Laki laki 45 th, BB 50 Kg, dehidrasi sedang

Dx. Peritonitis generalisata ec perforasi pylorus post appendektomi 5 hari yang lalu.
1. Kebutuhan cairan :
Cairan maintenance : 2 cc/KgBB/jam = 2400 cc
Elektrolit maintenance :
- Na : 1-3 meq x 50 Kg
= 50-150 meq 75 meq
- Cl : 1-3 meq x 50 Kg
= 50-150 meq 75 meq
- K : 1-2 meq x 50 Kg
= 50-100 meq 50 meq
2. Defisit cairan : 6 % x 50.000 = 3000 cc
Defisit elektrolit :
- Na : 120 meq x 3 = 360 meq
- Cl : 100 meq x 3 = 300 meq
- K : 10 meq x 3 = 30 meq
Cara pemberian cairan rehidrasi :
-

6 jam I : 50 % total cairan (maintenance + defisit)

= x (3000+2400) = 2700 cc = 150 tpm
masukkan RL 2 jalur, masing-masing 75 tpm
6 jam II : 25 %
= x (3000+2400) = 1350 cc = 75 tpm
masukkan RL 2 jalur , masing-masing 35 tpm
12 jam berikutnya : 25 %
= x (3000+2400) = 1350 cc = 37 tpm
masukkan RL 2 jalur masing-masing 18 tpm

Program nutrisi
-

Kebutuhan energi 25-30 kkal x 50 = 1500 kkal

Protein 15-20% kal, 1,2-2 gr/KgBB, 4 kkal/g
Lemak 20-35% kal, 9 kkal/g
Karbohidrat enteral 4 kkal/g, parenteral 3,4 kkal/g, max 7 gr/KgBB/hr
Trace element
Vit K : 10 mg initial, kemudian 10 mg iv tiap minggu
Vit B12 : 1000 g initial, kemudian 500 g iv tiap minggu
Asam folat : 10 mg
Zink : 20 mg tiap hari

Cairan maintenance : 2400 cc ~ 2500 cc

Na : 1-3 meq x 50 Kg
= 50-150 meq
Cl : 1-3 meq x 50 Kg
= 50-150 meq

Hari 0

K : 1-2 meq x 50 Kg

Cairan

Volume
2500 cc
1000 cc
1500
2500 cc

RL
D5%
Total

= 50-100 meq

Na (meq)
50-150
130
0
130

Cl (meq)
50-150
109
0
109

K (meq)
50-100
4
0
4

Kalori
0
300
300

Protein
0
0
0

Osm
273
278

Hari I
-

Cairan 2500 cc
Kalori 25 % total kalori 25% x 1500 = 375 Kkal
Na : 1-3 meq x 50 Kg
= 50-150 meq
Cl : 1-3 meq x 50 Kg
= 50-150 meq
K : 1-2 meq x 50 Kg
= 50-100 meq
%

Protein
Lipid
KH
Total

25%
30%
45%
100%

Cairan

Volume (cc)
2500
500
500
1000
25
2025

RL
D51/4N
Pan aminG
KCl otsu
Total

Na (meq)
50-150
65
19,25
0
0
84,25

Kal

gr/hr

93,75
112,5
168,75
375

Cl (meq)
50-150
55
19,25
52
25
151,25

K (meq)
50-100
2
0
0
25
27

23,4
12,5
42,1

Kal
375
0
100
200
0
300

Protein (g/L)
23,4
0
0
27,2
0
27,2

Osm
273
353
507

Pemberian :
-

Masukkan infus RL, D51/4N, Pan aminG, KCl otsu jalur perifer masing- masing 15

tpm
Minum air gula 4 x 120 cc

Hari II
-

Cairan 2500 cc
Kalori 50 % total kalori 50% x 1500 = 750 Kkal

Na : 1-3 meq x 50 Kg
Cl : 1-3 meq x 50 Kg
K : 1-2 meq x 50 Kg

= 50-150 meq
= 50-150 meq
= 50-100 meq
%

Protein
Lipid
KH
Total

25%
30%
45%
100%

Cairan

Volume (cc)
2500
500
500
1000
25
2025

RL
Kalbamin
Kaen MG3
KCl otsu
Total

Kal

gr/hr

187,5
225
337,5
750

Na (meq)
50-150
65
0
50
0
115

Cl (meq)
50-150
55
0
50
25
130

46,8
25
84,3

K (meq)
50-100
2
0
20
25
47

Kal
750
0
0
400
0
400

Protein (g/L)
46,8
0
45,5
0
0
45,5

Osm
273
808
695

Pemberian :
-

Masukkan infus RL, D10%, Kalbamin, Kaen MG3, KCl otsu jalur perifer masing-

masing 18 tpm
Minum diet cair 1, 4 x 120 cc (250 kkal, 1,3 gr protein)

Hari III
-

Cairan 2500 cc
Kalori 75 % total kalori 75% x 1500 = 1125 Kkal
Na : 1-3 meq x 50 Kg
= 50-150 meq
Cl : 1-3 meq x 50 Kg
= 50-150 meq
K : 1-2 meq x 50 Kg
= 50-100 meq
%

Protein
Lipid

25%
30%

Kal
281,5
337,5

gr/hr
70,3
37,5

KH
Total

45%
100%

Cairan

Volume (cc)
2500
1000
500
500

Kaen MG3
Kalbamin
Triparen 2
KCl otsu
Total

25
2025

506,25
1125

Na
(meq)
50-150
50
0
28,75
0
78,75

126,5

Cl (meq)

K (meq)

50-150
50
0
36,5

50-100
20
0
22,5

1125
400
0
583,7

70,3
0
45,5
0

25
67,5

5
0
983,7

45,5

25
111,5

Kal

Protein (g/L)

Osm

695
808
1468

Pemberian :
-

Masukkan infus Kaen MG3, Kalbamin, KCl otsu jalur perifer dan triparen 2 melalui

CVC masing- masing 18 tpm

Minum diet cair 1, 4 x 120 cc (137 kkal, 24,8 gr protein)

Hari IV
-

Cairan 2500 cc
Kalori 100 % total kalori 100% x 1500 = 1500 Kkal
Na : 1-3 meq x 50 Kg
= 50-150 meq
Cl : 1-3 meq x 50 Kg
= 50-150 meq
K : 1-2 meq x 50 Kg
= 50-100 meq
%

Protein
Lipid
KH
Total

25%
30%
45%
100%

Kal
375
450
675
1500

gr/hr
93,75
50
168,75

Cairan

Volume (cc)
2500
1000
1000
25
2025

Kaen MG3
Triparen 1
KCl otsu
Total

Na
(meq)
50-150
50
5
0
55

Cl (meq)

K (meq)

50-150
50
15
25
90

50-100
20
45
25
90

Kal
1500
400
933
0
1333

Protein (g/L)
93,75
0
0

Osm

695
1458

Pemberian :
-

Masukkan infus Kaen MG3, KCl otsu jalur perifer dan Triparen 1 melalui CVC

masing- masing 18 tpm

Minum diet cair 1, 4 x 120 cc (167 kkal, 94 gr protein)