Resusitasi Rehidrasi Pemberian cairan rumatan Akses pemberian obat

I. PHYSIOLOGY TOTAL BODY FLUID

INTRACELLULAR FLUID (ICF) 30 40 % BW

EXTRACELLULAR FLUID (ECF)

TRANSCELLULAR FLUID 1-3 % BW

INTRAVASCULAR FLUID
5 % BW

INTERSTITIIL FLUID
15 % BW

TOTAL BODY FLUID

stomach lungs intestines skin kidney

Blood plasma: 5% BW Interstitiil fluid: 15 % BW

Intracellular fluid: 40 % BW

Pembagian cairan berdasarkan komposisi

1.

Cairan Kristaloid

Mengandung zat dengan BM rendah (< 8000 dalton) Dengan atau tanpa gluklosa Tekanan onkotik rendah cepat terdistribusi ke seluruh ruang ekstraseluler Efek volume interstitial lebih baik daripada koloid

Lebih sering menyebabkan sembab perifer dibandingkan dengan cairan koloid Potensial menyebabkan sembab paru sama dengan cairan koloid Mudah didapat, mudah disimpan, murah, tidak toksik Contoh : Ringer Laktat, NaCl 0,9%, Dextrose 5%

INTRAVENOUS FLUIDS
A. CRYSTALLOIDS: - COMPOSITION: SIMILAR TO EXTRACELLULAR FLUID - INEXPENSIVE, AVAILABLE, NO CROSS MATCH, NO ALLERGIC / ANAPHILACTIC REACTION, SIMPLE STORAGE

- AS EFFECTIVE AS COLLOID IN APPROPIATE AMOUNT

- HALF LIFE IN INTRAVASCULAR SPACE: 20 30 MINUTES

2.

Cairan Koloid

Mengandung zat dengan BM tinggi (> 8000 dalton), seperti : Protein, gluklosa berpolimer besar Tekanan onkotik tinggi sebagian besar menetap di ruang intravaskular Menetap lebih lama di ruang intravaskular dibandingkan cairan kristaloid Lebih jarang menyebabkan sembab perifer dibandingkancairan kristaloid

Potensial menyebabkan sembab paru sama dengan cairan kristaloid Koloid biasanya dilarutkan dalam NaCl isotonik dapat menyebabkab hyperchloremia metabolic acidosis Mahal Resiko pada pemberian albumin: hepatitis, AIDS, edema paru, reaksi anafilaksis

Resiko pada pemberian koloid sintetik : reaksi alergi dan anafilaktoid, efek pada hemostatik, gagal ginjal akut,masalah pada waktu cross match Contoh : -Albumin, produk darah, Fraksi protein plasma -Koloid sintetik (dextran, HES, larutan gelatin) Cairan Kombinasi

3.

B. COLLOIDS
- NATURAL COLLOIDS:

-PLASMA PROTEIN FRACTION 5%

-HUMAN ALBUMIN 5% AND 2,5% - SYNTHETIC COLLOIDS - DEXTRAN 40 AND 70 - HYDROXYETHYL STARCH (HETASTARCH) 6% AND 10 % -GELATIN -MODIFIED FLUID GELATIN -UREA LINKED GELATIN -OXYPOLY GELATIN

Distribusi Cairan IV
Larutan Plasma Albumin 1000 Polygeline 700 Dextran 40 1600 NaCl 0,9% 200 RL 200 Dektrose5% 83 Interstitial 300 -260 800 800 333 Intrasel -340 583

CRYSTALLOID VS COLLOID
Crystalloid Advantages - Inexpensive - Promotes urinary flow - Fluid of choice for initial resuscitation of trauma/hemorrhage - Expands intravascular volume - Restores 3rd spaces losses Colloid -More sustained intravascular -Volume increase (1/3 still intravascular at 24 hrs) - Maintain or increase plasma oncotic pressure -Requires smaller volume for equal effects -Less peripheral oedem (more fluids remains intravascular) -May lower intracranial pressure

Disadvantages

- Dilutes colloid -Expensive osmotic pressure -May produce coagulopathy (dextrans and - Promotes peripheral hetastarch) oedem -With capillary leaks may potentiate fluid loss to - Higher incidence of the interstitium pulmpnary oedem -Impairs subsequent crossmatching of blood - Requires large (dextran) volume -Dilutes clotting factors and platelet - Effects are transient -Decrease platelet adhesiveness (absorption onto platelet membrane reseptor) -Potential blocking of renal tubules and reticuloendothelial cells in the liver -Possible anaphylactoid reaction with dextran

Tujuan Terapi Cairan

Mempertahankan status hidrasi dan perfusi jarinngan yang adekuat Keseimbangan elektrolit

Terapi Cairan
Resusitasi
Kristaloid Koloid

Rumatan
Elektrolit Nutrisi

Menilai Adekuat Terapi Cairan

Observasi tanda-tanda vital Pemeriksaan fisik Pengukuran asupan dan keluaran cairan Berat badan Urine output Elektrolit serum Monitoring invasif