Nama Pasien :

Ny Maya
Tanggal
20 juni 2014
No Medical Record :20123456
Tinggi Badan :
Berat Badan :
Serum/Darah
Sample Jam ke 2

Total Volume
Creatinin
Urea Nitrogen *
Ureum

170 cm
70 kg
Creatinin

Ureum
14

BUN*
171.2

80.2

Dialisate 24 Jam Urine 24 Jam

8.4
250 Liter/ ml
8.5
150 mg/dl
76.6
462.2 mg/dl
163.9
989.1 mg/dl

Cara Menghitng Body Surface Area ( BSA )

TB x BB
3600

BSA

1.82

Glucosa
135

Dialisate PET ( Dianeal 2.5%)

Sample Jam ke 0
Sample Jam ke 2
Sample Jam ke 4

Creatinin Glucosa
1.45
1960
4.86
950
6.7
530

PET Result
Nama Pasien :
Tanggal
No Medical Record :

Ny Maya
20 juni 2014
20123456

Overnight Drainage Volume :

Dwell Time :
Serum
Sample Jam ke 2

Creatinin Glucosa
14
135

Dialisate
Sample Jam ke 0
Sample Jam ke 2
Sample Jam ke 4

Creatinin Glucosa
1.45
1960
4.86
950
6.7
530

Drainange Volume
Worksheet
Corrected Creatini / Kreatinin terkoreksi
Serum Sample Jam ke 2
Creatinin Serum
Glukosa ( ______) X Corr Factor ( ______)
Corrected Creatinin

=
=
=

14
0.07 ( - )
13.93

Dialisate Sample
Sample Jam ke 0
Creatinin
Glukosa ( ______) X Corr Factor ( ______)
Corrected Creatini

=
=
=

1.45
1.04 ( - )
0.41

Sample Jam ke 2
Creatinin
Glukosa ( ______) X Corr Factor ( ______)
Corrected Creatini

=
=
=

4.86
0.50 ( - )
4.36

Sample Jam ke 4
Creatinin
Glukosa ( ______) X Corr Factor ( ______)
Corrected Creatini

=
=
=

6.7
0.28 ( - )
6.42

Correction factor University of Missouri - Columbia adalah .

0,000531415

D/P

Dialisate / Plasma Ratio

D/P Jam ke 0
Dialisate Kreatinin Terkoreksi Jam ke 0
Serum Kreatinin Terkoreksi

0.41
13.93

0.0293

D/P Jam ke 2
Dialisate Kreatinin Terkoreksi Jam ke 2
Serum Kreatinin Terkoreksi

4.36
13.93

0.3127

D/P Jam ke 4
Dialisate Kreatinin Terkoreksi Jam ke 4
Serum Kreatinin Terkoreksi

6.42
13.93

0.4608

950
1960

0.4847

530
1960

0.2704

D/DO
Glucosa Jam ke 2
Glucosa Jam ke 0
Glucosa Jam ke 4
Glucosa Jam ke 0

0,000531415

Data Pasien
Nama Pasien :
Tanggal
No Medical Record :

Ny Maya
20 juni 2014
20123456

Tinggi Badan :
Berat Badan :
Serum
Sample Jam ke 2

170 cm
70 kg
Creatinin

BUN*
14

80.2 mg/dl

Dialisate 24 Jam

Urine 24 Jam
8.4
250 Liter/ ml
8.5
150 mg/dl
76.6
462.2 mg/dl

Total Volume
Creatinin
Urea Nitrogen *
1. TARGET
OPTIMUM
MINIMUM

2
1,7

2. Residual KT/V
a) Residual Urea cLearence
Urine 24 jam x Urine Urea Nitrogen
1440 menit/hari x BUN

115550
115488

b) Residual Urea Clerence dalam weekly KT/V

Residual Urea clrearence x 1440 min
1000 ml x BB ( kg ) x ( 0.6 ( Male ) or 0.55 ( Female )

1.0

X 7 hari/ seminggu

3. Dialisate KT/V
D/P Urea x Vol Dialisate
X 7 hari/ seminggu
BB ( kg ) x ( 0.6 ( Male ) or 0.55 ( Female )
4. Total KT/V
Hasil Urea Clearance Weekly + Hasil Dialisate KT/V =

1.58

D/P Urea 24 Jam

Urea Nitrogen dialisate
Urea Nitrogen darah

0.96

1440.7730673317
42000

0.24

8.02
42

1.34

Data Pasien
Nama Pasien :
Tanggal
No Medical Record :

Ny Maya
20 juni 2014
20123456

Tinggi Badan :
Berat Badan :
Serum
Sample Jam ke 2

170 cm
70 kg
Creatinin

Urea
14

171.2 mg/dl

Dialisate 24 Jam

Urine 24 Jam
8.4
250 Liter/ ml
8.5
150 mg/dl
163.9
989.1 mg/dl

Total Volume
Creatinin
Ureum
1. TARGET
OPTIMUM
MINIMUM

2
1,7

2. Residual KT/V
a) Residual Urea Clerence dalam weekly KT/V
Urea dialisate
x Drain Volume =
Urea darah
3. Kandungan Urea Tubuh
BB ( kg ) x ( 0.6 ( Male ) or 0.55 ( Female )
4. Total KT/V
Hasil Urea Clearance Weekly =
Urea Tubuh

8.04 Weekly =

42

1.34

D/P Urea 24 Jam

Urea Nitrogen dialisate
Urea Nitrogen darah

56.29276

0.96

Data Pasien
Nama Pasien :
Tanggal
No Medical Record :

Ny Maya
20 juni 2014
20123456

Tinggi Badan :
Berat Badan :
Serum
Sample Jam ke 2

Total Volume
Creatinin
Urea Nitrogen *
1. TARGET
OPTIMUM
MINIMUM

170 cm
70 kg
Creatinin

BUN*
14

80.2 mg/dl

Dialisate 24 Jam Urine 24 Jam

8.4
250 Liter/ ml
8.5
150 mg/dl
76.6
462.2 mg/dl

60 L / 1.73 m
50 L / 1.73 m

2. Residual Cc L/wk
a. Residual Cc in ml/min
Urine 24 jam x Creatinin Urine
1440 x Creatinin Serum

37500
20160

1.86 ml/min Residual Cc

b. Creatinin Terkoreksi
Residual Cc + Residual Urea Clearence =
2
c. Residual Cc in Weekly
Creatinin terkoreksi x 1440
1000 ml

2.86
2

X 7 hari/ seminggu =

3. Dialisate ( Cc ) L/wk
D/P Creatinin x 24 Jam Drain Volume x 7 Hari/Minggu
4. Total ( Cc ) L/wk
Residual Cc in Weekly + Dialisate ( Cc ) L/wk =
5. Total Cc dalam 1.73 m2 BSA
Total Cc L/wk x 1.73 m2 =
BSA pasien

2059.672
1000

35.7

50.12

86.70
1.82

1.43

47.64

BSA

1.82

D/P Creatinin 24 Jam

Urea Creatinin dialisate
Urea Creatinin darah

Residual Urea cLearence

Urine 24 jam x Urine Urea Nitrogen
1440 menit/hari x BUN

ml/min Residual Cc

14.42

0.61

115550
115488

1.0

Data Pasien
Nama Pasien :
Ny Maya
Tanggal
20 juni 2014
No Medical Record :20123456
Tinggi Badan :
Berat Badan :
Serum
Sample Jam ke 2

170 cm
70 kg
Creatinin

Ureum
14

Dialisate 24 Jam
Total Volume
Creatinin
Ureum
1. TARGET
OPTIMUM
MINIMUM

171.2 mg/dl

Urine 24 Jam

8.4
8.5
163.9

250 Liter/ ml
150 mg/dl
989.1 mg/dl

60 L / 1.73 m
50 L / 1.73 m

2. Cc L/wk dalam 24 jam

Creatinin Dialisat x Total Volume Dialisate 24 Jam=
Creatinin Serum
Weekly Cc
Cc L/wk dlm 24 Jam x 7 hari/minggu =
3. Total Cc dalam 1.73 m2 BSA
Total Cc L/wk x 1.73 m2 =
BSA

5.10

35.7

61.761
1.82

33.93

BSA

1.82 ( Bisa di lihat di tabel atau di hitung )

D/P Creatinin 24 Jam

Urea Creatinin dialisate
Urea Creatinin darah

Residual Urea cLearence

Urine 24 jam x Urine Urea Nitrogen
1440 menit/hari x BUN

0.61

247275
246528

1.0