&
ELECTROLYTES
Oleh:
Dr. Husnil Kadri, M.Kes
Bagian Biokimia Fakultas Kedokteran
Universitas Andalas
Padang
ASAM BASA..
+
[H ]
pH
2
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).
8
H
2
3
3
CA
Assisted breathing:
A respirator is used to assist breathing by
expelling CO2, thus reducing PCO2 in blood
10
11
12
15
Reabsorption of Bicarbonate
16
17
CARA TRADISIONAL :
Hendersen-Hasselbalch
(1909)
18
Normal
[HCO
GINJAL
BASA3-]
HCO
HCO 3
3
pH = 6.1 + log
Normal
Kompensasi
PARU
pCO2
ASAM
CO
CO22
19
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
pCO2
SID
WEAK ACID
Atot
CO2
CO2 Didalam plasma berada
dalam 4 bentuk
sCO2 (terlarut)
H2CO3 asam karbonat
-
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
Cl102
KATION
ANION
SID
DEPENDENT VARIABLES
H+
HCO3OH-
AH
CO3-
A-
INDEPENDENT VARIABLES
DEPENDENT VARIABLES
Strong Ions
Difference
pCO2
Protein
Concentration
pH
APLIKASI
H3O+ = H+ = 40 mEq/L
K
Mg
Ca
HCO3-
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
KLASIFIKASI GANGGUAN
KESEIMBANGAN ASAM BASA
BERDASARKAN PRINSIP STEWART
KLASIFIKASI
ASIDOSIS
ALKALOSIS
PCO2
PCO2
[Na+], SID
[Na+], SID
[Cl-], SID
[Cl-], SID
[UA-], SID
I. Respiratori
[Alb]
[Alb]
[Pi]
[Pi]
RESPIRASI
METABOLIK
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.
40