air & elektrolit (air & elektrolitdisorder of water & s.)
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Air & ElektrolitTRANSCRIPT
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Disorder of Water and Sodium
KURNIA F. JAMIL
Department of Internal MedicineRSZA/FK UNSYIAH
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Age TBW as % of body weight
ECF as % of body weight
ICF as % body weight
Premature 75-80
Newborn 70-75 50 35
1 Year Old 65 25 40-45
Adolescent Male 60 20 40-45
Adolescent Female 55 18 40
Adapted from Feld. (1988)
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Body Weight
Total Body Water
ICF ECF
Intravascular Volume
Interstitial Volume
RULE OF THIRD
1/3
1/3
1/3
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THE INTEGRATED VOLUME RESPONSESYSTEMIC
HEMODYNAMIC CHANGES
EXTERNAL SALT AND WATER BALANCE
Response Tachycardia ThirstPeripheral resistance Renal Na+ , water retentionVenous capacitance
Onset Minutes HoursMajor activators
Catecholamines Catecholamines
ADH AldosteroneAngiotensin II ADHEndothelin-1 Prostaglandin H2
Thromboxane A2
Major inactivators
Prostaglandin E2 Prostaglandin E2
Atriopeptin Atriopeptin
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MAJOR CAUSES OF VOLUME DEPLETION
RENAL LOSSES EXTRARENAL LOSSES
Hormonal Deficit Hemorrhage Pituitary diabetes insipidus Cutaneous Losses Aldosterone insufficiency Sweating Addison's disease Burns Hyporeninemic hypoaldosteronism Gastrointestinal LossesRenal Deficits Vomiting Specific tubular nephropathies: Diarrheal disorders Renal tubular acidosis Gastrointestinal fistulas Bartter's syndrome Tube drainage Nephrogenic diabetes insipidus Diuretic abuse Postobstructive diuresis Excessive filtration of non-electrolytes: Osmotic diuresis Generalized renal disease: Chronic renal failure
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Gejala Klinis Dehidrasi Postural Giddiness Postural Tachycardia Weakness Circulatory Collapse Tidak ada gejala bukan berarti
tidak ada defisit Turgor kulit turun dan mukosa
lidah kering
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Gejala Klinis Dehidrasi Tergantung :
Jumlah volume tubuh yang hilang Kecepatan (Rate of volume loss) Jenis cairan tubuh yang hilang :
Air Air ditambah Natrium Darah
Response dari sistim pembuluh darah
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Sign and Symptoms of Hyponatremia
Central Nervous System Gastrointestinal SystemMild Anorexia Apathy Nausea Headache Vomiting Lethargy Musculoskeletal SystemModerate Cramps Agitation Diminished deep tendon reflexes Ataxia Confusion Disorientation PsychosisSevere Stupor Coma Pseudobulbar palsy Tentorial herniation Cheyne‑Stokes respiration Death
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Treatment of Hyponatremia
The rate of correction of hyponatremia should be dictated by the rapidity of its onset.
Acute hyponatremia may be corrected at rates of up to 1 to 2 mEq/L/hr, and Chronic hyponatremia should be corrected at a rate not greater than 0.5 mEq/L/hr. As a general rule, the serum sodium should not be corrected to above 120 mEq/L or increased by more than 20 mEq/L in a 24-hour period.
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Causes of Hypernatremia
Reduced water intake
Disorders of thirst perception Inability to obtain water
Depressed mentation Intubated patient
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Causes of HypernatremiaIncreased water loss
Gastointestinal Vomiting, diarrhea Nasogastric suctioning Third spacing
Renal Tubular concentrating defects Osmotic diuresis (e.g., hyper- glycemia, mannitol) Diabetes insipidus Relief of urinary obstruction
Dermal Excessive sweating Severe burns
Hyperventilation
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Causes of Hypernatremia
Gain of sodium Exogenous sodium intake
Salt tablets Sodium bicarbonate Hypertonic saline
solutions Improper formula
preparation Salt water drowning Hypertonic renal
dialysate Increased sodium reabsorption
Hyperaldosteronism Cushing's disease Exogenous
corticosteroids Congenital adrenal
hyperplasia
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Hypokalemia without total body K depletion
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Hypokalemia with total body k depletion
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Treatment of hypokalemia
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Diagnostic approach to Hyperkalemia
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Treatment of Hyperkalemia