iii - keseimbangan asam basa
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ASAM BASA..ASAM BASA..
pHpH
[H[H++
]]
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Acid Base
Notasi pH diciptakan oleh seorang ahli kimia dari DenmarkNotasi pH diciptakan oleh seorang ahli kimia dari Denmark
yaitu Soren Peter Sorensen pada thn 1909, yang berarti logyaitu Soren Peter Sorensen pada thn 1909, yang berarti log
negati dari konsentrasi ion hidrogen! Dalam bahasa "ermannegati dari konsentrasi ion hidrogen! Dalam bahasa "erman
disebutdisebutWasserstoffionenexponentWasserstoffionenexponent #eksponen ion hidrogen$#eksponen ion hidrogen$dan diberi simbol pH yang berarti% &dan diberi simbol pH yang berarti% &ppoten'( #po)er$ ooten'( #po)er$ o
HHydrogen!ydrogen!
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Acid-Base Balance
Normal pH of body fluids
Arterial blood is 7.4
enous blood and interstitial fluid is 7.3!
"ntracellular fluid is 7.#
Al$alosis or al$alemia arterial blood pH
rises abo%e 7.4!
Acidosis or acidemia arterial pH drops
belo& 7.3!
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'ources of Hydro(en "ons
)ost *ydro(en ions ori(inate from cellular
metabolism
Brea$do&n of p*osp*orus-containin( proteins
releases p*osp*oric acid into t*e +,Anaerobic respiration of (lucose produces lactic
acid
at metabolism yields or(anic acids and $etone
bodies
ransportin( carbon dio/ide as bicarbonate
releases *ydro(en ions
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!
Hydro(en "on 0e(ulation
,oncentration of *ydro(en ions is
re(ulated seuentially by
,*emical buffer systems act &it*in seconds
*e respiratory center in t*e brain stem acts
&it*in 1-3 minutes
0enal mec*anisms reuire *ours to days to
effect pH c*an(es
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AcidBase Homeostasis 5%er%ie&AcidBase Homeostasis 5%er%ie&
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0e(ulation of Blood pH
*e lun(s and $idneys play important role in
re(ulatin( blood pH.
*e lun(s re(ulate pH t*rou(* retention or
elimination of ,52by c*an(in( t*e rate and%olume of %entilation.
*e $idneys re(ulate pH by e/cretin( acid6
primarily in t*e ammonium ion NH48
96 and byreclaimin( H,53-from t*e (lomerular filtrate
and addin( it bac$ to t*e blood9.
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,arbonic acidbicarbonate buffer system,arbonic acidbicarbonate buffer system
,arbonic acid is formed &*en ,52combines &it* &ater. *is reaction is
catalysed by carbonic an*ydrase
,arbonic acid dissociates spontaneouslyto form a proton and a bicarbonate ion
,52 8 H25 H2,53H8 8 H,53
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,A
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;
*e
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1#
*e *en *ypercapnia or risin( plasma H8occurs
?eeper and more rapid breat*in( e/pels morecarbon dio/ide
Hydro(en ion concentration is reduced
Al$alosis causes slo&er6 more s*allo&
breat*in(6 causin( H8to increase
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*e 0enal 0e(ulation
,*emical buffers can tie up e/cess acids
or bases6 but t*ey cannot eliminate t*em
from t*e body
*e lun(s can eliminate carbonic acid byeliminatin( carbon dio/ide
5nly t*e $idneys can rid t*e body of
metabolic acids p*osp*oric6 uric6 andlactic acids and $etones9 and pre%ent
metabolic acidosis
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1!
0eabsorption of Bicarbonate
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Hydro(en "on +/cretion
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CARACARA
TRADISIONAL :TRADISIONAL :
Hendersen-HasselbalchHendersen-Hasselbalch
(1909)(1909)
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1:
pHpH * +!1 log* +!1 log
[HCO[HCO33--]]
pCOpCO22
GINJALGINJAL
PARUPARU
BASABASA
ASAMASAM CO2
HCO3
H-./
-.
ompensasiompensasi
NormalNormal
NormalNormal
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1;
-arbonic acid2bicarbonate buer system-arbonic acid2bicarbonate buer system
*e pa of carbonic acid is .1
,arbonic acid is t*e maor buffer in +,
*e pH of blood can be determined usin(
t*e Henderson-Hasselbalc* euation
H2,53 H8 8 H,53
-
,arbonic acid Bicarbonate ion
pa C .1
+,
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2#
pH C pa 8 lo( DH,53-EDH2,53E
pH C pa 8 lo( DH,53-E0!0// =,52
7.4 C .1 8 lo( 0 2 1
3!4C .1 8 1.3
=lasma pH euals 3!4&*en buffer ratio is 2#1
*e solubility constant of ,52is #.#3
Henderson5Hasselbalch e6uationHenderson5Hasselbalch e6uation
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DUA VARIABELDUA VARIABEL
pH atau [HpH atau [H++] DALAM PLASMA] DALAM PLASMA
DITENTUAN OLEHDITENTUAN OLEH
VARIABELVARIABEL
INDEPENDENINDEPENDEN
'te&art =A. ,an F =*ysiol =*armacol 11444-1416 1;:3.
VARIABELVARIABEL
DEPENDENDEPENDEN
a!a St"#a!t $a!a St"#a!t $
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Deinisi%Deinisi%
Strong ion dierence adalah ketidakseimbanganStrong ion dierence adalah ketidakseimbangan muatanmuatan
dari ion5ion kuat! 7ebih rinci lagi, S8D adalah umlahdari ion5ion kuat! 7ebih rinci lagi, S8D adalah umlah
konsentrasi basa kation kuat dikurangi umlah darikonsentrasi basa kation kuat dikurangi umlah dari
konsentrasi asam anion kuat! :ntuk deinisi ini semuakonsentrasi asam anion kuat! :ntuk deinisi ini semua
konsentrasi ion5ion diekspresikan dalam ekui;alensikonsentrasi ion5ion diekspresikan dalam ekui;alensi#m
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Gamblegram
NaNa88
14#14#
44
,a,a8888)()(8888
,l,l--
1#21#2
A"5N AN"5N
S8DS8D
STRONG IONSTRONG ION
DI%%ERENCEDI%%ERENCE
[Na+] + [K+] + [kation divalen] - [Cl-] - [asam organik kat-]
[Na+] + [K+] - [Cl-] ! ["#$]
1%0 m&' + % m&' - 10* m&' ! % m&'
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SIDSID()* ((++**
[H[H++]] [OH[OH--]]
?alam cairan biolo(is plasma9 d(n su*u 37#,6 '"? *ampir
selalu positif6 biasanya ber$isar 3#-4# m+
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Kombinasi protein dan posfat disebut asamlemah total (total weak acid) [Atot].
Reaksi disosiasinya adalah
[A[Atottot] (KA) ! [A] (KA) ! [A""].[#].[#$$]]
[%rotein #] [%rotein"] $ [#$]
&EA ACID&EA ACID
disosiasi
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Gamblegram
NaNa88
14#14#
44
,a,a8888)()(8888
,l,l--
1#21#2
H,5H,533--
2424
A"5N AN"5N
S8DS8D
=eak acid=eak acid
#Alb5,P5$#Alb5,P5$
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DEPENDENT VARIABLESDEPENDENT VARIABLES
HH++
OHOH--
CO3CO3-- AA--
AHAH
HCO3-HCO3-
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Strong 8onsStrong 8ons
DierenceDierence
p-.p-.
ProteinProtein
-oncentration-oncentration
pHpH
8ND
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NaNa,,
M.M.CaCa
C/C/
22
PPA/0A/0
H-.H-.//* 4* 4
C/C/
11
PPA/0A/0
H-.H-.//55
,sidosishierkloremi
"#$ n"#$
C/C/
22
7aktat2keto*:A
Ketolaktatasidosis
CLCL
11
PP
AlbAlb
SID
Alkalosishipokloremi
K,.#/NK,.#/N ,N#/N,N#/N
H/. * H * 40 m
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encl ?, "abor A, a'da A, igge "! Diagnosis o metabolic acid5base disturbances in
critically ill patients! Am " @espir -rit -are ed 000 DecC1+#+$%4+51
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AS8D.S8S A7A7.S8S
8! @espiratori P-.
P-.
88! Nonrespiratori #metabolik$
1! Eangguan pd S8D
a! elebi*an $e$uran(an airFNaG, S8D
FNaG, S8D
b! etida$seimban(an anion
$uat
i! elebi*an $e$uran(an ,l- F-l5G, S8D F-l5G, S8D
ii! Ada anion ta$ teru$ur F:A5G, S8D
! Eangguan pd asam lemah
i! adar albumin FAlbG FAlbG
ii! adar posp*ate FPiG FPiG
encl ?, "abor A, a'da A, igge "! Diagnosis o metabolic acid5base disturbances in
critically ill patients! Am " @espir -rit -are ed 000 DecC1+#+$%4+51
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@ A B . 7 8
AbnormalAbnormalp-.p-.
AbnormalAbnormalS8DS8D
AbnormalAbnormal=eak acid=eak acid
AlbAlb P.45P.45
AlkalosisAlkalosis
AsidosisAsidosis
TurunTurun
MeningkatMeningkat
TurunTurun
kelebihankelebihan
kekurangankekurangan
PositifPositif meningkatmeningkat
encl 6 Am F 0espir ,rit ,are )ed 2### ?ec@129224-!1
A8@A8@
Anion kuatAnion kuat
-l5-l5 :A5:A5
i!oi!o
i!eri!er
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Anion Eap
?escribed by Iamble in 1;3;
+lectroneutrality
Na86 ,l-6 and H,53are measured ions
Na :- * -l H-./ :A
:-* Sum o unmeasured cations
:A* Sum o unmeasured anions
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Anion Eap
:nmeasured -ations% total 11m+. Acid-Base ?isorders. &&&.acid-base.com
http://www.acid-base.com/http://www.acid-base.com/