KESEIMBANGAN KESEIMBANGAN ELEELEKKTROLTROLIITT

DR. Med. dr. Untung Widodo, SpAn.KICDR. Med. dr. Untung Widodo, SpAn.KICDeptDept.. of of Anest Anesthhesiologesiologyy & Reanima & Reanimationtion Medicine Faculty of U I IMedicine Faculty of U I IYogyakarta, 2010Yogyakarta, 2010

I. IntroductionI. Introduction Distribusi dan kadar elektrolit dalam Distribusi dan kadar elektrolit dalam

setiap kompartemen dalam tubuh setiap kompartemen dalam tubuh menentukan fungsi sel, organ, dan menentukan fungsi sel, organ, dan kehidupankehidupan

Gangguan distribusi dan penyimpangan Gangguan distribusi dan penyimpangan kadar dalam suatu kompartemen akan kadar dalam suatu kompartemen akan mengganggu fungsi sel, organ, kehidupanmengganggu fungsi sel, organ, kehidupan

Menentukan tegangan elektrik, eksitabil-Menentukan tegangan elektrik, eksitabil-itas membran sel, kemudian fungsi intra itas membran sel, kemudian fungsi intra selulerseluler

Merupakan faktor utama keseimbangan Merupakan faktor utama keseimbangan asam-basaasam-basa

II. BASIC CONCEPTS OF FLUIDS II. BASIC CONCEPTS OF FLUIDS && ELECTROLYTES ELECTROLYTES REGULATIONREGULATION1.1. ALL THE HOMEOSTATIC MECHANISMS ALL THE HOMEOSTATIC MECHANISMS

RESPOND TO CHANGES IN THE ECF, RESPOND TO CHANGES IN THE ECF, NOT IN THE ICFNOT IN THE ICF

2.2. NO RECEPTOR DIRECTLY MONITOR NO RECEPTOR DIRECTLY MONITOR FLUIDS & ELECTROLYTE BALANCE, FLUIDS & ELECTROLYTE BALANCE, BUT PLASMA VOLUME AND OSMOTIC BUT PLASMA VOLUME AND OSMOTIC CONCENTRATIONCONCENTRATION

3.3. CELLS CAN NOT MOVE WATER CELLS CAN NOT MOVE WATER MOLECULES BY ACTIVE TRANSPORTMOLECULES BY ACTIVE TRANSPORT

CONTINUED II. BASIC CONCEPTS ....CONTINUED II. BASIC CONCEPTS ....

4. BODY WATER & ELECTROLYTES WILL 4. BODY WATER & ELECTROLYTES WILL RISE IF DIETARY GAINS EXCEED RISE IF DIETARY GAINS EXCEED LOSSESLOSSES

5. THE HOMEOSTATIC ADJUSTMENT IS 5. THE HOMEOSTATIC ADJUSTMENT IS REGULATED PRIMARILY BY REGULATED PRIMARILY BY CIRCULATING HORMONES.CIRCULATING HORMONES.

IIIIII. ELECTROLYTE BALANCE. ELECTROLYTE BALANCE

ELECTROLYTES BALANCE EXIST WHEN ELECTROLYTES BALANCE EXIST WHEN THE RATE OF GAINS AND LOSSES ARE THE RATE OF GAINS AND LOSSES ARE EQUAL FOR EACH ELECTROLYTEEQUAL FOR EACH ELECTROLYTE

TOTAL ELECTROLYTE CONCENTRATION TOTAL ELECTROLYTE CONCENTRATION DIRECTLY AFFECTS WATER BALANCEDIRECTLY AFFECTS WATER BALANCE

THE CONCENTRATION OF INDIVIDUAL THE CONCENTRATION OF INDIVIDUAL ELECTROLYTE CAN AFFECT CELL ELECTROLYTE CAN AFFECT CELL FUFUNNCTIONCTION

CONTINUED IV. ELECTROLYTE BALANCECONTINUED IV. ELECTROLYTE BALANCE

2 GENERAL RULES CONCERNING Na & 2 GENERAL RULES CONCERNING Na & KK

BALANCE :BALANCE : THE MOST COMMON PROBLEM WITH THE MOST COMMON PROBLEM WITH

ELECTROLYTE BALANCE IS NaELECTROLYTE BALANCE IS Na++ BALANCEBALANCE

PROBLEM WITH KPROBLEM WITH K++ BALANCE IS MORE BALANCE IS MORE DANGEROUSDANGEROUS

DETERMINANT OF NaDETERMINANT OF Na++& K& K++ BALANCEBALANCE UPTAKE AT DIGESTIVE TRACTUPTAKE AT DIGESTIVE TRACT EXCRETION AT THE KIDNEYS EXCRETION AT THE KIDNEYS

(AFFECTED BY REGULATING HORMONE, (AFFECTED BY REGULATING HORMONE, NATRIURETIC PEPTIDE FOR NaNATRIURETIC PEPTIDE FOR Na++, , ALDOSTERONE FOR KALDOSTERONE FOR K++ ) )

ABOUT KABOUT K++ BALANCE, URINARY K BALANCE, URINARY K++SECRETION :SECRETION :

. . HIGHER KHIGHER K++ IN ECF, HIGHER K IN ECF, HIGHER K++ SECRETION SECRETION

. ECF pH FALLS, DECLINE K. ECF pH FALLS, DECLINE K++ SECRETION SECRETION

. ALDOSTERONE INCREASE K. ALDOSTERONE INCREASE K++ SECRETION SECRETION

RENAL COMPENSATION :RENAL COMPENSATION :

IN ACIDOTIC STATE, THE KIDNEYS IN ACIDOTIC STATE, THE KIDNEYS INCREASE BICARBONATE INCREASE BICARBONATE REABSORPTION TO REPLACE THOSE REABSORPTION TO REPLACE THOSE ALREADY USED TO REMOVE HALREADY USED TO REMOVE H++ IN IN WITHIN ECFWITHIN ECF

ANION GAP ANION GAP ((STRONG ION DIFFERENT, SID)STRONG ION DIFFERENT, SID)

= [Na= [Na++ + K + K++ ] – [ Cl ] – [ Cl-- + HCO + HCO33--]]

(ref lab. (12 (ref lab. (12 ±± 4 ) mEq/L (or 8 4 ) mEq/L (or 8 ±± 4, w.o K 4, w.o K++))

For individual patient :For individual patient :

Normal = 2 (alb) + 0,5 ([PONormal = 2 (alb) + 0,5 ([PO44==])])

or = 0,2 (alb) + 1,5 ([POor = 0,2 (alb) + 1,5 ([PO44==])])

Increase in patients with :Increase in patients with :

Ketoacidosis, Lactic acidosis, Poisoning,Ketoacidosis, Lactic acidosis, Poisoning,

Renal failureRenal failure

IV. Correction of electrolyte IV. Correction of electrolyte disturbancedisturbance

TERAPI KAUSATERAPI KAUSA HIPOKALEMIA : KOREKSI HIPOKALEMIA : KOREKSI ΔΔ K K++ X 1/3 BB X 1/3 BB

KECEPATAN MAX : 20 mEq/jamKECEPATAN MAX : 20 mEq/jam HIPERKALEMIA : HIPERKALEMIA :

- INFUS LARUTAN INSULIN & GLUKOSE- INFUS LARUTAN INSULIN & GLUKOSE

- DIURETIKA & BALANS CAIRAN- DIURETIKA & BALANS CAIRAN HIPONATREMIA : KOREKSI HANYA BILA HIPONATREMIA : KOREKSI HANYA BILA

BERAT (< 120 mEq/l) & manifes klinis, BERAT (< 120 mEq/l) & manifes klinis, max. naik 10 mEq dalam 48 jam.max. naik 10 mEq dalam 48 jam.

Lanjutan koreksi elektrolit …Lanjutan koreksi elektrolit …

HIPERNATREMIA :HIPERNATREMIA : - TERAPI KAUSA - TERAPI KAUSA - DIURESIS & SUBSTITUSI DG LARUTAN D 5 % .- DIURESIS & SUBSTITUSI DG LARUTAN D 5 % . HIPOKALSEMIA : HIPOKALSEMIA : - TERAPI KAUSA- TERAPI KAUSA - Ca glukonas :- Ca glukonas : ASIDOSIS & ALKALOSIS :ASIDOSIS & ALKALOSIS : - DILAKUKAN TERAPI- DILAKUKAN TERAPI ATAU RESUSITASI ATAU RESUSITASI TERHADAP TERHADAP PATOLOGI PATOLOGI YYANG MENDASARINYA, ANG MENDASARINYA, BUKAN NAIK-TURUN KAN BUKAN NAIK-TURUN KAN pH DARAHpH DARAH

V. V. CLOSING NOTESCLOSING NOTES

BODY FLUID, ELECTROLYTES AND ACID-BODY FLUID, ELECTROLYTES AND ACID-BASE HAVE A CLOSED RELATION ONE BASE HAVE A CLOSED RELATION ONE TO ANOTHERTO ANOTHER

DISTURBANCE OF THE FLUIDS BALANCE DISTURBANCE OF THE FLUIDS BALANCE HAS IMPACT TO ELECTROLYTES AND HAS IMPACT TO ELECTROLYTES AND ACID-BASE REGULATIONACID-BASE REGULATION

ALHAMDULILAHIALHAMDULILAHIROBBIL’ALAMINROBBIL’ALAMIN