PPT Kristaloid, koloid dan cairan nutrisi enteral dan parenteral.ppt

8/18/2019 PPT Kristaloid, koloid dan cairan nutrisi enteral dan parenteral.ppt

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CRYSTALLOID, COLLOID, FLUIDSENTERAL NUTRITION AND

PARENTERAL

Eva Natalia Manullang

Faculty of Medicine Trisakti University



• The body is mostly composed o !"te#

• body l$ids t#"%spo#ti%& %$t#ie%ts to "ll cells o the body

"%d #emo'e !"ste m"te#i"ls #om the met"bolism o cells



s$bst"%ces i%

body l$ids

("te#

N$t#ie%ts)p#otei%,

c"#bohyd#"tes "%d

"ts

T#"ce

Eleme%t

Elect#olyte



Presentasi Air Dalam Tubuh

Manusia



e*t#"cell$l"# l$id

I%t#"cell$l"# l$id

i%te#stiti"l l$id

i%t#"'"sc$l"# l$id

i%te#stiti"l



The mo'eme%t o body l$ids

• Osmosis

• Di$sio%

• Sodi$m pot"ssi$m p$mp



changes and the amount of body uidcomposition

Bleeding

Burn

dehydration

Fasting from preoperativeperioperative



c#yst"lloid l$ids

• sol$tio% !ith !"te# +"$eo$s- co%sisti%& o sm"ll

molec$les

• c"% pe%et#"te the c"pill"#y memb#"%e e"sily

• &i'i%& &#e"te# 'ol$me

• mo#e #"pid o%set, sho#t d$#"tio%, e!e# side eects "%dlo!e# p#ices



c#yst"lloid l$id

Normal

Saline

Ri%&e#

L"ct"te +RL-Dextrose

Ringer Asetat

(RA



No#m"l S"li%e

• Compositio% +mmol . l-) N" / 012, Cl / 012

• P"c3"&i%&) 044, 514, 144, 0444 ml6

• i%dic"tio%)

#es$scit"tio%

di"##he" b$#%s

Ac$te 7id%ey I%8$#y

co%t#"i%dic"tio%s)

$te#$s hype#to%ic

hypo%"t#emi"

l$id #ete%tio%

Used !ith st#ict s$pe#'isio% i% C9F

6 #e%"l i%s$icie%cy, hype#te%sio%, pe#iphe#"l edem" "%d

P$lmo%"#y Oedem



Ri%&e# L"ct"te +RL-

• Compositio% +mmol . 044ml-) N" / 0:4;024, 7 / 2;1, 5;: /

C", Cl / 04<;004, TC / 5=;:4 mE . l6

• P"c3"&i%&) 144, 0444 ml6

• D#$&s >ech"%ism ) elect#olyte compositio% "%d

co%ce%t#"tio% "#e 'e#y simil"# to those co%t"i%ed i% the

e*t#"cell$l"# l$id6

• I%dic"tio%s) dehyd#"tio% "%d hypo'olemic shoc3

• Co%t#"i%dic"tio%s) hype#%"t#emi", 3id%ey diso#de#s, li'e# cell

d"m"&e, l"ctic "cidosis



Dextrose

• Compositio%) &l$cose / 14 & . l +1?-, 044 & . l +04?-, 544

& . l +54?-

• P"c3"&i%&) 044, 514, 144 ml

•i%dic"tio%)l$id #es$scit"tio%

i%t#"'e%o$s l$id the#"py

• Co%t#"i%dic"tio%s) 9ype#&lycemi"• Adverse Reaction ) 9ype#to%ic &l$cose i%8ectio% !ith lo!

p9 i##it"tio% o the 'ei% "%d th#ombophlebitis



Ringer Asetat (RA

• RA is die#e%t #om RL sol$tio% +Ri%&e#@s l"ct"te- !he#e

l"ct"te is m"i%ly met"bolied i% the li'e#, !hile "cet"te is

met"bolied p#im"#ily i% m$scle

• I%dic"tio%)

"c$te l$id loss +#es$scit"tio%-) +di"##he", de%&$e

e'e#, b$#%s . hemo##h"&ic shoc3B l$id #epl"ceme%t

d$#i%& " s$#&ic"l p#oced$#eB lo"di%& li$id "t i%d$ctio% o

#e&io%"l "%esthesi"B p#imi%& sol$tio%, complic"tio%s o

"c$te st#o3e !ith dehyd#"tio%



Solution Tonicity

(mosml!"

Na#

(mE$!"

%l&

(mE$!"

'#

(mE$!"

%a

(mE$!"

)lucose

(g!"

"actate

(mE$!"

*+ Dextrose

in ,ater

(D*-

9ypo +51:- 14

Normal saline Iso +:4=- 012 012

D* . NS Iso +::4- :=,1 :=,1 14

D* / NS 9ype# +24- 14

D*NS 9ype# +10- 012 012 14

"actated

Ringers

0n1ection (R"

Iso +5:- 0:4 04< 2 : 5=

D*"R 9ype# +151- 0:4 04< 2 : 14 5=



Colloids

• sol$tio% o l"#&e molec$les th"t "#e diic$lt to pe%et#"te the c"pill"#y

memb#"%e, $sed to #epl"ce i%t#"'"sc$l"# l$id

• sm"lle#, slo!e# o%set, lo%&e# d$#"tio%, mo#e side eects, "%d mo#e

e*pe%si'e

• p#ope#ties s$ch "s pl"sm" p#otei%s %ot o$t o the c"pill"#y

memb#"%e "%d #em"i% i% the blood 'essels

• hype#to%ic "%d c"% d#"! l$id #om the blood 'essels

• Used to m"i%t"i% "%d i%c#e"se the p#ess$#e pl"sm" Osmose



Colloid"l l$idsAl2umin

)elatin

Dextran

3ES

(Hydroxyetyl

Starches)



ALU>IN• Compositio%) Alb$mi% "'"il"ble o# cli%ic"l p$#poses is " <;3D"

p#otei% p$#iied #om h$m"% pl"sm" +e*empl"#ily) "lb$mi% 1?-

• I%dic"tio%)

Pl"sm" 'ol$me s$bstit$tio% o# p#otei%

Pl"sm" 'ol$me s$bstit$tio% i% ARDS + Acute RespiratoryDistress Syndrome-

hypo"lb$mi%emi"

spontaneus bacterial peritonitis +SP-

• Co%t#"i%dic"tio%s) he"#t "il$#e, se'e#e "%emi"6

• P#od$ct) Pl"sb$mi% 54, Pl"sb$mi% 51



3ES (Hydroxyetyl Starches)

• Compositio%) st"#ches "#e composed o t!o types o

&l$cose polyme#, %"mely "mylose "%d "mylopecti%

• I%dic"tio% )

The $se o 9ES o% post;t#"$m" #es$scit"tio% c"%#ed$ce the pe#me"bility o blood 'essels the#eby

#ed$ci%& the #is3 o c"pill"#y le"3"&e6

• co%t#"i%dic"tio%s) Cardiopulmonary bypass

• Adverse reaction ) 9ES c"% "cc$m$l"te i% tiss$es #etic$lo

e%dotheli"l p#$#it$s



Dextran

• Compositio%) de*t#"% is composed o &l$cose polyme#s sy%thesied

#om the b"cte#i$m Le$co%ostoc mese%te#oides, !hich is &#o!% o%

s$c#ose medi$m

• I%dic"tio% )

Pl"sm" 'ol$me e%h"%ce# o% t#"$m", septic shoc3, myoc"#di"lischemi", ce#eb#"l ischemi", "%d pe#iphe#"l '"sc$l"# dise"se

"%ti;th#omb$s

• Co%t#"i%dic"tio%s) th#ombocytope%i", hipoib#i%o&e%emi", he"#t

"il$#e, #e%"l imp"i#me%t !ith oli&$#i" o# "%$#i" se'e#e

• E*"mple) hibi#o%, isotic te"#i%, te"#s %"t$#"le II, pl"sm"$si%



)elatin

• Compositio%) el"ti% is t"3e% #om the hyd#olysis o

bo'i%e coll"&e%

•I%dic"tio%s) I%c#eme%t"l pl"sm" 'ol$me "%d h"'e theeect o "%tico"&$l"%t

• Co%t#"i%dic"tio%s) h"em"cel composed o l"#&e "mo$%ts

o c"lci$m, so it sho$ld be "'oided i% the st"te ohype#c"lcemi"

• Adverse reaction ) c"% c"$se "%"phyl"ctic #e"ctio%s



LIGUID e%te#"l %$t#itio%

• Dei%itio% )

N$t#itio% is &i'e% to p"tie%ts !ho c"% %ot meet thei# %$t#itio%"l %eeds

th#o$&h o#"l, %$t#itio%"l o#m$l"s "dmi%iste#ed th#o$&h the t$be i%to

the stom"ch +&"st#ic t$be-, %"so&"st#ic t$be +NT-, o# 8e8$%$m

Ob8ect )To eed "%d d#$&s th#o$&h " t$be

To p#e'e%t %"$se", 'omiti%& "%d &"st#ic diste%tio% "te#

s$#&e#y

To #emo'e the co%te%ts o the stom"ch

To pe#o#m l"'"&e +stom"ch !"sh-





I%dic"tio% )

AIDS . 9IH +!hich is "ccomp"%ied by m"l%$t#itio%-

Imp"i#me%t o co%scio$s%ess o# com"

Dysph"&i" . obst#$ctio% o the esoph"&$s

A%o#e*i" i% se'e#e i%ectio% . ch#o%ic m"l%$t#itio% o# o%

S$#&e#y o# c"%ce# o the he"d . %ec3

Psycholo&ic"l diso#de#s s$ch "s dep#essio% o# "%o#e*i" %e#'os"The st"te o hype#met"bolism +b$#%s, t#"$m", 9IH i%ectio%-

I%"de$"te o#"l i%t"3e

I%l"mm"to#y bo!el o# C#oh%@s dise"se

I%t$b"tio% . 'e%til"tio%

P"%c#e"titis +to m"i%t"i% the i%te&#ity o the &$t-

S$#&e#y "%d t#"$m" !ith sepsis #is3



Co%t#" i%dic"tio%s)

•D$#"tio% o less th"% 1;04 d"ys•C"% %ot be $sed i% p"tie%ts !ith se'e#e "c$te p"%c#e"titis

•High-output p#o*im"l ist$l"s

•Inability to gain access

•E*cessi'e %"$se" o# di"##he"



LIGUID NUTRITION PARENTERAL

• " o#m o %$t#itio% &i'e% th#o$&h " 'ei% di#ectly !itho$t

&oi%& th#o$&h the di&esti'e t#"ct

•

P"#e%te#"l %$t#itio% is &i'e% !he% the &$t is %ot $sed "s "c"se e*"mple) i%testi%"l co%&e%it"l m"lo#m"tio%s,

%ec#otii%& e%te#ocolitis, "%d se'e#e #espi#"to#y dist#ess



• method o p"#e%te#"l %$t#itio%)

06P"#ti"l p"#e%te#"l %$t#itio%

56Tot"l p"#e%te#"l %$t#itio%



• i%dic"tio%s P"#e%te#"l )

Imp"i#ed "bso#ptio% o ood "s e%te#o3$%"te$s ist$l",

i%testi%"l "t#esi", i%ectio$s colitis, bo!el obst#$ctio%

p"%3#estitis !ei&ht, p#eope#"ti'e st"t$s !ith se'e#e

m"l%$t#itio%, i%te#ti%"l "%&i%", #ec$##e%t di"##he"

$t motility diso#de#s s$ch "s p#olo%&ed ile$s

E"t, pe#siste%t 'omiti%&, hemody%"mic dist$#b"%ces,

hype#emesis &#"'id"#$m



co%t#"i%dic"tio%s P"#e%te#"l)

•C"%ce# p"tie%ts !ho "#e #$%%i%& the #"di"tio% the#"py "%d

chemothe#"py6

•P#eope#"ti'e p"tie%ts !ho "#e %ot se'e#ely m"l%o$#ished6

•>ild "c$te p"%c#e"titis6•"c$te colitis6

• AIDS6

•P$lmo%"#y dise"se e*"ce#b"tio%s6

•$#%s6•Se'e#e dise"se e%d;st"&e +end-stage illness-



The be%eits o p"#e%te#"l %$t#itio%, "mo%& othe#s)

•P#o'ide %$t#ie%ts o# the body i%t#"'e%o$sly, bec"$se it

does %ot "llo! the &$t to m"3e the p#ocess o di&estio%

•P#e'e%t s$bc$t"%eo$s "t "%d m$scle is $sed by the body

to m"3e e%e#&y c"t"bolism

•>"i%t"i%i%& %$t#itio%"l %eeds



Co%cl$sio%

• The body co%t"i%s 4? !"te# !hich is "lso c"lled the

body l$ids6 This body l$id co%t"i%ed the#ei% %$t#ie%ts

c#$ci"l #ole i% cell met"bolism, so th"t is 'e#y impo#t"%t i%

s$ppo#ti%& lie6 I% s$#&e#y, the body is dehyd#"ted

bec"$se o bleedi%& d$#i%& s$#&e#y pl$s "sti%& beo#e"%d "te# s$#&e#y6 So l$id the#"py "#e %ecess"#y o#

m"i%te%"%ce "%d p#e'e%t l$id loss too m$ch c"% be

h"#m$l6



T9AN7 YOU

Te#im" 7"sih6

D"%3e6

>"t$# N$!$%6

S 3#o%

#"ci"s66

A#i"to6

PPT Kristaloid, koloid dan cairan nutrisi enteral dan parenteral.ppt

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