ASAM BASA..

[H ]
+

pH
1

Acid

Base

Notasi pH diciptakan oleh seorang ahli kimia dari Denmark

yaitu Soren Peter Sorensen pada thn 1909, yang berarti log
negatif dari konsentrasi ion hidrogen. Dalam bahasa Jerman
disebutWasserstoffionenexponent (eksponen ion hidrogen)
dan diberi simbol pH yang berarti: potenz (power) of
Hydrogen.
2

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

Alkalosis or alkalemia arterial blood pH

rises above 7.45
Acidosis or acidemia arterial pH drops
below 7.35
3

Sources of Hydrogen Ions

Most hydrogen ions originate from cellular
metabolism
Breakdown of phosphorus-containing proteins
releases phosphoric acid into the ECF
Anaerobic respiration of glucose produces lactic
acid
Fat metabolism yields organic acids and ketone
bodies
Transporting carbon dioxide as bicarbonate
releases hydrogen ions
4

Hydrogen Ion Regulation

Concentration of hydrogen ions is
regulated sequentially by:
Chemical buffer systems act within seconds
The respiratory center in the brain stem acts
within 1-3 minutes
Renal mechanisms require hours to days to
effect pH changes

Acid/Base Homeostasis: Overview

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).
7

Carbonic acid/bicarbonate buffer system

CO2 + H2O CA H2CO3 H+ + HCO3-

Carbonic acid is formed when CO2

combines with water. This reaction is
catalysed by carbonic anhydrase
Carbonic acid dissociates spontaneously
to form a proton and a bicarbonate ion
8

The Lung Regulation

Normal, unassisted breathing:
An increase in arterial PCO2 acts through the
respiratory centre to increase the rate of
pulmonary ventilation
A decrease in arterial PCO2 reduces the rate of
ventilation

Assisted breathing:
A respirator is used to assist breathing by
expelling CO2, thus reducing PCO2 in blood
9

The Lung Regulation

When hypercapnia or rising plasma H +
occurs:
Deeper and more rapid breathing expels more
carbon dioxide
Hydrogen ion concentration is reduced

Alkalosis causes slower, more shallow

breathing, causing H+ to increase

10

11

The Renal Regulation

Chemical buffers can tie up excess acids
or bases, but they cannot eliminate them
from the body
The lungs can eliminate carbonic acid by
eliminating carbon dioxide
Only the kidneys can rid the body of
metabolic acids (phosphoric, uric, and
lactic acids and ketones) and prevent
metabolic acidosis
12

The Renal Regulation

The most important renal mechanisms for
regulating acid-base balance are:
Conserving (reabsorbing) or generating new
bicarbonate ions
Excreting bicarbonate ions

Losing a bicarbonate ion is the same as

gaining a hydrogen ion; reabsorbing a
bicarbonate ion is the same as losing a
hydrogen ion
13

14

Reabsorption of Bicarbonate

15

Hydrogen Ion Excretion

16

CARA
TRADISIONAL :

Hendersen-Hasselbalch
(1909)
17

Normal

pH = 6.1 + log
Normal

[HCO ]
GINJAL
BASA
3

HCO
HCO 3
3

Kompensasi

ASAM
pCO2
PARU

CO
CO22

18

Carbonic acid/bicarbonate buffer system

pKa = 6.1
ECF:

H2CO3 H+
Carbonic acid

HCO3Bicarbonate ion

The pKa of carbonic acid is 6.1

Carbonic acid is the major buffer in ECF
The pH of blood can be determined using
the Henderson-Hasselbalch equation
19

Henderson-Hasselbalch equation
pH = pKa + log [HCO3-]/[H2CO3]
pH = pKa + log [HCO3-]/0.03 x PCO2
7.4 = 6.1 + log

20 / 1

7.4 = 6.1 + 1.3

Plasma pH equals 7.4 when buffer ratio is 20/1
The solubility constant of CO2 is 0.03
20

Cara Stewart ;
pH atau [H+] DALAM PLASMA
DITENTUKAN OLEH
DUA VARIABEL
VARIABEL
INDEPENDEN

VARIABEL
DEPENDEN

Stewart PA. Can J Physiol Pharmacol 61:1444-1461, 1983.

VARIABEL INDEPENDEN

CO2

STRONG ION
DIFFERENCE

pCO2

SID

WEAK ACID

Atot

CO2
CO2 Didalam plasma berada
dalam 4 bentuk
sCO2 (terlarut)
H2CO3 asam karbonat
HCO3- ion bikarbonat
CO32- ion karbonat

Rx dominan dari CO2 adalah rx

absorpsi OH- hasil disosiasi air

dengan melepas H+.
Semakin tinggi pCO2 semakin

banyak H+ yang terbentuk.

Ini yg menjadi dasar dari

terminologi respiratory acidosis,

yaitu pelepasan ion hidrogen akibat
pCO2

Definisi:
Strong ion difference adalah ketidakseimbangan muatan
dari ion-ion kuat. Lebih rinci lagi, SID adalah jumlah
konsentrasi basa kation kuat dikurangi jumlah dari
konsentrasi asam anion kuat. Untuk definisi ini semua
konsentrasi ion-ion diekspresikan dalam ekuivalensi
(mEq/L).
Semua ion kuat akan terdisosiasi sempurna jika berada didalam
larutan, misalnya ion natrium (Na+), atau klorida (Cl-). Karena
selalu berdisosiasi ini maka ion-ion kuat tersebut tidak
berpartisipasi dalam reaksi-reaksi kimia. Perannya dalam kimia
asam basa hanya pada hubungan elektronetraliti.

STRONG ION
DIFFERENCE

Gamblegram

Mg++
Ca++

K+ 4

SID

[Na+] + [K+] + [kation divalen] - [Cl-] - [asam organik kuat-]

Na+
140
Cl102
[Na+]

140 mEq/L

[K+]
+

4 mEq/L -

KATION

[Cl-]
102 mEq/L

ANION

[SID]
=

34 mEq/L

[H+]

[OH-]

Konsentrasi [H+]
Asidosis

()

Alkalosis

SID

( +)

Dalam cairan biologis (plasma) dgn suhu 370C, SID hampir

selalu positif, biasanya berkisar 30-40 mEq/Liter

WEAK ACID
[Protein-] + [H+]

[Protein H]
disosiasi

Kombinasi protein dan posfat disebut asam

lemah total (total weak acid) [Atot].
Reaksi disosiasinya adalah:

[Atot] (KA) = [A-].[H+]

Gamblegram
Mg++
Ca++

K+ 4

HCO324
Weak acid
(Alb-,P-)

Na+
140

KATION

Cl102

ANION

SID

DEPENDENT VARIABLES

H+

HCO3OH-

AH
CO3-

A-

INDEPENDENT VARIABLES

DEPENDENT VARIABLES

Strong Ions
Difference

pCO2

Protein
Concentration

pH

H3O+ = H+ = 40 mEq/L

K
Mg
Ca

HCO33--
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

Fencl V, Jabor A, Kazda A, Figge J. Diagnosis of metabolic acid-base disturbances in

critically ill patients. Am J Respir Crit Care Med 2000 Dec;162(6):2246-51

I. Respiratori

ASIDOSIS
PCO2

ALKALOSIS
PCO2

II. Nonrespiratori (metabolik)

1. Gangguan pd SID
a. Kelebihan / kekurangan air
b. Ketidakseimbangan anion
kuat:
i. Kelebihan / kekurangan Clii. Ada anion tak terukur

[Na+], SID

[Cl-], SID

[Na+], SID
[Cl-], SID

[UA-], SID

2. Gangguan pd asam lemah

i. Kadar albumin

[Alb]

[Alb]

ii. Kadar posphate

[Pi]

[Pi]

Fencl V, Jabor A, Kazda A, Figge J. Diagnosis of metabolic acid-base disturbances in

critically ill patients. Am J Respir Crit Care Med 2000 Dec;162(6):2246-51

RESPIRASI

M E T AB O L I K

Abnormal
pCO2

Abnormal
SID

AIR

Anion kuat

Cl-

Alkalosis

Turun

kekurangan

Hipo

Asidosis

Meningkat

kelebihan

Hiper

Fencl V, Am J Respir Crit Care Med 2000 Dec;162(6):2246-51

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)

Change in Anion Gap vs HCO3

In simple AG Metabolic Acidosis
decrease in plasma bicarbonate = increase
in AG

Anion Gap = 1
HCO3
Helpful in identifying mixed disorders

Sources
1.
2.
3.
4.
5.
6.
7.
8.

Achmadi, A., George, YWH., Mustafa, I. Pendekatan Stewart

Dalam Fisiologi Keseimbangan Asam Basa. 2007
Beaudoin, D. Electrolytes and ion sensitive electrodes. PPT.
2003.
Ivkovic, A ., Dave, R. Renal review. PPT
Kersten. Fluid and electrolytes. PPT.
Marieb, EN. Fluid, electrolyte, and acid-base balance. PPT.
Pearson Education, Inc. 2004
Rashid, FA. Respiratory mechanism in acid-base homeostasis.
PPT. 2005.
Silverthorn, DU. Integrative Physiology II: Fluid and Electrolyte
Balance. Chapter 20, part B. Pearson Education, Inc. 2004
Smith, SW. Acid-Base Disorders. www.acid-base.com

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