4. Sumber: Human anatomy & physiology, Marieb, 6 th edition

9. Komposisi Cairan Tubuh: Ca 2+ Mg 2+ K+K+ Na + Cl - PO 4 3- Organic anion HCO 3 - Protein 0 50 100 150 100 150 CationsAnions ECF ICF Osmolaritas = terlarut/(terlarut+pelarut) Osmolaritas = terlarut/(terlarut+pelarut) Osmolalitas = terlarut/pelarut (290~310mOsm/L) Osmolalitas = terlarut/pelarut (290~310mOsm/L) Tonicity = effective osmolalitas Tonicity = effective osmolalitas Plasma osmolilitas = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma osmolilitas = 2 x (Na) + (Glucose/18) + (Urea/2.8) Plasma tonicity = 2 x (Na) + (Glucose/18) Plasma tonicity = 2 x (Na) + (Glucose/18)

13. Regulation of Fluids: Hydrostatic pressure v.s. Oncotic pressure  Albumin is the major determining oncotic pressure

15. Mekanisme Haus Sumber: Human anatomy & physiology, Marieb, 6 th edition

17. Tanda-tanda Hipovolemik: Penurunan turgor kulit Membran mukus mulut kering Oliguri - <500ml/hari - normal: 0.5~1ml/kg/jam Takikardia Hipotensi Hipoperfusi  sianosis Perubahan status mental

18. Diagnosis Hipovolemia: Pengkajian riwayat: asupan cairan kurang, p’drhan GI …etc BUN : kreatinin > 20 : 1 - BUN↑: hiperalimentasi, terapi glucocorticoid, p’drhan GI atas Peningkatan hematokrit Ggn keseimbangan elektrolite Ggn asam-basa

19. Terapi Parenteral Cairan : Crystalloids: - m’andung Na sbg partikel aktif scr osmotik - berguna u/ ekspansi volume (terutama ke ruang interstisial) - u/ maintenance cairan - koreksi imbalans elektrolit

20. Crystalloids: Isotonic crystalloids - Lactated Ringer, NaCl 0.9% - hanya 25% yg masuk ke intravaskular Hipertonic saline solutions - NaCl 3% Hypotonic solutions - D5W, NaCl 0.45% - <10% menetap di intra- vaskular, tdk adekuat u/ resusitasi cairan

21. Colloid Solutions: M’andung byk substansi molekul berat  sulit u/ berpindah mll membran dinding kapiler Sediaan: - Albumin: 5%, 25% - Dextran - Gelifundol - Haes-steril 10%

22. SolutionsVolumes Na + K+K+K+K+ Ca 2+ Mg 2+ Cl - HCO 3 - DextrosemOsm/L ECF1424510327280-310 Lactated Ringer’s 1304310928273 0.9% NaCl 154 308 0.45% NaCl 77 154 D5W D5/0.45% NaCl 77 50406 3% NaCl 513 1026 6% Hetastarch 500154 310 5% Albumin 250,500 130- 160 <2.5 130- 160 330 25% Albumin 20,50,100 130- 160 <2.5 130- 160 330 Common parenteral fluid therapy

23. Pengaruh Colloid & Crystalloid Volume darah: 1000cc 500cc 2006001000 Lactated Ringers 5% Albumin 6% Hetastarch Whole blood Blood volume Infusion volume

24. Tanda-tanda hipervolemik Hipertensi Poliuria Peripheral edema Wet lung Peningkatan nilai urine specific gravity P’besaran vena jugular Terutama ketika hipoalbumin

25. Manajemen Hipervolemik: Prevention is the best B’dsrkan nilai CVP atau pulmonary wedge pressure Diuretik Meningkatkan tekanan onkotik: FFP or albumin infusion (dpt diberikan terapi diuretik) Dialisis Hindari asupan cairan b’lebihan, t’utama pd psn malnutrisi, ggl jtg, insufisiensi renal

26. Manajemen Cairan: Perdarahan akut - Mulai berikan 2-3L isotonic crystalloid u/ m’p’thnkan TD & perfusi perifer - Berikan scr dini koloid - Crystalloid + 5% albumin dgn rasio4:1 - Transfusi Darah - Large borne IV line

27. The rules of fluid replacement: Replace blood with blood Replace plasma with colloid Resuscitate with colloid Replace ECF depletion with saline Rehydrate with dextrose

29. Ggn keseimbangan cairan: kurang dr Obs TTV, nilsi CVP, JVP, haluaran urin Pasang IV line pd vena besar Obs turgor kulit, kelemhan otot, gambran EKG Obs asupan cairan per jam Kolab: terpai cairan