Fluid and Electrolite Rescusitation
-
Upload
tri-kurniawan -
Category
Documents
-
view
229 -
download
0
Transcript of Fluid and Electrolite Rescusitation
-
7/23/2019 Fluid and Electrolite Rescusitation
1/46
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
-
7/23/2019 Fluid and Electrolite Rescusitation
2/46
Fluid and electrolite disturbanceFluid and electrolite disturbance
EmergencyEmergency
DeathDeath
-
7/23/2019 Fluid and Electrolite Rescusitation
3/46
ost commonconditions include
DiarrheaDiarrhea
VomitingVomiting
PeritonitisPeritonitis Ileuses obstructiveIleuses obstructive
StarvationStarvation
BurnBurn SepsisSepsis
HyperglycemiaHyperglycemia
-
7/23/2019 Fluid and Electrolite Rescusitation
4/46
Issue ?Issue ?
Pulmonary edemaPulmonary edema
Hypernatremia and hyperchloremia.Hypernatremia and hyperchloremia.
SIRS & MODS ( dr. P.Gosling, emergSIRS & MODS ( dr. P.Gosling, emerg
Med !""#$ !"%#" ' #) *Med !""#$ !"%#" ' #) *
-
7/23/2019 Fluid and Electrolite Rescusitation
5/46
"+ - ir
HOW TO MANAGE ?
Distribution of fluids Fluid demand. Crystalloid or olloid !at"s a##roa"
-
7/23/2019 Fluid and Electrolite Rescusitation
6/46
$% & '(& (&
ICF ISF IVF
De)trose (&
*+, NaCl %.-&
Colloid/lood!lasma!lasma e)#ander
Distribution of Fluids
-
7/23/2019 Fluid and Electrolite Rescusitation
7/46
SODIUM AND WATER HOMEOSTASISSODIUM AND WATER HOMEOSTASIS
AFTER INJURAFTER INJUR
Summary o/ the endocrine responses to acute in0ury,
1hich are directed to1ards maintaining
per/usion o/ essential organs and retention o/ 1ater and sodium.
-
7/23/2019 Fluid and Electrolite Rescusitation
8/46
!E"UTU#AN DASAR!E"UTU#AN DASARELE!TROLITELE!TROLIT
Kebutuhan KKebutuhan K ++ :: KK ++ x BB x 0!x BB x 0!"" Kecepatan pemberian max #0Kecepatan pemberian max #0
m$%&'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
-
7/23/2019 Fluid and Electrolite Rescusitation
9/46
$ENIS CAIRAN %AN&$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
-
7/23/2019 Fluid and Electrolite Rescusitation
10/46
T!e Cr"st#lloidsT!e Cr"st#lloids
Cr"st#lloids #re # $rou% of intr#&enous fluid in '!i(!Cr"st#lloids #re # $rou% of intr#&enous fluid in '!i(!)#" be*)#" be*
Ionic solutionIonic solution2 Ringer lactate3 acetateRinger lactate3 acetate
2 4a5l physiologic (".6+ saline*4a5l physiologic (".6+ saline*2 Hartman7s solutionHartman7s solution2 8tc8tc9 Mostly iso'osmolar - isotonicMostly iso'osmolar - isotonic9 5heap, easy to manu/acture5heap, easy to manu/acture9
Has no immunologic reactionHas no immunologic reaction9 MainlyMainlycon/ined to the e:tracellular /luidcon/ined to the e:tracellular /luid 4on ionic4on ionic
2 De:trose )+De:trose )+2 Maltose "+Maltose "+2 8tc8tc
9 Distri;uted to intracellular spaceDistri;uted to intracellular space
-
7/23/2019 Fluid and Electrolite Rescusitation
11/46
Ele(trol"te Co)%#risonEle(trol"te Co)%#rison
+et'een R, - N#Cl ./01+et'een R, - N#Cl ./01
N#N#22
3322
C#C#22
ClCl44
,#(t#te,#(t#te Os)/Os)/
PlasmaPlasma
-
7/23/2019 Fluid and Electrolite Rescusitation
12/46
T!e ColloidsT!e Colloids
5olloids are /luids 1hich contain oncotic5olloids are /luids 1hich contain oncotic
particles, there/ore e:ert an oncotic pressureparticles, there/ore e:ert an oncotic pressure
loodlood PlasmaPlasma
l;uminl;umin
rti/icial colloids -rti/icial colloids -plasma e:panderplasma e:pander2 5el#tins65el#tins6 /rom collagen/rom collagen7H#e)#((el - 5elofusine87H#e)#((el - 5elofusine8
2 De9tr#nDe9tr#n is a polysaccharidesis a polysaccharides7De9tr#n :. - ;.87De9tr#n :. - ;.8
2 HESHES (Hydro:yethyl starch*(Hydro:yethyl starch*e/$/ !e)o!es .1e/$/ !e)o!es .1
-
7/23/2019 Fluid and Electrolite Rescusitation
13/46
Intr#&enous fluidIntr#&enous fluid
@luid@luid De:troseDe:trose
(g3d=*(g3d=*
4aA4aA
(m8B3=*(m8B3=*
5l'5l'
(m8B3=*(m8B3=*
OsmolarityOsmolarity
(mosmol3=*(mosmol3=*
Oncotic POncotic P
(mmHg*(mmHg*
De:trose )+De:trose )+ )")" !?>!?>
Cr"st#lloidsCr"st#lloidsDe:trose )+ A 4a5l ".#">
"!"!
"6>"6>
ColloidsColloids
PlasmaPlasma
l;umin )+l;umin )+
Can0i heta + in 4a5l ".6+Can0i heta + in 4a5l ".6+
-
7/23/2019 Fluid and Electrolite Rescusitation
14/46
DE#IDRASDE#IDRAS
II De3sit cairan interstitiel (engan ge'ala :De3sit cairan interstitiel (engan ge'ala :" turgor )ulit yang 'ele)" turgor )ulit yang 'ele)" mata ce)ung" mata ce)ung
" ubun"ubun ce)ung 1bayi 4 ana)2" ubun"ubun ce)ung 1bayi 4 ana)2" mu)osa bibir (an )ornea )ering" mu)osa bibir (an )ornea )ering
De3sit cairan intravas)ular (enganDe3sit cairan intravas)ular (engan
ge'ala :ge'ala :" hipotensi ta)i)ar(i" hipotensi ta)i)ar(i" vena"vena )olaps" vena"vena )olaps
" 5apillary re3lle( time6 meman'ang" 5apillary re3lle( time6 meman'ang ""oligourioligouri ""
syo) 1 ren'atan 2syo) 1 ren'atan 2
-
7/23/2019 Fluid and Electrolite Rescusitation
15/46
DE#IDRASI DITIN$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
-
7/23/2019 Fluid and Electrolite Rescusitation
16/46
$ENIS($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)
-
7/23/2019 Fluid and Electrolite Rescusitation
17/46
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&
-
7/23/2019 Fluid and Electrolite Rescusitation
18/46
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+
-
7/23/2019 Fluid and Electrolite Rescusitation
31/46
(& "aus, mu8osa 8erin=
('%& tur=or, tensi, nadi
B'%& 7HOC6, urine %
DEFISIT
(%& (%&
1 am ' am
REHIDRASI
33 Maintenane
5ntu8 #asien tan#a syo8
-
7/23/2019 Fluid and Electrolite Rescusitation
32/46
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
-
7/23/2019 Fluid and Electrolite Rescusitation
33/46
Too mu"
!enya8it #aru
Too little
Tida8 sembu"
de. ordisedema
7"o8
Ga=al =inal
*F >7F >CF
' 0
-
7/23/2019 Fluid and Electrolite Rescusitation
40/46
>nfus
> >> >>>
> re"idrasi e#at
>> re"idrasi lambat
-
7/23/2019 Fluid and Electrolite Rescusitation
41/46
*e"idrasi e#at
*+
-
7/23/2019 Fluid and Electrolite Rescusitation
42/46
Tentukan Jumlah Cairan
Tentukan Macam Cairan
Tentukan Keceatan
-
7/23/2019 Fluid and Electrolite Rescusitation
43/46
/leedin=
*+ 0$ ) loss
>8uti #erfusi @ nadi @ tensi
HD bai8 HD ele8
Hb B 1 m=
-
7/23/2019 Fluid and Electrolite Rescusitation
44/46
Kaan K!r"an Menin##al$
O+5ME dara" "ilan= 'T*O7>T "ilan= 0
-
7/23/2019 Fluid and Electrolite Rescusitation
45/46
N%& S& '( tahun) KET
PreopPreop OpOp PostopPostop
FensiFensi >">" "" !"!" ""
4adi4adi ">"> """" >">"
Per/usiPer/usi '' '' 44 44
H;H; ?,"?," ,),) >,>,
*+ '(%% 3 0%%% W/ (%%
-
7/23/2019 Fluid and Electrolite Rescusitation
46/46