GANGGUAN

KESEIMBANGAN ASAM
DAN BASA
SARI HARYATI
Fisiologik
Asam zat yang dapat memberikan ion H+ ke zat lain
(donor proton)

Basa zat yang dapat menerima ion H+ dari zat lain

(akseptor proton)

Keseimbangan asam basa keadaan dimana

konsentrasi ion hydrogen yang diproduksi setara dengan
konsentrasi ion hydrogen yang dikeluarkan oleh tubuh

Patofisiologi, Sylvia A.Price

 Asam

Hampir terurai sempurna

Asam Kuat dalam larutan
(HCl) Melepaskan lebih banyak
ion H+

Hanya sebagian terurai

Asam Lemah dalam larutan
(H2CO3) Melepaskan sedikit ion
H+

Patofisiologi, Sylvia A.Price

 Basa

Terurai mudah dalam

Basa Kuat larutan
(NaOH) Bereaksi kuat dengan
asam

Hanya sebagian terurai

Basa Lemah dalam larutan
(NaHCO3) Kurang bereaksi dengan
asam

Patofisiologi, Sylvia A.Price

 Tingkat keasaman ditentukan konsentrasi H+ pH
pH = -log [H+]

Jika H+ pH larutan lebih asam

Jika H + pH larutan lebih basa

Di dalam tubuh konsentrasi ion hidrogen normal

dipertahankan dalam batas <<<

5
Patofisiologi, Sylvia A.Price
Pendekatan Handerson-Hasselbach

pH = pK + log [ HCO3-]
S x [ PCO2]
6,1 + log 24 meq/L
0,03 x 40 mmHg
6,1 + log 20
1
7,4 = 6,1 +1,3
 pH normal darah sekitar 7,4 dgn batas terjauh
yang masih dapat ditanggulangi 6,8 7,8

7
 Pertahanan tubuh terhadap perubahan ion
hidrogen : sistem penyangga ( buffer) ,
mekanisme pernafasan dan mekanisme ginjal
 Acids take in with foods
Acids produced by metabolism of carbohydrates,
lipids and proteins
Cellular metabolism produces CO2.
CO2 + H20 H2CO3 H+ + HCO3-

9
Pengaturan Asam Basa
Bicarbonate
Buffer
Phosphate
First Line of defense Chemical Buffer Buffer
againt pH shift System
Hb Buffer

Protein Buffer

Respiratory
Second Line of mechanism
Physiological
defense againt pH
Buffers Renal
shift
mechanism
Sistem Penyangga (buffer)
Menetralisir kelebihan ion hydrogen
mencegah perubahan pH yang disebabkan oleh
pengaruh asam pada cairan ekstraseluler.
Bicarbonate Buffer
Sistem penyangga bikarbonat terdiri dari larutan air
yang mengandung dua zat : asam lemah H2CO3 dan
garam bikarbonat NaHCO3
CO2 + H2O H2CO3 HCO3- + H+ (1)
NaHCO3 Na+ + HCO3 - (2)
CO2 + H2O H2CO3 H+ + HCO3- (3)
Pendekatan Handerson-Hasselbach
pH = pK + log [ HCO3-]
[ PCO2]
 Melalui persamaan Henderson-Hasselbalch,
kontrol fisiologis komposisi asam dan basa
ekstraseluler, konsentrasi ion bicarbonat
diatur oleh ginjal, sedang pCO2 diatur oleh
paru-paru
Phosphate buffer
Major intracellular buffer, tubulus renal
H+ + HPO42- H2PO4-

OH- + H2PO4- H2O + H2PO42-

14
Hb Buffer

Hb adalah suatu bufer ion H+ yang efektif,

diproduksi dalam eritrosit dalam perjalanan
transpor CO2 dari jaringan ke paru dalam
bentuk HCO3-
Respiratory mechanisms
Exhalation of carbon dioxide
Powerful, but only works with volatile acids
Doesnt affect fixed acids like lactic acid
CO2 + H20 H2CO3 H+ + HCO3-
Body pH can be adjusted by changing rate and
depth of breathing

16
Renal Mechanism
Can eliminate large amounts of acid
Can also excrete base
Most effective regulator of pH
If kidneys fail, pH balance fails

17
 Rates of correction
Buffers function almost instantaneously

Respiratory mechanisms take several minutes to

hours

Renal mechanisms may take several hours to days

18
 pH< 7.35
Acid-Base
acidosis Imbalances
pH > 7.45 alkalosis
The body response to acid-base imbalance is
called compensation
Complete if brought back within normal limits
Partial compensation if range is still outside
norms.

19
 Compensation
If underlying problem is metabolic, hyperventilation
or hypoventilation can help : respiratory
compensation.

If problem is respiratory, renal mechanisms can bring

about metabolic compensation.

20
 Keseimbangan Asam Basa
melalui Pendekatan Stewart
Definisi SID

Strong Ion Difference adalah ketidakseimbangan

muatan dari ion-ion kuat. Jumlah dari basa kation
kuat asam anion kuat

Semua ion kuat akan terdisosiasi

sempurna jika berada dalam larutan,
misalnya Na atau Cl
The Relationship Between SID,OH, H+
The practical point
PRINSIP-PRINSIP DASAR SISTEM STEWART
Asidosis

Metabolik

Respiratorik

40
 Metabolic Acidosis
Causes:
Loss of bicarbonate through diarrhea or renal
dysfunction
Accumulation of acids (lactic acid or ketones)
Failure of kidneys to excrete H+

Symptoms
Headache, lethargy
Nausea, vomiting, diarrhea
Coma
Death
41
Compensation for Metabolic Acidosis
Increased ventilation
Renal excretion of hydrogen ions if possible
K+ exchanges with excess H+ in ECF
( H+ into cells, K+ out of cells)

Treatment :
SodiumBicarboat

42
 Respiratory Acidosis
Carbonic acid excess caused by blood levels of CO2
> 45 mm Hg.
Acute conditons:
Adult Respiratory Distress Syndrome
Pulmonary edema
Pneumothorax
Chronic conditions:
Depression of respiratory center in brain that
controls breathing rate drugs or head trauma
Paralysis of respiratory or chest muscles
Emphysema
43
Compensation for Respiratory Acidosis
Kidneys eliminate hydrogen ion and retain
bicarbonate ion

Treatment
Restore ventilation
Treat underlying dysfunction or disease

44
 Alkalosis

Metabolik Respiratorik

45
 Metabolic Alkalosis
Causes:
Excess vomiting = loss of stomach acid
Excessive use of alkaline drugs
Certain diuretics
Heavy ingestion of antacids
Severe dehydration
Conpensation :
Alkalosis most commonly occurs with renal
dysfunction
Respiratory compensation difficult
hypoventilation limited by hypoxia
Symptoms of Metabolic Alkalosis
Respiration slow and shallow
Hyperactive reflexes ; tetany
Often related to depletion of electrolytes
Atrial tachycardia
Dysrhythmias

Therapy :
Electrolytes to replace those lost
Treat underlying disorder

47
 Respiratory Alkalosis
Carbonic acid deficit
pCO2 less than 35 mm Hg (hypocapnea)
Most common acid-base imbalance
Primary cause is hyperventilation

Compensation :
Kidneys conserve hydrogen ion
Excrete bicarbonate ion

48
 Respiratory Alkalosis
Conditions that stimulate respiratory center:
Oxygen deficiency at high altitudes
Pulmonary disease and CHF caused by hypoxia
Acute anxiety
Fever, anemia
Sepsis

Treatment :
Treat underlying cause
Breathe into a paper bag/ rebreathing mask
49
TERIMA KASIH