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ACIDOSIS –

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

(overproduction of organic acids such as lactic


and keto acids or decreased elimination of acid
by the kidney) or loss of base (i.e. in diarrhoea).
An acidosis (pH<7.36) is caused by too high a
concentraion of CO2 (hypercapnia,respiratory
acidosis)
Or too low a concentration of HCO3 (metabolic
acidosis) in blood.
There are several causes of metabolic acidosis

• 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

Acid and acetoacetic acid accumulate in certain enzyme


defects but especially in increased fat mobilization, for
example, in starvation,diabetes mellitus,and
hyperthyroidism.
A protein rich diet
promotes the
development of metabolic
acidosis, because when
amino acids containing
sulfur are broken down
(methionine,
cystine,cysteine), are
generated;when lysine
and arginine
Are broken down H+
Is produced
The extent of acidosis depends among
Other factors, on the blood’s buffering
capacity.
The effects of respiratory and metabolic acidosis
are largely similar.

In extracellular acidosis the cells lose HCO3 Through


depolarization they also lose K
In addition, acidosis inhibits Na+/K+-ATPase. Hyper-
kalemia develops , can stimulate insulin release.

On the other hand,acidosis stimulates Na+/H+exchange.


Theresult is not only Na+ uptake but also cell swelling.
Furthermore,intracellular acidosis inhibits
K + channels and has a negative inotropic effect
as well as (by blocking the intercellular
connections) a negative dromotropic effect on
the cardiac muscle.

Hypercapnia induces vasodilation (fallin blood


pressure, rise in intracerebralp ressure) and
relaxation of the bronchial musculature.
Intracellular acidosis
Inhibits the pace maker enzymes of glycolysis
And hyperglycemia occurs.

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+

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Mekanisme Regulasi Keseimbangan
Asam-Basa

• Sistem dapar hanya mengatasi ketidakseimbangan


asam-basa sementara

• Ginjal: meregulasi keseimbangan ion H+  dengan


menghilangkan ketidakseimbangan kadar H+ secara
lambat; terdapat sistem dapar fosfat & amonia

• Paru-paru: berespons scr cepat thd perubahan kadar


H+ dalam darah & mempertahankan kadarnya
sampai ginjal menghilangkan ketidakseimbangan
tersebut

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Gangguan Keseimbangan
Asam-Basa
1. Asidosis respiratori
hipoventilasi  retensi CO2 H2CO3H+
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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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

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Regulasi Pernapasan dlm Keseimbangan
Asam-Basa

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Kompensasi Sistem Pernafasan terhadap Asidosis Metabolik

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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

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Kompensasi Ginjal terhadap Asidosis
Respiratorik

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HOW ABOUT
ALCALOCIS ????
THANK YOU

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