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G A N G G U A N ELEK TR O LIT

Dr. Ery Leksana, Sp.An,KIC, KAO

Gangguan elektrolit yang sering


mengancam kehidupan pada pasien
dalam keadaan kritis adalah :
potassium
sodium
calcium
Magnesium
phosphate

Potassium
Kalium

mempertahankan
electrical membrane potensial.
Gangguan pada kadar kalium terutama
dapat mempengaruhi: cardiovascular,
neuromuscular dan gastrointestinal
system
Kadar normal : 3,5 5,5 meq/L

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, nauseavomitting
K < 2 meq/L, FATAL

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

Terapi : berikan KCL


K> 3 meq/L
NGT : 20-40 m.mol
K< 3 meq/L
0,3 =
meq

oral atau via


(4,5 X) x BW x

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

Terapi : berikan KCL


Significant ECG abnormalities : CaCl2 10% = 5-10
ml,pelan2
Untuk distribusi kalium : 10 umit insulin dan 500 ml
5 % dextrose iv
sodium bicarbonat
1 meq/kg i.v slowly,
beta 2 agonist
albuterol inhaled = 10-20 mg

Membuang kalium dari dalam tubuh: loop diuretic,


sodiun polyestyrene sulfonate 25-50 g in sorbitol per
os, dialysis
Hyperventilation
CO2
alkalosis
respiratoric

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

restriction of free water


35 NaCl .(140-X ) x Bw x

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

CALCIU M
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)
Nacl 9 % : restore intravascular
volume
adequate tissue
perfusion, renal blood flow
diuresis ; Imvrease renal calcium
loss

PH O SPH ATE
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

Penurunan kadar phospate : mempengaruhi


neuromuscular dan central nervous system
Manifestasi klinis : muscle weakness,
respiratory filure, rhabdo,yolisis, paresthesia,
lethargy, disorientation, ontundation, coma,
seizure, impaired renal, tubular function,
impaired pressor respon, hepatic dysfunction,
immune dysfunction,sintesa protein terganggu,
hemolisis, gamgguan fungdi platelet,
gangguan pelepasan oksigen oleh hemoglobin

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

M AG N ESIU M
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.

Manifestasi klinis : tumpang tindih


antara hyperkalemian dan
hypomagnesemia.
Cardiovascular abnormalities( QT
prolongation, arrhythmia, vasosapsm,
myocardial ischemia), neuromuscular
abnormalities ( weaknes, tre,or,
seizure, tetany, obtundation, coma),
electrolyte abnoramalities

Terapi;
Emergency ( arrhythmia )
Magnesium sulphate = 1-2 g i.v, 5-10
menit (0,2 ml/kg; lar. 10% )