DIKLAT RSUD dr LOEKMONO HADI

KUDUS

GANGGUAN ELEKTROLIT

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,
nausea-vomitting

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
40 m.mol
K< 3 meq/L
meq

oral atau via NGT : 20(4,5 X) x BW x 0,3 =

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 m.mol/l/hours

CALCIUM
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

PHOSPHATE
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

MAGNESIUM
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 ( hypokalemia,
hypocalcemia).

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