DEHYDRATION

dr Putra Hendra SpPD

UNIBA
 Dehydration
Dehydration can be defined as
when the loss of water and salts
is more than is replenished.

The average person loses about

2.5 liters of water every day. So
to stay properly hydrated you
must replenish this water in order
to keep from being dehydrated.
 KOMPARTEMEN CAIRAN
 Seluruh cairan tubuh didistribusikan
diantara dua kompartemen utama, yaitu :
1. Cairan intraselular (CIS)
2. Cairan ekstra selular (CES)
3. Pada orang dewasa 60% dari berat
badan adalah air (cairan dan
elektrolit).
 Body Fluid Compartments:

2/3
ICF:
55%~75%

X 50~70% TBW
lean body weight

3/4 Extravascular
Interstitial
 Male (60%) > female (50%) 1/3 fluid
ECF
 Most concentrated in skeletal muscle
 TBW=0.6xBW Intravascular
 ICF=0.4xBW 1/4 plasma
 ECF=0.2xBW
 Regulation of Fluids:

Renal sympathetic nerves

Renin-angiotensin-
aldosterone system
Atrial natriuretic peptide (ANP)
 CARA PENGELUARAN CAIRAN

a.  Ginjal
b. Kulit
c. Paru –paru
d. Gastrointestinal
Composition of Body Fluids:
Cations Anions
150

100

F
EC
Na+
50 Cl-

0 HCO3-
Ca 2+

Mg 2+ Protein
50 PO 4
3-

Organic

F
IC
K+
anion

100

150
Osmolarity = solute/(solute+solvent)
Osmolality = solute/solvent (290~310mOsm/L)
Tonicity = effective osmolality
Plasma osmolility = 2 x (Na) + (Glucose/18) + (Urea/2.8)
Plasma tonicity = 2 x (Na) + (Glucose/18)
 PROSENTASE TOTAL CAIRAN TUBUH
DIBANDINGKAN BERAT BADAN

Umur Total cairan tubuh (%)

terhadap BB
Bayi BL 77
6 Bulan 72
2 Tahun 60
16 Tahun 60
20-39 Tahun:  
Pria/Wanita 60/50
40-59 Tahun:
Pria/Wanita 55/47
Electrolyte Composition of Body Fluid
Electolyte Plasma(mEq/L Interstetiel Intracelluler
(mEq/KgH2o) (mEq/KgH2o)
Cation:
Na+ 142 145 10
K+ 4 4 159
Ca2+ 5 3 1
Mg2+ 2 2 40
Total 153 154 210
Anion:      
Cl- 103 117 3
HCO3- 25 28 7
Protein 17 - 45
Others 8 9 155
Total 153 154 210
 INTAKE DAN OUTPUT RATA-RATA HARIAN DARI
UNSUR TUBUH YANG UTAMA

Intake (Range) Output (range)

AIR (ml) 1.Urine = 1400 – 1.800
Air minum = 1400 – 1800 2.Faeces = 100
Airdalam makanan= 700 – 1000
3.Kulit = 300 - 500
Air hasil oksidasi = 300 - 400
 
4.Paru-paru = 600 - 800
 
TOTAL = 2400 -3200 TOTAL = 2400 – 3200
 Dangers of Dehydration
Dehydration can lead to any of the following
problems:
 Cramps
 Headaches
 Diarrhea
 Fever
 Vomiting
 Hallucinations
 ARF
 Syok
 Death
In fact, dehydration is the leading cause in
deaths of infants.
 Clinical Presentation of
Acute Renal Failure

A c u te R e n a l F a ilu re

P re re n a l R enal P o s tre n a l
d e c re a s e d re n a l p e rfu s io n in trin s ic re n a l d is e a s e o b s tru c tio n
8 0 % o f ca ses 1 0 % o f ca ses 10%
Etiology of ARF
 Degree of Dehydration

 Mild dehydration (3-5%)

 Moderate dehydration (7-10%)

 Severe dehydration (10-15%)

 Degree of Dehydration

Severe dehydration (10-15%)

-Rapid weak pulse.
-Low BP, sunken eyes and fontanel
-No tears or urine & v. dry mucous membrane
-Clear skin tenting. Cool mottled skin with
delayed capillary refill.
The Cardiovascular
System
 Clinical Diagnosis of Hypovolemia:
 Thorough history taking: poor intake, GI
bleeding…etc
 BUN : Creatinine > 20 : 1
- BUN↑: hyperalimentation, glucocorticoid
therapy, UGI bleeding
 Increased specific gravity
 Increased hematocrit
 Electrolytes imbalance
 Acid-base disorder
 ETIOLOGI
 Kehilangan GI abnormal : muntah, penghisapan NG,
diare, drainase intestinal
 Kehilangan kulit abnormal : diaforesis berlebihan
sekunder terhadap demam atau latihan, luka bakar,
fibrosis sistik
 Kehilangan ginjal abnormal : terapi diuretik, diabetes
insipidus, diuresis osmotik (bentuk poliurik),
insufisiensi adrenal, diuresis osmotik (DM
takterkontrol, pasca penggunaan zat kontras
 Spasium ketiga atau perpindahan cairan plasma ke
interstisial : peritonitis, obtruksi usus, luka bakar,
acites
 Hemorragia
 Perubahan masukan : koma, kekurangan cairan.
 Diarrhea
 Definition:
abnormal increase in stool liquidity, stool
frequency, and stool weight (more than 200
grams per day).
 Patofisiologi diare:
 Osmotic, secretory, exudative, motility
 Diarrhea :
< 2 weeks: acute –infection
> 2 weeks: chronic
 Penyebab diare yang sering menyebabkan syok:
 Kholera
Peningkatan sekresi Cl
Daldiyono score :

Gejala klinis
score

•Muntah 1
•Voxs cholerica 2
•Kesadaran apatis 1
•Kesadaran somnolen, soporous s/d coma 2
•Sis tolik </ sama dengan 90 mmhg 2
•Nadi > / sama dengan 120/m 1

•Napas Kussmaul (>30/m) 1

•Turgor kulit kurang 1
•Facies cholerica 2
•Extremitas dingin 1
•Washer hand 1
•Sianosis 2
•Umur>50 -1
•Umur>60 -2

Cairan yg diberikan dalam 2 jam :

Score/15 x 10%xBB kgX 1 liter
Cholera in Zimbabwe

Robin Cochran-Dirksen
 PEMERIKSAAN PENUNJANG
Pemeriksaan tinja
Makroskopis dan mikroskopis
Ph dan kadar gula dalam tinja
Kultur dan uji resistensi
Pemeriksaan keseimbangan asam
basa  AGD
Urinalisis : Bj, endapan
Pemeriksaan kadar ureum
kreatinin faal ginjal
Pemeriksaan keseimbangan cairan &
elektrolit  Hb-Ht, Na, K, Ca dan F
EKG  menilai deplesi elektrolit
(biasanya kalium)
 Tata laksana
Pilihan Cairan
Beri Rl (utama) atau NaCl
Jika pasiennya tidak dapat makan diberi Dekstros dan RL
Jika muntah2 maka berikan Dekstros dan NaCl, tetapi jika pasien
muntah + diare utamakan RL
Oralit
Cara Pemberian
IV  Untuk dehidrasi berat
Enteral Untuk dehidrasi ringan, sedang tetapi anak tidak mau/
tidak dapat minum atau jika kesadaran menurun
Oral Bila kesadaran anak baik, anak mau minum, biasanya
diberikan untuk dehidrasi ringan dan sedang
Observasi kondisi fisik klien terutama status hidrasi
 Common parenteral fluid therapy

Solutions Volumes Na+ K+ Ca2+ Mg2+ Cl- HCO3- Dextrose mOsm/L

ECF 142 4 5 103 27 280-310
Lactated
130 4 3 109 28 273
Ringer’s

0.9% NaCl 154 154 308

0.45%
77 77 154
NaCl

D5W

D5/0.45%
77 77 50 406
NaCl

3% NaCl 513 513 1026

6%
500 154 154 310
Hetastarch
5% 130- 130-
250,500 <2.5 330
Albumin 160 160
25% 130- 130-
20,50,100 <2.5 330
Albumin 160 160
 Crystalloids:
 Isotonic crystalloids
- Lactated Ringer’s, 0.9% NaCl
- only 25% remain intravascularly
 Hypertonic saline solutions
- 3% NaCl
 Hypotonic solutions
- D5W, 0.45% NaCl
- less than 10% remain intra-
vascularly, inadequate for fluid
resuscitation
 Colloid Solutions:
 Contain high molecular weight
substancesdo not readily migrate across
capillary walls
 Preparations
- Albumin: 5%, 25%
- Dextran
- Gelifundol
- Haes-steril 10%
The Influence of Colloid & Crystalloid on
Blood Volume:
Blood volume
Infusion 200 600 1000
volume

1000cc Lactated Ringers

500cc 5% Albumin

500cc 6% Hetastarch

500cc Whole blood

 Komplikasi rehidrasi

Gejala hipervolemia:
Hypertension
 Polyuria
Especially when hypo-
 Peripheral edema albuminemia

 Wet lung
 Jugular vein engorgement
 Management of Hypervolemia:
 Prevention is the best way
 Guide fluid therapy with CVP level or
pulmonary wedge pressure
 Diuretics
 Increase oncotic pressure: FFP or
albumin infusion (may followed by diuretics)
 Dialysis