cairan elek diana ira

KESEIMBANGAN CAIRAN dan
ELEKTROLIT

General Objective
 After completing this

chapter, you should be able
to understand fluid,
electrolyte, and acid base
balance

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
common fluid, electrolyte, and acid base
imbalance

PENDAHULUAN
 Tujuan :
Homeostasis
 Melibatkan :
1. Ginjal : Hormonhormon
2. Sistem
Pernafasan
3. Sistem
penyangga
Tubuh :
Mempertahanka
n pH

Electrical Neutrality

Mg++ Ca++

Na+ K+

H+

lactate PO4- Cl
alb CO2

SO4- -, OH -, others

WATER COMPARTEMENS
1. CAIRAN INTRASEL : 40%

BB



2.

PADA PRIA DEWASA ( 70KG ) :
25 L
PADA BAYI SETENGAH DARI
BB BAYI

CAIRAN EKSTRASELULER :
20%



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

3.

CAIRAN INTERSTISIAL DAN
CAIRAN LIMFE: 15% BB

PLASMA
: 5% BB

CAIRAN TRANSEL


TERDAPAT PADA OTAK, SENDI,
LIUR PENCERNAAN DAN AIR
KEMIH

WATER COMPARTEMENS
 ICF :
1. Semua cairan yang berada dalam sel

2.

1.
2.

tubuh, (42% dari jumlah total berat

badan)
2/3 total cairan tubuh 28 lt pria, 20 lt
wanita
ECF :
Terdiri atas interstitial, intravaskuler,
transeluler
17% BB Total,1/3 jumlah total cairan tubuh

WATER COMPARTEMENS

WATER INTAKE and OUTPUT

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.
Tony fluid, alectrolyte,acid base, FN IV

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
Memiliki tekanan osmotik yang lebih besar
c/ NaCl 3%

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
PROPOSIONAL, KARENA WANITA LEBIH BANYAK
MENGANDUNG LEMAK TUBUH.

16

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
 Positive = cations
 Negative = anions

ELECTROLYTE
CONCENTRATIONS

An overview of the primary regulatory
hormones affecting fluid and
electrolyte balance

Mediated by three hormones:
 ADH
MORE IMPORTANT
 Aldosterone
 Atrial Natriuretic Peptide

Non hormonal:
Mediated by Sympathetic activation

Osmoreceptors
stimulated

 ADH
release
 thirst

HOMEOSTASIS
DISTURBED
[Na] in ECF
HOMEOSTASIS

[Na] in ECF normal

Homeostasis
restored

Homeostasis
restored
HOMEOSTASIS
DISTURBED
[Na] in ECF
Osmoreceptors
inhibited

 ADH
release
 thirst

 Urinary water loss
 water gain

Additional water
dilutes ECF,
volume

Water loss
Concentrates ECF
volume

Urinary water loss
 Water gain

The Homeostatic Regulation of normal [Na] in Body Fluids

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

adrenal cortex, or activation of reninangiotensin system
Renin release if:
- a drop in plasma volume and BP at
juxtglomerular
apparatus;

Tony fluid, alectrolyte,acid base, FN IV

Imbalance Electrolyte

MENGAPA
PENGATURAN pH
SANGAT PENTING ?

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
mechanisms and renal function
Tony fluid, alectrolyte,acid base, FN IV

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
Tony fluid, alectrolyte,acid base, FN IV

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

Tony fluid, alectrolyte,acid base, FN IV

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

Tony fluid, alectrolyte,acid base, FN IV

AKIBAT DARI ASIDOSIS BERAT
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

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

Menghambat respon
kardiovaskular
Management terhadap
of life-threatening Acid-Base Disorders, Horacio J. Adrogue, And
katekolamin
Nicolaos EM: Review Article;The New England Journal of Medicine;1998

AKIBAT DARI ALKALOSIS BERAT
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
Management of life-threatening Acid-Base Disorders, Horacio J. Adrogue, And
Nicolaos EM: Review Article;The New England Journal of Medicine;1998

Norm
al

pH = 6.1 + log
Norm
al

[HCO
GINJAL
BASA ]
3

ASAM
pCO2
PARU

HCO
HCO3
3

Kompensa
si
CO
CO22

Gangguan asam-basa primer
l

no

P CO

Lo
w

-

ig

h

H

CO 3

2

ig

h

HC

O

3

pH

ma
nor

Lo
w

-

H

ig

H

CO 3

h

CO 2

Asidosis Metabolik

-

Alkalosis Respiratori

Asidosis Respiratori

P

H

CO 2

l

no
rm

pH

al

P CO

2

Lo
w

P

H

pH

rm
al

Lo
w

pH

ma
nor

H
ig

h

HC

O

3

Alkalosis Metabolik

-

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 :
Depresi pernafasan, tidak adequatnya ekspansi dada,
obstruksi jalan nafas, penurunan dfusi dialveolus

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
penggunaan glukosa tidak
menggunakan oksigen.

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

bikarbonat, asetat, sitrat dan laktat