkalosis, diuretics; corticosteroids; gastric suctioning;

vomiting Chloride resistant: any hyperaldosterone state, e.g., Cushings’s

syndrome; Bartter’s syndrome; severe K + depletion



RESPIRATORY ACIDOSIS 8PaCO2 & 9pHCentral nervous system depression (e.g., drug overdose)

Chest bellows dysfunction (e.g., Guillain-Barré syndrome,myasthenia gravis) Disease of lungs and/or upper airway (e.g.,chronic obstructive lung disease, severe asthma attack, severe

pulmonary edema)

RESPIRATORY ALKALOSIS 9PaCO2 & 8 pH

Hypoxemia (includes altitude)

Anxiety

Sepsis

Any acute pulmonary insult, e.g., pneumonia, mild asthma attack,early pulmonary edema, pulmonary embolism



pH=pKa + log [A-]/[HA]

Termasuk buffer: bikarbonat, protein, Hb,fosfat



Dipakai darah arteri:

Hasil dipengaruhi suhu tubuh, dan konsentrasioksigen yang dihirup

Parameter yang diukur: pH

pCO2

PO2

[HCO3]



Base excess

AaDO2

SO2



• pH 7.35-7.45

• PaCO2 35-45 mm Hg

• PaO2 70-100 mm Hg**

• SaO2 93-98% • HCO3

- 22-26 mEq/L

• Base excess -2.0 to 2.0 mEq/L



Condition State ofPaCO2 in blood alveolar ventilation

>45 mm Hg Hypercapnia Hypoventilation

35 - 45 mm Hg Eucapnia Normal ventilation<35 mm Hg Hypocapnia Hyperventilation



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Regulasi asam-basa.ppt