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sensor

Biochemistry departement of medical faculty


lampung university

+
[H ]

pH

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.

Syazili Mus

Maintenance of relatively constant blood pH value is essential


for health, since changes in blood pH will affect intracell pH
alter :

- metabolism

- protein conformation
- enzyme activity
- equilibria of reaction that consume / generate H+
(oxidation - reduction reaction)
Maintenance of a constant blood pH is, in part, achieved by
- buffer system in the blood control short - term
changes in acid - base metab.

- in long term : balancing proton loss & proton gain

Syazili Mustofa

pH value of plasma may be affected by :


- malfunctioning of buffer system or
- disturbance of acid base balance
e.g. due to

- kidney disease or
- altered breathing frequency ( hypo
/ hyperventilation)

Normal alterial plasma pH : 7.40 0.05


- pH < 7.35 acidosis
- pH > 7.45 alkalosis

Syazili Mustofa

3 major body water components :


- plasma : within circulating system
- interstitial fluid : fluid that bathes cells
- intracellular fluid
Composition :
- plasma :
- major kation : Na+
- small amounts : K+, Ca2+, Mg2+
- dominant anions : HCO3-, Cl- small amount anion : protein, HPO42-, SO42- mixture organic anions
- interstitial fluid :
- similar
- contain less protein
plasma & interst. fluid extracell. Fluid

- intracell fluid :

- major kation : K+
- major anions : - organic P (ATP, BPG, glycolitic intrmd)
- protein

Syazili Mustofa

Each fluid makes a different contribution to buffering

* Major buffer of extracell fluid : HCO3- / CO2 system


- not very effective in resisting pH changes from
changes in pCO2
- effective in controlling pH changes caused by other

than pCO2 changes


* Intracell fluid : responsible for buffering pCO2 changes
( Hb buffering within RBC)
* Extracell fluid & intracell fluid : equal in buffering strong
organic / inorganic acids

Plasma : excellent indicator to handle additional loads of


acids

Syazili Mustofa

Every buffer consist of :

- a weak acid : H A

- conjugate base : Ae.g. acetate-/acetic acid, NH3 / NH4+, HPO42- / H2PO4- weak acid : neutral, (+) charged, (-) charged

- conjugate base : 1 less (+) charge / 1 more (-) charge


than weak acid
Henderson - Hesselbalch equation :
[conj. base ]
pH = pK + log

[acid]

direct relationship between pH & ratio .

Syazili Mustofa

[HCO3-] / [CO2] buffer system :


Blood pH : 7,4
p.k.

: 6,1

7,4 = 6,1 + log 20/1

[HCO3-] / [CO2] ratio = 20/1 at normal blood pH = 7,4


Every changes in [HCO3-] or [CO2] changes the ratio

changes pH compensation to normalize blood pH.

Syazili Mustofa

Blood plasma is a mixed buffer system :


HCO3- / CO2 , HPO42- / H2PO4-, protein / H protein
Major buffer of plasma : bicarbonate buffer system
an open system : pCO2 is adjusted to meet the
bodys needs

If respiration can not accomplish this adjustment


pCO2 changes strikingly bicarbonate syst. would
be ineffective.

10

Syazili Mustofa

Acidosis : excess acid or def. of alkali in the body


Alkalosis : excess alkali or def. of acid in the body

There exist mechanisms where the body normally rids itself of


excess acid or alkali

Individuals produce large amounts of acids


*

Major acid : CO2 volatile : normally excreted by the lungs


Inability of the lungs respiratory acidosis or alkalosis

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Syazili Mustofa

* Respiratory acidosis : result of hypoventilation of alveoli


CO2 accumulates
Alv. hypoventilation : occur when depth or rate of respiration
- airway obstruction

Acute resp. acidosis

- neuromuscular disorders
- diseases of CNS

- chronic resp. acidosis : chronic obstructive lung


disease (emphyema)
- inhalation of gas mixture with high pCO2 resp. acidosis
Increase the PCO2 ------> the pH goes down.

Hypoventilation.

12

Syazili Mustofa

* Respiratory alkalosis : arises from decreased alv. pCO2


Hyperventilation :

- anxiety : most common cause


- CNS injury involving resp. center
- salicylate poisoning
- fever
- artificial ventilation

High altitude

alv. pCO2 chronic resp. alkalosis

Decrease the PCO2 ------> the pH goes up.

Hyperventilation.
13

Syazili Mustofa

* Metabolic acidosis

The body produced nonvolatile acids

H+

+ SO42-

- hydrolysis of phosphate- esters phosphoric acid

- metabolism

- lactic acid
- acetoacetic acid
- - hydr. butyric acid

produced in excess

accumulation
acidosis

- administration of : NH4Cl / Arg hydrochloride / Lys


hydrochloride

urea

+ HCl

Decrease the HCO3------> the pH goes down

14

Syazili Mustofa

- ingestion of salicylate, methyl alcohol, ethylene glycol

production of strong organic acid

accumulation of nonvolatile acids metabolic acidosis


- abnormal loss of base ;
- renal tubular acidosis : abnormal amount of HCO3escape from blood into urine
- severe diarrhea

HCO3-

15

Syazili Mustofa

* Metabolic alkalosis

- intake excess alkali :


- NaHCO3
- salt of organic acid : Na - lactate NaHCO3
- fruits & vegetables : contain mixture of organic acids
- metabolized to CO2 + H2O
no long term. effect on acid
base balance
- salt of organic acids

[HCO3-]

- abnormal loss of acids : vomiting, gastric lavage (Lose enough stomach acid to

produce alkalosis)
- rapid loss of body water :diuresis temporary

[HCO3-]

Increase the HCO3------> the pH goes up


16

Syazili Mustofa

Causes of acid base imbalance


Acidosis :
Respiratory : alveolar hypoventilation
Metabolic :

- H+ overproduction
- HCO3- overexcretion

Alkalosis :

Respiratory : alveolar hyperventilation


Metabolic :

- alkali ingestion
- H+ overexcretion

17

Syazili Mustofa

Cause

Blood
pH

Urine
pH

[HCO3- ]/
[H2CO3

7,4

6 7

20/1

Acidosis
- Respiratory
- Metabolic

20 / > 1
< 20 / 1

Hypoventilation
H+ production
or HCO3- excretion

Alkalosis
- Respiratory
- Metabolic

20 / < 1
>20 / 1

Hyperventilation
Alkali ingestion
or H+ excretion

Normal

18

Kardiovaskular
Gangguan kontraksi otot jantung
Dilatasi Arteri,konstriksi vena, dan
sentralisasi volume darah

Respirasi
Hiperventilasi
Penurunan kekuatan otot nafas dan
menyebabkan kelelahan otot
Sesak

Metabolik
Peningkatan tahanan vaskular paru
Penurunan curah jantung, tekanan
darah arteri, dan aliran darah
hati dan ginjal
Sensitif thd reentrant arrhythmia dan
penurunan ambang fibrilasi
ventrikel

Menghambat respon kardiovaskular


terhadap katekolamin

Peningkatan kebutuhan
metabolisme
Resistensi insulin
Menghambat glikolisis anaerob
Penurunan sintesis ATP
Hiperkalemia
Peningkatan degradasi protein

Otak
Penghambatan metabolisme dan
regulasi volume sel otak
Koma

Management of life-threatening Acid-Base Disorders, Horacio J. Adrogue, And Nicolaos EM:


Review Article;The New England Journal of Medicine;1998

Kardiovaskular
Konstriksi arteri
Penurunan aliran darah koroner
Penurunan ambang angina
Predisposisi terjadinya supraventrikel dan ventrikel
aritmia yg refrakter

Respirasi
Hipoventilasi yang akan menjadi hiperkarbi dan
hipoksemia

Metabolic
Stimulasi glikolisis anaerob dan produksi asam organik
Hipokalemia
Penurunan konsentrasi Ca terionisasi plasma
Hipomagnesemia and hipophosphatemia

Otak
Penurunan aliran darah otak
Tetani, kejang, lemah delirium dan stupor
Management of life-threatening Acid-Base Disorders, Horacio J. Adrogue, And Nicolaos EM:
Review Article;The New England Journal of Medicine;1998

Essentially, the difference between the


concentrations of cations (Na+ primarily) and
anions (Cl-, HCO3-) in the blood.
Anion

gap

= ( Na + K ) ( Cl + HCO)
= 4-17 mmol l

High Anion Gap: It is high in any condition with


reduced clearance or excess production of any
unmeasured anions. Metabolic Acidosis. It
indicates that you have added acids to the
blood: salicylic acid, formic acid, lactic acid,
oxalic acid, sulfuric acid.
Normal Anion Gap: Respiratory Acidosis. It
occurs when you ultimately become acidotic
because of losing HCO3

It is low in hyperalbuminaemia, liver disease and


paraproteinaemias

Item

value

pH

7,4

[HCO3-]

22 - 28 mEq / L

PaCO2

33 - 44 mEq / L

PaO2

90 - 100 mEq / L

Inget
brho.

Rapid regulation
(short-term)

Chronic control
(long-term)

pH n

PCO2

pH
Kompensasi

SID

PPOK

Sintesis Alb <<..?

NH4

Absorpsi Cl

Cl
NH4Cl

Hipokloremi
Hipoalbumin..?