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Pengaruh Pemberian Cairan Intavena antara cairan NaCl 0,9%,Ringers lactate, dan D5% terhadap Osmolalitas serum pada

pasien cedera kepala

Ignatius Mardjono; Farid Yudoyono; M. Z. Arifin

Abstract Introduction . The administration of intravenous fluid maintenance in head injured patients isconsidered to be very important to maintain fluid and elecrolyte balance. Such a condition isrequired to reduce the incidence of secondary head injury. Irrational use of intravenous useof intavenousfluid my lead to reduce of serum osmolality with its impact on fatal brainedema.M ethod . A non-randomized and non-blinded study is being held on 60 patients of moderatehead injury samples were dividedinto three groups based on the types of administered fluid,i.e. sodium chloride 0,9%, Ringers lactate and dextrose 5%. Comparison is focused onGCS, serum osmolality, blood sodium, blood potassium, blood glucose, and blood ureaconcenration before and after fluid intervention.Result. The compared result between the three groups on serum osmolality show significant difference (p < 0.001). the most significant osmolality change was found between sodiumchloride 0.9% group and dextrose 5% group (p < 0.001). in the later group, all patients had a decreased of osmolality and 30% of population showed a decreased more than 7 mOsm/kg,with no impact to GCS. Serum sodium concrentation is known to be the most influencing factor on serum osmolality, which is followed by serum potassium, serum urea, and serum glucose concentration.

Conclusion. NaCl 0.9% is the best solutionto be administered in moderate head injured patients as its ability in maintaining the serum osmolality balance. (J I Bedah Indones. 2013 ;41 (1) : 16022)

Keywords : head injury, serum osmolality, brain edema.

Abstrak

Intoduksi. Pemberian cairan intravena pada pasien cedera kepala dirasakan sangatlah pentinguntuk mempertahankan keseimbangan cairan elektrolit. Pada akhirnya keseimbangan ini

bertujuan untuk mengurangi insiden terjadinya cedera kepala sekunder. Terapi cairanintravena yang irrasional dapat menyebabkan penurunan osmolaritas serum dan akanmenyebabkan edema otak yang fatal.Metode. Sebuah eksperimen non-randomized dan non-blind yang dilakukan pada 60 pasiendengan cedera kepala sedang. Sampel dibagi menjadi 3 kelompok berdasarkan jenis cairanyang diberikan, NaCl 0,9% , Ringers Lactate, atau Dekstrosa 5%. Perbandingan yangdiamati pada GCS, serum osmolaritas, natrium serum glukosa darah, dan konsentrasi ureadalam darah sebelum dan sesudah pemberian cairan intravena.Hasil. Perbandingan hasil 3 kelompok pada osmolaritas serum menunjukan hasil yang berarti(p , 0,001) perubahan osmolaritas yang paline berarti ditemukan antara kelompok NaCl 0,9%dan dektrosa 5% dengan nilai p < 0,001. Pada kelompok lain, seluruh pasien mengalami pengurangan osmolaritas dan 30%-nya datang dengan pengurangan osmolaritas 7mOsm/kg,

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