PENGATURAN ASAM BASA
-
Upload
indah-prasetya-putri -
Category
Documents
-
view
108 -
download
5
description
Transcript of PENGATURAN ASAM BASA
![Page 1: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/1.jpg)
BLOK IX : UROLOGIFK UNRI 2009-2010
dr. Enikarmila Asni, M.Med.Ed, M.Biomed
![Page 2: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/2.jpg)
Menjaga homeostasis asam basa penting utk kehidupan organisme.
Perubahan pH: - gangguan stabilitas membran sel - kelainan struktur protein - perubahan aktifitas enzim
Nilai normal : PCO2 : 35 – 45 mmHg PO2 : 75 – 100 mmHg pH : 7.35 – 7.45 HCO3 : 22 – 26 mEq/L
![Page 3: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/3.jpg)
![Page 4: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/4.jpg)
pH cairan tubuh refleksi interaksi : - asam, basa, garam dlm larutan
• Persamaan Henderson : [H+] = 24 PaCO2/ [HCO3]
• Kelainan asam basa dimulai oleh :Gangguan asam basa
perubahan pd PaCO2
kelainan respirasi asidosis/alkalosis respiratorik
perubahan pd bikarbonat plasma
kelainan metabolik asidosis/alkalosis metabolik
![Page 5: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/5.jpg)
1. Buffer kimiawi dlm cairan ekstra dan intra selluler.
2. Pemindahan karbondioksida oleh paru-paru.
3. Regulasi konsentrasi ion hidrogen oleh ginjal
![Page 6: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/6.jpg)
![Page 7: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/7.jpg)
![Page 8: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/8.jpg)
a. Sistem buffer asam karbonat-bikarbonat
b. Sistem buffer phosphatc. Sistem buffer protein
![Page 9: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/9.jpg)
9
Sodium Bicarbonat (NaHCO3) dan asam karbonat (H2CO3)
Mempertahankan rasio HCO3- : H2CO3 =
20:1
HCl + NaHCO3 ↔ H2CO3 + NaCl
NaOH + H2CO3 ↔ NaHCO3 + H2O
![Page 10: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/10.jpg)
Berperan penting dlm mempertahankan derajat asam basa cairan dlm tubula ginjal.
Derajat pH ditentukan oleh naik atau turunnya ekskresi ion hidrogen.
![Page 11: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/11.jpg)
Sistem buffer terbesar dan terkuat Dijumpai : Hb, plasma protein dan
protein intraseluler. Protein dalam Hb, plasma & intraseluler
akan mempertahankan derajat asam basa dengan mempertahankan ion hidrogen & CO2 ketika berdifusi melalui membran sel ke dalam sel.
![Page 12: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/12.jpg)
CO2 + H2O H2 CO3
Jk konsentrasi CO2 pH darah asidosis
Jk konsentrasi CO2 pH darah alkalosis
Jk H2 CO3 terurai mk CO2 akan berdifusi ke alveoli paru-paru & dikeluarkan saat exhalasi. Shg respiratory rate (RR) mempengaruhi konsentrasi ion hidrogen.
Jk RR CO2 dikeluarkan pH Jk RR CO2 tertahan pH
![Page 13: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/13.jpg)
Derajat pH dipengaruhi oleh naik turunnya konsentrasi ion hidrogen dlm cairan
Hidrogen disekresikan ke dlm tubula ginjal & dikeluarkan dlm urin.
Pd saat yg sama, Sodium di re-absorpsi dr cairan tubula ginjal ke dlm ECF utk m’gantikan hidrogen.
Kemudian Sodium berikatan dg ion HCO3 utk m’bentuk NaHCO3.
![Page 14: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/14.jpg)
![Page 15: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/15.jpg)
![Page 16: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/16.jpg)
![Page 17: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/17.jpg)
![Page 18: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/18.jpg)
![Page 19: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/19.jpg)
Etiologi : - kelainan yg mempengaruhi buffer sirkulasi, performa respirasi, fungsi ginjal. - kondisi kardiovaskuler. - kondisi yg pengaruhi CNS.
![Page 20: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/20.jpg)
20
Jika yang bermasalah adalah metabolik, maka terjadi proses hiperventilasi/hipoventilasi :kompensasi respiratori.
Jika yang bermasalah adalah respiratorius, mekanisme ginjal : kompensasi metabolik
![Page 21: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/21.jpg)
21
Efek utama asidosis adalah penekanan CNS karena ↓ in penghantaran sinaps
Kelemahan menyeluruh Ancaman : gangguan fungsi CNS Asidosis berat mengakibatkan
Disorientasikoma kematian
![Page 22: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/22.jpg)
22
Alkalosis menyebabkan kepekaan CNS dan sistem saraf perifer meningkat.
Nyeri kepala peka cahaya Dapat menyebabkan:
kebingunganSpasme muskular/tetaniKonvulsiKehilangan kesadaranKematian
![Page 23: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/23.jpg)
23
![Page 24: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/24.jpg)
24
Kelebihan asam karbonat : karena level CO2 darah diatas 45 mm Hg.
Hiperkapnia – tingginya kadar CO2 dalam darah
Kondisi kronis:Depresi pusat pernafasan di otak yang
mengontol kecepatan pernafasan : obat/trauma
Paralysis otot pernafasanEmfisema
Kondisi akutAdult Respiratory Distress SyndromePulmonary edemaPneumothorax
![Page 25: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/25.jpg)
25
Ginjal mengeluarkan ion hidrogen dan dan mempertahankan ion bikarbonat
Gejala :Pernafasan menurunLetargy dan disorientasiTremor, convulsion, comaPernafasan cepat, kemudian
meurun/depressedKulit hangat dan memerah karena
vasodilatasi akibat kelebihan CO2
![Page 26: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/26.jpg)
26
![Page 27: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/27.jpg)
27
Kekuranan asam karbonat pCO2 kurang dari 35 mm Hg
(hypocapnea) Kejadian paling sering terhadap ggn
asam-basa. Penyebab utama : hiperventilasi
![Page 28: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/28.jpg)
28
Penyebab :Defisitoksigen : ketinggianPulmonary disease dan Congestive heart failure–
caused by hypoxia Acute anxietyFever, anemiaEarly salicylate intoxicationCirrhosisGram-negative sepsis
![Page 29: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/29.jpg)
29
Ginjal mempertahankan ion H Ekskresi ion bikarbonat
Salah satu cara : bernafas dalam kantung
![Page 30: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/30.jpg)
30
![Page 31: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/31.jpg)
31
Kekurangan Bikarbonat – konsentrasi dalam darah dibawah 22mEq/L
PenyebabDiare/kelainan ginjalPenumpukan asam(lasam laktat/keton)Kegagalan ginjal dalam eksresi H+
Gejala : Headache, lethargyNausea, vomiting, diarrheaComaDeath
![Page 32: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/32.jpg)
32
Ventilasi meningkat Eksresi H di ginjal K+ tukar dengan H+
( H+ ke dalam sel, K+ keluar sel)
![Page 33: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/33.jpg)
33
![Page 34: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/34.jpg)
34
Kelebihan Bicarbonate : lebih besar dari 26 mEq/L
Penyebab:Excess vomiting = loss of stomach acidExcessive use of alkaline drugsCertain diureticsEndocrine disordersHeavy ingestion of antacidsSevere dehydration
![Page 35: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/35.jpg)
35
Alkalosis paling sering terjadi karena disfungsi renal, ok itu tidak dapat dikompensasi ginjal
Kompensasi respiratorius sulit : hypoventilasi dibatasi oleh kondisi hipoksia
Gejala : Pernafasan lambat dan dangkal Refleks hiperaktif; tetani Atrial tachycardia Dysrhythmias
![Page 36: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/36.jpg)
36
![Page 37: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/37.jpg)
37
1. Tandai bahwa pH rendah(asidosis) atau tinggi (alkalosis)
2. Tentukan nilai pCO2 atau HCO3- ,
normal atau dapat merupakan penyebab masalah. Jika penyebabnya adalah perubahan pCO2, masalah respiratorius. Jika penyebabnya adalah perubahan HCO3
-, masalah
metabolik.3. Tentukan nilai lain : kompensasi/tidak
![Page 38: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/38.jpg)
38
Seorang pasien di intensive care unit (ICU) karena serangan myocardial infarction berat 3 hari yang lalu. Hasil lab :pH 7.3HCO3- = 20 mEq / L ( 22 - 26)pCO2 = 32 mm Hg (35 - 45)
Tentukan kondisi kestimbangan asam-basanya
![Page 39: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/39.jpg)
39
Asidosis metabolik dikompensasi
![Page 40: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/40.jpg)
40
![Page 41: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/41.jpg)
![Page 42: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/42.jpg)
![Page 43: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/43.jpg)
![Page 44: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/44.jpg)
![Page 45: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/45.jpg)
![Page 46: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/46.jpg)
![Page 47: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/47.jpg)
![Page 48: PENGATURAN ASAM BASA](https://reader036.fdocuments.net/reader036/viewer/2022081417/577c81511a28abe054ac5b17/html5/thumbnails/48.jpg)