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ALCALOSIS
Anisyah Achmad, S.Si., Apt., Sp.FRS
Departement of Clinical Pharmacy, Major of Pharmacy
FK - UB
The Henderson Hasselbalch equation
DEFINITION
• Decreases in plasma bicarbonate can be the
result of addition of acid to body fluids
• Hypoaldosteronism
(Normally aldosteron
estimulates H) ,
secretion
in the distal tubules.
Hyperglukokortikoid
Loss of bicarbonate from the
gut ( vomiting of intestinal
contents, diarrhea, or fistulas)
As the liver need two HCO3
Ions when incorporating two
molecules of NH4
,increased urea pro-duction
can lead to acidosis.In this
way the supply of NH4Cl can
cause acidosis
Infusion of CaCl2 results in the deposition of Ca2+ in bone in the
form of alkaline salts(cal-cium phosphate,calcium carbonate). H
+ ions,
Formed when bicarbonate and phosphate dissociate,can cause
acidosis. Mineralization of bone, even without CaCl2 favors the
development of acidosis
HYPERCALCIURIA decreased tubular reabsorption of calcium.
KIDNEY STONE
HYPOPHOSFATEMIA
• Osteomalacia
• Osteoporosis
Acidosis can also develop when there is increased
formation or decreased breakdown of
Organic acids. These acids a repractically fully
dissociated at the blood , for example in O2
deficiency,circulatoryfailure
, severe physical exercise, fever, or tumors
Fattyacids, β-hydroxybutyric
Prolonged acidosis
Promotes demineralization of bone,
Because alkaline bone salts are dissolved by
acids
In intracellular acidosis is taken up by the
mitochondria in exchange for Ca+H+, also
inhibits adenylylcyclase and thus impairs
hormonal effects. Finally, cellular acidosis
inhibits cell division and favors apoptotic cell
death
Sistem Dapar
1. Asam karbonat:Bikarbonat
sistem dapar di CES untuk asam non-karbonat
2. Protein
sistem dapar di CIS & CES
3. Hemoglobin
sistem dapar di eritrosit untuk asam karbonat
4. Phosphat
sistem dapar di ginjal dan CIS
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Keseimbangan ion H+
faal_cairan-asam-basa/ikun/2006 21
Mekanisme Regulasi Keseimbangan
Asam-Basa
faal_cairan-asam-basa/ikun/2006 22
Gangguan Keseimbangan
Asam-Basa
1. Asidosis respiratori
hipoventilasi retensi CO2 H2CO3H+
2. Alkalosis respiratori
hiperventilasi CO2 banyak yg hilang H2CO3 H+
3. Asidosis metabolik
Diare, DM HCO3- PCO2 H+
4. Alkalosis metabolik
muntah H+ HCO3- PCO2
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faal_cairan-asam-basa/ikun/2006 24
Regulasi Pernapasan dlm Keseimbangan
Asam-Basa
• Kadar CO2 meningkat pH menurun
• Kadar CO2 menurun pH meningkat
• Kadar CO2 & pH merangsang kemoreseptor yg
kemudian akan mempengaruhi pusat
pernapasan
hipoventilasi meningkatkan kadar CO2
dlm darah
hiperventilasi menurunkan kadar CO2
dlm darah
faal_cairan-asam-basa/ikun/2006 25
Regulasi Pernapasan dlm Keseimbangan
Asam-Basa
faal_cairan-asam-basa/ikun/2006 26
Kompensasi Sistem Pernafasan terhadap Asidosis Metabolik
faal_cairan-asam-basa/ikun/2006 27
Regulasi Ginjal dlm
Keseimbangan Asam-Basa
• Sekresi H+ ke dalam filtrat & reabsorpsi HCO3-
ke CES menyebabkan pH ekstrasel meningkat
• HCO3- di dlm filtrat diabsorbsi
• Laju sekresi H+ meningkat akibat penurunan
pH cairan tubuh atau peningkatan kadar
aldosterone(hiperaldosteron)
• Sekresi H+ dihambat jika pH urin < 4,5
faal_cairan-asam-basa/ikun/2006 28
Kompensasi Ginjal terhadap Asidosis
Respiratorik
faal_cairan-asam-basa/ikun/2006 29
HOW ABOUT
ALCALOCIS ????
THANK YOU