Beruflich Dokumente
Kultur Dokumente
[H ]
+
pH
1
Acid
Base
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
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).
7
Assisted breathing:
A respirator is used to assist breathing by
expelling CO2, thus reducing PCO2 in blood
9
10
11
14
Reabsorption of Bicarbonate
15
16
CARA
TRADISIONAL :
Hendersen-Hasselbalch
(1909)
17
Normal
pH = 6.1 + log
Normal
[HCO ]
GINJAL
BASA
3
HCO
HCO 3
3
Kompensasi
ASAM
pCO2
PARU
CO
CO22
18
H2CO3 H+
Carbonic acid
HCO3Bicarbonate ion
Henderson-Hasselbalch equation
pH = pKa + log [HCO3-]/[H2CO3]
pH = pKa + log [HCO3-]/0.03 x PCO2
7.4 = 6.1 + log
20 / 1
Cara Stewart ;
pH atau [H+] DALAM PLASMA
DITENTUKAN OLEH
DUA VARIABEL
VARIABEL
INDEPENDEN
VARIABEL
DEPENDEN
VARIABEL INDEPENDEN
CO2
STRONG ION
DIFFERENCE
pCO2
SID
WEAK ACID
Atot
CO2
CO2 Didalam plasma berada
dalam 4 bentuk
sCO2 (terlarut)
H2CO3 asam karbonat
HCO3- ion bikarbonat
CO32- ion karbonat
Definisi:
Strong ion difference adalah ketidakseimbangan muatan
dari ion-ion kuat. Lebih rinci lagi, SID adalah jumlah
konsentrasi basa kation kuat dikurangi jumlah dari
konsentrasi asam anion kuat. Untuk definisi ini semua
konsentrasi ion-ion diekspresikan dalam ekuivalensi
(mEq/L).
Semua ion kuat akan terdisosiasi sempurna jika berada didalam
larutan, misalnya ion natrium (Na+), atau klorida (Cl-). Karena
selalu berdisosiasi ini maka ion-ion kuat tersebut tidak
berpartisipasi dalam reaksi-reaksi kimia. Perannya dalam kimia
asam basa hanya pada hubungan elektronetraliti.
STRONG ION
DIFFERENCE
Gamblegram
Mg++
Ca++
K+ 4
SID
140 mEq/L
[K+]
+
4 mEq/L -
KATION
[Cl-]
102 mEq/L
ANION
[SID]
=
34 mEq/L
[H+]
[OH-]
Konsentrasi [H+]
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
H3O+ = H+ = 40 mEq/L
K
Mg
Ca
HCO33--
HCO3 = 24
HCO
Alb
3
P
Alb
Laktat/keto=UA
P
Na
140
Alb
P
Keto/laktat
Asidosis
hiperkloremi
asidosis
Cl
CL
Cl
115
95
102
Alkalosis
hipokloremi
KATION
ANION
SID
SID n
SID
I. Respiratori
ASIDOSIS
PCO2
ALKALOSIS
PCO2
[Na+], SID
[Cl-], SID
[Na+], SID
[Cl-], SID
[UA-], SID
[Alb]
[Alb]
[Pi]
[Pi]
RESPIRASI
M E T AB O L I K
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
Anion Gap
Described by Gamble in 1939
Electroneutrality
Na+, Cl-, and HCO3 are measured ions
Na + UC = Cl + HCO3 + UA
UC = Sum of unmeasured cations
UA = Sum of unmeasured anions
Anion Gap
Unmeasured Cations:
total 11 mEq/L
Potassium 4
Calcium
5
Magnesium 2
Unmeasured Anions:
total 23 mEq/L
Sulfates
1
Phosphates 2
Albumin
16
Lactic acid 1
Org. acids 3
Anion Gap
Na + UC = Cl + HCO3 + UA
140 + 11 = 104 + 24 + 23
151 = 151
UA UC = Na - (Cl + HCO3);
Anion Gap = Na - (Cl + HCO3)
Anion Gap = 1
HCO3
Helpful in identifying mixed disorders
Sources
1.
2.
3.
4.
5.
6.
7.
8.
39