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KUDUS
GANGGUAN ELEKTROLIT
POTASSIUM
Kalium
mempertahankan electrical
membrane potensial.
Gangguan pada kadar kalium terutama dapat
mempengaruhi: cardiovascular, neuromuscular
dan gastrointestinal system
Hypokalemia
K < 3 meq/L
Gejala : arrhythmia ( ventricular tachycardia,
supravebtricular tachycardia, bradycardia,conduction
delay),ECG abnormalities ( U waves, QT interval
prolongation, flat or inverted T wave), muscle weakness
or paralyse, paresthesia, ileus, abdominal cramps,
nausea-vomitting
Etiologi:
Pergeseran antar sel: alkalosis, hyperventilation,
insulin, beta adrenergic agonist.
kehilangan lewat ginjal : diuresis, metabolic
alkalosis, renaltubular defect, diabetic
ketoacidosis,drugs ( diuretic, aminoglycoside),
hypomagnesemia, vomitting,
hyperaldosteronism, cushings disease
kehilangan ekstra renal: diarrhea, profuse
sweating, nasogastric suction
Asupaan kurang : malnutrition, alcoholism,
anorexia nervosa
Hyperkalemia
K > 6 meq/L
Gejala : arrhythmia , hearth
block,bradycardia,diminished conduction and
contraction,ECG abnormalities ( diffuse
peaked T waves, PR prolongation, QRS
widening, diminished P wave, sine waves),
muscle weakness, paralyse, paresthesia,
hypoactives reflexes
K > 7 meq/L, FATAL
Etiologi:
Renal dysfunction
Hypoaldosteronism
Drugs(pottasium sparing diuretic, ACE
inhibitor, succinycholine, NSAIAs)
Cell death(rhabdomyolysis, tumor lysis,
burns, hemolysis)
Excessive intake
SODIUM
Fungsi : mengatur osmolalitas darah dan
mengatur regulasi volume ekstraseluler
Nilai normaal : 135-145 mg/L
Hyponatremia
< 120 mg/L
Gejala : disosientation, decreased
mentation, letargy, irritability, weakness,
respiratiry arrest.
< 110 mg/L, gejala: seizure, koma
Etiologi: of hypo
osmolar hyponatremia
Euvolemia : SIADH, psychogenic polydipsi,
hypothyroid in appropriate water.
hypovolemia: Diuretic use,aldosteron deficiency,
renal tubular dysfunction, vomitting, diarrhea,
third spaces fluid losses
kehilangan ekstra renal: diarrhea, profuse
sweating, nasogastric suction
Hypervolemia: CHF, cirrhosis, nephrosis
Terapi:
Na 125 mg/l
Na < 120 mg/l
0,6 = mg
Hypernatremia
Na > 160 mg/l
Gejala : altered mentation, letargy,
seizure,coma, muscle weakness
Etiologi:
Kehilangan cairan : diarrhea, vomitting,diuresis,
excessive sweating, diabetes insipid
asupan kurang : altered thirst, impaired access
asupan berlebihan : salt tablet, hypertonic
saline, sodium bicarbonate
Terapi:
Sodium excess : ( X- 140 ) x BW x 0,6 = .mg
water deficit : ( X-140) x BW x 0,6 = L,
cairan
140
5% dextrose in water
Pediatric : free water deficit= 4 ml/kg for
every 1 m.mol/L sodium > 145 m.mol/L no
faster tahan 0,5 m.mol/l/hours
CALCIUM
Diperlukan untuk kontraksi otot, transmisi
impuls syaraf, sekresi hormon, pembekuan
darah, pe,belahan dan gerak sel serta
penyembuhan luka
Lebih efektif bila yang dip[eriksa ionized
calcium
Hypocalcemia
Ca < 1 m.mol/L
Gejala : hypotension, bradycardia , hearth
failure, cardiac arrest, digitalis
intensitivity,ECG abnormalities ( QT and ST
prolongation), weakness,muscle
spasm,hyperreflexia, tetany, paresthesia,
seizure
Etiologi:
Hypoparathyroidism
Sepsis
Burbs
Rhabdomyolysis
Pancreatitis
Malabsorption
Liver disease
Renal disease
Calcium chelators
Hypomagnesemia
Massive transfusion
Perlakuan
Calcium chloride 105 ; 3-4 ml
Calcium glucobate 10%: 10 ml
Hypercalcemia
Ca > 1,3 m.mol/L
Gejala : hypertension, cardiac ischemia,arrhythnia,
bradycardia ,Conduction abnormalities,digitalis
toxicity, dehydration, hypotension, weakness,
depressed mentation, coma , seizure, sudden
death,nausea, nomitury,anorexia, abdominal pain,
constipation, pancreatitis, ulcer disease
Etiologi : hyperparathyroidism, malignancy,
immobilization, excess vitamin A or D intake,
thyrotoxicosis, ciranulo malous disease
Perlakuan
Nacl 9 % + Loop diuretic ( furosemide)
PHOSPHATE
Diperlukan untuk energi pada metabolisme sel
Etiologi:
Perpindahan antar sel : alkalosis akut,
pemberian karbohidratm obt ( insulin,
epineprine)
Kehilangan lewat gingal: hyperparathyroidisn,
biuretic use, hypokalemia, hipomagnesia, steroid
Kehilangan lewat gastrointestinal;
malabsorption, diarrhea, antacids
Asupan kurang: malnutrition, parenteral
nutrition
Therapi :
> 1 mg/dl : enteral
< 1 mg/dl: potassium phosphate: 0,6-0,9
mg/kg/jam iv, kemudian 1000 mg/hari i.v +
kehilangan
MAGNESIUM
Diperlukan untuk enrgy transfer dan electrical
stability
ETIOLOGY :
Kehilangan lewat ginjal: renal tubular
dysfunction, diuresis, hypokalemia, obat
( aminoglycoside, amphoterisin dll).
Kehilangan lewat gastrointestinal:
malabsorption, diarrhea, nasogastric suction
Perpindahan antar sel: refeeding, recovery from
hypotermia
Asupan kurang; malnutrition, alcoholism,
parenteral nutrition.
Terapi;
Emergency ( arrhythmia )
Magnesium
sulphate = 1-2 g i.v, 5-10 menit (0,2 ml/kg; lar.
10% )