Sumber: Human anatomy & physiology, Marieb, 6th edition

Komposisi Cairan Tubuh:

Cations Anions
150

100

ECF
Na+
50 Cl-

0 HCO3-
Ca 2+

Mg 2+ Protein
50 PO43-

ICF
Organic
K+
anion

100

150
Osmolaritas = terlarut/(terlarut+pelarut)
Osmolalitas = terlarut/pelarut (290~310mOsm/L)
Tonicity = effective osmolalitas
Plasma osmolilitas = 2 x (Na) + (Glucose/18) + (Urea/2.8)
Plasma tonicity = 2 x (Na) + (Glucose/18)
Regulation of Fluids:

Hydrostatic pressure v.s. Oncotic pressure

Albumin is the major determining oncotic pressure
Sumber: Human anatomy & physiology, Marieb, 6th edition
Tanda-tanda Hipovolemik:
Penurunan turgor kulit
Membran mukus mulut kering
Oliguri
- <500ml/hari
- normal: 0.5~1ml/kg/jam
Takikardia
Hipotensi
Hipoperfusisianosis
Perubahan status mental
Diagnosis Hipovolemia:

Pengkajian riwayat: asupan cairan kurang,

pdrhan GI etc
BUN : kreatinin > 20 : 1
- BUN: hiperalimentasi, terapi
glucocorticoid , pdrhan GI atas
Peningkatan hematokrit
Ggn keseimbangan elektrolite
Ggn asam-basa
Terapi Parenteral Cairan :

Crystalloids:
- mandung Na sbg partikel aktif scr
osmotik
- berguna u/ ekspansi volume
(terutama ke ruang interstisial)
- u/ maintenance cairan
- koreksi imbalans elektrolit
Crystalloids:
Isotonic crystalloids
- Lactated Ringer, NaCl 0.9%
- hanya 25% yg masuk ke
intravaskular
Hipertonic saline solutions
- NaCl 3%
Hypotonic solutions
- D5W, NaCl 0.45%
- <10% menetap di intra-
vaskular, tdk adekuat u/
resusitasi cairan
Colloid Solutions:
Mandung byk substansi molekul berat sulit u/
berpindah mll membran dinding kapiler
Sediaan:
- Albumin: 5%, 25%
- Dextran
- Gelifundol
- Haes-steril 10%
 Common parenteral fluid therapy

Solutions Volumes Na+ K+ Ca2+ Mg2+ Cl- HCO3- Dextrose mOsm/L

ECF 142 4 5 103 27 280-310
Lactated
130 4 3 109 28 273
Ringers

0.9% NaCl 154 154 308

0.45%
77 77 154
NaCl

D5W

D5/0.45%
77 77 50 406
NaCl

3% NaCl 513 513 1026

6%
500 154 154 310
Hetastarch
5% 130- 130-
250,500 <2.5 330
Albumin 160 160
25% 130- 130-
20,50,100 <2.5 330
Albumin 160 160
Pengaruh Colloid & Crystalloid Volume
darah:
Blood volume
Infusion 200 600 1000
volume

1000cc Lactated Ringers

500cc 5% Albumin

500cc 6% Hetastarch

500cc Whole blood

Tanda-tanda hipervolemik

Hipertensi
Poliuria
Peripheral edema Terutama ketika
hipoalbumin
Wet lung
Peningkatan nilai urine specific gravity
Pbesaran vena jugular
Manajemen Hipervolemik:
Prevention is the best
Bdsrkan nilai CVP atau pulmonary wedge
pressure
Diuretik
Meningkatkan tekanan onkotik: FFP or
albumin infusion (dpt diberikan terapi
diuretik)
Dialisis
Hindari asupan cairan blebihan, tutama pd
psn malnutrisi, ggl jtg, insufisiensi renal
Manajemen Cairan:

Perdarahan akut
- Mulai berikan 2-3L isotonic crystalloid u/
mpthnkan TD & perfusi perifer
- Berikan scr dini koloid
- Crystalloid + 5% albumin dgn rasio4:1
- Transfusi Darah
- Large borne IV line
The rules of fluid replacement:
Replace blood with blood
Replace plasma with colloid
Resuscitate with colloid
Replace ECF depletion with saline
Rehydrate with dextrose