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basa
Hendy Buana Vijaya
Keseimbangan asam basa
• Keasaman dan kebasaan larutan tergantung ion hydrogen yang dikandung
• Peningkatan kadar H+ akan menurunkan pH sehingga larutan menjadi asam
• Penurunan kadar H+ akan meningkatkan pH sehingga larutan menjadi basa
• Asam : molekul yang mengandung ion H dan dapat melepaskan ion H
• Basa : Molekul yang menerima H
Regulasi asam basa
• Sistem respirasi
• Sistem renal
• Sistem penyangga BUFFER ( Bicarbonat, Fosfat, Protein, Hb)
Mekanisme hemoestatis
1. Ginjal mengeksresikan urin yang bersifat asam atau basa, sehingga membantu
konsentrasi ion hidrogen cairan ekstraseluler tubuh kembali normal
2. Pernafasan akan terangsang untuk mengubah kecepatan ventilasi paru-paru, yang
berakibat pada perubahan kecepatan pengeluaran karbondioksida dari cairan
tubuh yang akan menyebabkan konsentrasi ion hidrogen kembali normal
3. Sistem penyangga (buffer) asam-basa yang segera bergabung dengan setiap asam
ataupun basa yang kemudian mencegah terjadinya perubahan konsentrasi ion
hidrogen yang berlebihan
Metabolic acidosis
• Increased input of acids
• An increased generation of acids
• An increased loss of bicarbonate
Body response :
• Including producing buffers (extracellular bicarbonate and intracellular buffers from muscle
and bone)
• Increasing ventilation ( Kussmaul’s respiration)
• Increasing renal reabsorption and generation of bicarbonate
• Increase secretion of hydrogen
• Treatment is to restore perfusion with volume resuscitation than to attempt
to correct abnormality
• With adequate perfusion tha lactic acids is rapidly metabolized by the liver
• In clinical studies of lactic acidosis and ketoacidosis, the administration of
bicarbonate has not reduced morbidity or mortality or improved cellular
function
Metabolic acidosis
• Evaluation of a patient with a low serum bicarbonate level and metabolic
acid dosis includes determination of anion gap (AG) an index of
unmeasured anions
AG = (Na) – (Cl + HCO3)
• The normal AG is <12 mmol/L and is due primarily to the
albumin effect, so that the estimated AG
Corrected AG = actual AG – [2.5(4.5 – albumin)]
Anion
gap
Etiologi
Metabolic alkalosis
• Metabolic alkalosis result from the loss of fixed acid or the gain of bicarbonate and
isworsened by potassium depletion
• Hypochloremic and hypokalemic metabolic alkalosis can occur from isolated
logastric contents in infants with pyloric stenosis or adults with duodenal ulcer
disease
• In response to the associated volume deficit, aldosterone-mediated sodium
reabsorption increases potassium excretion.
• Treatment include replacement of the volume deficit with isotonic saline and
then potassium replacement once adequate urine output is achived
• Acetazolamide (diamox).Dosis dewasa 5-10 mg/kg/hr PO/IV terbagi q6h.
Pediatric 5 mg/kg PO qd/qod;
8-30 mg/kg/hr IV/IM dibagi q6-8h;
maksimal 1 g/d
Etiologi
Metabolic Acidosis VS Metabolic Alkalosis
Respiratory acidosis
• Respiratory acidosis is associated with the retention of CO2
• Treatment of acute respiratory acidosis is directed at the underlying cause.
• Treatment of acute respiratory acidosis is directed at the underlying cause.
• Measures to ensure adequate ventilation are also initiated.
• This may entail patient-initiated volume expansion using noninvasive bilevel positive
airway pressure or may require endotracheal intubation to increase minute
ventilation.
etiologi
Respiratory alkalosis
• Most case of respiratory alkalosis are acute and secondary to alveolar ventilation.
• Causes include ; pain, anxiety, and neurologic disorder
• Acute hypocapnia can cause an uptake of potassium and phosphate into cells and
increased binding of calcium to albumin, leading to symptomatic hypokalemia,
hypophosphatemia, and hypocalcemia with subsequent arrhythmias, paresthesias,
muscle cramps, and seizures
Respiratory Acidosis VS REspiratory Alkalosis
Analisa Gas Darah
• Dapat membantu menilai pertukaran gas, control ventilasi, dan
keseimbangan asam basa
• Sebagai penunjang dalam diagnosis, panduan rencana terapi, dan penunjang
penatalaksanaan ventilator
• AGD tidak dapat menghasilkan diagnosis yang spesifik
• PaO2 yang rendah tidak langsung menandakan hipoksia jaringan dan PaO2
yang normal juga tidak pasti menandakan oksigenasi jaringan yang adekuat
Blood Gas analysis
PaO2 SaO2 (%)
• Untuk pH, normalnya : 7.35 - 7.45 (mmHg)
• pH: 7.26,
• paCO2: 32
• HCO3: 18
ROME
• Respiratorik Opposite (paCO2)