Fluid Balance

Tony Suharsono Nursing Program, Medicine Faculty Brawijaya University, 2012

Functions of Water in the Body

Transporting nutrients to cells and wastes from cells
Transporting hormones, enzymes, blood platelets, and

red and white blood cells Facilitating cellular metabolism and proper cellular chemical functioning Acting as a solvent for electrolytes and nonelectrolytes Helping maintain normal body temperature Facilitating digestion and promoting elimination Acting as a tissue lubricant

Body Fluid Compartmen

Body Fluid Compartments

2/3 (65%) of TBW is intracellular (ICF)
1/3 extracellular water 25 % interstitial fluid (ISF) 8 % in plasma (IVF intravascular fluid) 2 % in transcellular fluids CSF, intraocular fluids, serous membranes, and in GI, respiratory and urinary tracts

Intracellular Fluid Compartment (ICF)

Includes all water and electrolytes within cell

membranes 2/3 of TBW or approximately 25 liters (70 Kg)

Extracellular Fluid Compartement (ECF)

Cairan yang ada di luar sel

1/3 dari total cairan tubuh atau 15 liter (70 Kg)

Relatif menurun dengan meningkatnya usia Dibagi menjadi tiga kompartemen Interstitial fluid Intravascular fluid

Transcellular fluid

Interstisial Fluid (ISF)

Cairan yang ada di sekitar sel 25% dari TBW atau kira-kira 8 liter pd orang

dewasa (70 Kg) Termasuk di dalamnya cairan limfe

Intravascular Fluid (IVF)

Cairan yang terkandung dalam pembuluh darah
8% dari TBW atau rata-rata 5-6 liter pada dewasa

(70 Kg), 3 liter terdapat di dalam plasma dan sisanya di sel darah merah

Trascellular fluid
Cairan yang terkandung dalam rongga khusus dari

tubuh Terdapat dalam cairan cerebrospinal, pericardial, pleural, sinovial, cairan intraokular, dan ekskresi lambung Jumlahnya kurang lebih 2% TBW

Body Volume in Infant

Total body water varies from just under 800 ml/kg in

the neonate to about 600 ml/kg at one year, after this it varies little.
Of this about two-thirds (400 ml/kg) is intracellular

fluid, the rest being extracellular fluid.

Faktor Yang Mempengaruhi Jumlah Cairan Dalam Tubuh

Sel sel lemak Usia Jenis kelamin

Movement of Fluid Between Compartments

Fluids are constantly moving from one

compartment to another by the processes of filtration and osmosis Volume of each compartment remains stable Fluid movements are regulated by hydrostatic pressure and osmotic pressure Osmotic pressure gradients are determined by solute concentrations (electrolytes)

Regulation of body water

Tony fluid, alectrolyte,acid base, FN IV

Regulation of body water

ADH antidiuretic hormone + thirst Decreased amount of water in body Increased amount of Na+ in the body

Increased blood osmolality

Decreased circulating blood volume Stimulate osmoreceptors in hypothalamus ADH released from posterior pituitary Increased thirst

Tony fluid, alectrolyte,acid base, FN IV

Renin-angiotensin-aldosteron system

ADH release and effect

Tony fluid, alectrolyte,acid base, FN IV

FLUID THERAPY
RESUSCITATION MAINTENANCE

Crystalloid

Colloid

ELECTROLYTES

NUTRITION

1. Replace acute loss (hemorrhage, GI loss, 3rd space etc)

1. Replace normal loss (IWL + urine+ faecal) 2. Nutrition support

BACIC PRINCIPLES
Replace

Abnormal loss: GIT, 3rd space, Ongoing loss, septic and Hypovolemic shock
IWL + urine Acid base, electrolyte imbalances

Maintain Repair

FLUID SELECTION
Replace : RA, RL, NS
Maintain: N/2 + D (adult) + K+ 20 mEq

N/4 + D (children) + K+ 20 mEq

Ringer lactate, Ringer Acetate
Repair : NaHCO3 8,4%

KCl 25 mEq/25 ml NaCl 3%

Estimating maintenace fluid requirements (adult/children)

Weight
For the first 10kg

Rate
4cc/kgBW/h

For the next 10 - 20 kg

Add 2cc/kgBW/h

For each kg above10kg

Add 1cc/kgBW/h

Morgan, G E, clinical Anesthesiology 2nd Ed 1996

Estimating maintenace fluid requirements (Infant)

Jenis cairan intravena

Kristaloid (isotonik, hipotonik dan hipertonik) Tidak mengandung partikel onkotik dan karena

itu tidak terbatas dalam ruang intravaskuler

Jenis Cairan Kristaloid

Isotonic - Fluid has the same osmolarity as plasma Normal Saline (N/S or 0.9% NaCl), Ringers Acetate(RA), Ringers lactate (RL) Hypotonic -Fluid has fewer solutes than plasma Water, 1/2 N/S (0.45% NaCl), and D5W (5% dextrose in water) after the sugar is used up Hypertonic-Fluid has more solutes than plasma 5 % Dextrose in Normal Saline (D5 N/S), 3% saline solution, D5 in RL.Koloid.

Jenis cairan intravena

Kolloid (darah, albumin, gelatin, dekstran, HES) Cairan yang mengandung partikel onkotik, shg

menghasilkan tekanan onkotik Akan tinggal terutama dalam ruang intravaskuler Darah dan produk darah menghasilkan tekanan onkotik karena mengandung molekul protein besar

Change in volume of body compartement during fluid infussion

Compartement Intravaskuler Interstisiil Intracelluler Hipotonis isotonis Kolloid

Keuntungan Kolloid
Meningkatkan cardiac output

Meningkatkan vol darah

Mengembalikan aliran darah regional pada

hipovolemia Menurunkan viskositas

Kerugian kristaloid
Edema interstisiil Otak edema

Jantung, penurunan fungsi

Paru, oksigenasi menurun

Pemilihan kristaloid VS Kolloid

Ikuti prinsip dasar fisiologis yang telah mapan Bukan oleh karena resusitator pemakai kristalloid

atau kolloid Ditentukan oleh pasien Pertahankan kadar Hb dan faktor koagulasi

Peran perawat dalam resusitasi cairan

Pengkajian Apakah terjadi gangguan fisiologis???? Pengkajian dapat menjawah dua pertanyaan Apakah oksigenasi darah adekuat??? Apakah aliran darah ke organ cukup???

Perawat bertanggung jawab untuk

Mengetahui : Jenis cairan yang diberikan (kolaborasi) Mengapa cairan tersebut diberikan Pengaruh pemberian cairan tersebut pada pasien Kemungkinan efek samping dapat terjadi

Perawat bertanggung jawab untuk

Mempersiapkan pasien secara fisik dan psikologis

Memberikan infus secara benar

Melakukan pemantauan selama terapi Pencatatan dan pelaporan

Dokumentasi
Tanda dan gejala klinis Hasil pemeriksaan laboratorium

Intervensi keperawatan
Pengkajian ulang setelah resusitasi

Obat yang diberikan

End-point of fluid resuscitation

-perfusion back to normal -BP (sistole) about 90 100 mmhg

-Urine production 0,5 1 ml/kgBW/hour

A nurse is someone A nurse is who listens who someone with heart hearth listens with