Air Elektrolit Uro 1
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Transcript of Air Elektrolit Uro 1
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KESEIMBANGAN
AIR & ELEKTROLIT
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TIU Memahami keseimbangan air & elektrolit
TIK Memahami pengatran keseimbangan air
Memahami pengatran keseimbangan elektrolit
tama !
Natrim " Na#
Kalim " K#
$hlori%a " $l
Kalsim " $a'#
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() * +,* ,
I$-
E$-A.ULT
Total bo%/ 0ater ! 1) * Bo%/ -t
Interstitial 0ater
2lasma 0ater
I$- ! intra3elllar 0ater
E$- ! e4tra3elllar 0ater
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Urine +5, L"%
I$- E$-
'6 L +7 L
-ATER BALAN$E 8li% +5( L"%8oo% )59 L"%
Metabolism )5( L"%
Skin )5( L"%
8ae3es )5+ L"%
M3os memb:
)5 , L"%
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ELEKTROLIT TUBU;
ANION KATION
$l ;2O(' Na# K#
;2O(' SO(
$a## Mg##
;$O6 Tra3e elementLaktat
Elektrolit tama " 2ro=il elektrolit !
Na+ , K+, Cl-, HCO3-
?
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2engatran @olme E$- & Osmolalitasn/a !
Mekanisme pengatran
@OLUME AIR &
KAN.UNGAN ELEKTROLIT!
+: 2engatran Osmotik !
2sat has
Anti%ireti3 hormone
': 2engatran @olme
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8AKTOR8AKTOR G MEM2ENGARU;I
KESEIMBANGAN AIR
KESEIMBANGAN AIR
Osmolalitas E$-? ', C '7 mOsm"LIN2UT OUT2UT
;ipotalams ! A.;
Al%osteron
Reninangiotensin
Atrial natriretik ginDal
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RENAL -ATER E$RETION
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RENAL SO.IUM E$RETION
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GANGGUAN KESEIMBANGAN
AIR & NATRIUM
+: .ehi%rasi
F .ehi%rasi hipernatremi
F .ehi%rasi hiponatremi
F .ehi%rasi normonatremi
': Oerhi%rasi
Ganggan homeostasis air & natrim saling berkaitan
erat5 shg %ibi3arakan bersamasama
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GeDala %ehi%rasi !
rasa has
membran mkosa kering trgor klit trn
ot pt rin trn
osmolaritas rin meningkat
rea %arah meningkat hematokrit meningkat
Lebih berat lagi !
lemah5 letargi5 hipotensi5 s/ok
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2ENEBAB .E;I.RASI ;I2ER Na !
krang makan & minm
keringat HH osmotik %iresis
pengobatan %iresis
2ENEBAB .E;I.RASI ;I2O Na !
pengobatan %iretik
keringat HH
pen/akit ginDal
ins=isiensi a%renokortikal
2ENEBAB .E;I.RASI NORMO C Na !
mntah C %iare
penggantian 3airan %g lartan ren%ah natrim
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O@ER C ;I.RASI
-2oli%ipsia -SIA.; -Gagal ginDal %g oligria-Sin%roma ne=rotik
-Sirosis-Gagal Dantng kongesti= -;iperal%osteronisme
GEALA !
nasea5 omiting5 seiJres5 koma
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NATRIUM " SO.IUM
-Kation ma/or %i E$-
Kan%ngan normalF tbh total ! ,, mmol"kgBB
F plasma ! +6, C +(, mmol"L
KESEIMBANGAN
Natrim
Fplasma
Fsel"Daringan
INTAKE
Natrim
',)'))
Mmol"hr
OUT2UT !
FKlit"keringat
,) mmol"hr
Fgastrointestin
+' mmol"hr FginDal ! tama
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;I2ONATREMI
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$AUSES O8 ;2ONATREMIA
EU@OLAEMI$!
F 2se%oh/ponatremia ! h/perlipi%emia5 h/perproteinemia
F E43ess intra3elllar solte !
h/pergl/3emia
F A3te 0ater oerloa% !
%rgs ! 3hlorpromaJine5 barbitrat5 %ireti35e3t
stress ! postsrger/5 ps/3hogeni3en%okrin %isor%ers ! h/poth/roi%ism
renal ins==i3ien3/
F $hroni3 0ater oerloa% !
SIA.;
%rgs
3hroni3 renal =ailre
en%o3rine %isor%ers ! h/poth/roi%ism5 3ortisol
%e=i3ien3/
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;2O@OLAEMIA !
F E4trarenal 3ases !
gastrointestinal ! omiting5 %iareaskin ! brns5 seere s0eating
F Renal 3ases !
%ireti3 therap/
A%%isons %isease
saltlosing nephritis
;2ER@OLEMIA !
F Oe%ematos 3on%ition !
3ongestie 3ar%ia3 =ailrenephroti3 s/n%rome
lier 3irrhosis
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AKIBAT .ARI ;I2ONATREMIA
E4tra3elllar
h/potoni3it/
$elllar oe%ema
0ater
•Sel otak ! oe%em sellar sel otak
INTRA$RANIAL 2RESSURE ↑
•Sel organ lain ! ti%ak begit berpengarh
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2SEU.O;2ONATREMIA
2lasma normal
7'7(* 0ater
2rotein &
lipi%
;/perlipi%emia
Or ;/perproteinemia
-ater
2se%oh/ponatremia
Less 0ater
& there=oreLess so%im
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2URE -ATER .E2LETION !
F E4trarenal 3ases
too ol%5 too /ong5 to si3k
a33ess to 0ater %enie%
oesophageal obstr3tions
thirst 3entre lesions
F Renal 3ases ! .iabetes insipi%s
SO.IUM & -ATER .E2LETION !
F Gastrointestinal omiting5 %iarrhoea
F Skin ! e43essie s0eating
F Osmoti3 %iresis ! gl3ose5 rea manitol
SO.IUM GAIN !F Iatrogeni3 ! I@ h/pertoni3 saline or so%im
bi3arbonat
F Salt ingestion ! intentional5 a33i%ental
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AKIBAT .ARI ;I2ERNATREMI
E4tra3elllar
h/pertoni3it/
$elllar %eh/%ration
0ater
OTAK shrinkage
;ATI' 2ENURUNAN tonisitas hars pelanpelan
;in%ari aliran air kembali ke sel Oe%ema 3erebral
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KALIUM " 2OTASSIUM
.istribsi !
intrasel 7* ! +,)+1) mmol"l E$- '* ! 65, C ,5) mmol"l
Na# K# AT2 2UM2
mempertahankan ioni3 gra%ient
aktiitas neroms3lar
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8AKTOR G MEM2ENGARU;I TRANS8ER KALIUM
MELE-ATI MEMBRAN SEL !
+: K LOA. ! ,) * K %ari lar
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(: INSULIN
Inslin 3elllar K# ptake ↑
K#
Inslin
,: KATEKOLAMIN
A%renalin & beta re3eptor agonist
K#
;2ERKALAEMIA
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;2ERKALAEMIA
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AKIBAT ;I2ERKALEMIA
- ;iperkalemia ringan !
geDala !
gelisah5 mental 3on=sion
kelemahan otot
mal5 mntah
iles paralitik
parastesia
3ar%ia3 arrh/tmia5 3ar%ia3 arrestperbahan E$G !
< T 0ae tinggi5 RS 3omple4 lebar5
2R interal lebar>
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;2OKALAEMIA
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;/pokalaemia perio%i3 paral/sis
-2aralisis otot perio%ik /g berhbngan %g hipokalemi
-$elllar potassim ptake HH
.iin%ksi oleh !stress =isik
makan karbohi%rat HH
ke%inginan5 %ll
Mekanisme !
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KLORI.A
-Ka%ar serm " plasma ! 7+)9 mmol"l
-2en/ebab kelainan $l sesai %g kelainan Natrim
Namn ! simptom lebih mengarah p% kelainan Na
ke3ali pa%a !Asi%osis metabolik kronik !
hiperkloremi tanpa hipernatremia
Alkalosis metabolik kronik !
hipoklori%a tanpa hiponatremia
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METO.A ANALISA KLORI.A
•Kolorimetri•Kolometri titrasi•Ion sele3tie ele3tro%e
SAM2EL !-Serm " plasma !
normal 7 C +)9 mmol"l
Urine !
normal ++)',) mmol"l
METO.A ANALISA Na #
& K#
•ISE•8AES•Kolorimetri
SAM2EL !-Serm " plasma heparin-Urine-$airan tbh
Sampel hemolisis K#
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KALSIUM
8UNGSI !
•Mineralisasi•Eksitabilitas neromsklar •2embekan %arah•Kontrol signal intra sel
.ISTRIBUSI !
Kalsim tbh total ', C 6, mol
F H77 * %i tlang
F )5, * %i Daringan lnakF )5+ * %i E$-
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Kalsim serm "plasma ! '5+) C '51) mmol"l
F ()(, * terikat protein < t: Albmin )*>
F (,,) * ionise% F ,+) * berikatan %g sbstansi lain
+ gr albmin ≈ )5)' mmol ion $a'#
penrnan +) gr"l albmin
total kalsim serm ↓ )5')5', mmol"l
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KONTROL KALSIUM
•2ARAT;ROI. ;ORMONE
•@IT: .
•Kalsitonin•;ormon th/roi%•A%reno3orti3al steroi%
•2rostaglan%ins•Osteo3last a3tiit/ =a3tor
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2EMERIKSAAN KALSIUM !•Kimia0i ! total kalsim•ISE ! ION kalsim
•Atomi3 absorption spe3trophotometr/ ! total kalsim
Bila /g %ikr a%alah kalsim total
ION KALSIUM BEBAS masih hars %iperhitngkan
*$a terikat protein )5 4ALb # 6
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KOREKSI KALSIUM
F ;iperalbminemia !
$a'# terkoreksi
Total kalsim terkr ()Q 4 )5)'
•;ipoalbminemia !
$a'# terkoreksi
Total kalsim terkr Q )5)'
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;I2ERKALSEMIA
;iperkalsemia
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;I2OKALSEMIA
;ipokalsemia akt
Ganggan aktiitas neroms3lar
-Ms3le 3ramps-2erioral praesthesiae-$arpope%al spasms
-$onlsion