Keseimbangan asam basa

KESEIMBANGAN ASAM BASA TUBUH

Keseimbangan asam basa adalah homeostasis dari kadar ion hidrogen dalam tubuh
Kadar normal ion hidrogen (H) arteri adalah: 4x10-8 atau pH = 7,4 (7,35 7,45)
Asidosis = asidemia kadar pH darah <7,35 Alkalemia = alkalosis kadar pH darah >7,45
Kadar pH darah <6,8 atau >7,8 tidak dapat diatasi oleh tubuh
Partial pressure of oxygen (PaO2) - 75 - 100 mmHg
Partial pressure of carbon dioxide (PaCO2) - 38 - 42 mmHg
Arterial blood pH of 7.38 - 7.42
Oxygen saturation (SaO2) - 94 - 100%
Bicarbonate - (HCO3) - 22 - 28 mEq/L


Sistem Buffer Tubuh
Sistem buffer ECF asam karbonat-bikarbonat (NaHCO3 dan H2CO3)
Sistem buffer ICF fosfat monosodium-disodium (Na2HPO4 dan NaH2PO4)
Sistem buffer ICF eritrosit oksihemoglobin-hemoglobin (HbO2- dan HHb)
Sistem buffer ICF dan ECF protein (Pr- dan HPr)

Pertahanan pH darah normal tercapai melalui kerja gabungan dari buffer darah, paru dan
ginjal
Persamaan Handerson Hasselbach:
20 [HCO3-]
pH = 6,1 + log ---------------------
1PaCO2
[HCO3-] faktor metabolik, dikendalikan ginjal
PaCO2 faktor respiratorik, dikendalikan paru
pH 6,1 efek buffer dari asam karbonat-bikarbonat
Selama perbandingan [HCO3-] : PaCO2 = 20 : 1 pH darah selalu = 6,1 + 1,3 = 7,4

Gangguan Asam Basa darah
Asidosis metabolik [HCO3-] dikompensasi dengan PaCO2
Alkalosis metabolik [HCO3-] dikompensasi dengan PaCO2
Asidosis respiratorik PaCO2 dikompensasi dengan [HCO3-]
Alkalosis respiratorik PaCO2 dikompensasi dengan [HCO3-]

Asidosis Metabolik
Ciri: [HCO3-] <22mEq/L dan pH <7,35 kompensasi dengan hiperventilasi PaCO2,
kompensasi akhir ginjal ekskresi H+, sebagai NH4+ atau H3PO4
Penyebab: Penambahan asam terfiksasi: ketoasidosis diabetik, asidosis laktat (henti jantung
atau syok), overdosis aspirin Gagal ginjal mengekskresi beban asam Hilangnya HCO3- basa
diare
Gejala Asidosis Metabolik Tidak jelas dan asimptomatis Kardiovaskuler: disritmia, penurunan
kontraksi jantung, vasodilatasi perifer dan serebral Neurologis: letargi, stupor, koma
Pernafasan: hiperventilasi (Kussmal) Perubahan fungsi tulang: osteodistrofi ginjal (dewasa)
dan retardasi pada anak
Penatalaksanaan Asidosis Metabolik Tujuan: meningkatkan pH darah hingga ke kadar aman
(7,20 hingga 7,25) dan mengobati penyakit dasar NaHCO3 dapat digunakan bila pH <7,2 atau
[HCO3-] <15mEq/L
Risiko NaHCO3 yang berlebihan: penekanan pusat nafas, alkalosis respiratorik, hipoksia
jaringan, alkalosis metabolik, hipokalsemia, kejang, tetani Alkalosis Metabolik Ciri: [HCO3-]
>26mEq/L dan pH >;7,45 kompensasi dengan hipoventilasi PaCO2, kompensasi akhir
oleh ginjal ekskresi [HCO3-] yang berlebihan

Penyebab:
Hilangnya H+ (muntah, diuretik, perpindahan H+dari ECF ke ICF pada hipokalemia)
Retensi [HCO3-] (asidosis metabolik pasca hiperkapnia)

Gejala Alkalosis Metabolik
Gejala dan tanda tidak spesifik
Kejang dan kelemahan otot akibat hipokalemia dan dehidrasi
Disritmia jantung, kelainan EKG hipokalemi
Parestesia, kejang otot hipokalsemia

Penatalaksanaan Alkalosis Metabolik
Tujuan: menghilangkan penyakit dasar
Pemberian KCl secara IV dalam salin 0,9% (diberikan jika Cl- urine <10mEq/L)
menghilangkan rangsangan aldosteron ekskresi NaHCO3 Jika Cl- urine >20mEq/L
disebabkan aldosteron yang berlebihan tidak dapat diobati dengan salin IV, tapi dengan
diuretik

Asidosis Respiratorik
Ciri: PaCO2 >45mmHg dan pH <7,35 kompensasi ginjal retensi dan peningkatan
[HCO3-]
Penyebab: hipoventilasi (retensi CO2), inhibisi pusat nafas (overdosis sedatif, henti jantung),
penyakit dinding dada dan otot nafas (fraktur costae, miastemia gravis), gangguan pertukaran
gas (COPD), obstruksi jalan nafas atas
Gejala Asidosis Respiratorik Tidak spesifik Hipoksemia (dominan) asidosis respiratorik
akut akibat obstruksi nafas Somnolen progresif, koma asidosis respiratorik kronis
Vasodilatasi serebral meningkatkan ICV papiledema dan pusing
Penatalaksanaan Asidosis Respiratorik Pemulihan ventilasi yang efektif sesegera mungkin
pemberian O2 dan mengobati penyebab penyakit dasar PaO2 harus ditingkatkan >60mmHg
dan pH >7,2

Alkalosis Respiratorik
Ciri: penurunan PaCO2 <35mmHg dan peningkatan pH serum >7,45 kompensasi ginjal
meningkatkan ekskresi HCO3-
Penyebab: hiperventilasi (tersering psikogenik karena stress dan kecemasan), hipoksemia
(pneumonia, gagal jantung kongestif, hipermetabolik (demam), stroke, stadium dini keracunan
aspirin, septikemia

Gejala Alkalosis Respiratorik
Hiperventilasi (kadar gas, frekuensi nafas)
Menguap, mendesak, merasa sulit bernafas
Kecemasan: mulut kering, palpitasi, keletihan, telapak tangan dan kaki dingin dan berkeringat
Parastesia, otot berkedut, tetani
Vasokontriksi serebal hipoksia cerebral kepala dingin dan sulit konsentrasi

Penatalaksanaan Alkalosis Respiratorik
Menghilangkan penyebab dasar
Kecemasan dapat dihilangkan dengan pernafasan kantong kertas yang dipegang erat disekitar
hidung dan mulut dapat memulihkan serangan akut
Hiperventilasi mekanik diatasi dengan menurangi ventilasi dalam satu menit, menambah
ruang hampa udara atau menghirup 3% CO2 dalam waktu singkat
Metabolic acidosis
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Metabolic acidosis is a condition in which there is too much acid in the body fluids.
Causes
Metabolic acidosis occurs when the body produces too much acid, or when the kidneys are not
removing enough acid from the body.
There are several types of metabolic acidosis:
Diabetic acidosis (also called diabetic ketoacidosis and DKA): Develops when acidic substances
known as ketone bodies, build up in the body. This occurs with uncontrolled type 1 diabetes
Hyperchloremic acidosis: Results from excessive loss of sodium bicarbonate from the body. This can
occur with severe diarrhea
Lactic acidosis: Results from a buildup of lactic acid. It can be caused by:
Alcohol
Cancer
Exercising intensely
Liver failure
Medications, such as salicylates
Prolonged lack of oxygen from shock, heart failure, or severe anemia
Seizures
Other causes of metabolic acidosis include:
Kidney disease (distal renal tubular acidosis and proximal renal tubular
acidosis)
Poisoning by aspirin, ethylene glycol (found in antifreeze), or methanol
Severe dehydration
Symptoms
Most symptoms are caused by the underlying disease or condition that is causing the metabolic
acidosis. Metabolic acidosis itself usually causes rapid breathing. Confusion or lethargy may also
occur. Severe metabolic acidosis can lead to shock or death. In some situations, metabolic acidosis can
be a mild, chronic (ongoing) condition.
Exams and Tests
Arterial blood gas
Serum electrolytes
Urine pH
Arterial blood gas analysis and a serum electrolytes test (such as a basic metabolic panel) will confirm
acidosis is present and determine whether it is respiratory acidosis or metabolic acidosis.
Other test may be needed to determine the cause of the acidosis.
Treatment
Treatment is aimed at the underlying condition. In some cases, sodium bicarbonate (the chemical in
baking soda) may be given to reduce the acidity of the blood.
Outlook (Prognosis)
The outlook will depend on the underlying disease causing the condition.
Possible Complications
Very severe metabolic acidosis can lead to shock or death.
When to Contact a Medical Professional
Seek medical help if you have symptoms of any disease that can cause metabolic acidosis.
Prevention
Diabetic ketoacidosis can be prevented by keeping type 1 diabetes under control.
Respiratory acidosis
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Respiratory acidosis is a condition that occurs when the lungs cannot remove all of the carbon dioxide
the body produces. This causes body fluids, especially the blood, to become too acidic.
Causes
Causes of respiratory acidosis include:
Diseases of the airways (such as asthma and chronic obstructive lung
disease)
Diseases of the chest (such as scoliosis)
Diseases affecting the nerves and muscles that "signal" the lungs to inflate
or deflate
Drugs that suppress breathing (including powerful pain medicines, such
as narcotics, and "downers," such as benzodiazepines), especially when
combined with alcohol
Severe obesity, which restricts how much the lungs can expand
Chronic respiratory acidosis occurs over a long period of time. This leads to a stable situation, because
the kidneys increase body chemicals, such as bicarbonate, that help restore the body's acid-base
balance.
Acute respiratory acidosis is a condition in which carbon dioxide builds up very quickly and before the
kidneys can return the body to a state of balance.
Symptoms
Symptoms may include:
Confusion
Easy fatigue
Lethargy
Shortness of breath
Sleepiness
Exams and Tests
The health care provider will perform a physical exam. Tests that may be done include:
Arterial blood gas, which measures oxygen and carbon dioxide levels in
the blood
Basic metabolic panel
Chest x-ray
Pulmonary function test
Treatment
Treatment is aimed at the underlying disease, and may include:
Bronchodilator drugs to reverse some types of airway obstruction
Noninvasive positive-pressure ventilation (sometimes called CPAP or
BiPAP) or a breathing machine, if needed
Oxygen if the blood oxygen level is low
Treatment to stop smoking
Outlook (Prognosis)
How well you do depends on the disease causing the respiratory acidosis.
Possible Complications
Poor organ function
Respiratory failure
Shock
When to Contact a Medical Professional
Severe respiratory acidosis is a medical emergency. Seek immediate medical help if you have
symptoms of this condition.
Call your health care provider if you have symptoms of lung disease.
Prevention
Do not smoke. Smoking leads to the development of many severe lung diseases that can cause
respiratory acidosis.
Losing weight may help prevent respiratory acidosis due to obesity (obesity-hypoventilation
syndrome).
Be careful about taking sedating medicines, and never combine these medicines with alcohol.
Respiratory alkalosis
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Respiratory alkalosis is a condition marked by low levels of carbon dioxide in the blood due to
breathing excessively.
See also: Alkalosis
Causes
Common causes include:
Anxiety
Fever
Hyperventilation
Any lung disease that leads to shortness of breath can also cause respiratory alkalosis.
Symptoms
The symptoms may include:
Dizziness
Lightheadedness
Numbness of the hands and feet
Exams and Tests
Your doctor or nurse will perform a physical exam. Tests that may be done include:
Arterial blood gas, which measures oxygen and carbon dioxide levels in
the blood
Basic metabolic panel
Chest x-ray
Pulmonary function test
Treatment
Treatment is aimed at the condition that causes respiratory alkalosis. Breathing into a paper bag -- or
using a mask that causes you to re-breathe carbon dioxide -- sometimes helps reduce symptoms.
Outlook (Prognosis)
What will happen depends on the condition that is causing the respiratory alkalosis.
Possible Complications
Seizures may occur if the alkalosis is extremely severe. This is very rare.
When to Contact a Medical Professional
Call your health care provider if you have any symptoms of lung disease, such as chronic cough or
shortness of breath.
Alternative Names
Alkalosis - respiratory