Electrolyte Corrections ; Koreksi Elektrolit

A. NATRIUM

Na+: ion utama diluar sel;

N: 135-145 meq/L

– Intrasel 10 meq/L

– Dipertahankan oleh sistim Na-K-ATPase

– Sangat menentukan osmolalitas extrasel selain kadar glukosa dan ureum.

osmol.=2X Na plasma+ gluc/18+ BUN/2,8

N: osmol.efektif= 2X kadar Na plasma

– hipoNa :akibat hilangnya Na+/ retensi 

Hiponatremi

Kehilangan Na= 0,6XBBX (140-Na.Pl) + 140X ↓ nya BB

– Pemberian NaCl: deplesi cairan, Insuf.adrenal, ok.diuretik

Koreksi Hiponatremi 

– Koreksi Hiponatremi Bila Na> 125 mEq/L Koreksi dgn NS 500 cc / 8 jam

– Bila Na< 125 mEq/L

Rumus: 0,6X BBX (140-Na plasma)

Maintenance dewasa: 1 meq/BB/hr anak : 2 meq/BB/hr

 

Penatalaksanaan Hipernatremi

Koreksi Volume dengan NS ½, NS

Jika Na serum awal > 175 mEq/L, cegah terjadinya edema serebri dengan monitor setiap jam sampai Na serum 155 mEq/L

Penurunan Na serum ; 2mEq/L setiap jam

½ defisit diberikan 24 jam I, sisa dikoreksi dalam 1 – 2 hari

 

B. KALIUM

Koreksi Hipokalemi Harga Normal : 3,5 – 5,1 meq/L

Koreksi Hipokalemi  Defisit K+ : K+ x BB x 0,8

Maintenance : Dewasa : 1 meq / BB / hr Anak : 2 meq / BB / hr 6 Jam I : Defisit + ¼ maintenance 6 Jam II,III,IV : ¼ Maintenance

Sediaan: KCl Flacon 25 cc (25 meq/fl)

Syarat Pemberian infus K: Konsentrasi < 40 meq/L (preparat KCL perdrip) Kecepatan 10 meq / jam

Hiperkalemia

Koreksi Hiperkalemi

Ringan ( 5 – 6 mEq/L)   Oral kayexalate (Na : K exchange resin) 3 x 50 mg

Sedang (6 – 7 mEq/L)    Oral kayexalate (Na : K exchange resin) 3 x 50 mg

       Insulin 12 unit dalam D5% 500 mL (1 : 2) 20 tpm

       D40% 2 flab + 10 IU insulin 16 tetes/menit

Berat (>7 mEq/L)

  Ca glukonas 10% 1 ampul iv selama 1 – 2 menit (onset segera, durasi 15 – 30 menit).       Dapat diulang setelah 5 menit jika tidak   ada perubahan EKG

KALSIUM

– 40% Ca serum terikat albumin

– Harga Normal : 8,5 – 10,5 mg/dl

Pengobatan : koreksi defisiensi dg kalsium i.v (Ca.Gluconat/ klorida 10%) atau peroral (Ca.Gluconas/karbonat); dpt Disertai pemberian vit.D dosis besar

Hiperkalsemia

Terapi Hiperkalsemia

1. Fosfat: meningkatkan deposisi kalk tulang & menghambat resorbsi tulang; hati2 pada GGK

2. Indometasin : berguna pada hiperkalsemia akibat keganasan

3. Meningkatkan ekskresi dg. Lar.NaCl.

4. Diet rendah kalsium

5. Jika fungsi ren terganggu hemodialisis HiperCa (>10,5 mg/dL) 

Koreksi = Ca serum + (0,8 x Jumlah albumin)

Jika fungsi ren baik : 1 – 2 L NS + furosemide 80 – 100 mg tiap 12 jam slama 24 jam I 

Prednison 60 mg/hr PO atau hidrokortison suksinat 200-300 mg iv

Bifosfonat (hambat aktiv.osteoklast) 

Pamidronat 60 – 90 mg i v selama 4 – 24 jam

Disodium etadronat 7,5 mg/Kg iv @hari slama 4 jam untuk 3 – 7 hari 

Plikamisin (mitramisin) 25ug/Kg iv dalam 500 ml D5% slama 3 – 6 jam, diulang bbrp kali dgn selang 24-48 jam

MAGNESIUM

Harga Normal : 0.74 – 0.99 mmol/L

Hipomagnesemia  Tx/: pemberian kalsium 5-10 meq I.v diuretik bila fungsi ginjal baik hemodialisis

A. Hypocalcemia

Normal Values: Total 8.5-10.5 mg/dl.

(Ionized 4.5-5.3 mg/dl. Use Ionized Calcium Levels before treating or Calculate Albumin Levels)
  • Inj:  Calcium Chloride, Calcium Gluconate PO: Calcium Carbonate, Calcium Gluconate
  • Dosing: 
  1. Ionized Ca. 4.0-4.4 give  0.5-1 g Ca-Gluc, IVP over 5-10 min. Repeat 8-12 hr. prn.
  2. Ionized Ca. 3.5-3.9 give 1-2 g Ca-Gluc. IVP/IVPB over 15-30 min. Repeat a4-8 hr. prn.
  3. Ionized Ca < 3.5 or symptomatic, give 1-2 gm Ca-Gluc. IVP/IVPB over 5-10 min. Repeat q1-2 hr.prn.
  • WARNING: Correct Hypomagnesia and Hyperphosphatemia. Wait min. of 30 min. before rechecking.

B. HypoMagnesia

  • Normal Values: 1.8-2.3 mg/dl
  • Inj: MgS04 PO: MgS04/Mg02.
  • Dosing: 
  1. If between 1.0-1.8 give 1-2 gm MgSo4 IVPB over 1 hr. Repeat q 6-12 hr. prn
  2. If <1.0 give 4 gm MgS04 over 2 hrs. then 2 gm MgS04 IVPB over 1 hr q 2 hrs.
  • WARNING:
  1. Hypomagnesia may cause hypokalemia and hypocalcemia.
  2. Rapid Infusion may cause hypotension and flushing. 1 gm= 8.12 meq

C. Hypokalemia (potassium)

  • Normal Values:  3.5-5.4 mEq/L
  • Inj. KCL, K-phos, PO: KCL, (K-Lyte®, K-Dur®, liquid KCL)
  • Dosing: 
  1. If 3.0-3.5 give 40mEq/L over 1 hr. (40mEq/250 ml over 2 hr.)
  2. If ❤.0, give 40mEq/100 ml IVPB q2-4 hr until depletion is corrected.
  • WARNING: Infuse through central line with continuous EKG monitoring. Don’t give more than 80 mEq before rechecking levels. Correct Concurrent Hypocalcemia

D. Hyperkalemia (potassium)

  • Normal Values: 3.5-5.4 mEq/L
  • Dosing:
  1.  If K >5.5, consider 15gm PO qd-qid  of Kayexalate (mix in water or sorbitol) to decrease levels.
  2. Stop K- IV fluids.

E. Hypophosphatemia (Phosphorus)

  • Normal Values:  2.0-4.6 mg/dl
  • Inj: K-Phos, Na-Phos: PO: Phospho-soda (20.8 mmol/5ml)
  • dosing:
  1. If between 1.5-1.9 give 0.125 mmol/kg IVPB over 4 hrs. ( max 15 mmol) or Phospho-soda 5 ml PO bid-tid.
  2. If between 1.0-1.4 give 0.25 mmol/kg (IVPB over 4 hrs. (max 25 mmol). If <1.0, give 0.375-0.5 mmol/kg (max dose 40 mmol)
  • WARNING: Avoid use of phosphate in severe hypocalcemia.. Wait 30 minutes before rechecking.
* BID- Twice a day, TID- Three times a day, PRN- as needed, Inj-Injection, PO- By Mouth, hr- hours

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