Tatalaksana

Cairan
!

1!

Cairan
Tubuh
Total!

Distribusi Cairan Tubuh!

Cairan
Ekstra!
Sel!

80%!
70%!

60%!
55%!

50%!

45%!

45%!
40%!

35%!
25%!

20%!

Cairan
Intra!
Sel!

2!

Keseimbangan Cairan Tubuh!

3!

4!

Komposisi Elektrolit Tubuh

!

5!

Cairan Isotonik

!
- Osmolalitas

= plasma:!
- Tidak ada pengaruh
!
perpindahan CIS ke CES !
pressure)!
- Cocok untuk: !
"fluid replacement"!
!

6!

Cairan Hipotonik

!
- Osmolalitas < plasma.!
- Air masuk ke intra sel.!
- Tidak cocok untuk edema !
otak!

7!

Cairan Hipertonik

-Osmolalitas > plasma.!

- Air keluar sel.!
- Ex: Saline 3%, 5%.!

8!

INTRACELLULAR FLUID!
(ICF)!
0.4 x BW!

!
INTERSTITIAL FLUID!
3/4 of ECF!

!
PLasma!
1/4 of ECF!

EXTRACELLULAR FLUID!
(ECF)!
0.2 x BW!

9!

!
C-Interstisial!

!
CIS!

!
C-Intravaskular!

10!

Jenis!

Glukose (g/L)!

Na mEq/L!

Cl mEq/L!

Osm (mosm/L!

D5%!

50!

-!

-!

278!

D10%!

100!

-!

-!

556!

D20%!

200!

-!

-!

1112!

NaCl 0,9%!

-!

154!

154!

308!

NaCl 3%!

-!

513!

513!

1026!

N1D5!

50!

154!

154!

578!

N2D2,5!

25!

77!

77!

289!

N2D5!

50!

77!

77!

428!

N4D5!

50!

38,5!

38,5!

353!

N5D10!

100!

31!

31!

615!

11!

12!

Perbedaan Komposisi Cairan Ringer

!

[mmol/l]!

Ringer!

Ringers
lactate!

Ringers
acetat!

Ringerfundin!

Na+!

147!

130!

130!

140!

K+!

4.0!

5.0!

5.0!

4.0!

Ca++!

2.25!

1.0!

1.0!

1.25!

Mg++!

1.0!

1.0!

1.0!

1.0!

Cl-!

156!

112!

112!

127!

Lactate-!

-!

27.0!

-!

-!

Acetate-!

-!

-!

27.0!

24.0!

Malate-!

-!

-!

-!

5.0!

BEpot!

-24!

3.0!

2.5!

0!

Osmolarity (mOsm/L)!

309!

276!

276!

304!

0!

1.8 !l

1.2 !l

1.4 !l

O2-consumption (O2/l)!

13!

14!

Kristaloid VS Koloid

Cristalloid!

Colloid!

Advantages!

Advantages!

Extracellular space expanders!

Good intravascular persistence!

Lactare buffer!

Reduced resuscicitation time!

Maintain urinee output!

Moderate volume required!

Reduced plasma oncotic pressure! Enhancing microvascular flow!

Cheap!

Minor risk of tissue oedem!

Moderation of SIRS!

Disadvantages!

Disadvantages!

Poor plasma volume support!

Risk of volume overload!

Large quantities needed!

Adverse effect on haemostasis!

Risk of overhydration!

Tissue accumulation!

Risk of hyponatremia!

Adverse effect on renal function!

Risk of anaphylaxis!
More expensive!

15!

16!

17!

Konsep Dasar Pemberian Cairan

!

Specific treatment , necessary in patients with volume

(Blood) losses!

Fluid Management!

Target : intravascular space!

Indication : plasma and blood losses!
Colloid + crystalloid!

Crystalloid!

Fluid replacement!

Fluid Management!

Volume replacement!

Target : tissue, interstitium!

Indication : dehydration, maintenance!
Basic treatment, necessary in all patients!

18!

!
Menghitung Kebutuhan Cairan!

!
!
4:2:1!
!
!
100:50:20!

19!

!
Anak BB. = 15 Kg!

!
!
1250 kal/ hari!

? Kebutuhan Cairan!
!
!
3 mEq/100mL!
= 3 x 12,5 = 36,5
mEq/hari = 30
mEq/ L!

1.Kalori!
2.Cairan!
5% Dektrose!
3.Na!mL!
= 5g/100
4.K! = 62,5!
= 5 x12,5
5.Jenis
~ 250
kal! Cairan!
6.Cara Emberian!

!
!
1250 mL/ hari!
!
!
2 mEq/100mL!
= 2 x 12,5 = 20 mEq/
hari = 20 mEq/ L!

20!

Monitoring

Balans Cairan!
Urine!
Berat Badan!
Klinis!

21!

22!

23!

Faktor-faktor yang mengurangi kebutuhan cairan :

Humidifikasi
!
Dilumpuhkan
!
Sekresi ADH tinggi !

!
!

!
!

!x 0,75!
!x 0,7!

!(pasien dalam ventilator, koma)

!x 0,7!
Hipotermi !
!
!
!
!- 12% per 1C
!
!
!
!
!
!suhu rektal <37!
Kelembaban lingkungan tinggi!x 0,7!
Gagal ginjal
!
!
!
!x 0,3 (+ produksi
!
!
!
!
!
!urin)!
24!

Faktor-faktor yang meningkatkan

kebutuhan cairan :
!

Aktifitas penuh dan diet oral

Demam
!
!
!

!x 1,5 / minum bebas!

!+ 12% peroC suhu rektal !
> 37oC!
Suhu ruangan >31C
!
!+ 30% peroC !
Hiperventilasi
!
!
!x 1,2!
Neonatus preterm (< 1,5 kg)
!x 1,2!
Radiant heater
!
!
!x 1,5!
Fototerapi !
!
!
!x 1,5!
Luka bakar hari 1 !
!
!+ 4% per 1% luas luka
!
!
!
!
!bakar!
Luka bakar hari >2!
!+ 2% per 1% luas luka
!
!
!
!
!bakar!
25!

Kebutuhan elektrolit per hari!

!
!

!!
!Natrium

!
!

!Kalium
!Klorida

!: 2 4 mEq/100ml kebutuhanair/hari!
!: 1 2 mEq/100ml kebutuhan air/hari!
!: 2 4 mEq/100ml kebutuhanair/

hari!

26!

27!

28!