Fluid and Electrolite Rescusitation

7/23/2019 Fluid and Electrolite Rescusitation

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FLUID AND ELECTROLITE

RESUSCITATION

DEPARTEMENT OF ANESTHESIOLOGIST , INTENSIVE CAREDEPARTEMENT OF ANESTHESIOLOGIST , INTENSIVE CARE

AND PAIN MANAGEMENT HASANUDDIN UNIVERSITYAND PAIN MANAGEMENT HASANUDDIN UNIVERSITY

20072007

Andi Salahuddin


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Fluid and electrolite disturbanceFluid and electrolite disturbance

EmergencyEmergency

DeathDeath


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ost commonconditions include

DiarrheaDiarrhea

VomitingVomiting

PeritonitisPeritonitis Ileuses obstructiveIleuses obstructive

StarvationStarvation

BurnBurn SepsisSepsis

HyperglycemiaHyperglycemia


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Issue ?Issue ?

Pulmonary edemaPulmonary edema

Hypernatremia and hyperchloremia.Hypernatremia and hyperchloremia.

SIRS & MODS ( dr. P.Gosling, emergSIRS & MODS ( dr. P.Gosling, emerg

Med !""#$ !"%#" ' #) *Med !""#$ !"%#" ' #) *


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"+ - ir

HOW TO MANAGE ?

Distribution of fluids Fluid demand. Crystalloid or olloid !at"s a##roa"


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$% & '(& (&

ICF ISF IVF

De)trose (&

*+, NaCl %.-&

Colloid/lood!lasma!lasma e)#ander

Distribution of Fluids


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SODIUM AND WATER HOMEOSTASISSODIUM AND WATER HOMEOSTASIS

AFTER INJURAFTER INJUR

Summary o/ the endocrine responses to acute in0ury,

1hich are directed to1ards maintaining

per/usion o/ essential organs and retention o/ 1ater and sodium.


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!E"UTU#AN DASAR!E"UTU#AN DASARELE!TROLITELE!TROLIT

Kebutuhan KKebutuhan K ++ :: KK ++ x BB x 0!x BB x 0!"" Kecepatan pemberian max #0Kecepatan pemberian max #0

m$%&'amm$%&'am

" atau #00 m$% & #! 'am" atau #00 m$% & #! 'am

" Pro(u)si urine" Pro(u)si urine >>* ml & Kg BB & 'am* ml & Kg BB & 'am

" * # m$% & Kg BB & #! 'am" * # m$% & Kg BB & #! 'am

Kebutuhan ,aKebutuhan ,a ++:: ,a,a ++x BB x 0-x BB x 0-"" # . m$% & Kg BB & #! 'am# . m$% & Kg BB & #! 'am


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$ENIS CAIRAN %AN&$ENIS CAIRAN %AN&DI&UNA!ANDI&UNA!AN

*/*/ airan pemeliharaan 1maintenance2airan pemeliharaan 1maintenance2" 'umlah cairan yang (iguna)an & #! 'am" 'umlah cairan yang (iguna)an & #! 'am

#/#/ airan (e3sitairan (e3sit

" 'umlah )e)urangan cairan yang ter'a(i/" 'umlah )e)urangan cairan yang ter'a(i/

./ airan pengganti 1replacement2./ airan pengganti 1replacement2

a2a2 Se)uesterasi 1cairan thir( space2Se)uesterasi 1cairan thir( space2b2b2Pengganti (arah yang hilangPengganti (arah yang hilangc2c2 Pengganti cairan yang hilang melaluiPengganti cairan yang hilang melalui

(rainage 3stel (an maag slang(rainage 3stel (an maag slang


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T!e Cr"st#lloidsT!e Cr"st#lloids

Cr"st#lloids #re # $rou% of intr#&enous fluid in '!i(!Cr"st#lloids #re # $rou% of intr#&enous fluid in '!i(!)#" be*)#" be*

Ionic solutionIonic solution2 Ringer lactate3 acetateRinger lactate3 acetate

2 4a5l physiologic (".6+ saline*4a5l physiologic (".6+ saline*2 Hartman7s solutionHartman7s solution2 8tc8tc9 Mostly iso'osmolar - isotonicMostly iso'osmolar - isotonic9 5heap, easy to manu/acture5heap, easy to manu/acture9

Has no immunologic reactionHas no immunologic reaction9 MainlyMainlycon/ined to the e:tracellular /luidcon/ined to the e:tracellular /luid 4on ionic4on ionic

2 De:trose )+De:trose )+2 Maltose "+Maltose "+2 8tc8tc

9 Distri;uted to intracellular spaceDistri;uted to intracellular space


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Ele(trol"te Co)%#risonEle(trol"te Co)%#rison

+et'een R, - N#Cl ./01+et'een R, - N#Cl ./01

N#N#22

3322

C#C#22

ClCl44

,#(t#te,#(t#te Os)/Os)/

PlasmaPlasma


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T!e ColloidsT!e Colloids

5olloids are /luids 1hich contain oncotic5olloids are /luids 1hich contain oncotic

particles, there/ore e:ert an oncotic pressureparticles, there/ore e:ert an oncotic pressure

loodlood PlasmaPlasma

l;uminl;umin

rti/icial colloids -rti/icial colloids -plasma e:panderplasma e:pander2 5el#tins65el#tins6 /rom collagen/rom collagen7H#e)#((el - 5elofusine87H#e)#((el - 5elofusine8

2 De9tr#nDe9tr#n is a polysaccharidesis a polysaccharides7De9tr#n :. - ;.87De9tr#n :. - ;.8

2 HESHES (Hydro:yethyl starch*(Hydro:yethyl starch*e/$/ !e)o!es .1e/$/ !e)o!es .1


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Intr#&enous fluidIntr#&enous fluid

@luid@luid De:troseDe:trose

(g3d=*(g3d=*

4aA4aA

(m8B3=*(m8B3=*

5l'5l'

(m8B3=*(m8B3=*

OsmolarityOsmolarity

(mosmol3=*(mosmol3=*

Oncotic POncotic P

(mmHg*(mmHg*

De:trose )+De:trose )+ )")" !?>!?>

Cr"st#lloidsCr"st#lloidsDe:trose )+ A 4a5l ".#">

"!"!

"6>"6>

ColloidsColloids

PlasmaPlasma

l;umin )+l;umin )+

Can0i heta + in 4a5l ".6+Can0i heta + in 4a5l ".6+


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DE#IDRASDE#IDRAS

II De3sit cairan interstitiel (engan ge'ala :De3sit cairan interstitiel (engan ge'ala :" turgor )ulit yang 'ele)" turgor )ulit yang 'ele)" mata ce)ung" mata ce)ung

" ubun"ubun ce)ung 1bayi 4 ana)2" ubun"ubun ce)ung 1bayi 4 ana)2" mu)osa bibir (an )ornea )ering" mu)osa bibir (an )ornea )ering

De3sit cairan intravas)ular (enganDe3sit cairan intravas)ular (engan

ge'ala :ge'ala :" hipotensi ta)i)ar(i" hipotensi ta)i)ar(i" vena"vena )olaps" vena"vena )olaps

" 5apillary re3lle( time6 meman'ang" 5apillary re3lle( time6 meman'ang ""oligourioligouri ""

syo) 1 ren'atan 2syo) 1 ren'atan 2


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DE#IDRASI DITIN$AU DARIDE#IDRASI DITIN$AU DARI

DEFISIT CAIRAN 'DEFISIT CAIRAN '

ELE!TROLITELE!TROLIT*/*/ Dehi(rasi ringan 1 (e3sit !7 BB 2Dehi(rasi ringan 1 (e3sit !7 BB 2

#/#/ Dehi(rasi se(ang 1 (e3sit 87 BB 2Dehi(rasi se(ang 1 (e3sit 87 BB 2././ Dehi(rasi berat 1 (e3sit *#7 BB 2Dehi(rasi berat 1 (e3sit *#7 BB 2

!/!/ Syo) 1 (e3sit lebih (ari *#7 BB 2Syo) 1 (e3sit lebih (ari *#7 BB 2

$ENIS $ENIS$ENIS $ENIS


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$ENIS($ENIS$ENIS($ENISDE#IDRASIDE#IDRASI

*/*/Dehi(rasi hipertoni)Dehi(rasi hipertoni) 1hipernatrem1hipernatrem

#/#/Dehi(rasi hipotoni)Dehi(rasi hipotoni) 1hiponatremi1hiponatremi)

././Dehi(rasi isotoni)Dehi(rasi isotoni)


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EHI RASI HIPOTONIK

EHI RASI HIPOTONIK

( HIPONATREMIK )

HIPONATREMIK )

Pa(a ana) (engan (iare yang

minum banya) air atau cairanhipotoni) atau (iberi in9us

glu)osa 7/

Ka(ar natrium ren(ah 1;*.0

mmol&


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EHI RASI HIPERTONIK

EHI RASI HIPERTONIK

( HIPERNATREMIK )

HIPERNATREMIK )

?Biasa ter'a(i setelah inta)e cairan

hipertoni) 1natrium glu)osa la)tosa2selama (iare

?Kehilangan air @@ )ehilangan natrium

?Konsentrasi ,a @ *0 mmol&nta8e

E)tra

Abnormal +osses

Normal 5rine Out#ut

7 9 >

0( m+


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(& "aus, mu8osa 8erin=

('%& tur=or, tensi, nadi

B'%& 7HOC6, urine %

DEFISIT

(%& (%&

1 am ' am

REHIDRASI

33 Maintenane

5ntu8 #asien tan#a syo8


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M Maintenane

+a8ila8i % ta"un, berat badan (% 8=

D< CA, oma, #aralyti ileus

M (% 8= ) (% m+ 0(%% m+

(% 8= ) 2 mE; '(% mE; Na '%%% m+ *+< *D

3 '(%% m+ D(< D'%

/ila ra=ura=u 8uran=i 0%&

7etela" 0$ am, e8 urine


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Too mu"

!enya8it #aru

Too little

Tida8 sembu"

de. ordisedema

7"o8

Ga=al =inal

*F >7F >CF

' 0


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>nfus

> >> >>>

> re"idrasi e#at

>> re"idrasi lambat


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*e"idrasi e#at

*+


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Tentukan Jumlah Cairan

Tentukan Macam Cairan

Tentukan Keceatan


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/leedin=

*+ 0$ ) loss

>8uti #erfusi @ nadi @ tensi

HD bai8 HD ele8

Hb B 1 m=


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Kaan K!r"an Menin##al$

O+5ME dara" "ilan= 'T*O7>T "ilan= 0


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N%& S& '( tahun) KET

PreopPreop OpOp PostopPostop

FensiFensi >">" "" !"!" ""

4adi4adi ">"> """" >">"

Per/usiPer/usi '' '' 44 44

H;H; ?,"?," ,),) >,>,

*+ '(%% 3 0%%% W/ (%%


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Fluid and Electrolite Rescusitation