KESEIMBANGAN

ASAM BASA

Prof. dr. Achsanuddin Hanafie, SpAn, KIC, KAO

Departemen/SMF-Anestesiologi dan Terapi Intensif
FK-USU/RSUP Haji Adam Malik Medan
 Saya punya hasil
astrup & elekt,
artinya apa
Who cares nich..?
about acid
base
balance…&
fluid therapy!?
Respon tubuh terhadap alkalosis
ABCs of Blood Gas Classification

• Acid-base status

• Basic primary problem(s)

• Compensation assessment
SEQUENCE of ABG EVALUATION

• pH

• PaCO2

• [HCO3]

• PaO2
pH Symptoms
7,80 Death
Convulsions
Arrythmias
Irritabilty
7,40 Normal
Drowsiness
Lethargy
Coma
6,80 Death
 pH Classification

Classification pH
Normal 7,35 – 7,45
Acidosis < 7,35
Alkalosis > 7,45
 Classification of Respiratory
Acid-Base Component

PaCO2
Classification
(mmHg)
Normal respiratory
35-45
component
Respiratory acidosis >45
Respiratory alkalosis <35
 Classification of Metabolic
Acid-Base Component

Classification [HCO3] [BE]

Normal
metabolic 24 + 2 0+2
component
Metabolic
<22 <-2
acidosis
Metabolic
>26 >+2
alkalosis
 Effect of PaCO2 and
[HCO3] Change on pH
Index Effect on pH
PaCO2↑ pH↓
PaCO2↓ pH↑
HCO3↑ pH↑
HCO3↓ pH↓
 Alkalosis

Respiratory Metabolic
PaCO2 <35 (bicarb >26)

pH
Respiratory Metabolic
PaCO2 >45 (bicarb <22)

The two potential Acidosis

categories/origins of
acidosis or alkalosis
 Determination of the
Primary Problem
pH
>7,40 Alkalosis is primary; acidosis
is compensatory
<7,40 Acidosis is primary; alkalosis
is compensatory
 pH>7,40

PaCO2 < 35 HCO3 > 26

Primary Primary
Primary
respiratory metabolic
problem
alkalosis alkalosis
determination
pH<7,40 in complete
compensation
PaCO2 > 45 HCO3 < 22

Primary Primary
respiratory metabolic
acidosis acidosis
Causes of Respiratory Alkalosis
Hypoxemia
Overzealous mechanical ventilation
Restrictive lung disorders
Fibrosis
Ascites
Scoliosis and thoracic cage deformities
Third trimester of pregnancy
Pneumonia
ARDS
CHF
Emboly in pulmonary circulation
Neurologic origin
Fever
Anxiety
Cerebrospinal fluid acidosis
Trauma
Severe pain
Shock/decreased cardiac output
Potential sources of respiratory alkalosis
CNS

Mechanical Respiratory Cardiovascular

ventilation Alkalosis system

Drugs Aspirin Thoracic cage

OD Lungs
Potential sources of metabolic alkalosis

Stomach Mechanical
Oral Ventilation
Bases

Drugs
Metabolic NaHCO3
alkalosis

Fluid Loss
Hypokalemia
Adrenal
Cortex
Causes of Metabolic Alkalosis
Hypokalemia
Ingestion of large amounts of alkali or licorice
Gastric fluid loss
Vomiting
Nasogastric drainage
Hyperaldosteronism secondary to nonadrenal factors
Bartter’s syndrome
Inadequate renal perfusion
Diuretics
Bicarbonate administration
Sodium bicarbonate overcorrection
Blood transfusions
Adrenocortical hypersecretion
Steroids
Eucapnic ventilation posthypercapnia
 Blood Gastric cell Stomach

CO2 +H2O
Carbonic
anhydrase
H2CO3

HCO3 - HCO3- + H+ H+

Cl - Cl -

Production of HCl in gastric cells. Hydrogen ions generated in the gastric cells via
the hydrolysis reaction are secreted into the stomach with chloride. The
bicarbonate produced via the hydrolysis reaction enters the blood in exchange for
the chloride
 Respiratory alkalosis
pH > 7.45
PaCO2 < 35 mmHg

Oleh karena hiperventilasi atau penurunan

produksi CO2
 Penyebab Respiratory alkalosis
Stmulasi
Stimulasi perifer Iatrogenik Lainnya
sentral
Nyeri Hypoxemia(anemia berat, Mechanical Sepsis
di ketinggian) ventilator

Cemas Penyakit paru(Asma, CHF, Self-induced Liver

Edema pulmonum, emboli hyperventilation failure
pulmonum)
Cedera
cerebral
Demam/infeksi

Kehamilan

Salycilate
THANK YOU