Therapy CairanFluid Management

J. Iswanto

INTRACELLULAR40 % BB = 28 L

EXTRACELLULAR20 % BB = 14 L

KATIONNa+ 12,0 mEq/L K+ 150 Ca2+ 4,0 mEq/LMg2+ 34,0

ANIONCl- 4,0 mEq/L Protein 54 mEq/L

HCO3- 12,0

Others 90 HPO4

2- , H2PO4- 40 mEq/L.

KATION Na+ 142 mEq/L. K+ 4

ANIONCl- 104 mEq/L.

HC03- 24

HPO42 , H2PO4

- 2,0 mEq/L

KATION

Ca2+ 2,5 mEq/L.Mg2+ 1,1

Protein 14 mEq/L.Others 5,9

INTERSTITIEL (10,5 L )

PLASMA ( 3,5 L)

TOTAL BODY WATER( 60 % BB = 42 L Dari BB 70 Kg )

Dikutip dari : Norton Surgery, hal. 152.

Volume of TBW

Male (70 Kg) Female ( 60 Kg )

E xtra Cellular Volume

14.000 mL 10.000 mL

Plasma 3.500 mL 2.500 mL.

Interstitiel 10.500 mL 7.500 mL

Intrcellular Volume

28.000 mL 20.000 mL

42.000 mL 30.000 mL

Functional body fluid compartments. TBW = Total Body Water

% of TBWExtra Cellular Volume

Plasma ( 5 % )

Interstitiel ( 15 % )

Intracellular Volume ( 40 % )

Schwartz, Textbook of Surgery.

Daily Water Loss

• Urine ± 1.000 – 1.500 mL/ 24 jam• Feces ± 100 – 250 mL/ 24 jam• IWL ± 8 – 12 mL/KgBB/24 jam

± 750 mL/ 24 jam.• Total Cairan Hilang :

= ± 1.800 – 2.000 mL/24 jam.

Daily Water Loss

• Urine Output harian minimal ± 800 mL/24 jam.

• IWL adalah penguapan air melalui kulit dan pernapasan.

• IWL melalui kulit meningkat sebanyak ± 10 %, bersamaan dengan naiknya Suhu Tubuh setiap 1o C diatas suhu 37o C.

FLUID THERAPY

Introduksi

Hospital Inpatients :• Many adult patients need iv fluid

therapy

Fluid therapy - Goals

• To correct the problem )• To prevent the problem )

• Fluid and Electrolyte status.

Fluid Therapy – Questions

• Optimal amount of IV Fluids ?• Composition of IV Fluids ?• The best rate to be administered ?

• Difficult and complex task

Fluid Therapy

Assessment Klinis

S. O. A. P

Terapi Cairan – Kekeliruan

• Emergency Department• Acute Admission Unit• Medical wards• Surgical wards

Survai membuktikan :

Banyak staf yang me – resep – kan IV Fluids :

• Tidak tahu cairan dan elektrolite yang dibutuhkan pasien

• Tidak tahu komposisi dari sekian banyak pilihan IV – Fluids yang tersedia.

Goals of Fluid Therapy

• To normalize hemodynamic parameters• To normalize body fluid electrolyte

abnormality

What must be normalized ??

• Pre-existing volume and electrolyte abnormalities

• Administration of fluid to replace normal daily losses ( maintenance )

• To replace additional ongoing fluid losses

Fluid Therapy – Indication

• Normovolemic – maintenance• Ongoing loss – volume replacement• Hypovolemic shock - resuscitation

Electrolyte Solutions for Parenteral Administration

Solutions

Electrolyte Composition (mEq/L)

Na Cl K HCO3- Ca Mg mOsm

Extracel Fluid

142 103 4 27 5 3 280-310

RL 130 109 4 28 3 273

NaCl 0.9 %

154 154 308

D5 – 0.45 NS

77 77 407

D5W 253

NaCl 3 % 513 513 1026