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KESEIMBANGAN ASAMBASA
pH Review
pH = - log [H+]
H+ is really a proton
Range is from 0 - 14
If [H+] is high, the solution is acidic; pH < 7
If [H+] is low, the solution is basic or
alkaline ; pH > 7
NH3 + H2 O NH4 + + OH
In this situation, water is the proton donor, the Brnsted-Lowry
acid, and ammonia the proton acceptor, the Brnsted-Lowry
base.
HCl + H2 O H3 O+ + Cl
In the previous reaction, hydrogen chloride acts as a
Brnsted-Lowry acid and water as a Brnsted-Lowry base.
CO2 + H2 O H2 CO3 H+ + HCO3
In this reaction, carbon dioxide is hydrated to carbonic acid, a
Brnsted-Lowry acid, which subsequently dissociates to
hydrogen (H+ ) and bicarbonate (HCO3 - ) ions.
10
Parameter Reported
and Symbol Used
Carbon dioxide
tension*
Normal Value
PCO2
35 45 mm Hg
(average, 40)
Oxygen tension*
PO2
80 100 mm Hg
Oxygen percent
saturation
SO2
97
Hydrogen ion
concentration*
pH
7.35 7.45
Bicarbonate
* Indicates measured parameter
HCO3-
22 26 mmol/L
pH
PRIMER
RESPON
KOMPENSASI
ASIDOSIS
METABOLIK
HCO3-
pCO2
ALKALOSIS
METABOLIK
HCO3-
pCO2
ASIDOSIS
RESPIRATORI
pCO2
HCO3-
ALKALOSIS
RESPIRATORI
pCO2
HCO3-
CARA TRADISIONAL
Hendersen-Hasselbalch
Normal
pH = 6.1 + log
Normal
[HCO
GINJAL
BASA ]
3
HCO
HCO 3
3
Kompensasi
ASAM
pCO2
PARU
CO
CO22
RANGKUMAN GANGGUAN
KESEIMBANGAN ASAM BASA
TRADISIONAL
DISORDER
pH
PRIMER
ASIDOSIS
METABOLIK
HCO3-
RESPON
KOMPENSASI
pCO2
ALKALOSIS
METABOLIK
HCO3-
pCO2
ASIDOSIS
RESPIRATORI
pCO2
HCO3-
ALKALOSIS
RESPIRATORI
pCO2
HCO3-
KLASIFIKASI GANGGUAN
KESEIMBANGAN ASAM BASA
BERDASARKAN PRINSIP
STEWART
Menurut Stewart ;
DEPENDEN
T
VARIABLES
VARIABEL INDEPENDEN
CO2
STRONG ION
DIFFERENCE
pCO2
SID
WEAK ACID
Ato
t
CO2
CO2 Didalam plasma berada Rx dominan dari CO2 adalah rx
absorpsi OH- hasil disosiasi air
dalam 4 bentuk
dengan melepas H+.
sCO2 (terlarut)
H2CO3 asam karbonat
STRONG ION
DIFFERENCE
Gamblegram
Mg++
Ca++
K+ 4
SID
Na+
140
[Na+]
140 mEq/L
[K+]
+
Cl102
-
4 mEq/L -
KATION
[Cl-]
102 mEq/L
ANION
[SID]
=
34 mEq/L
Konsentrasi [H+]
[H+]
[OH-]
Asidosis
()
Alkalosis
SID
(+)
WEAK ACID
[Protein-] + [H+]
[Protein H]
disosiasi
Gamblegram
Mg++
Ca++
K+ 4
HCO324
Weak acid
(Alb-,P-)
Na+
140
KATION
Cl102
ANION
SID
DEPENDENT VARIABLES
H+
HCO3OH-
AH
CO3-
A-
INDEPENDENT VARIABLES
DEPENDENT VARIABLES
Strong Ions
Difference
pCO2
Protein
Concentration
pH
KLASIFIKASI
I. Respiratori
ASIDOSIS
PCO2
ALKALOSIS
PCO2
[Na+], SID
[Cl-], SID
[Na+], SID
[Cl-], SID
[UA-], SID
[Alb]
[Alb]
[Pi]
[Pi]
RESPIRASI
METABOLIK
Abnormal
pCO2
Abnormal
SID
AIR
Anion kuat
Cl-
Alkalosis
Turun
kekurangan
Hipo
Asidosis
Meningkat
kelebihan
Hiper
Abnormal
Weak acid
Alb
PO4-
UA-
Turun
Positif
meningkat
Plasma
Plasma
1 liter
SID : 38 76 = alkalosis
ALKALOSIS KONTRAKSI
liter
Plasma
1 Liter
H2O
1 liter
140/2 = 70 mEq/L
102/2 = 51 mEq/L
SID = 19 mEq/L
2 liter
SID : 38 19 = Acidosis
ASIDOSIS DILUSI
GANGGUAN PD SID:
Pengurangan ClPlasma
SID
2 liter
ALKALOSIS
ALKALOSIS HIPOKLOREMIK
GANGGUAN PD SID:
Penambahan/akumulasi
ClPlasma
SID
2 liter
ASIDOSIS
ASIDOSIS HIPERKLOREMIK
Plasma
NaCl 0.9%
1 liter
SID : 38
1 liter
2 liter
SID : 19 Asidosis
Plasma
Ringer laktat
Laktat cepat
dimetabolisme
Na = 140 mEq/L
Cl- = 102 mEq/L
SID= 38 mEq/L
+
1 liter
SID : 38
1 liter
2 liter
Plasma;
Plasma + NaHCO3
asidosis
hiperkloremik
25 mEq
NaHCO3
1 liter
1.025
liter
HCO3 cepat
Na = 165 mEq/L dimetabolisme
+
UA = Unmeasured Anion:
Laktat, acetoacetate, salisilat,
metanol dll.
K
HCO3-
SID
SID
KetoA-
A
-
Na+
HCO3-
Na+
Cl-
ClLactic/Keto asidosis
Normal
Ketosis
HCO3
SID
Na
Cl
Normal
SID
Alb-/P
Alb-/P-
Na
HCO3
SID
Alb/P
Asidosis Na
hiperprotein/
hiperposfatemi
Cl
Acidosis
HCO3
Alkalosis
hipoalbumin
Cl/hipoposfate
mi
Alkalosis
Lactic Acidosis
Has many etiologies
Cyanide, CO, Toluene,
HS
Poor perfusion
Ethylene glycol
Salicylates
Methyl salicylate
(Oil of wintergreen)
Mg salicylate
Levraut J et al. Int Care Med
23:417, 1997
Negative AG
more unmeasured cations than unmeasured anions
Bromide, Iodide, Multiple Myeloma