FLUIDS THERAPY

NAME : OKTAVIA SULISTIANA

NIM : G1A214058
ADVISER : dr. Sulistyowati, Sp.An
 INTRODUCTION
• There are some fluids of our body.
• The fluids have many function, it’s to
transport the food essences to all of the
tissues in our body, and put outside the
residues of cell’s metabolism to support the
life.
• Fluids therapy is an action to keep, change
the fluids components of our body with
cristalloids or colloids by veins.
BODY FLUIDS
• Intracellular fluids
• Extracellular fluids
• Interstisial fluids
• Inravascular
fluids
• Transcellular
fluids
 ELECTOLYTES &
NON-ELECTROLYTES
1. Electrolytes
The substance which dissosiation in fluids and
have the electrical. There are positive ions
(cations) and negative ions (anions). Examples:
Sodium, Calcium, Potassium, Magnesium,
Carbonat.
2. Non-electrolytes
There are glucose and urea which not
dissosiation in fluids. The others is creatinins and
billirubins.
 BODY FLUIDS CHANGE
1. Osmosis
The molecules move
from the low solute to
the high solute via the
semipermeable
membrane.
 BODY FLUIDS CHANGE
2. Diffusion
The molecules move from the high
concentration to the low concentration of
the water via the pores.
 BODY FLUIDS CHANGE
3. Sodium-Pottasium Pump
A transport process which pumped the
Sodium outside via cell membrane and at
the same time pumped the pottasium
inside (active transport, needs energy)
 THE FLUIDS
CRISTALLOIDS
 The compossition is near the extracellular
fluids
 It is cheap and didn’t need the
crossmatch, didn’t activate the allergic or
anaphylactic.
 It is simple saved and It is can saved long
time.
 Usually it is used to fluids resuscitation
although it is hipotonic which near the
intravascular fluids.
 THE FLUIDS
The Cristalloids
 MACAM-MACAM CAIRAN
COLLOIDS
 Its called plasma substitute´ or ‘plasma
expander´.
 Its save a long time in intravascular (3-6
hours)
 Usually it is used to fast fluids resuscitation,
especially hypovolemic shock or
haemorragic shock, severe
hypoalbuminemia, and loss many proteins
(example: burning)
 Detriment: It is expensive and sometime it
was induced the anaphylactic
 COLLOIDS
There are:
1. Nature colloids, plasma protein fraction 5% and
human albumin.
2. Syntetic colloids:
• Dextran
• Dextran 40 (Rheomacrodex)
• Hydroxylethyl Starch (Heta starch)
• Gelatin
 TECHNIQUE OF FLUIDS
TERAPHY
1. The fluids resuscitation
It is used to fast changed the acute body
fluids loss or to expansion by fast of
intravascular fluids to complete the tissue
perfussion. Example:
Hypovolemic/Haemorragic shock and
burning.
2. The fluids maintenance
It is purpose to keep the balance of body
fluid.
 RESUSCITATION
• The resuscitation is used Normal Saline (NS), Ringer
Asetat (RA), or Ringer lactat (RL) 20 ml/kg in 30-60
minutes.
• In Haemorragic shock, its can 2-3 liters in 10 minutes.
• The plasma expander is used to burn, myocardial
infarc, cardiogenic shock, haemorragic shock, and
septic shock.
• Colloids can be gelatin (hemaksel, gelafunin,
gelafusin), polimere of dextrose (dextran 40, dextran
70), atau the derivates (haes, ekspafusin)
 MAINTENANCE

- In 80 ml/hour for adult.

- To kids:
 4 ml/kg/hour for first 10 kg
 2 ml/kg/hour for second10 kg
 1 ml/kg/hour for the next ammount of kg
 THE ATTENTION FACTORS OF
FLUIDS TERAPHY

• The days necessary of normal fluids and

electrolytes
• Fluids and electrolytes deficit pre-operation
• Ammount of fluids loss at the operation
• Kidney disorders
 HOW TO USE THE FLUIDS
PRE-OPERATIVE
Assessment the fluids status:
• Questions: Bleeding? Vomit? Diarhea?
Thirsty? Ammount and the colors of urine?
• Physical examination: fluids status (blood
pressure, pulse, weight, skin, abdominal,
eyes, and mucose.
• Laboratory: electrolytes, BUN,
haematocrite, haemoglobin, and protein.
 PRE-OPERATIVE
• 2 ml/kgBB/hour in adult. For weight >20kg
we can give 60 ml plus 1 ml/kg.
• Kids:
 4 ml/kg/hour for first 10 kg
 2 ml/kg/hour for second10 kg
 1 ml/kg/hour for the next ammount of
kg
 PERI OPERATIVE
Based of the bleeding:
• Minimal bleeding (10-15% bleeding
or10% EBV), its changed with electrolytes
fluids.
• Moderate (15-30% or10 – 20% EBV), 15 –
30%, its changed with cristalloids and
colloids.
• Severe (>30% bleeding or 20 – 50% EBV)
its changed with blood transfussion.
 PERI OPERATIVE
Based of Haemorhagic Shock Classification
Intravenous fluid replacement in haemorrhagic shock
Class I 2.5 l Ringer-lactate solution or 1.0 L
(haemorrhage 750 ml (15%)) polygelatin

Class II 1.0 l polygelatin plus 1.5 L Ringer-

(haemorrhage 800-1500 ml (15- lactate solution
30%))

Class III 1.0. l Ringer-lactate solution plus 0.5

(haemorrhage 1500-2000 ml (30- l whole blood or 0.1-1.5 l equal
40%)) volumes of concentrated red cells
and polygelatin

Class IV 1.0 l Ringer-lactate solution plus 1.0

(haemorrhage 2000 ml (48%)) l polygelatin plus 2.0 l whole blood
or 2.0 l equal volumes of
concentrated red cells and
polygelatin or hestastarch
 POST OPERATIVE
The purpose:
• Complete the necessary of fluids,
electrolytes, and nutrition.
• To change the loss fluids post
operation.
• To change the deficit of fluids from
pre operative and peri operative
• To correct the fluid imbalance
THANK YOU GUYS