AGD Adit (edited) analisa asam basa metode

agd

1. ANALISA ASAM BASA DENGAN METODE HANDERSON HASSELBACH “Gaps” untuk Evaluasi Acidosis Metabolic

2. Nilai Normal AGD pH = 7.35–7.45 PCO2 = 35–45 mm Hg HCO3 = 22–26 mEq /L

3. METODE HANDERSON HASSELBACH

4. Tiga Tahap Pembacaan AGD (MARINO) 1 2 3

5. Referensi rentang nilai normal : Aslinya Rentang nilai normal AG adalah 12±4 mEq /L (range = 8 to 16 mEq /L) AG = Na – (Cl + HCO3) Gunakan “Gap” untuk Evaluasi Acidosis Metabolic

6. AGc = AG + 2,5 x (4,5 – (albumin dlm g/dL) Pengaruh Albumin Albumin adalah asam lemah (i.e., poorly dissociated ) yg berkontribusi 3 mEq /L untuk AG untuk setiap 1 g/dL albumin dalam plasma (pada normal pH)

7. Contoh : AG = 10 mEq /L Albumin = 2 g/dL AGc =10 + (2.5×2.5) = 16 mEq /L

8. 1. High Anion Gap Acidosis L actic acidosis K etoacidosis E nd- stage renal failure (due to loss of H+ secretion in the distal renal tubules) Other notable sources are toxic ingestions of methanol (which produces formic acid) E thylene glycol (which produces oxalic acid) S alicylates (which produce salicylic acid).

9. 2. Normal Anion Gap Acidosis Common causes of metabolic acidosis with a normal AG include diarrhea (especially secretory diarrhea ) I sotonic saline infusion E arly renal failure (due to loss of HCO3 reabsorption in the proximal tubules)  The HCO3 loss in these conditions is replaced by chloride for electrical neutrality, and the term hyperchloremic metabolic acidosis is also used for this type of metabolic acidosis.

10. Isotonic saline infusion ( Adverse Effects ) a . Edema interstisial merupakan risiko pada semua cairan kristaloid, tetapi risikonya paling besar pada larutan garam isotonik karena beban natrium melebihi beban pada cairan kristaloid lainnya (dan natrium merupakan penentu utama volume ekstraselular ). b . Infus larutan garam isotonik yang cepat atau dalam volume besar sering kali disertai dengan “asidosis metabolik hiperkloremik ”, yang disebabkan oleh kelebihan klorida dalam larutan garam isotonik. Ada bukti bahwa hiperkloremia dikaitkan dengan peningkatan mortalitas pada pasien yang sakit kritis

11. Isotonic saline infusion ( Adverse Effects ) c. Infus larutan garam isotonik disertai dengan penurunan perfusi ginjal, akibat dari vasokonstriksi ginjal yang dimediasi oleh klorida. Hal ini telah menimbulkan kekhawatiran tentang potensi larutan garam isotonik untuk meningkatkan cedera ginjal akut (AKI). Namun, kurang lebih 12 uji klinis tidak menunjukkan bukti adanya hubungan kausal antara larutan garam isotonik dan AKI

12. Acid-Base Effect Large-volume infusions of 0.9% NaCL produce metabolic acidosis, as demonstrated in Figure 12.3 .

13. Acid-Base Effect In this clinical study, infusion of isotonic saline (0.9% NaCL ) at a rate of 30 mL/kg/h was accompanied by a progressive decline in the pH of blood (from 7.41 to 7.28) over two hours, while the pH was unchanged when Ringer’s lactate solution was infused at a similar rate. The saline-induced metabolic acidosis is a hyperchloremic acidosis, and is caused by the high concentration of chloride in 0.9% saline relative to plasma (154 versus 103 mEq /L). The close match between the chloride concentration in Ringer’s lactate solution and plasma (see Table 12.1 ) explains the lack of a pH effect associated with large-volume infusion of Ringer’s lactate solution.

14. Acid-Base Effect E xplains the lack of a pH effect associated with large-volume infusion of Ringer’s lactate solution. In this clinical study, infusion of isotonic saline (0.9% NaCL ) at a rate of 30 mL/kg/h was accompanied by a progressive decline in the pH of blood (from 7.41 to 7.28) over two hours, while the pH was unchanged when Ringer’s lactate solution was infused at a similar rate.