FORM

MONITORING INTAKE DAN OUTPUT CAIRAN

Nama : IWL :
Usia : Kebutuhan Cairan 24 Jam :
BB :
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Per Oral
I
N
T
A Perenteral
K
E

Jumlah
O BAK
U BAB
T
NGT
P
U Drain
T IWL
Jumlah
Balance

Panduan :
IWL 0-6 bln 40ml/kgBB/24jam
6 bln-5thn 30ml/kgBB/24jam
5-10 thn 20ml/kgBB/24jam
Dewasa 10ml/kgBB/24jam
Kebutuhan Cairan
Anak BB<10kg 100ml/kgBB/24jam
Anak BB 10-20kg 100ml+(50mlx(BB-10))/kgBB/24jam
Anak BB>20kg 1500ml+(20ml+(BB-20))/kgBB/24jam
Dewasa 50ml/kgBB/24jam