8b.-terapi-cairan.ppt

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

Komposisi Cairan Tubuh: Cations

150

Anions

100 50 0

ECF

Na+ ClHCO3-

2+

Ca Mg 2+

Protein K+

Organic anion

ICF

50

PO43-

100 150

Osmolaritas = terlarut/(terlarut+pelarut) Osmolalitas = terlarut/pelarut (290~310mOsm/L) Tonicity = effective osmolalitas Plasma osmolilitas = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma tonicity = 2 x (Na) + (Glucose/18)

Regulation of Fluids:

Hydrostatic pressure v.s. Oncotic pressure  Albumin is the major determining oncotic pressure

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

Common parenteral fluid therapy Solutions

Volumes

Na+

K+

Ca2+

Mg2+

Cl-

HCO3-

Dextrose

mOsm/L

ECF

142

4

5

103

27

280-310

Lactated Ringer’s

130

4

3

109

28

273

0.9% NaCl

154

154

308

0.45% NaCl

77

77

154

D5/0.45% NaCl

77

77

3% NaCl

513

513

1026

500

154

154

310

5% Albumin

250,500

130160

<2.5

130160

330

25% Albumin

20,50,100

130160

<2.5

130160

330

D5W

6% Hetastarch

50

406

Pengaruh Colloid & Crystalloid Volume darah: Blood volume

Infusion volume

200

1000cc

500cc

500cc

500cc

600

1000

Lactated Ringers

5% Albumin

6% Hetastarch

Whole blood

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

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