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Potassium
Kalium
mempertahankan
electrical membrane potensial.
Gangguan pada kadar kalium terutama
dapat mempengaruhi: cardiovascular,
neuromuscular dan gastrointestinal
system
Kadar normal : 3,5 5,5 meq/L
Hypokalemia
K < 3 meq/L
Gejala : arrhythmia ( ventricular tachycardia,
supravebtricular tachycardia,
bradycardia,conduction delay),ECG abnormalities
( U waves, QT interval prolongation, flat or
inverted T wave), muscle weakness or paralyse,
paresthesia, ileus, abdominal cramps, nauseavomitting
K < 2 meq/L, FATAL
Etiologi:
Pergeseran antar sel: alkalosis, hyperventilation,
insulin, beta adrenergic agonist.
kehilangan lewat ginjal : diuresis, metabolic
alkalosis, renaltubular defect, diabetic
ketoacidosis,drugs ( diuretic, aminoglycoside),
hypomagnesemia, vomitting, hyperaldosteronism,
cushings disease
kehilangan ekstra renal: diarrhea, profuse
sweating, nasogastric suction
Asupaan kurang : malnutrition, alcoholism,
anorexia nervosa
Hyperkalemia
K > 6 meq/L
Gejala : arrhythmia , hearth
block,bradycardia,diminished conduction
and contraction,ECG abnormalities
( diffuse peaked T waves, PR prolongation,
QRS widening, diminished P wave, sine
waves), muscle weakness, paralyse,
paresthesia, hypoactives reflexes
K > 7 meq/L, FATAL
Etiologi:
Renal dysfunction
Hypoaldosteronism
Drugs(pottasium sparing diuretic, ACE
inhibitor, succinycholine, NSAIAs)
Cell death(rhabdomyolysis, tumor
lysis, burns, hemolysis)
Excessive intake
sodium
Fungsi : mengatur osmolalitas darah
dan mengatur regulasi volume
ekstraseluler
Nilai normaal : 135-145 mg/L
Hyponatremia
< 120 mg/L
Gejala : disosientation, decreased
mentation, letargy, irritability,
weakness, respiratiry arrest.
< 110 mg/L, gejala: seizure, koma
Etiologi: of hypo
osmolar hyponatremia
Euvolemia : SIADH, psychogenic polydipsi,
hypothyroid in appropriate water.
hypovolemia: Diuretic use,aldosteron
deficiency, renal tubular dysfunction,
vomitting, diarrhea, third spaces fluid losses
kehilangan ekstra renal: diarrhea, profuse
sweating, nasogastric suction
Hypervolemia: CHF, cirrhosis, nephrosis
Terapi:
Na 125 mg/l
Na < 120 mg/l
0,6 = mg
Hypernatremia
Na > 160 mg/l
Gejala : altered mentation, letargy,
seizure,coma, muscle weakness
Etiologi:
Kehilangan cairan : diarrhea, vomitting,diuresis,
excessive sweating, diabetes insipid
asupan kurang : altered thirst, impaired access
asupan berlebihan : salt tablet, hypertonic
saline, sodium bicarbonate
Terapi:
Sodium excess : ( X- 140 ) x BW x 0,6
= .mg
water deficit : ( X-140) x BW x 0,6 =
L, cairan
140
5% dextrose in water
Pediatric : free water deficit= 4
ml/kg for every 1 m.mol/L sodium >
145 m.mol/L no faster tahan 0,5
CALCIU M
Diperlukan untuk kontraksi otot,
transmisi impuls syaraf, sekresi
hormon, pembekuan darah, pe,belahan
dan gerak sel serta penyembuhan luka
Lebih efektif bila yang dip[eriksa
ionized calcium
Hypocalcemia
Ca < 1 m.mol/L
Gejala : hypotension, bradycardia ,
hearth failure, cardiac arrest, digitalis
intensitivity,ECG abnormalities ( QT
and ST prolongation), weakness,muscle
spasm,hyperreflexia, tetany,
paresthesia, seizure
Etiologi:
Hypoparathyroidism
Sepsis
Burbs
Rhabdomyolysis
Pancreatitis
Malabsorption
Liver disease
Renal disease
Calcium chelators
Hypomagnesemia
Massive transfusion
Perlakuan
Calcium chloride 105 ; 3-4 ml
Calcium glucobate 10%: 10 ml
Hypercalcemia
Ca > 1,3 m.mol/L
Gejala : hypertension, cardiac ischemia,arrhythnia,
bradycardia ,Conduction abnormalities,digitalis toxicity,
dehydration, hypotension, weakness, depressed
mentation, coma , seizure, sudden death,nausea,
nomitury,anorexia, abdominal pain, constipation,
pancreatitis, ulcer disease
Etiologi : hyperparathyroidism, malignancy,
immobilization, excess vitamin A or D intake,
thyrotoxicosis, ciranulo malous disease
Perlakuan
Nacl 9 % + Loop diuretic
( furosemide)
Nacl 9 % : restore intravascular
volume
adequate tissue
perfusion, renal blood flow
diuresis ; Imvrease renal calcium
loss
PH O SPH ATE
Diperlukan untuk energi pada metabolisme sel
Etiologi:
Perpindahan antar sel : alkalosis akut,
pemberian karbohidratm obt ( insulin,
epineprine)
Kehilangan lewat gingal: hyperparathyroidisn,
biuretic use, hypokalemia, hipomagnesia, steroid
Kehilangan lewat gastrointestinal;
malabsorption, diarrhea, antacids
Asupan kurang: malnutrition, parenteral nutrition
Therapi :
> 1 mg/dl : enteral
< 1 mg/dl: potassium phosphate:
M AG N ESIU M
Diperlukan untuk enrgy transfer dan electrical
stability
ETIOLOGY :
Kehilangan lewat ginjal: renal tubular
dysfunction, diuresis, hypokalemia, obat
( aminoglycoside, amphoterisin dll).
Kehilangan lewat gastrointestinal:
malabsorption, diarrhea, nasogastric suction
Perpindahan antar sel: refeeding, recovery
from hypotermia
Asupan kurang; malnutrition, alcoholism,
parenteral nutrition.
Terapi;
Emergency ( arrhythmia )
Magnesium sulphate = 1-2 g i.v, 5-10
menit (0,2 ml/kg; lar. 10% )