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+
[H ]
pH
Acid
Base
Syazili Mus
- metabolism
- protein conformation
- enzyme activity
- equilibria of reaction that consume / generate H+
(oxidation - reduction reaction)
Maintenance of a constant blood pH is, in part, achieved by
- buffer system in the blood control short - term
changes in acid - base metab.
Syazili Mustofa
- kidney disease or
- altered breathing frequency ( hypo
/ hyperventilation)
Syazili Mustofa
- intracell fluid :
- major kation : K+
- major anions : - organic P (ATP, BPG, glycolitic intrmd)
- protein
Syazili Mustofa
Syazili Mustofa
- a weak acid : H A
- conjugate base : Ae.g. acetate-/acetic acid, NH3 / NH4+, HPO42- / H2PO4- weak acid : neutral, (+) charged, (-) charged
[acid]
Syazili Mustofa
: 6,1
Syazili Mustofa
10
Syazili Mustofa
11
Syazili Mustofa
- neuromuscular disorders
- diseases of CNS
Hypoventilation.
12
Syazili Mustofa
High altitude
Hyperventilation.
13
Syazili Mustofa
* Metabolic acidosis
H+
+ SO42-
- metabolism
- lactic acid
- acetoacetic acid
- - hydr. butyric acid
produced in excess
accumulation
acidosis
urea
+ HCl
14
Syazili Mustofa
HCO3-
15
Syazili Mustofa
* Metabolic alkalosis
[HCO3-]
- abnormal loss of acids : vomiting, gastric lavage (Lose enough stomach acid to
produce alkalosis)
- rapid loss of body water :diuresis temporary
[HCO3-]
Syazili Mustofa
- H+ overproduction
- HCO3- overexcretion
Alkalosis :
- alkali ingestion
- H+ overexcretion
17
Syazili Mustofa
Cause
Blood
pH
Urine
pH
[HCO3- ]/
[H2CO3
7,4
6 7
20/1
Acidosis
- Respiratory
- Metabolic
20 / > 1
< 20 / 1
Hypoventilation
H+ production
or HCO3- excretion
Alkalosis
- Respiratory
- Metabolic
20 / < 1
>20 / 1
Hyperventilation
Alkali ingestion
or H+ excretion
Normal
18
Kardiovaskular
Gangguan kontraksi otot jantung
Dilatasi Arteri,konstriksi vena, dan
sentralisasi volume darah
Respirasi
Hiperventilasi
Penurunan kekuatan otot nafas dan
menyebabkan kelelahan otot
Sesak
Metabolik
Peningkatan tahanan vaskular paru
Penurunan curah jantung, tekanan
darah arteri, dan aliran darah
hati dan ginjal
Sensitif thd reentrant arrhythmia dan
penurunan ambang fibrilasi
ventrikel
Peningkatan kebutuhan
metabolisme
Resistensi insulin
Menghambat glikolisis anaerob
Penurunan sintesis ATP
Hiperkalemia
Peningkatan degradasi protein
Otak
Penghambatan metabolisme dan
regulasi volume sel otak
Koma
Kardiovaskular
Konstriksi arteri
Penurunan aliran darah koroner
Penurunan ambang angina
Predisposisi terjadinya supraventrikel dan ventrikel
aritmia yg refrakter
Respirasi
Hipoventilasi yang akan menjadi hiperkarbi dan
hipoksemia
Metabolic
Stimulasi glikolisis anaerob dan produksi asam organik
Hipokalemia
Penurunan konsentrasi Ca terionisasi plasma
Hipomagnesemia and hipophosphatemia
Otak
Penurunan aliran darah otak
Tetani, kejang, lemah delirium dan stupor
Management of life-threatening Acid-Base Disorders, Horacio J. Adrogue, And Nicolaos EM:
Review Article;The New England Journal of Medicine;1998
gap
= ( Na + K ) ( Cl + HCO)
= 4-17 mmol l
Item
value
pH
7,4
[HCO3-]
22 - 28 mEq / L
PaCO2
33 - 44 mEq / L
PaO2
90 - 100 mEq / L
Inget
brho.
Rapid regulation
(short-term)
Chronic control
(long-term)
pH n
PCO2
pH
Kompensasi
SID
PPOK
NH4
Absorpsi Cl
Cl
NH4Cl
Hipokloremi
Hipoalbumin..?