Beruflich Dokumente
Kultur Dokumente
GANGGUAN KESEIMBANGAN
ASAM BASA, CAIRAN, DAN
ELEKTROLIT
Acid Base Disorders
ACID-BASE REGULATION
Buffer systems
Respiration
Renal function
Maintain tight control within range 7.35 7.45
Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 27.11a
The Central Role of the Carbonic Acid-
Bicarbonate Buffer System in the Regulation of
Plasma pH
Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 27.11b
Measurements and Calculations
Hemoglobin
Protein
The Henderson Hasselbalch
equation
Clinically, the carbonic acid bicarbonate
system is most important. By applying
the law of mass action to the following
reaction:
CO2 + H2O H2CO3 H+ +HCO3-
one obtains the classic equation:
pH = 6.1 + log [HCO3] / pCO2
The Henderson Hasselbalch
equation
The classic equation:
pH = 6.1 + log [HCO3] / pCO2
The practical equation:
[H+] = 24 x pCO2 / [HCO3-]
pH = 7.40
[HCO3-] = 24 mEq/L
[H+] = 40 nmol/L
pCO2 = 40 mmHg
Specific Disturbances
Metabolic acidosis (a fall in pH and a
decrease in HCO3-)
Metabolic alkalosis (a rise in pH and an
increase in HCO3-)
Respiratory acidosis (a fall in pH resulting
from a primary increase in pCO2)
Respiratory alkalosis (a rise in pH from a
decrease in pCO2)
Figure 27.6 The Basic Relationship between PCO2
and Plasma pH
Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 27.6
Acid-Base Disorders
Respiratory acidosis
Results from excessive levels of CO2 in body
fluids
Respiratory alkalosis
Relatively rare condition
Associated with hyperventilation
Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 27.12a
Respiratory Acid-Base Regulation
Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 27.12b
Incomplete Compensation
When compensation fails to occur, it is
because of disease in that system.
Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 27.13
Workup of metabolic acidosis.
low Bicarbonate
1. Measure pH
high pH low pH
Respiratory alkalosis Metabolic acidosis
2. Determine AG
pH >5.5 pH<5.5
Proximal RTA
Acute Diarrhea
Distal RTA
Metabolic Alkalosis
Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 27.14
Causes of metabolic alkalosis
HCl loss
a. Gastrointestinal
b. Increased urine acidification
Excess alkali intake
a. Alkali abuse
b. Treatment of acidosis
Severe potassium depletion
Primary causes of alkalosis
Vomiting/Diuretics
Vomiting/Diuretics
H+secretion
Alkalosis
Alkalosis
Secondary causes of alkalosis
K ECF
Depletion Contraction
AKALOSIS
1. measure pH
low pH high pH
Respiratory acidosis Metabolic alkalosis
2. Assess ECV
a. history
b. exam
c. urine Na
Pulmonary disease
Chronic bronchitis, Chronic emphysema, Asthma, Pneumonia
Depression of respiratory
center
Strokes
Tumors
Encephalitis
Drugs : narcotics
sedatives
tranquilizers
Limitation of chest wall
movement
Neuromuscular disorder :
myasthenia gravis
Guillain Barr
tetanus
Trauma and surgery
Fixation of ribs
Pulmonary disease
Chronic bronchitis
Chronic emphysema
Asthma
Pneumonia
Respiratory alkalosis
This disorder results from hyperventilation due
to a variety of causes.
Acute hypocapnia causes release of H ions
from tissue buffers, this tends to minimize the
reduction of plasma bicarbonate.
Chronic hypocapnia stimulates renal adaptation
with reduced bicarbonate generation, thus
lowering plasma bicarbonate concentration.
Causes of respiratory
alkalosis
Direct stimulation of respiratory center.
Psychogenic, CNS disease, Sepsis, Hypermetabolic state,
Exercise, Liver failure, Drugs
Copyright 2004 Pearson Education, Inc., publishing as Benjamin Cummings Figure 27.15
Aging and Fluid, Electrolyte, and Acid-base
Balance
GANGGUAN METABOLIK
Baik asidosis maupun alkalosis respon paru
Asidosis hiperventilasi PCO2 , [H+]
Alkalosis hipoventilasi PCO2 , [H+] kembali N kompensasi ini terba
tas karena dapat menyebabkan hipoksia (PO2 <<) memicu kembali ventila
si (saat PO2 60 mmHg)
KESIMPULAN
GANGGUAN RESPIRATORIK
Kompensasi oleh ginjal pengaturan kadar bikarbonat
Asidosis respiratorik produksi dan retensi HCO3-
Alkalosis respirarorik ekskresi HCO3-, [HCO3-] plasma pH N
Kompensasi oleh ginjal berjalan lambat (beberapa jam)
GANGGUAN KOMPENSASI
Asidosis metabolik Setiap 1 mEq [HCO3-], PCO2 1-1.3 mmHg
Alkalosis metabolik Setiap 1 mEq [HCO3-], PCO2 0.6 mmHg
Asidosis respiratorik akut Setiap 1 mm PCO2 , [HCO3-] 0.1 mEq
Alkalosis respiratorik akut Setiap 1 mm PCO2 , [HCO3-] 0.2 mEq
Asidosis respiratorik kronik Setiap 1 mm PCO2 , [HCO3-] 0.35 mEq
Alkalosis respiratorik kronik Setiap 1 mm PCO2 , [HCO3-] 0.5 mEq
ETIOLOGI
PATOGENESIS
Gangguan
ekskresi Sirkulasi
bilirubin enterohepaptik
Gangguan aliran
empedu pada
kolestasis
Merckmanual. Neonatal hyperbilirubinemia. 2009. Diunduh dari: http://www.merckmanuals.com. Pada tanggal 29 Desember 2010
PATOFISIOLOGI
Bilirubin unconjugated >>>
Neurotoksik
Kern icterus
Merckmanual. Neonatal hyperbilirubinemia. 2009. Diunduh dari: http://www.merckmanuals.com. Pada tanggal 29 Desember 2010
Hansen TWR. Jaundice, neonatal. 2010. Diunduh dari: http://emedicine/medscape.com. Pada tanggal 29 Desember 2010
GEJALA KLINIK
Bila terdapat bilirubin encephalopathy terdapat gejala:
Hipotonia
Letargi
Kejang
koma
PEMERIKSAAN FISIK
Ikterik pada sklera dan kulit
Penilaian derajat ikterik menggunakan Kramers rules
1.KIMIA:
Bilirubin total, direk, dan indirek
2. HEMATOLOGI
Hematologi lengkap
Gambaran darah tepi
Retikulosit
Golongan darah ABO/rhesus
Coombstest
G6PD
3. URINALISIS
4. KULTUR bila dicurigai sepsis
Hansen TWR. Jaundice, neonatal. 2010. Diunduh dari: http://emedicine/medscape.com. Pada tanggal 29 Desember 2010.
Statewide Maternity and Neonatal Clinical Guidelines Program. Neonatal jaundice: prevention, assessment, and management. 1st ed. Queensland: Queensland Government; 2009.p5-9.
American Academic of Pediatrics. Clinical practice guidelines:management of hyperbilirubinemia in the newborn infant 35 or more weeks gestation. Pediatrics. 2004;114(1):297-316.
DIAGNOSIS
Diagnosis ditegakkan berdasarkan anamnesis, pemeriksaan fisik, dan
pemeriksaan laboratorium
Indikasi pemeriksaan billirubin serum :
1. Ikterik tampak pada 24 jam pertama neonatus
2. Ikterik tidak sesuai dengan umur neonatus
3. Keraguan derajat ikterus, terutama kulit gelap
4. Ikterik berkelanjutan hingga 2 minggu (aterm) dan > 3 minggu (preterm)
5. Ikterus pada neonatus dengan kondisi klinis yang tidak baik
Mencari faktor risiko :
1. Hemolitik isoimun
2. Defisiensi G6PD
3. Asfiksia
4. Letargi
5. Suhu tubuh tidak stabil
6. Sepsis
7. Asidosis
8. Kadar albumin serum <3 g/dL (bila diperiksa)
Hansen TWR. Jaundice, neonatal. 2010. Diunduh dari: http://emedicine/medscape.com. Pada tanggal 29 Desember 2010.
Statewide Maternity and Neonatal Clinical Guidelines Program. Neonatal jaundice: prevention, assessment, and management. 1st ed. Queensland: Queensland Government; 2009.p5-9.
American Academic of Pediatrics. Clinical practice guidelines:management of hyperbilirubinemia in the newborn infant 35 or more weeks gestation. Pediatrics. 2004;114(1):297-316.
Risiko Neonatus
Resiko sedang
1. Neonatus cukup bulan
(>38 minggu) dengan
faktor risiko
2. Neonatus kurang bulan
(35-37 6/7 mgg) sehat
American Academic of Pediatrics. Clinical practice guidelines:management of hyperbilirubinemia in the newborn infant 35 or more weeks gestation. Pediatrics. 2004;114(1):297-316.
DETEKSI HIPOTIROIDISME PADA NEONATUS