REFERAT ILMU PENYAKIT DALAM

MANAGEMENT OF LIFE-THREATENING ACID

BASE DISORDER

Preceptor:

dr. Dasril Nizam, Sp.PD, KGEH

Compiled by:

Aria Pratama Hayanto (07120110062)

KEPANITERAAN KLINIK ILMU PENYAKIT DALAM

RUMAH SAKIT BHAYANGKARA TK. I RADEN SAID SUKANTO

FAKULTAS KEDOKTERAN UNIVERSITAS PELITA HARAPAN

FOREWORD

Praise to Almighty God for the gift of grace so that I can finish the task referat

given by the supervisor. Referat is made for the settlement of their clinical duties for

Co-Ass the Faculty of Medicine, University of Pelita Harapan granted by SMF

Section of Interanl medicine Level I Police Hospitals Raden Said Sukanto.

Referat discussed thoroughly on Management of Life-Threatening Acid Base

Balnce Disorder. Materials for referat taken from books and journals and articles that

are available online. The authors hope that this made referat be useful for the readers.

Hope the authors that the presence of this referat can help understand more

thoroughly the topics being discussed.

Thank you to all those who have assisted in the completion of this referat

manufacture. Especially the counselors at the child, especially dr. Dasril Nizam, Sp.

PD-KGEH writer in the making as mentors this referat and all parties that provide

direction and support in the process of resolving this referat.

The author realizes that this referat still far from perfect and has many flaws.

Therefore, the authors are happy to accept all criticisms and feedback given that this

referat be more perfect. Finally, I hope this referat be useful for writers and readers.

May God bless us all. Amen.

Jakarta, July 2015

author

Table of Contents

CHAPTER I INTRODUCTION...............................................................1

1.1 Background………………………………………………………………………………………..1

1.2 Purpose of writing………………………………………………………………………………1

1.3 Problems……………………………………………………………………………………………1

1.4 Benefits of writing..............................................................................................................2

CHAPTER II LITERATURE REVIEW...................................................3

2.1 Definition.........................................................................................................3

2.2 Proton concentration and pH...........................................................................3

2.3 Acids & Bases in the Body................................................................................4

2.4 System responsible for maintenance of the acid-base system………………...7

2.5 Buffering Systems…………………..…………………………………...........9

2.5.1 Blood Buffers and their buffer capacity…………………………………....11

2.5.2 Bicarbonate Buffer………………………………...............................…....12

2.5.3 Protein Buffer………………………………………………........................13

2.5.4 Phosphate Buffer…………………………………………………………...14

2.5.5 Urine Buffer...........………………………………………………………...14

2.6 Role of the respiratory tract in maintaining the acid-base balance…………..14

2.7 Role of the kidneys in maintaining the acid-base balance…………………...15

2.7.1 Bicarbonate reabsorption…………………………………………………..16

2.7.2 New bicarbonate production……………………………………………….17

2.7.3 Ammonium Ion excretion.............................................................................18

2.7.4 Proton excretion in the kidneys....................................................................19

2.7.5 Bicarbonate secretion...................................................................................19

2.8 Laboratory assessment of the acid-base balance.............................................19

2.8.1 Base Excess..................................................................................................21

2.8.2 Ions and pH..................................................................................................21

2.8.3 Anion Gap....................................................................................................22

2.9 Basic disturbances in the acid-base balance and compensation.....................23

2.10 Compensation and correction of acid-base disturbances.............................24

2.11 Respiratory acid-base balance disturbance..................................................24

2.12 Respiratory Acidosis....................................................................................25

2.13 Respiratory Alkalosis..................................................................................25

2.14 Metabolic Acidosis......................................................................................26

2.15 Metabolic Alkalosis....................................................................................28

2.16 Mixed disturbances of acid-base balance...................................................29

2.17 Adverse consequences of severe acidemia.................................................30

2.18 Management of life-threatening acidosis...................................................31

2.18.1 Metabolic Acidosis..................................................................................31

2.18.1.1 Alkali Therapy.....................................................................................31

2.18.1.2 Risk of sodium bicarbonate therapy....................................................32

2.18.1.3 Alternative alkalinizing agents............................................................33

2.18.1.4 Specific disorders................................................................................34

2.18.2 Respiratory acidosis...............................................................................38

2.18.3 Mixed acidosis.......................................................................................42

2.19 Adverse consequence of severe alkalemia...............................................42

2.20 Management of life-threatening alkalosis................................................43

2.20.1 Metabolic alkalosis...............................................................................43

2.20.2 Respiratory alkalosis.............................................................................46

2.20.3 Pseudorespiratory alkalosis.....................................................................47

2.20.4 Mixed alkalosis.......................................................................................48

BIBLIOGRAPHY…………………………………………………......49