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AIR, ELEKTROLIT DAN ASAM BASA
Wahyu SiswandariBagian Patologi KlinikJurusan Kedokteran FKIK UNSOED
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Learning objectives•Menjelaskan konsep dasar regulasi air
dan elektrolit•Menjelaskan pergerakan cairan•Menjelaskan mekanisme Na, K, Ca, Cl
dalam keseimbangan elektrolit•Menjelaskan keseimbangan asam basa•Menjelaskan pemeriksaan laboratorium
yang berhubungan dengan elektrolit dan asam basa
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Reference•Martini. Fundamentals of Anatomy and
Physiology. 8th. Pearson. San Fransisco. 2008
•Hardjoeno. Interpretasi hasil tes laboratorium diagnostik. Edisi 3. LEPHAS. Makasar. 2003
•Silbernagl & Lang. Color Atlas of Pathophysiology. Thieme. New York. 2000
•Sacher & McPherson. Tinjauan Klinis Hasil Pemeriksaan Laboratorium. Edisi 11. EGC. Jakarta. 204
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Keseimbangan air•Keseimbangan air jika jumlah air yang
didapat sebanding dgn jumlah yg dikeluarkan
•Dijaga dgn regulasi distribusi cairan tubuh di ECF dan ICF
•Sumber air sal GI (>>>), hasil metabolisme (<<<)
•Pengeluaran urin (>>>), kelj keringat
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Keseimbangan elektrolit•Elektrolit ion yang dihasilkan dari
pemecahan bahan inorganik•Keseimbangan elektrolit jika jumlah
elektrolit yang didapat sebanding dgn jumlah yg dikeluarkan
Keseimbangan asam basa•Kesimbangan asam basa jumlah produksi
ion hidrogen sama dengan jumlah yang hilang
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KESEIMBANGAN AIR04/22/23
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ECF dan ICFKandungan air •♂ : 60% ICF : 33% ECF : intersitial 21.5%, plasma 4.5%
•♀ : 50% ICF : 27% ECF : intersitial 18%, plasma 4.5%
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Regulasi air dan elektrolit• Mekanisme homeostatik tubuh dijaga dengan
komposisi cairan tubuh yang berespon terhadap perubahan di ECF
• Tidak ada reseptor yg scr langsung memonitor keseimbangan air dan elektrolit reseptor hanya mendeteksi volume plasma & konsentrasi osmotik
• Sel tdk dpt menggerakkan molekul air melalui transport aktif melalui transport pasif berdasarkan perbedaan tekanan osmotik
• Keseimbangan air & elektrolit akan terganggu jika terjadi perubahan pd intake dan pengeluaran
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Kandungan elektrolitECF• Plasma :
kation : Na+, K+, Ca2+
anion : HCO3-, Cl-, HPO42- , (protein)• Intersitial :
kation : Na+, K+
anion : HCO3-, Cl-, HPO42- , SO42-
ICF Kation : Na+, K+, Mg2+
Anion : HCO3-, Cl-, HPO42- , SO42-, (protein)
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Hormon yg berperan•ADH ~ tekanan osmotik ~ ADH efek :- me penyimpanan air di ginjal, me pengeluaran air lewat urin- mestimulasi rangsang haus minum>>
•Aldosteron mengatur absorbsi Na & ekskresi K di tubulus distal di ginjal
•Natriuretic peptide memblok release ADH & aldosteron diuresis tekanan darah & volume plasma
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Regulasi air & elektrolit dgn tek hidrostatik & tek osmotik•Tekanan hidrostatik air keluar dr
plasma dan masuk rongga intersitial•Air bergerak melewati membran
mesotelial Jumlah aliran ~ jumlah produksi = jumlah reabsorbsi
•Air bergerak antara darah-CSF, humor aquos-vitreous, perilimfe-endolimfe
•Air dpt bergerak antara ECF dan ICF jarang terjadi pd kondisi normal
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Fluid gains & lossesWATER BALANCE
INPUT
Air dari makanan 1000 ml
Air dari minuman 1200 ml
Air hasil metabolisme 300 ml
TOTAL 2500 ml
OUTPUT
Urin 1200 ml
Kulit 750 ml
Paru 400 ml
Faeces 150 ml
TOTAL 2500 ml
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•Tek osmotik di ECF hipertonik air dr ICF masuk ke ECF
•Tek osmotik di ECF hipotonik air dr ECF masuk ke ICF
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KESEIMBANGAN ELEKTROLIT04/22/23
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•Na+ & K+ berperan penting :- Menentukan osmositas ECF & ICF- Berpengaruh thd fungsi sel•Na+ kation utama di ECF (140 mEq/L),
kadar di ICF 10 mEq/L•K+ kation utama di ICF (160 mEq/L),
kadar di ECF 3.8-5.0 mEq/L
Sangat berpengaruh terhadap keseimbangan elektrolit
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Keseimbangan Sodium (Na+)•Na+ kation utama di ECF (140 mEq/L),
kadar di ICF 10 mEq/L•Na+ diuptake lwt epitel traktus digestivus•Na+ diekskresi lwt ginjal (>>) &
pernafasan•Kadar Na normal di ECF masuk ~
keluar ECF
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Keseimbangan Sodium (Na+) cont…
•Na inhibisi osmoreseptor ADH , rasa haus pe pengeluaran lwt urin, intake air pe jml air di ECF, pe volume homeostasis
•Na stimulasi osmoreseptor ADH , rasa haus pe pengeluaran lwt urin, intake air pe jml air di ECF, pe volume homeostasis
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Keseimbangan Na+ ~ air cont…•Vol ECF krn kehilangan air &/Na
volume & tekanan darah renin , aktivasi angiotensin aldosteron , ADH , rasa haus pe urinari dgn retensi Na, pe urinari dgn water loss, intake air homeostasis
•Vol ECF krn masuknya air &/Na volume darah & distensi atrial NP aldosteron , ADH , rasa haus pe urinari dgn hilangnya Na, pe urinari dgn water loss, intake air homeostasis
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Keseimbangan potasium (K)K+ disekresi di tubular ginjal sebagai
respon thd: 1.Perubahan konsentrasi K di ECF K
ECF ~ sekresi K 2.Perubahan pH pH di ECF ~ pH di
cairan peritubuler sekresi K 3.Kadar aldosteron dikeluarkannya K
lwt urin
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Keseimbangan potasium (K) cont…
•K+ kation utama di ICF (160 mEq/L), kadar di ECF 3.8-5.0 mEq/L
•K+ di ECF menggambarkan keseimbangan antara K yg diuptake lwt epitel traktus digestivus & yg dibuang lwt urin
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KESEIMBANGAN ASAM BASA04/22/23
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•pH tubuh dipengaruhi kadar asam dan basa
•pH ECF normal 7.35 – 7.45•pH < 7.35 asidosis•pH > 7.45 alkalosis•pH < 6.8 atau pH > 7.7 mati :SSP terganggukontraksi jantung melemah, ireguler
gagal jantungvasodilatasi tekanan darah turun
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Mekanisme kontrol pH•Keseimbangan pH ion H sistem
bufferHY H+ + Y
•Sistem buffer:1.Buffer protein regulasi pH di ECF & ICF2.Buffer H2CO3 & HCO3- regulasi pH di
ECF3.Buffer fosfat di ICF & urin
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Buffer protein•pH gugus karboksil (--COOH)
melepas ion H ( berperan sbg asam lemah)
•pH ion karboksil & gugus amino (--NH2) menerima ion H ( berperan sbg basa lemah)
•Stabilisasi ph di ECF& ICF
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Buffer hemoglobin•SDM berefek thd pH di ECF krn
m’absorbsi CO2 di plasma & m’ubah jd asam karbonat (H2CO3) ion bikarbonat (HCO3-) HCO3- ke plasma, H- sbg penyangga Hb
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Buffer asam karbonat - bikarbonat•CO2 + H2O H2CO3 H+ + HCO3-
•Reaksi bersifat reversibel •Keterbatasan;1.Tdk dpt melindungi ECF dr perubahan
pH akibat peningkatan/penurunan kadar CO2
2.Berfungsi sistem pernafasan & sistem pusat pernafasan normal
3.Kemampuan buffer asam dibatasi oleh ketersediaan ion bikarbonat
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Buffer fosfat•H2PO4- H+ + HPO42-
(dihidrogen fosfat ) (monohidrogen fosfat)
•Di ECF hanya membantu regulasi pH, krn sdh ada HCO3-
•Di ICF lebih banyak berperan
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Hubungan pCO2 - pH04/22/23Air, elekt,
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pCO2 (40-45 mmHg)
HOMEOSTASIS
PH (7.35 -7.45)
pCO2
pH pCO2
pH
pCO2 pCO2
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Maintenance keseimbangan asam basa•Kelebihan / kekurangan H+ diatasi
mekanisme respirasi & ginjal
•Cara :1.Sekresi / absorbsi H+
2.Mengontrol ekskresi asam & basa3.Mengaktifkan sistem buffer
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Kompensasi repiratori•Respirasi pCO2 buffer asam
karbonat – bikarbonat•pCO2 merangsang kemoreseptor
respiratory rate CO2 dibuang lewat paru pCO2 kembali normal
•pCO2 menghambat kemoreseptor respiratory rate pernafasan pCO2 naik di ECF
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Kompensasi ginjal•Ginjal sekresi & reabsorbsi H+ &
HCO3-•Dilakukan melalui 3 sistem buffer asam
karbonat-bikarbonat, fosfat, amoniak
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Kelainan•Asidosis respiratorik•Alkalosis respiratorik•Asidosis metabolik•Alkalosis metabolik
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Asidosis respiratorik•Tjd jk sistem respirasi tdk dpt
mengeliminasi CO2 •Ditandai dgn: pH , pCO2 , hiperkapnia•Penyebab : hipoventilasi•pCO2 stimulasi kemoreseptor
kompensasi respiratorik, RR pCO2 balans kompensasi renal sekresi H+, HCO3- sdkt meninggi balans
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Alkalosis respiratorik•Jarang terjadi •Ditandai dgn: pH, pCO2, hipokapnia•Penyebab : hiperventilasi•pCO2 inhibisi kemoreseptor
kompensasi respiratorik, RR pCO2 balans kompensasi renal H+ sdkt meninggi, sekresi HCO3- balans
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Asidosis metabolik• Penyebab:1.Produksi asam organik >>>2.Berkurangnya kemampuan ekskresi H di ginjal3.Hilangnya bikarbonat >>>
•Ditandai dgn : pH , HCO3 , BE < -2.5
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Alkalosis metabolik•Jarang terjadi•Penyebab: HCl lambung dikeluarkan
(muntah), antasida berlebihan, infus bikarbonat berlebihan, efek aldosteron
•Ditandai dgn: pH , HCO3 , BE > 2.5
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PEMERIKSAAN ELEKTROLIT04/22/23
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Tujuan pemeriksaan•Melihat kandungan elektrolit yg ada di
dalam plasma•Di dalam sel?
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Sampel •Darah vena•Serum, plasma heparin (EDTA )•Sampel hemolisis •Metoda elektroda ion selektif (Na, K) titrasi (Cl) ensimatik (bikarbonat)
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Nilai rujukan•Na : 135 – 148 mEq/L•K : 3.5 – 5.3 mEq/L•Cl : 98 – 106 mEq/L(Sacher, 2004)
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PEMERIKSAAN AGD04/22/23
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Tujuan pemeriksaan AGD•Evaluasi pertukaran gas di paru•Menetapkan asam basa darah•Dasar menentukan terapi oksigen•Memonitor terapi
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Sampel •Pasien dalam keadaan ‘tenang’•Darah arteri + antikoagulan heparin (0.05
mg/ 1 ml darah)•Sampel segera diperiksa•Data yang dibutuhkan: Hb, suhu, O2
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Pengambilan darah arteri• Diperlukan skill yang baik• Dokter atau perawat terlatih• Tempat pengambilan :
1. A. Radialis, pergelangan tangan2. A. Brachialis, siku3. A. Fermoralis
• Ditentukan pulsasi
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Pengambilan darah arteri lanj..
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•Jarum & syringe dibilas heparin•Syringe plastik dihindari, permeabel
terhadap gas•Tidak dipakai vakutainer•Sesudahnya tempat penusukan ditekan
minimum 5 menit•Pem BGA ujung jarum ditutup, dibawa
dengan tempat air es secepatnya, diperiksa dalam waktu 15 menit
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Darah vena?•Bisa digunakan•SvO2 20-25% < SaO2•pH 0.5-1 pH < pH arteri•pCO2 5-10mmHg > arteri
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Parameter~normal•pH : 7.35 – 7.45•pO2 : 80 – 100 mmHg•pCO2 : 35 – 45 mmHg•HCO3 : 22 – 26 mmol/L•BE : -2 – +2
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PaO2
•Tekanan parsial O2 arterial•Normal: 80-100 mmHg (12.6-13.3kPa)•Estimate formula of age: PaO2=100mmHg-(age×0.33) ±5mmHg
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Hypoxia
Mild : 80-60mmHgMediate : 60-40mmHgSevere : <40mmHg
PaO2<60mmHg respiratory failure
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PaCO2
•Tekanan parsial CO2 arterial•Normal: 35-45 mmHg (4.7-6.0kPa)
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SaO2•Saturasi O2 arterial•Normal: 0.95-0.98• evaluasi hypoxia, tp tidak sensitive
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HCO3- (bicarbonate)
SB (standard bicarbonate) AB (actual bicarbonate)
•SB the contents of HCO3- of serum of arterial
blood in 38℃, PaCO2 40mmHg, SaO2 100%.Normal: 22-27mmol/L (mean: 24mmol/L)
•AB The contents of HCO3- in actual
condition.•In normal person: AB=SB•AB and SB are parameters to reflect
metabolism, regulated by kidney.•Difference of AB-SB can reflect the respiratory
affection on serum
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HCO3-
• Respiratory acidosis : AB>SB• Respiratory alkalosis : AB<SB• Metabolic acidosis : AB =
SB<Normal• Metabolic alkalosis :
AB=SB>Normal
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Buffer bases ( BB)
•is the total of buffer negative ion of blood HCO3
- , hemoglobin, plasma proteins, HPO42- (phosphate)
•Normal: 45-55 mmol/L (mean: 50mmol/L)
•Significance: Metabolic acidosis: BB Metabolic alkalosis: BB
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Bases excess ( BE)
•the acid or bases used to regulate blood PH 7.4 . ( in 38℃ , PaCO2 40mmHg, SaO2 100%)
•Normal: 0±2.3 mmol/L•Significance: add acid: BE(+), BB add base: BE(-), BB
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Classification of Acid-basic Disorder
PH PaCO2 HCO3-
Resp. acidosis Resp. alkalosis Meta. Acidosis Meta. Alkalosis
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Cek pH
Asidosis pH < 7.35
Alkalosis pH > 7.45
Cek pCO2
Tdk meningkat
Cek pCO2
Meningkat > 50 mmHg
Meningkat > 45 mmHg
Menurun < 35 mmHg
Asidosis metabolik
Asidosis respiratorik
Alkalosis metabolik
Alkalosisrespiratorik
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Prinsip koreksi•Asidosis/alkalosis respiratorik
perbaikan ventilasi•Asidosis/alkalosis metabolik pemberian
asam / basa lihat BE
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