CRYSTALLOIDS,

COLLOIDS, and
BLOOD TRANSFUSION

By : MEIRIA SARI
(03011186)
TRISAKTI UNIVERSITY
Coach : Dr. Purwito Nugroho, Sp.An, M.M
• Name : Meiria Sari
• NIM : 030.11.186
• Faculty : Medical
• University : Trisakti University
• Level : Physician Professional Education
• Program Education : Anesthesiology and Intensive Therapy
• Title of Paper : Crystalloids , Colloids , and Blood Transfusion
• Filed : November 17th 2015
• Supervisor : Dr. Purwito Nugroho , Sp . An MM
CAIRAN KRISTALOID, KOLOID, DAN TRANSFUSI DARAH
Meiria Sari *, Purwito Nugroho**
ABSTRACT
Water is a major part of the human body , the percentage can be changed depending on the age ,
sex and degree of obesity of a person. Within 24 hours the amount of water and electrolytes
equivalent to the amount that goes out. Parenteral fluid therapy is needed to replace fluid deficits
. An anesthesiology need to estimate the amount of intravascular fluid to correct fluid and
electrolyte deficiencies that occur . With fluid therapy need for water and electrolytes can be met
, so that will restore circulating blood volume . Types of liquids that can be given to fluid therapy
is a crystalloid solution ( electrolyte ) and colloid fluids ( plasma expanders ) , as well as blood
transfusion when bleeding occurs more than 20 % .Key words: fluid , electrolyte , transfusion ,
blood
ABSTRAK
Air merupakan bagian terbesar pada tubuh manusia, persentasenya dapat berubah tergantung
pada umur, jenis kelamin dan derajat obesitas seseorang. Dalam waktu 24 jam jumlah air dan
elektrolit yang masuk setara dengan jumlah yang keluar. Terapi cairan parenteral diperlukan
untuk mengganti defisit cairan. Seorang anestesiologi perlu memperkirakan jumlah cairan
intravaskular untuk memperbaiki kekurangan cairan dan elektrolit yang terjadi. Dengan terapi
cairan kebutuhan akan air dan elektrolit dapat terpenuhi, sehingga akan memulihkan volume
sirkulasi darah. Jenis cairan yang bisa diberikan untuk terapi cairan adalah cairan kristaloid
(elektrolit) dan cairan koloid (plasma ekspander), serta transfusi darah bila perdarahan yang
terjadi lebih dari 20%.
Kata kunci: cairan, elektrolit, transfusi, darah
*Coassistans Anestesi FK USAKTI 19 Oktober – 21 November 2015
**Dokter Spesialis Anestesiologi dan Terapi Intensif RSUD Kota Semarang
 Introduction
• Water is essential, major
• Body fluids are vital
• Total Body Fluid, approximately 60% of body weight
•INTAKE AND OUTPUT AVERAGE DAILY
Intake (Range) Output (range)
Water (ml) 1.Urine = 1400 -1800
Ingested = 1400 - 1800 2.Faeces = 100
Food = 700 - 1000 3.Skin = 300 - 500
Oxidation = 300 - 400 4.Lung = 600 - 800

TOTAL = 2400 - 3200 TOTAL = 2400 - 3200

Natrium(mEq)=70 (50-100) q Urine = 65 (50-100)
q Faeces = 5 (2-20)
Kalium (mEq) = 100 (50-120) qUrine = 90 (50-120)
q Faeces = 10 (2-40)
Magnesium (mEq)= 30 (5-60) q Urine = 10 (2-20)
q Faeces = 20 (2-50)
Kalsium (mEq) = 15 (2-50) q Urine = 3(0-10)
q Faeces = 12 (2-30)
Protein (g) = 55 (30-80)
Nitrogen (g) = 8 (4-12)
Kalori = 1800-3000
 Fluid Imbalances
Cause Signs/Symptoms Treatment
Fluid Acute weight loss Serum Restore fluid and
Volume Hypotension, Hematocrit: Increased electrolyte
Deficit Syncope, vertigo, dizziness Hemoglobin: Increased balance using
Weak pulse, nausea, vomiting Proteins: Increased isotonic sodium
Decreased urine output Osmolarity: Normal chloride
Poor skin turgor Urine solutions.
Dry skin and mucous membrane Sodium: 50 mEg/L Treat underlying
Sunken eyes Osmolarity: 500 mOsm/L cause.
Specific gravity: Above 1.030

Fluid Weight gain Serum Reduce fluid

Volume Edema occurs, when 2–4 kg of
Excess fluid is retained
Altered respiratory and
cardiovascular function:
hypertension, tachycardia;
altered LOC, skeletal muscle
weakness, and increased
bowel sounds
Hematocrit: Normal to low retention by
Hemoglobin: Normal to low salt and fluid
Proteins: Normal to low restriction.
Osmolarity: Normal Diuretics to
BUN: Normal to low increase fluid
Urine Excretion. Treat
Sodium: Reduced
underlying cause.
Osmolarity 500 mOsm/L
Specific gravity: 1.010
•Water requirements increase :
Fever Burn Tachypnea

Gastrointestin
Surgical drains Polyuria
al losses

•Idication of fluidtherapy :
Severe
Coma,
vomiting and Dehydration
anaesthesia
diarrhoea

Critical
Hypoglycemia Vehicle
problems
Electrolyte Composition of Body Fluids
Electrolyte Composition of IV Fluids
FLUID THERAPY

Supplying fluid directly into intravenous, fluid

compartment producing rapid effect with
availability of injecting large volume
Types of Fluid

Crystalloids Colloids Blood

water with large proteins or products
electrolytes, which other similarly sized,
form a true solution cannot pass through corpuscles
and are able to pass the walls of the (erythrocytes,
through a capillaries and onto leukocytes, platelets)
semipermeable the cells and blood plasma
membrane
Crystalloids

0.9% sodium chloride • 0.45% sodium chloride - D5W in normal, half

(0.9%NaCl) (0.45% NaCl), - D10W.

lactated Ringer's solution • 0.33% sodium chloride

 5% dextrose in water • 0.2% sodium chloride

(D5W)
• 2.5% dextrose in water
Ringer's solution
Crystalloids
Solution Type Uses Nursing Considerations

Dextrose 5% Isotonic •Fluid loss •Use cautiously in renal and cardiac patients
in water •Dehydration •Can cause fluid overload
(D5W) •Hypernatremia •May cause hyperglycemia or osmotic diuresis

0.9% Sodium Isotonic •Shock •Can lead to overload

Chloride •Hyponatremia •Use with caution in patients with heart failure or edema
(normal •Blood transfusions •Can cause hyponatremia, hypernatremia hyperchloremia or
saline-NaCl) •Resuscitation calorie depletion
•Fluid challenges
•Diabetic Ketoacidosis

Lactated Isotonic •Dehydration •Contains potassium, don’t use with renal failure patients
Ringer’s •Burns •Don’t use with liver disease, can’t metabolize lactate
•Lower GI fluid loss
•Acute blood loss
•Hypovolemia due to third spacing

0.45% Sodium Hypotonic •Water replacement •Use with caution

Chloride (1/2 •Diabetic Ketoacidosis •May cause cardiovascular collapse or increased intracranial
normal saline) •Gastric fluid loss from NG or vomiting pressure
•Don’t use with liver disease, trauma, or burns

Dextrose 5% Hypertonic •Later in Diabetic Ketoacidosis •Use only when blood sugar falls below 250 mg/dL
in ½ normal treatment
saline

Dextrose 5% Hypertonic •Temporary treatment from shock if plasma •Don’t use in cardiac or renal patients
in normal expanders aren’t available
saline •Addison’s crisis

Dextrose 10 % Hypertonic •Water replacement •Monitor blood sugar levels

in water •Conditions where some nutrition with
glucose is required
 Isotonic Solutions (250-375 mOsm/L)
EXAMPLES Action: Indications: Nursing
Interventions/Concerns
■5% dextrose in Will hydrate the Treatment of  5% dextrose in water is
water extracellular vascular isotonic when infused but
■ 0.9% sodium compartment; dehydration; becomes hypotonic when the
chloride replaces fluid replaces dextrose has been
Solution (Normal volume without sodium and metabolized.
Saline) disrupting the chloride  Use cautiously in patients
■ Ringer’s injection intracellular and who are fluid-overloaded or
■ Lactated Ringer’s interstitial volumes who would be compromised if
Solution vascular volume would
increase, such as renal and
cardiac patients.
 Hypotonic solutions (<250 mOsm/L)
EXAMPLES ACTION : Indications: Nursing
Interventions/Concern
s
■2.5% dextrose Will hydrate the Treatment of  These solutions may
in water cells; pulls fluid hypertonic further exaggerate
■0.25% sodium from the vascular dehydration hypotension due to
chloride solution space into the fluid shifting out of
■0.33% sodium cellular space vascular space.
chloride solution  Do not administer
■0.45% sodium these solutions to
chloride Solution hypotensive patients.
 Hypertonic Solutions (>375 mOsm/L)
EXAMPLES Action: Indications: Nursing Interventions/Concerns

■ 5% dextrose in 0.45% Will draw Treatment of  These solutions can be very

sodium chloride fluid out of hypotonic irritating to veins, so observing
solution intracellular dehydration; the IV site for inflammation is
■ 5% dextrose in 0.9% space, treatment of imperative.
sodium chloride leading to circulatory  may cause circulatory overload,
solution increased collapse; so these solutions should be
■ 5% dextrose in extracellular increase fluid infused slowly to prevent this in
lactated Ringer’s volume both shift from vulnerable patients.
solution in vascular interstitial space  May increase serum glucose in
■ 10% dextrose in water and to vascular patients with glucose intolerance,
■ 20% dextrose in water interstitial space which would make more
■ 50% dextrose in water space frequent glucose monitoring an
■ 70% dextrose in water important nursing intervention
Colloids
 BLOOD TRANSFUSION
INDICATION :
• Acute bleeding (Hb <8 g% or hematocrit <30%)
• Major surgery blood loss (> 20% volume)
• Lost blood as much as 20%, with normal hemoglobin levels
 BLOOD PRODUCTS
PRODUCTS DESCRIPTION

 Most common
  oxygen-carrying
A. Packed Red Blood Cells
capacity
(PRC)
 1 unit of PRC = raises
hematocrit by 2-3%
 PRODUCTS DESCRIPTION
 Plasma, proteins called
clotting factors
 Expands blood volume
B. Fresh Frozen Plasma  Provides clotting factors
(FFP)  Contains no RBCs
 1 unit of FFP = increases
level of any clotting factor
by 2-3%
 PRODUCTS DESCRIPTION
 Tiny cell, in blood clotting
process
 Bleeding disorders, or
platelet deficiency
C. Platelets/thrombocytes
 1 unit = increases the
average adult client’s
platelet count by about
5,000 platelets/microliter
 PRODUCTS DESCRIPTION
 Extreme acute
hemorrhage
D. Whole Blood
 Replaces blood volume
and all blood products
 Following planned elective
E. Autologous Red Blood surgery
Cells  Donated 4-5 weeks prior
to surgery
 TRANSFUSION REACTIONS
• Reaction Hemolytic
• Infection
– viruses (hepatitis, HIV-AIDS and CMV).
– Bacteria (Staphylococus, Yersinia, and Citrobacter).
– parasite (malaria and toxoplasmosis).
• Others
Fever, urticaria, anaphylactic, acidosis.
 CONCLUSION
• Intravenous fluid consists of a crystalloid, colloid and
blood.
• Based on the nature of the liquid is divided into three:
– Hypotonic fluids
– Isotonic fluids
– Hypertonic fluids
• Blood transfusion is the transfer of blood or a blood
component from a person (donor) to another person
(recipient) given intravenously through a vein
Last Slide
It’s Over

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