Koreksi Elektrolit atau imbalance elktrolite

koreksi elektrolite

1. Koreksi Elektrolit d r Ahmad Mukhlis

2. Koreksi Hiponatremia Defisite Natrium : 0,6 x BB x ( Na Target – Na Lab ) NaCl 0,9 : 1000 cc – 154 Na Nacl 3% : 1000 cc – 513 Na Kecepatan Pemberian : 0,5 Meq /jam – 1 meq /jam Maksimal Koreksi : 10-12 Meq Koreksi Cepat : dengan Menaikkan target menjadi 5 Meq dengan kecepatan 1 Meq /jam kemudian sisanya akan dikoreksi dengan kecepatan 0,5 Meq / jam Hati hati koreksi Natrium terlalu cepat akan mengakibatkan central demyeleminating lessions

3. Koreksi Hipernatremia Free Water Deficite : ( BB x 0,6 ) x ( 1 – ( Na target / Na Lab) x 1000 ) – dengan kecepatan 0,5 – 1 mmol / jam Kemdian dilanjutkan dengan cairan Full Holzeq Dapat dikoreksi dengan Cairan Dextrose 5 %

4. Koreksi Hipokalemia < 2,5 mmol /L : 0,75 x BB 2,5 mmol /L – 3 mmol /L : 0,5 x BB > 3 mmol /L : 0,25 x BB

5. Koreksi Hiperkalemia If the potassium concentration is more than 6.5 mEq /L with associated ECG changes, additional measures are indicated. In the absence of digitalis toxicity, hyperkalemia with ECG changes should be treated with a secure and rapid IV infusion of calcium chloride or calcium gluconate . Hand injection with ECG monitoring is reasonable beginning with the administration of 10 mg/kg of calcium chloride (or gluconate equivalent) over 1 to 5 minutes . It should be anticipated that ECG changes will recur in 15 to 30 minutes unless additional measures are taken immediately to treat the hyperkalemia. The effective calcium dose may be repeated as necessary to preserve cardiac function while additional treatments are in progress. Additional, rapidly effective treatments include nebulized albuterol (rapid neb or continuous neb of 0.3 to 0.5 mg/kg) or salbutamol (IV dose of 4 to 5 µg/kg over 20 minutes and repeated after 2 hours)

6. Insulin and glucose are also rapidly helpful in redistributing potassium to the ICF. Glucose (1 g/kg) and insulin (0.2 U/g of glucose) may be given over 15 to 30 minutes and then infused continuously with a similar amount per hour Sodium bicarbonate (1–2 mEq /kg given intravenously) has been a part of the classic treatment of hyperkalemia. Its benefit, however, is more difficult to predict and slower in onset than that of the measures mentioned earlier Hemodialysis is the treatment of choice for removal of K+ in emergent conditions

7. Koreksi Hipokalsemia 0,5 – 1 Meq x BB

8. Koreksi Hiperkalsemia A serum calcium level greater than 15 mg/ dLc may be life threatening and requires direct Ca -lowering therapy in addition to attention to the underlying disorder. Hydration with isotonic saline (200 to 250 mL/kg/day) and furosemide diuresis results in calciuresis and amelioration of hypercalcemia in the majority of cases. Excessive losses of sodium, potassium, magnesium, and phosphate may require replacement

9. Koreksi Hipomagnesium Patients undergoing or at immediate risk of hypomagnesemic malignant ventricular arrhythmias (such as torsades ) or seizures can be given magnesium sulfate intravenously with careful monitoring. An IV infusion of 25 to 50 mg/kg per dose diluted to 10 mg/mL can be administered over 15 to 60 minutes

10. Koreksi Hipermagnesium An initial dose of calcium chloride at 10 mg/kg or an equivalent amount of calcium gluconate has been suggested for infants and children. Magnesium-containing medications obviously should be discontinued. If renal function is normal, IV furosemide may be administered to increase magnesium excretion while urine output is replaced with half-normal saline. In patients with renal failure or severe toxicity, dialysis may be necessary for removal.

11. TERIMA KASIH