CRYSTALLOIDS,

COLLOIDS, and
BLOOD
TRANSFUSION

By : MEIRIA SARI
(03011186)
TRISAKTI
UNIVERSITY
Coach : Dr. Purwito Nugroho, Sp.An, M.M
Date : 18th November, 2015

Name
: Meiria Sari
NIM
: 030.11.186
Faculty
: Medical
University
: Trisakti University
Level
: Physician Professional Education
Program Education
: Anesthesiology and Intensive Therapy
Title of Paper
: Crystalloids , Colloids , and Blood Transfusion
Filed
: November 17th 2015
Supervisor
: Dr. Purwito Nugroho , Sp . An MM

CAIRAN KRISTALOID, KOLOID, DAN TRANSFUSI DARAH

Meiria Sari *, Purwito Nugroho**
ABSTRACT
Water is a major part of the human body , the percentage can be changed depending on the age ,
sex and degree of obesity of a person. Within 24 hours the amount of water and electrolytes
equivalent to the amount that goes out. Parenteral fluid therapy is needed to replace fluid deficits
. An anesthesiology need to estimate the amount of intravascular fluid to correct fluid and
electrolyte deficiencies that occur . With fluid therapy need for water and electrolytes can be
met , so that will restore circulating blood volume . Types of liquids that can be given to fluid
therapy is a crystalloid solution ( electrolyte ) and colloid fluids ( plasma expanders ) , as well as
blood transfusion when bleeding occurs more than 20 % .Key words: fluid , electrolyte ,
transfusion , blood
ABSTRAK
Air merupakan bagian terbesar pada tubuh manusia, persentasenya dapat berubah tergantung pada umur, jenis kelamin dan derajat obesitas seseorang. Dalam waktu 24
jam jumlah air dan elektrolit yang masuk setara dengan jumlah yang keluar. Terapi cairan parenteral diperlukan untuk mengganti defisit cairan. Seorang anestesiologi
perlu memperkirakan jumlah cairan intravaskular untuk memperbaiki kekurangan cairan dan elektrolit yang terjadi. Dengan terapi cairan kebutuhan akan air dan
elektrolit dapat terpenuhi, sehingga akan memulihkan volume sirkulasi darah. Jenis cairan yang bisa diberikan untuk terapi cairan adalah cairan kristaloid (elektrolit)
dan cairan koloid (plasma ekspander), serta transfusi darah bila perdarahan yang terjadi lebih dari 20%.
Kata kunci: cairan, elektrolit, transfusi, darah

Coassistans Anestesi FK USAKTI 19 Oktober 21 November 2015

Dokter Spesialis Anestesiologi dan Terapi Intensif RSUD Kota Semarang

**

Introducti
on

Water is essential, major

Body fluids are vital

Total Body Fluid, approximately 60% of body
weight

INTAKE AND OUTPUT AVERAGE DAILY

Intake (Range)

Output (range)

Water (ml)
Ingested = 1400 - 1800
Food
= 700 - 1000
Oxidation = 300 - 400

1.Urine = 1400 -1800

2.Faeces = 100
3.Skin
= 300 - 500
4.Lung = 600 - 800

TOTAL

TOTAL = 2400 - 3200

= 2400 - 3200

Natrium(mEq)=70 (50-100)

q Urine = 65 (50-100)
q Faeces = 5 (2-20)

Kalium (mEq) = 100 (50-120)

Urine = 90 (50-120)
Faeces = 10 (2-40)

Magnesium (mEq)= 30 (5-60)

q Urine = 10 (2-20)
q Faeces = 20 (2-50)

Kalsium (mEq)

q Urine = 3(0-10)
q Faeces = 12 (2-30)

= 15 (2-50)

Protein (g)

= 55 (30-80)

Nitrogen (g)

= 8 (4-12)

Kalori
3000

= 1800-

Fluid Imbalances
Cause

Signs/Symptoms

Treatment

Fluid
Volu
me
Defici
t

Acute weight loss

Hypotension,
Syncope, vertigo, dizziness
Weak pulse, nausea,
vomiting
Decreased urine output
Poor skin turgor
Dry skin and mucous
membrane
Sunken eyes

Serum
Hematocrit: Increased
Hemoglobin: Increased
Proteins: Increased
Osmolarity: Normal
Urine
Sodium: 50 mEg/L
Osmolarity: 500
mOsm/L
Specific gravity: Above
1.030

Restore fluid
and
electrolyte
balance using
isotonic
sodium
chloride
solutions.
Treat
underlying
cause.

Fluid
Volu
me
Exces
s

Weight gain
Edema occurs, when 24
kg of fluid is retained
Altered respiratory and
cardiovascular function:
hypertension, tachycardia;
altered LOC, skeletal
muscle
weakness, and increased

Serum
Hematocrit: Normal to
low
Hemoglobin: Normal to
low
Proteins: Normal to low
Osmolarity: Normal
BUN: Normal to low
Urine
Sodium: Reduced

Reduce fluid
retention by
salt and fluid
restriction.
Diuretics to
increase fluid
Excretion.
Treat
underlying

Water requirements increase :

Fever

Surgical
drains

Burn

Tachypnea

Polyuria

Gastrointest
inal losses

Idication of fluidtherapy :
Coma,
anaesthesia

Severe
vomiting and
diarrhoea

Dehydration

Hypoglycemia

Vehicle

Critical
problems

Electrolyte Composition of Body Fluids

Electrolyte Composition of IV Fluids

FLUID THERAPY

Supplying fluid directly into intravenous, fluid

compartment producing rapid effect with
availability of injecting large volume

Types of Fluid

Crystalloi
ds
water with
electrolytes, which
form a true solution
and are able to pass
through a
semipermeable
membrane

Colloids
large proteins or
other similarly sized,
cannot pass through
the walls of the
capillaries and onto
the cells

Blood
products
corpuscles
(erythrocytes,
leukocytes,
platelets) and
blood plasma

Crystalloids

0.9% sodium
chloride (0.9%NaCl)
lactated Ringer's
solution
5% dextrose in
water (D5W)
Ringer's solution

0.45% sodium
chloride (0.45%
NaCl),

0.33% sodium
chloride

0.2% sodium
chloride

2.5% dextrose in
water

D5W in normal,
half
D10W.

Crystalloids

Solution

Type

Uses

Nursing Considerations

Dextrose
5% in
water
(D5W)

Isotonic

Fluid loss
Dehydration
Hypernatremia

Use cautiously in renal and cardiac patients

Can cause fluid overload
May cause hyperglycemia or osmotic diuresis

0.9%
Sodium
Chloride
(normal
salineNaCl)

Isotonic

Shock
Hyponatremia
Blood transfusions
Resuscitation
Fluid challenges
Diabetic Ketoacidosis

Can lead to overload

Use with caution in patients with heart failure or
edema
Can cause hyponatremia, hypernatremia
hyperchloremia or calorie depletion

Lactated
Ringers

Isotonic

Dehydration
Burns
Lower GI fluid loss
Acute blood loss
Hypovolemia due to third spacing

Contains potassium, dont use with renal failure

patients
Dont use with liver disease, cant metabolize
lactate

0.45%
Sodium
Chloride
(1/2 normal
saline)

Hypotonic

Water replacement
Diabetic Ketoacidosis
Gastric fluid loss from NG or
vomiting

Use with caution

May cause cardiovascular collapse or increased
intracranial pressure
Dont use with liver disease, trauma, or burns

Dextrose
5% in
normal
saline

Hypertoni
c

Later in Diabetic Ketoacidosis

treatment

Use only when blood sugar falls below 250 mg/dL

Dextrose
5% in
normal
saline

Hypertoni
c

Temporary treatment from shock if

plasma expanders arent available
Addisons crisis

Dont use in cardiac or renal patients

Dextrose
10 % in
water

Hypertoni
c

Water replacement
Conditions where some nutrition
with glucose is required

Monitor blood sugar levels

Isotonic Solutions (250-375 mOsm/L)

EXAMPLES

Action:

5% dextrose in
water
0.9% sodium
chloride
Solution (Normal
Saline)
Ringers
injection
Lactated
Ringers
Solution

Will hydrate the

extracellular
compartment;
replaces fluid
volume without
disrupting the
intracellular
and interstitial
volumes

Indications: Nursing
Interventions/Concerns
Treatment of 5% dextrose in water is
vascular
isotonic when infused but
dehydration;
becomes hypotonic when
replaces
the dextrose has been
sodium and
metabolized.
Use cautiously in patients
chloride
who are fluid-overloaded
or
who
would
be
compromised if vascular
volume would increase,
such as renal and cardiac
patients.

Hypotonic solutions (<250

mOsm/L)
EXAMPLES

2.5% dextrose
in water
0.25% sodium
chloride
solution
0.33% sodium
chloride
solution
0.45% sodium
chloride
Solution

ACTION :

Indications:

Will hydrate the

cells; pulls fluid
from the
vascular space
into the
cellular space

Treatment of
hypertonic
dehydration

Nursing
Interventions/Conc
erns
These
solutions
may
further
exaggerate
hypotension
due
to fluid shifting out
of vascular space.
Do not administer
these solutions to
hypotensive
patients.

Hypertonic Solutions (>375 mOsm/L)

EXAMPLES
5% dextrose in 0.45%
sodium chloride
solution
5% dextrose in 0.9%
sodium chloride
solution
5% dextrose in
lactated Ringers
solution
10% dextrose in water
20% dextrose in water
50% dextrose in water
70% dextrose in water

Action:

Indications:

Nursing
Interventions/Concerns
These solutions can be very
Will draw
Treatment of
fluid out of hypotonic
irritating to veins, so
intracellular dehydration;
observing the IV site for
space,
treatment of
inflammation is imperative.
may cause circulatory
leading to
circulatory
increased collapse;
overload, so these solutions
extracellul increase fluid
should be infused slowly to
ar volume shift from
prevent this in vulnerable
both in
interstitial
patients.
May increase serum glucose
vascular
space to
and
vascular space
in patients with glucose
interstitial
intolerance, which would
space
make more frequent glucose
monitoring an important
nursing intervention

Colloids

BLOOD TRANSFUSION
INDICATION :
Acute bleeding (Hb <8 g% or hematocrit <30%)
Major surgery blood loss (> 20% volume)
Lost blood as much as 20%, with normal hemoglobin levels

BLOOD PRODUCTS
PRODUCTS

A. Packed Red Blood Cells

(PRC)

DESCRIPTION

Most common
oxygen-carrying
capacity
1 unit of PRC = raises
hematocrit by 2-3%

PRODUCTS

B. Fresh Frozen Plasma

(FFP)

DESCRIPTION
Plasma, proteins called
clotting factors
Expands blood volume
Provides clotting factors
Contains no RBCs
1 unit of FFP = increases
level of any clotting factor
by 2-3%

PRODUCTS

C. Platelets/thrombocytes

DESCRIPTION
Tiny cell, in blood clotting
process
Bleeding disorders, or
platelet deficiency
1 unit = increases the
average adult clients
platelet count by about
5,000 platelets/microliter

PRODUCTS
D. Whole Blood

E. Autologous Red Blood

Cells

DESCRIPTION
Extreme acute
hemorrhage
Replaces blood volume
and all blood products
Following planned elective
surgery
Donated 4-5 weeks prior
to surgery

TRANSFUSION REACTIONS
Reaction Hemolytic
Infection
viruses (hepatitis, HIV-AIDS and CMV).
Bacteria (Staphylococus, Yersinia, and Citrobacter).
parasite (malaria and toxoplasmosis).

Others
Fever, urticaria, anaphylactic, acidosis.

CONCLUSION
Intravenous fluid consists of a crystalloid, colloid and
blood.
Based on the nature of the liquid is divided into three:
Hypotonic fluids
Isotonic fluids
Hypertonic fluids

Blood transfusion is the transfer of blood or a blood

component from a person (donor) to another person
(recipient) given intravenously through a vein

Last Slide
Its Over

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