cairan elek diana ira

General Objective



After completing this

chapter, you should be able

to understand fluid,

Specific objective

 _{After completing this chapter, you should}

be able to :

List the various function water performs in the

body

Describe three ways in which body fluids are

continually being distributed among the fluid compartment

List the major electrolyte and the function of

each

Identify common sign and symptoms of the

PENDAHULUAN

 _{Tujuan :}

Homeostasis

 _{Melibatkan :}

1. Ginjal : Hormon-hormon

2. Sistem

Pernafasan

3. Sistem

penyangga Tubuh :

Electrical Neutrality

Mg++ Ca++

K+

H+ CO2

lactate PO₄

-alb- Cl

-SO₄- -, OH -, others

WATER COMPARTEMENS

2. CAIRAN EKSTRASELULER : 20%

 PADA PRIA DEWASA ( 70kG) : 15 L  TERDIRI DARI :

 CAIRAN INTERSTISIAL DAN CAIRAN LIMFE: 15% BB

 PLASMA : 5% BB

3. CAIRAN TRANSEL

 TERDAPAT PADA OTAK, SENDI,

WATER COMPARTEMENS

 _{ICF :}

1. Semua cairan yang berada dalam sel tubuh, (42% dari jumlah total berat badan)

2. 2/3 total cairan tubuh 28 lt pria, 20 lt wanita

 _{ECF :}

1. Terdiri atas interstitial, intravaskuler, transeluler

Movement of Fluid Between Compartments

 _Diffussion

Particle move across a permeable membrane and disperse all

direction

Rate of diffusion influenced by size of molecule, concentration,

and temperature.

 Filtration

Movement of the fluid through the semipermeable membrane

from an area with higher hidrostatic pressure to an area with lower hidrostatic pressure.

 Osmosis

 Perpindahan cairan melalui membran semipermeabel dari

konsentrasi tinggi ke rendah

 Active transport

Occur when a cell membrane moves molecules or ions against

an electrochemical gradient from an area of lesser concentration to an area of greater concentration

 Colloid osmotic pressure

Mevement the fluid between the intravascular and interstitial

compartment, based on the number of solute particles on the concentrated side and the presence of a semipermeable

membrane.

LARUTAN

 _ISOTONIK

Merupakan larutan yang memiliki osmolaritas yg sama dengan plasma darah

c/ NaCl 0.9%, Normal Saline,

 _HIPOTONIK

Memiliki takanan osmotik yang lebih besar c/ NaCl 0.45%

 _HIPERTONIK

16

FAKTOR-FAKTOR YANG

MEMPENGARUHI AIR TUBUH

1. SEL-SEL LEMAK

 JIKA LEMAK TUBUH MENINGKAT, MAKA JUMLAH AIR

DALAM TUBUH SEDIKIT

2. USIA

 _{PADA BAYI, ANAK DAN DEWASA SERTA ORANG TUA}

BERBEDA JUMLAH AIR DALAM TUBUHNYA

3. JENIS KELAMIN

 PADA WANITA AIR TUBUH KURANG SECARA

Electrolyte

 _{Electrolyte are minerals or salt that}

are dissolved in body fluid.

 _{When in solution they break up into}

particles known as ion that have a tiny electrical charge

ELECTROLYTE

An overview of the primary regulatory hormones affecting fluid and

electrolyte balance

Mediated by three hormones:

 _ADH

 _Aldosterone

 _{Atrial Natriuretic Peptide}

Non hormonal:

Mediated by

Sympathetic activation

Osmoreceptors stimulated

 ADH release

 thirst

 Urinary water loss

 water gain

Urinary water loss  Water gain

 ADH [Na] in ECF normal

HOMEOSTASIS

Aldosterone

 _{Secretion of adrenal cortex}

Effects: (along the kidney’s DCT and collecting system)

- Na reabsorption followed by Cl and water - K loss

 _{Response to:}  _{[K] or}  _{[Na] plasma in}

MENGAPA

PENGATURAN pH

Acid base balance

 _{Maintained by controlling the}

hydrogen (H+) concentrations of

body fluids

 _{Concentrations within a narrow pH}

range of 7.35-7.45 are essential for survival

 _{Hydrogen ion homeostasis is}

dependant on:

- buffer systems, respiratory

Buffer Systems

 _{Prevent rapid, drastic changes in the pH of body}

fluids

 _{Help to maintain constancy}

 _{Consists of a pair of chemicals, one a weak acid}

and one the salt of the weak acid, which functions as a weak base, that resists changes in pH

 _{When there is an excess of hydrogen ions, the}

weak base combines with the hydrogen ion, forming a weak acid

 _{When there is a shortage of hydrogen ions, the}

weak acid dissociates releasing more hydrogen ions

Respiratory Mechanisms

 _{Rate and depth of breathing can}

adjust pH of body fluids, usually within 1-3 minutes

 _{Increase in exhalation of carbon}

dioxide increases the pH

 _{Decrease in exhalation of carbon}

dioxide decreases pH

Renal Mechanisms

 _{Renal tubules raise blood pH by:}

- secretion and excretion of hydrogen ions

- reabsorption of filtered bicarbonate ions (HCO ₃-)

- synthesis and absorption of newly formed bicarbonate ions

Respirasi

Hiperventilasi

Penurunan kekuatan otot nafas dan menyebabkan kelelahan otot

Sesak

Metabolik

Peningkatan kebutuhan metabolisme

Resistensi insulin

Menghambat glikolisis anaerob

Penurunan sintesis ATP Hiperkalemia

Peningkatan degradasi protein

Otak

Penghambatan metabolisme dan regulasi volume sel otak

Koma

Kardiovaskular

Gangguan kontraksi otot jantung

Dilatasi arteri,konstriksi vena, dan sentralisasi volume darah

Peningkatan tahanan vaskular paru

Penurunan curah jantung, tekanan darah arteri, dan aliran darah hati dan ginjal Sensitif thd reentrant

arrhythmia dan penurunan ambang fibrilasi ventrikel Menghambat respon

kardiovaskular terhadap

katekolaminManagement of life-threatening Acid-Base Disorders, Horacio J. Adrogue, And _{Nicolaos EM: Review Article;The New England Journal of Medicine;1998}

Kardiovaskular

Konstriksi arteri

Penurunan aliran darah koroner Penurunan ambang angina

Predisposisi terjadinya supraventrikel dan ventrikel aritmia yg refrakter

Respirasi

Hipoventilasi yang akan menjadi hiperkarbi dan hipoksemia

Metabolic

Stimulasi glikolisis anaerob dan produksi asam organik

Hipokalemia

Penurunan konsentrasi Ca terionisasi plasma Hipomagnesemia and hipophosphatemia

Otak

Penurunan aliran darah otak

Tetani, kejang, lemah delirium dan stupor

AKIBAT DARI ALKALOSIS BERAT

Low

ASIDOSIS RESPIRATORIK

 _{Terjadi pada saat ada gangguan pada}

fungsi pernafasan ( pertukaran O2 dan CO2 )

 Gangguan ini mneyebabkan adanya

retensi CO2

 _{CO2 meningkat : ion hidrogen} ↑

 _CO2 ↑ menyebabkan asidosis

 Etiologi berdasarkan gangguan pada pernafasan :

ASIDOSIS METABOLIK

 _{Terjadi peningkatan ion hidrogen}

karena pemecahan asam lemak, pemecahan anaerob glukosa.

 _{Pemecahan asam lemak dapat}

terjadi pada diabetes ketoasidosis

 _{Anaerobic lactic acidosis terjadi saat}

ALKALOSIS RESPIRATORIK

 _{Terjadi karena perubahan pada}

HCO3- _{Penurunanion hidrogen didalam}

darah dengan pH > 7.45

 _{Adanya kehilangan CO2 yg}

berlebihan pada hiperventilasi

 Hiperventilasi terjadi karena cemas,

takut , dapat juga akibat stimulasi pusat pernafasan akibat adanya

demam, lesi SSP, drugs

ALKALOSIS METABOLIK

 _{Terjadi karena peningkatan}