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Seorang wanita 34 tahun hamil 32 minggu datang ke rumah sakit dengan keluhan muntah-muntah selama dua hari terakhir. Penderita adalah peminum alkohol berat. Awal muntah terjadi setelah meneguk alkohol dalam jumlah besar, tetapi segera berhenti minum setelah mengalami muntah. Hasil pemeriksaan darah: pH : 7,17 (7,35 7,45) PCO2 : 14 mm Hg (23 33)
pH
Simbol kadar ion H+ Besarnya = -log [H+]
HCO pH pK log
3
S.pCO2
pH pK log
0,03xS.PCO 2
HCO
3
Henderson-Hasselbalch Equation
0.03 * P CO2
[ HCO 3] 20 [ H 2CO3] 1
pH 7.70 [H+] = 20 nmol/L pH7.20 [H+]=60 nmol/L 7.60 25 7.10 80 7.50 30 7.00 100 7.40 40 6.90 125 7.30 50 6.80 160
ACID
Result of metabolism and digestion Consist of: volatile and nonvolatile Volatile
Nonvolatile:
Small amount. Lactic acid, acetic acid Removed via the kidney
Base :
NaOH: Sodium hydroxide KOH: Potasium hydroxide NH3+: Ammonia HCO3-: Bicarbonate
Amphoteric Substance:
Can function as both an acid and a base. Glycine( +H3N-CH2-COO-):
NaOH++H3N-CH2-COO-=>H2N-CH2-COO-Na+ + H2O HCl + +H3N-CH2-COO- => Cl-+H3N-CH2-COOH
Normal:
PaCO2 = 40 mm Hg. H2CO3 = 40 x 0.03 = 1.2 mEq/L
HCO3-=Metabolic component
Regulated by the kidney.
By modulating the rate of re-absorption
Na+
Na+
-
HCO3-
HCO3
H+
H+
HCO3-
H2CO3
CA
H2O + CO2 CO2 CO2
H2CO3
H2O
Tubular Epithelium
Na+
Tubular Urine
Na+
HCO3-
HCO3
H+
H+
HPO42-2Na
+
CO2 CO2
Glucose or CO2
H+ 2Na+
HCO32HCO3CA 2H2O + 2CO2 2CO2 2H2CO3
Na+
Normal Range
PaCO2 = 38 to 42 mmHg HCO3- = 22 to 26 mEq/L pH = 7.38 to 7.42 HCO3- / H2CO3 = 20 : 1 Acid-base disturbance (blood):
Acidemia: pH< 7.38 Alkalemia: pH> 7.42
Acid-Base Disturbance
Simple :
Respiratory acidosis: PaCO2 high / HCO3- normal or slightly high Respiratory alkalosis: PaCO2 low /HCO3- normal or low Metabolic acidosis: HCO3- low / PaCO2 normal or low Metabolic alkalosis: HCO3- high / PaCO2 normal or high
Mixed / Combination:
(Respiratory + Metabolic)
Physiologic compensation
Primary disorder Respiratory acidosis Physiol. compensation Kidney retention of HCO3; excretion of H+ Respiratory alkalosis Kidney excretion of HCO3-; retention of H+ Metabolic acidosis Lung excretion of H+ (CO2). Metabolic alkalosis Lung possible retention of H+ (CO2)
Exercise
pH
= 7.33 PaCO2 = 50 mmHg HCO3- =25.8 mEq/L Answer: Acidemia Primary respiratory Acute
pH
= 7.55 PaCO2 = 30 mmHg HCO3- = 23.4 mEq/L Answer: Alkalemia Primary respiratory Acute
Exercise
pH = 7.31 PaCO2 = 29.5 mmHg HCO3- = 14.5 mEq/L Answer: Acidemia Primary metabolic Respiratory compensation pH = 7.59 PaCO2 = 46.5 mmHg HCO3- = 45 mEq/L Answer: Alkalemia Primary metabolic Respiratory compensation