Sumber: Human anatomy & physiology, Marieb, 6 th edition.

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Presentation transcript:

Sumber: Human anatomy & physiology, Marieb, 6 th edition

Komposisi Cairan Tubuh: Ca 2+ Mg 2+ K+K+ Na + Cl - PO 4 3- Organic anion HCO 3 - Protein CationsAnions ECF ICF Osmolaritas = terlarut/(terlarut+pelarut) Osmolaritas = terlarut/(terlarut+pelarut) Osmolalitas = terlarut/pelarut (290~310mOsm/L) Osmolalitas = terlarut/pelarut (290~310mOsm/L) Tonicity = effective osmolalitas Tonicity = effective osmolalitas Plasma osmolilitas = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma osmolilitas = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma tonicity = 2 x (Na) + (Glucose/18) Plasma tonicity = 2 x (Na) + (Glucose/18)

Regulation of Fluids: Hydrostatic pressure v.s. Oncotic pressure  Albumin is the major determining oncotic pressure

Mekanisme Haus Sumber: Human anatomy & physiology, Marieb, 6 th edition

Tanda-tanda Hipovolemik: Penurunan turgor kulit Membran mukus mulut kering Oliguri - <500ml/hari - normal: 0.5~1ml/kg/jam Takikardia Hipotensi Hipoperfusi  sianosis Perubahan status mental

Diagnosis Hipovolemia: Pengkajian riwayat: asupan cairan kurang, p’drhan GI …etc BUN : kreatinin > 20 : 1 - BUN↑: hiperalimentasi, terapi glucocorticoid, p’drhan GI atas Peningkatan hematokrit Ggn keseimbangan elektrolite Ggn asam-basa

Terapi Parenteral Cairan : Crystalloids: - m’andung Na sbg partikel aktif scr osmotik - berguna u/ ekspansi volume (terutama ke ruang interstisial) - u/ maintenance cairan - koreksi imbalans elektrolit

Crystalloids: Isotonic crystalloids - Lactated Ringer, NaCl 0.9% - hanya 25% yg masuk ke intravaskular Hipertonic saline solutions - NaCl 3% Hypotonic solutions - D5W, NaCl 0.45% - <10% menetap di intravaskular, tdk adekuat u/ resusitasi cairan

Colloid Solutions: M’andung byk substansi molekul berat  sulit u/ berpindah mll membran dinding kapiler Sediaan: - Albumin: 5%, 25% - Dextran - Gelifundol - Haes-steril 10%

SolutionsVolumes Na + K+K+K+K+ Ca 2+ Mg 2+ Cl - HCO 3 - DextrosemOsm/L ECF Lactated Ringer’s % NaCl % NaCl D5W D5/0.45% NaCl % NaCl % Hetastarch % Albumin 250, < % Albumin 20,50, < Common parenteral fluid therapy

Pengaruh Colloid & Crystalloid Volume darah: 1000cc 500cc Lactated Ringers 5% Albumin 6% Hetastarch Whole blood Blood volume Infusion volume

Tanda-tanda hipervolemik Hipertensi Poliuria Peripheral edema Wet lung Peningkatan nilai urine specific gravity P’besaran vena jugular Terutama ketika hipoalbumin

Manajemen Hipervolemik: Prevention is the best B’dsrkan nilai CVP atau pulmonary wedge pressure Diuretik Meningkatkan tekanan onkotik: FFP or albumin infusion (dpt diberikan terapi diuretik) Dialisis Hindari asupan cairan b’lebihan, t’utama pd psn malnutrisi, ggl jtg, insufisiensi renal

Manajemen Cairan: Perdarahan akut - Mulai berikan 2-3L isotonic crystalloid u/ m’p’thnkan TD & perfusi perifer - Berikan scr dini koloid - Crystalloid + 5% albumin dgn rasio4:1 - Transfusi Darah - Large borne IV line

The rules of fluid replacement: Replace blood with blood Replace plasma with colloid Resuscitate with colloid Replace ECF depletion with saline Rehydrate with dextrose

Ggn keseimbangan cairan: kurang dr Obs TTV, nilsi CVP, JVP, haluaran urin Pasang IV line pd vena besar Obs turgor kulit, kelemhan otot, gambran EKG Obs asupan cairan per jam Kolab: terpai cairan