Unit V Cairan Tubuh dan Ginjal PDF

BAB 25 UNIT V ,PNQPOFO$BJSBO5VCVI$BJSBO &LTUSBTFMVMBSEBO*OUSBTFMVMBS&EFNB.FNQFSUBIBOLBO WPMVNF DBJSBO NFMBMVJ LVMJU ZBOH LFEVBOZB NFOHFMVBSLBO BJS TFLJUBS NM UVCVI BHBS SFMBUJGLPOTUBO EBO IBSJ QBEB LFBEBBO OPSNBM )BM JOJMBI ZBOH EJTFCVU JOTFOTJCMF LPNQPTJTJOZB UFUBQ TUBCJM QFOUJOH XBUFS MPTT LBSFOB LJUB UJEBL NFOZBEBSJOZB XBMBVQVO UFSKBEJ VOUVL IPNFPTUBTJT TFQFSUJ ZBOH UFSVTNFOFSVTQBEBTFNVBNBLIMVLIJEVQ EJCJDBSBLBO EJ #BC #FCFSBQB *OTFOTJCMF XBUFS MPTT ZBOH UFSKBEJ NFMBMVJ LVMJU UJEBL CFS NBTBMBIQBMJOHVNVNEBOQFOUJOH HBOUVOH LFQBEB LFSJOHBU EBO CBILBO UFUBQ UFSKBEJ QBEB PSBOH EBMBN LFEPLUFSBO LMJOJT UJNCVM BLJCBU BCOPSNBMJUBT EBMBN ZBOHMBIJSUBOQBLFMFOKBSLFSJOHBUKVNMBISBUBSBUBLFIJMBOHBOBJS TJTUFN QFOHFOEBMJBO ZBOH NFNQFSUBIBOLBO LFTUBCJMBO DBJSBO EFOHBODBSBEJGVTJNFMBMVJLVMJULJSBLJSBTBNQBJNMIBSJ UVCVIJOJ%BMBNCBCJOJEBOCBCCFSJLVUOZBUFOUBOHHJOKBM LJUB ,FIJMBOHBO JOJ EJNJOJNBMLBO PMFI MBQJTBO LPSOFVN LVMJU ZBOH BLBO NFNCBIBT QFOHBUVSBO WPMVNF DBJSBO UVCVI TFDBSB NFOHBOEVOH LPMFTUFSPM ZBOH NFNCFSJLBO QFSMJOEVOHBO LFTFMVSVIBO LBOEVOHBO DBJSBO FLTUSBTFMVMBS LFTFJNCBOHBO UFSIBEBQ LFIJMBOHBO ZBOH CFSMFCJIBO NFMBMVJ EJGVTJ #JMB MBQJTBO BTBNCBTB EBOLPOUSPMQFSUVLBSBODBJSBOBOUBSBLPNQBSUFNFO LPSOFVN JOJ IJMBOH TFQFSUJ ZBOH UFSKBEJ QBEB MVLB CBLBS ZBOH FLTUSBTFMEBOJOUSBTFM MVBT LFDFQBUBO FWBQPSBTJ EBQBU NFOJOHLBU TBNQBJ LBMJ *JQBU NFODBQBJ TBNQBJ -IBSJ 0MFI TFCBC JUV LPSCBO MVLB CBLBS Asupan dan Keluaran Cairan Seimbang Selama IBSVT EJCFSJ DBJSBO EBMBN KVNMBI ZBOH CFTBS CJBTBOZB TFDBSB Kondisi Keadaan-mantap JOUSBWFOB VOUVLNFOHJNCBOHJLFIJMBOHBODBJSBO *OTFOTJCMF XBUFS MPTT NFMBMVJ USBLUVT SFTQJSBUPSJVT SBUBSBUB ,FTUBCJMBOSFMBUJGDBJSBOUVCVIBEBMBITBOHBUNFOHBHVNLBOLB CFSLJTBS TBNQBJ NMIBSJ 4FXBLUV VEBSB NFNBTVLJ SFOB BEBOZB QFSUVLBSBO DBJSBO EBO [BU UFSMBSVU ZBOH UFSVT USBLUVT SFTQJSBUPSJVT VEBSB BLBO EJKFOVILBO EFOHBO QFOHFN NFOFSVT EFOHBO MJOHLVOHBO FLTUFSOBM TFQFSUJ KVHB BOUBS CVOBO EBONFODBQBJUFLBOBOVBQLJSBLJSBNN)H TFCFMVN CFSCBHBJ LPNQBSUFNFO UVCVI MBJOOZB $POUPIOZB BEBOZB EJLFMVBSLBO 0MFI LBSFOB UFLBOBO VBQ EBSJ VEBSB JOTQJSBTJ BTVQBO DBJSBO ZBOH TBOHBU CFSBHBN ZBOH IBSVT EFOHBO DFSNBU CJBTBOZB LVSBOH EBSJ NN )H DBJSBO UFSVTNFOFSVT IJMBOH EJTFTVBJLBOEFOHBOQFOHFMVBSBOBJSZBOHTFCBOEJOHEBSJUVCVI NFMBMVJ QBSVQBSV EFOHBO SFTQJSBTJ 1BEB DVBDB ZBOH EJOHJO VOUVL NFODFHBI QFOVSVOBO BUBV QFOJOHLBUBO WPMVNF DBJSBO UFLBOBO VBQ BUNPTGFS UVSVO NFOEFLBUJ NFOZFCBCLBO LFIJMB UVCVI OHBO BJS ZBOH CBILBO MFCJI CFTBS EBSJ QBSVQBSV CFSTBNBBO Asupan Cairan Tubuh Harian EFOHBOUVSVOOZBTVIVUVCVI)BMUFSTFCVUNFOKFMBTLBOQFSBTBBO $BJSBO EJUBNCBILBO LF EBMBN UVCVI EBSJ EVB TVNCFS VUBNB LFSJOHQBEBTBMVSBOOBQBTTBBUDVBDBEJOHJO CFSBTBMEBSJBJSBUBVDBJSBOEBMBNNBLBOBO ZBOHOPSNBMOZB NFOBNCBI DBJSBO UVCVI TFLJUBS NMIBSJ EBO CFSBTBM ,FIJMBOHBO "JS MFXBU ,FSJOHBU +VNMBI BJS ZBOH IJMBOH EBSJ TJOUFTJT EJ UVCVI TFCBHBJ IBTJM PLTJEBTJ LBSCPIJESBU ZBOH NFMBMVJLFSJOHBUTBOHBUCFSWBSJBTJ CFSHBOUVOHQBEBBLUJWJUBTGJTJL NFOBNCBI TFLJUBS NMIBSJ ,FEVB IBM JOJ NFNCFSJLBO EBOTVIVMJOHLVOHBO7PMVNFLFSJOHBUOPSNBMLJSBLJSBNM BTVQBODBJSBOIBSJBOUPUBMLJSBLJSBNMIBSJ 5BCFM IBSJ UBQJ QBEB DVBDB ZBOH TBOHBU QBOBT BUBV TFMBNB BLUJWJUBT "LBO UFUBQJ BTVQBO BJS TBOHBU CFSWBSJBTJ QBEB NBTJOHNBTJOH CFSBU LFIJMBOHBO DBJSBO NFMBMVJ LFSJOHBU LBEBOHLBEBOH PSBOHEBOCBILBOQBEBPSBOHZBOHTBNBQBEBIBSJZBOHCFSCF NFOJOHLBU TBNQBJ -KBN )BM UFSTFCVU BLBO EFOHBO DFQBU EB CFSHBOUVOH QBEB DVBDB LFCJBTBBO EBO UJOHLBU BLUJWJUBT NFOHIBCJTLBO DBJSBO UVCVI KJLB BTVQBO KVHB UJEBL EJUJOHLBULBO GJTJL EFOHBONFOHBLUJWBTJNFLBOJTNFIBVT ZBOHBLBOEJCBIBTEJ#BC Kehilangan Cairan Tubuh Harian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nit V Cairan Tubuh dan Ginjal Tabel 25-1 Asupan dan Keluaran Cairan Harian (dalam ml/hari) Ginjal Paru Normal Aktivitas Berat eses Berkepanjangan eringat Plasma istem im atik ulit airan ekstraselular Asupan embran kapiler Minuman dan makanan 2100 ? aran Dari metabolisme 200 200 interstisial Total asupan 2300 ? Keluaran embran sel Tidak dirasakan—Kulit 350 350 Tidak dirasakan—paru 350 650 Keringat 100 5000 Feses 100 100 airan intraselular Urine 1400 500 Toatal keluaran 2300 6600 ,FIJMBOHBO"JSNFMBMVJ(JOKBM,FIJMBOHBOBJSMBJOOZBEBSJ UVCVI BEBMBI MFXBU VSJOF ZBOH EJFLTSFTJLBO PMFI HJOKBM "EB Gambar 25-1 Ringkasan pengaturan cairan tubuh, meliputi CFSCBHBJ NFLBOJTNF ZBOH NFOHBUVS LFDFQBUBO FLTLSFTJ VSJOF kompartemen-kompartemen cairan tubuh utama dan membran yang #BILBO DBSB UFSQFOUJOH ZBOH EJMBLVLBO PMFI UVCVI EBMBN memisahkan kompartemen-kompartemen ini. Nilai yang diperlihatkan NFNQFSUBIBOLBO LFTFJNCBOHBO BTVQBO EBO LFMVBSBO DBJSBO adalah untuk orang "rata-rata" dengan berat badan 70 kg. TFSUBLFTFJNCBOHBOBOUBSBBTVQBOEBOLFMVBSBOTFCBHJBOCFTBS FMFLUSPMJUEJUVCVIBEBMBIEFOHBONFOHBUVSLFDFQBUBOFLTLSFTJ 3BUBSBUB TFPSBOH MBLJMBLJ EFXBTB EFOHBO CFSBU LJMPHSBN [BU[BU UFSTFCVU EBSJ HJOKBM.JTBMOZB WPMVNF VSJOF EBQBU NFNJMJLJ UPUBM DBJSBO UVCVI TFLJUBS QFSTFO CFSBU CBEBO BUBV CFSLVSBOH TBNQBJ -IBSJ QBEB PSBOH ZBOH NFOHBMBNJ TFLJUBS - 1FSTFOUBTF JOJ EBQBU CFSVCBI CFSHBOUVOH LFQBEB EFIJESBTJ BUBV CJTB TFCBOZBL -IBSJ QBEB PSBOH ZBOH VNVS KFOJT LFMBNJO EBO EFSBKBU PCFTJUBT 4FJSJOH EFOHBO NFNJOVNTFKVNMBICFTBSBJS QFSUVNCVIBO TFTFPSBOH QFSTFOUBTF UPUBM DBJSBO UVCVI UFSIBEBQ 7BSJBTJ BTVQBO JOJ KVHB UFSKBEJ QBEB LFCBOZBLBO FMFLUSPMJU CFSBUCBEBOCFSBOHTVSBOHTVSUVSVO)BMUFSTFCVUBEBMBITFCBHJBO UVCVI TFQFSUJ OBUSJVN LMPSJEB EBO LBMJVN 1BEB CFCFSBQB BLJCBU EBSJ QFOVBBO ZBOH CJBTBOZB CFSIVCVOHBO EFOHBO PSBOH BTVQBOOBUSJVNEBQBUTFSFOEBIN&RIBSJ TFEBOHLBO QFOJOHLBUBO QFSTFOUBTF MFNBL UVCVI TFIJOHHB NFOHVSBOHJ QBEB PSBOH MBJO EBQBU NFODBQBJ TBNQBJ N&RIBSJ QFSTFOUBTFDBJSBOEBMBNUVCVI (JOKBMCFSUVHBTVOUVLNFOZFTVBJLBOLFDFQBUBOFLTLSFTJBJSEBO 0MFILBSFOBXBOJUBQBEBOPSNBMOZBNFNQVOZBJMFNBLUVCVI FMFLUSPMJU EFOHBO BTVQBO [BU[BU UFSTFCVU EBO NFOHPNQFOTBTJ MFCJI CBOZBL EBSJ QSJB DBJSBO UVCVI UPUBM NFSFLB SBUBSBUB LFIJMBOHBOBJSEBOFMFLUSPMJUZBOHCFSMFCJIBOZBOHUFSKBEJQBEB CFSLJTBS TFLJUBS QFSTFO EBSJ CFSBU CBEBOOZB 1BEB CBZJ QFOZBLJUQFOZBLJU UFSUFOUV 1BE #BC TBNQBJ LJUB BLBO QSFNBUVS EBO ZBOH CBSV MBIJS KVNMBI UPUBM DBJSBO UVCVIOZB NFNCBIBT NFLBOJTNF ZBOH NFNVOHLJOLBO HJOKBM VOUVL CFSLJTBSBOUBSBTBNQBJQFSTFOEBSJCFSBUCBEBOOZB+BEJ CJMB NFMBLVLBOUVHBTOZBZBOHMVBSCJBTBJOJ LJUBNFNCBIBTLPNQBSUFNFODBJSBOUVCVISBUBSBUB LJUBIBSVT NFOZBEBSJBEBOZBWBSJBTJ CFSHBOUVOHQBEBVNVS KFOJTLFMBNJO EBOQFSTFOUBTFMFNBLUVCVI Kompartemen Cairan Tubuh Kompartemen Cairan Instraselular 4FNVB DBJSBO UVCVI EJEJTUSJCVTJLBO UFSVUBNB EJ BOUBSB EVB 4FLJUBS EBSJ - DBJSBO UVCVI BEB EJ EBMBN USJMJVO TFM LPNQBSUFNFO DBJSBO FLTUSBTFMVMBS EBO DBJSBO JOUSBTFMVMBS EBOTFDBSBLFTFMVSVIBOEJTFCVUDBJSBOJOUSBTFMVMBS+BEJ DBJSBO (BNCBS $BJSBO FLTUSBTFMVMBS EJCBHJ NFOKBEJ DBJSBO JOUSBTFMVMBS NFSVQBLBO QFSTFO EBSJ CFSBU CBEBO UPUBM QBEB JOUFSTUJTJBMEBOQMBTNBEBSBI SBUBSBUBPSBOH "EBKVHBLPNQBSUFNFODBJSBOMBJOOZBZBOHLFDJMZBOHEJTF $BJSBO NBTJOHNBTJOH TFM NFOHBOEVOH DBNQVSBOOZB CVUTFCBHBJDBJSBOUSBOTFMVMBS,PNQBSUFNFOJOJNFMJQVUJDBJSBO UFSTFOEJSJ EFOHBO CFSCBHBJ [BU OBNVO LPOTFOUSBTJ [BU[BU JOJ EBMBNSPOHHBTJOPWJBM QFSJUPOFVN QFSJLBSEJVN EBOJOUSBPLV NJSJQBOUBSBTBUVTFMEFOHBOTFMMBJOOZB4FCFOBSOZB LPNQPTJTJ MBS TFSUB DBJSBO TFSFCSPTQJOBM DBJSBODBJSBO UFSTFCVU CJBTBOZB DBJSBO TFM TBOHBU NJSJQ CBILBO QBEB IFXBO ZBOH CFSCFEB EJBOHHBQ TFCBHBJ KFOJT DBJSBO FLTUSBTFMVMBS LIVTVT XBMBVQVO NVMBJ EBSJ NJLSPPSHBOJTNF QBMJOH QSJNJUJG TBNQBJ NBOVTJB QBEB CFCFSBQB LBTVT LPNQPTJTJOZB EBQBU TBOHBU CFSCFEB 0MFI TFCBC JUV DBJSBO JOUSBTFMVMBS EBSJ TFMVSVI TFM ZBOH EFOHBO LPNQPTJTJ QMBTNB BUBV DBJSBO JOUFSTUJTJBM $BJSBO CFSCFEBCFEB EJBOHHBQ TFCBHBJ TBUV LPNQBSUFNFO DBJSBO ZBOH USBOTFMVMBSTFMVSVIOZBCFSKVNMBITFLJUBSTBNQBJMJUFS CFTBS 286 Bab 25 Kompartemen Cairan Tubuh: Cairan Ekstraselular dan Intraselutar; Edema Komposisis Ion Plasma Serupa dengan Komposisi Ion Kompartemen Cairan Ekstraselular Cairan Interstisial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olume Darah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nsur-Unsur Cairan Intraselular TFMTFM JOJ NFOKBEJ CFOBSCFOBS NBNQBU EJ CBHJBO CBXBI UB $BJSBO JOUSBTFMVMBS EJQJTBILBO EBSJ DBJSBO FLTUSBTFMVMBS PMFI CVOH4FNVBTFMEBSBINFSBIUJEBLNVOHLJOVOUVLEJNBNQBU NFNCSBOTFM ZBOH TBOHBUQFSNFBCFMUFSIBEBQBJS UFUBQJUJEBL LBOLBSFOBOZB TFLJUBSTBNQBJQFSTFOQMBTNBUFUBQUFSKFCBL QFSNFBCFM UFSIBEBQ TFCBHJBO CFTBS FMFLUSPMJU EBMBN UVCVI EJ BOUBSB TFMTFM EBO OJMBJ IFNBUPLSJU ZBOH TFCFOBSOZB IBOZB #FSCFEBEFOHBODBJSBOFLTUSBTFMVMBS DBJSBOJOUSBTFMVMBSIBOZB TFLJUBSQFSTFOEBSJOJMBJIFNBUPLSJUZBOHUFSVLVS NFOHBOEVOH TFKVNMBI LFDJM JPO OBUSJVN EBO LMPSJEB EBO 1BEBQSJB OJMBJIFNBUPLSJUZBOHUFSVLVSOPSNBMOZBTFLJUBS IBNQJS UJEBL BEB JPO LBMTJVN.BMBI DBJSBO JOJ NFOHBOEVOH EBO QBEB XBOJUB LJSBLJSB 1BEB BOFNJB CFSBU TFKVNMBICFTBSJPOLBMJVNEBOGPTGBUEJUBNCBIJPONBHOFTJVN IFNBUPLSJU EBQBU UVSVO TBNQBJ ZBJUV TVBUV OJMBJ ZBOH EBO TVMGBU EBMBN KVNMBI TFEBOH TFNVB JPO JOJ NFNJMJLJ IBNQJSUJEBLDVLVQVOUVLNFNQFSUBIBOLBOIJEVQ4FCBMJLOZB LPOTFOUSBTJ ZBOH SFOEBI EJ DBJSBO FLTUSBTFMVMBS 4FM KVHB BEBCFCFSBQBLPOEJTJZBOHNFOHBLJCBULBOUFSKBEJOZBQSPEVLTJ NFOHBOEVOH TFKVNMBI CFTBS QSPUFJO IBNQJS FNQBU LBMJ TFM EBSBI NFSBI ZBOH CFSMFCJIBO ZBJUV QPMJTJUFNJB 1BEB KVNMBIQSPUFJOEBMBNQMBTNB LPOEJTJUFSTFCVU OJMBJIFNBUPLSJUEBQBUNFOJOHLBUTBNQBJ Pengukuran Volume Cairan di Berbagai Kompartemen Cairan Tubuh—Prinsip Pengeceran- indikator. Konstituensi Cairan Ekstraselular dan Intraselular 7PMVNF LPNQBSUFNFO DBJSBO EBMBN UVCVI EBQBU EJVLVS EFOHBONFNBTVLLBOTVBUV[BUJOEJLBUPSEBMBNLPNQBSUFNFO 1FSCBOEJOHBO LPNQPTJTJ DBJSBO FLTUSBTFMVMBS ZBOH NFMJQVUJ ZBOH EJCJBSLBO UFSTFCBS TFDBSB NFSBUB LF TFMVSVI DBJSBO QMBTNB EBO DBJSBO JOUFSTUJTJBM EBO DBJSBO JOUSBTFMVMBS LPNQBSUFNFO EBO LFNVEJBO NFOHBOBMJTJT TFKBVI NBOB [BU EJQFSMJIBULBOQBEB(BNCBSEBOEBOQBEB5BCFM UFSTFCVUUFSFODFSLBO(BNCBSNFNQFSMJIBULBONFUPEF 287 Unit V Cairan Tubuh dan Ginjal a n n n 150 100 os olipid- mg dl 50 HCO3 Na Ca Cl 0 K Mg Protein m PO ––4 dan anion organik olestrol mg dl 50 100 emak netral mg dl – Glukosa mg dl 150 I Urea - mg dl Gambar - ation dan anion utama airan intraselular sam laktat - mg dl dan ekstraselular onsentrasi a dan g me akili sam urat- mg dl jumla kedua ion ml onsentrasi ang diperli atkan reatinin- mg dl me akili keseluru an ion bebas dan ion kompleks ilirubin- mg dl Garam empedu- sangat sedikit Gambar - plasma non-elektrolit Tabel 25-2 Osmolaritas Zat-Zat dalam Cairan Ekstraselular dan Intraselular Plasma (mOsm/L H2O) Interstisial (mOsm/L H2O) intraselular (mOsm/L H2O) Na+ 142 139 14 K + 4.2 4.0 140 Ca ++ 1.3 1.2 0 Mg++ 0.8 0.7 20 Cl− 108 108 4 HCO3 24 28.3 10 HPO4 , H2PO4 = 2 2 11 SO4= 0.5 0.5 1 Fosfokreatin 45 Karnosin 14 Asam amino 2 2 8 Kreatin 0.2 0.2 9 Laktat 1.2 1.2 1.5 Adenosin trifosfat 5 Heksosa monofosfat 3.7 Glukosa 5.6 5.6 Protein 1.2 0.2 4 Urea 4 4 4 Lain-lain 4.8 3.9 10 Total mOsm/L 301.8 300.8 301.2 Aktivitas osmolar terkoreksi(mOsm/L) 282.0 281.0 281.0 Tekanan osomotik total pada 37 °C (mm Hg) 5443 5423 5423 288 Bab 25 Kompartemen Cairan Tubuh: Cairan Ekstraselular dan Intraselutar; Edema.FUPEFJOJEBQBUEJHVOBLBOVOUVLNFOHVLVSWPMVNFEBO IBNQJS TFNVB LPNQBSUFNFO UVCVI LBMBV JOEJLBUPS UFSTFCBS TFDBSB NFSBUB LF TFMVSVI LPNQBSUFNFO ndikator ass olume onsentrasi JOEJLBUPS IBOZB UFSTFCBS QBEB LPNQBSUFNFO ZBOH TFEBOH EJVLVS EBO JOEJLBUPSUJEBLNFOHBMBNJNFUBCPMJTNFBUBV UNIT V EJFLTLSFTJ #FCFSBQB [BU EBQBU EJHVOBLBO VOUVL NFOHVLVS ndikator assa ndikator ass WPMVNFNBTJOHNBTJOHDBJSBOUVCVIZBOHCFSCFEB Penentuan Volume Kompartemen Cairan Tubuh yang Spesifik 1FOHVLVSBO$BJSBO5VCVI5PUBM"JSSBEJPBLUJG USJUJVN ) BUBV BJS CFSBU EFVUFSJVN ) EBQBU EJHVOBLBO ndikator ass olume on entration VOUVL NFOHVLVS DBJSBO UVCVI UPUBM #FOUVL DBJSBO JOJ olume ndikator assa on entration CFSDBNQVS EFOHBO DBJSBO UVCVI UPUBM EBMBN LVSVO XBLUV Gambar - etoda pengen eran indikator untuk CFCFSBQB KBN TFUFMBI EJTVOUJLLBO LF EBMBN EBSBI EBO mengukur volume airan QSJOTJQ QFOHFODFSBO EBQBU EJHVOBLBO VOUVL NFOHIJUVOH DBJSBO UVCVI UPUBM 5BCFM ;BU MBJO ZBOH UFMBI QFOHFODFSBOJOEJLBUPS JOJ VOUVL NFOHVLVS WPMVNF LPNQBSUF EJHVOBLBO VOUVL NFOHVLVS DBJSBO UVCVI UPUBM BEBMBI NFODBJSBO.FUPEFJOJEJEBTBSLBOQBEBQSJOTJQLFLFLBMBONBTTB BOUJQJSJO ZBOH TBOHBU MBSVU EBMBN MFNBL EBO DFQBU ZBOH CFSBSUJ CBIXB NBTTB UPUBM [BU ZBOH TVEBI UFSTFCBS EBMBN CFSQFOFUSBTJNFMBMVJNFNCSBOTFMEBOUFSTFCBSTFDBSBNFSBUB LPNQBSUFNFODBJSBOBLBOTBNBEFOHBONBTTBUPUBMZBOHEJTVO LFTFMVSVILPNQBSUFNFOJOUSBTFMEBOFLTUSBTFM UJLLBOLFEBMBNLPNQBSUFNFO 1FOHVLVSBO7PMVNF$BJSBO&LTUSBTFMVMBS7PMVNFDBJSBO %BMBNDPOUPIZBOHEJQFSMJIBULBOQBEB(BNCBS TFKVNMBI FLTUSBTFMVMBS EBQBU EJQFSLJSBLBO EFOHBO NFOHHVOBLBO CFCF LFDJM [BU QFXBSOB BUBV [BU MBJO ZBOH UFSEBQBU EBMBN TFNQSJU SBQB[BUZBOHUFSTFCBSEBMBNDBJSBOJOUFSTUJTJBMEBOQMBTNBUBQJ EJJOKFLTJLBO LF EBMBN TVBUV SVBOHBO MBMV [BU JOJ EJCJBSLBO UJEBL EBQBU NFOFNCVT NFNCSBO TFM EFOHBO NVEBI ;BU[BU UFSTFCBSLFTFMVSVISVBOHBOTBNQBJUFSDBNQVSEBMBNLPOTFOUSBTJ JOJ NFMJQVUJ OBUSJVN SBEJPBLUJG LMPSJEB SBEJPBLUJG JPUBMBNBU ZBOHTBNBEJTFMVSVIBSFB,FNVEJBOEJBNCJMTVBUVDPOUPIDBJSBO SBEJPBLUJG JPOUJPTVMGBU EBOJOVMJO#JMBTBMBITBUVEBSJ[BU[BU ZBOH NFOHBOEVOH [BU ZBOH UFSTFCBS JUV EBO LPOTFOUSBTJOZB JOJEJTVOUJLLBOLFEBMBNEBSBI [BUUFSTFCVUCJBTBOZBUFSTFCBS EJBOBMJTJTTFDBSBLJNJBXJ GPUPFMFLUSJL BUBVEFOHBODBSBMBJO+JLB IBNQJS TFDBSB NFSBUB LF TFMVSVI DBJSBO FLTUSBTFMVMBS EBMBN UJEBLBEB[BUZBOHCPDPSEBSJLPNQBSUFNFO NBTTBUPUBM[BUEBMBN XBLUV TBNQBJ NFOJU /BNVO CFCFSBQB [BU JOJ TFQFSUJ LPNQBSUFNFO 7PMVNF # Y ,POTFOUSBTJ # BLBO TBNB EFOHBO OBUSJVNSBEJPBLUJG EBQBUCFSEJGVTJLFEBMBNTFMEBMBNKVNMBI NBTTB UPUBM [BU ZBOH EJJOKFLTJLBO 7PMVNF " Y ,POTFOUSBTJ " ZBOH LFDJM 0MFI LBSFOB JUV LJUB TFSJOH LBMJ NFOZFCVUOZB %FOHBO NFOZFEFSIBOBLBO QFSIJUVOHBO TFTFPSBOH BLBO EBQBU TFCBHBJ SVBOH OBUSJVN BUBV SVBOH JOVMJO EBO CVLBO NFOHIJUVOHWPMVNF#ZBOHUJEBLEJLFUBIVJEFOHBOSVNVT QFOHVLVSBOWPMVNFDBJSBOFLUSBTFMZBOHTFTVOHHVIOZB Volume A n en ra A Volume B = n en ra B Tabel 25-3 Pengukuran Volume Cairan Tubuh Volume Indikator 1FSIBUJLBO CBIXB IBMIBM ZBOH QFSMV EJLFUBIVJ VOUVL QFSIJUVOHBOJOJBEBMBI KVNMBIUPUBM[BUZBOHEJJOKFLTJLBOLF Total cairan tubuh H2O, 2H2O, antipirin 3 EBMBNSVBOHBO QFNCJMBOHEBOQFSTBNBBO EBO LPOTFOUSBTJ Cairan ekstraselular 22Na,125I-iotalamat, tiosulfat, DBJSBOEBMBNSVBOHBOTFUFMBI[BUUFSTFCBS QFOZFCVU inulin Cairan intraselular (Dihitung dengan; Total cairan $POUPIOZB KJLB NM MBSVUBO ZBOH NFOHBOEVOH NH NM tubuh-volume cairan ekstraselular) [BU XBSOB EJTFCBS LF EBMBN SVBOHBO # EBO LPOTFOUSBTJ BLIJS EBMBN SVBOH # BEBMBI NJMJHSBN VOUVL TFUJBQ NJMJMJUFS Volume plasma 123I-albumin, pewarna biru Evans (T-1824) DBJSBO WPMVNFSVBOH#EBQBUEJIJUVOHTFCBHBJCFSJLVU Volume darah Sel darah merah berlabel 51Cr, atau dihitung dengan: volume darah = Volume plasma/(1 - Hermatokrit) Cairan interstisial (Calculated as extracellular 1 ml 10 mg/ml Volume B = = 1000 ml fluid volume − Plasma volume) 0.01 mg/ml 289 Unit V Cairan Tubuh dan Ginjal 1FOHIJUVOHBO 7PMVNF *OUSBTFM 7PMVNF JOUSBTFM UJEBL MBUJGDBJSBOFLTUSBTFMVMBSZBOHEJEJTUSJCVTJLBOBOUBSBQMBTNBEBO EBQBU EJVLVS TFDBSB MBOHTVOH /BNVO EBQBU EJIJUVOH TFCBHBJ SVBOH JOUFSTUJTJBM UFSVUBNB EJUFOUVLBO PMFI LFTFJNCBOHBO EBZB CFSJLVU IJESPTUBUJLEBOPTNPUJLLPMPJEEJTFQBOKBOHNFNCSBOLBQJMFS 4FCBMJLOZB EJTUSJCVTJDBJSBOBOUBSBLPNQBSUFNFOFLTUSBTFMVMBS Volume intrasel= Cairan tubuh total –Volume ekstrasel EBO JOUSBTFMVMBS UFSVUBNB EJUFOUVLBO PMFI FGFL PTNPUJL EBO [BU UFSMBSVU ZBOH MFCJI TFEJLJU LIVTVTOZB OBUSJVN LMPSJEB EBO 1FOHVLVSBO 7PMVNF 1MBTNB 6OUVL NFOHVLVS WPMVNF FMFLUSPMJU MBJO ZBOH CFLFSKB EJ TFQBOKBOH NFNCSBO TFM "MBTBO QMBTNB IBSVTEJHVOBLBOTVBUV[BUZBOHUJEBLEBQBUNFOFNCVT VOUVL IBM JOJ JBMBI CBIXB NFNCSBO TFM TBOHBU QFSNFBCFM NFNCSBO LBQJMFS EFOHBO NVEBI UBQJ UFUBQ EBMBN TJTUFN UFSIBEBQ DBJSBO UFUBQJ SFMBUJG JNQFSNFBCFM UFSIBEBQ JPO ZBOH WBTLVMBS TFUFMBI EJJOKFLTJ 4BMBI TBUV [BU ZBOH QBMJOH TFSJOH LFDJMTFQFSUJOBUSJVNEBOLMPSJEB0MFILBSFOBJUV DBJSBOEFOHBO EJHVOBLBO VOUVL NFOHVLVS WPMVNF QMBTNB JBMBI BMCVNJO DFQBU CFSHFSBL NFMJOUBTJ NFNCSBO TFM EBO DBJSBO JOUSBTFMVMBS TFSVN ZBOH EJMBCFM EFOHBO SBEJPBLUJG *"MCVNJO ;BU UFUBQJTPUPOJLUFSIBEBQDBJSBOFLTUSBTFMVMBS QFXBSOB ZBOH KVHB UFSJLBU LVBU QBEB QSPUFJO QMBTNB TFQFSUJ %J CBHJBO CFSJLVUOZB LJUB BLBO NFNCBIBT NFOHFOBJ IVCV QFXBSOB &WBOT #MVF KVHB EJTFCVU 5 EBQBU EJHVOBLBO OHBOBOUBSBWPMVNFDBJSBOJOUSBTFMVMBSEBOFLTUSBTFMTFSUBGBLUPS VOUVLNFOHVLVSWPMVNFQMBTNB GBLUPS PTNPUJL ZBOH EBQBU NFOZFCBCLBO QFSQJOEBIBO DBJSBO BOUBSBLFEVBLPNQBSUFNFOUFSTFCVU 1FOHIJUVOHBO 7PMVNF $BJSBO *OUFSTUJTJBM 7PMVNF DBJ SBO JOUFSTUJTJBM UJEBL EBQBU EJIJUVOH TFDBSB MBOHTVOH UFUBQJ Prinsip Dasar Osmosis dan EBQBUEJIJUVOHEFOHBOSVNVT Tekanan Osmotik Volume Cairan Interstisial = 1SJOTJQ EBTBS PTNPTJT EBO UFLBOBO PTNPUJL TVEBI EJKFMBTLBO EJ Volume Cairan Ekstraselular– Volume plasma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olume plasma Volume darah total = 1 –Hematokrit SFOEBI LPOTFOUSBTJ BJSOZB 4FMBOKVUOZB DBJSBO CFSEJGVTJ EBSJ EBFSBIEFOHBOLPOTFOUSBTJ[BUUFSMBSVUZBOHSFOEBI LPOTFOUSBTJ $POUPIOZB KJLB WPMVNF QMBTNB JBMBI - EBO IFNBUPLSJU BJS ZBOH UJOHHJ LF EBFSBI EFOHBO LPOTFOUSBTJ [BU UFSMBSVU ZBOH BEBMBI WPMVNFEBSBIUPUBMEBQBUEJIJUVOHTFCBHBJCFSJLVU UJOHHJ LPOTFOUSBTJBJSZBOHSFOEBI 0MFI LBSFOB NFNCSBO TFM SFMBUJG JNQFSNFBCFM UFSIBEBQ MJUFS LFCBOZBLBO [BU UFSMBSVU UBQJ TBOHBU QFSNFBCFM UFSIBEBQ BJS MJUFS QFSNFBCFMTFMFLUJG NBLBCJMBQBEBTBMBITBUVTJTJNFNCSBOTFM LPOTFOUSBTJ [BU UFSMBSVUOZB MFCJI UJOHHJ BJS BLBO CFSEJGVTJ $BSB MBJO VOUVL NFOHVLVS WPMVNF EBSBI JBMBI EFOHBO NFMJOUBTJ NFNCSBO NFOVKV EBFSBI EFOHBO LPOTFOUSBTJ [BU NFOZVOUJLLBONBUFSJBMCFSMBCFMSBEJPBLUJGLFEBMBNTJSLVMBTJ UFSMBSVU ZBOH MFCJI UJOHHJ +BEJ KJLB TVBUV [BU UFSMBSVU TFQFSUJ TFMEBSBINFSBI4FUFMBI[BUJOJCFSDBNQVSEJEBMBNTJSLVMBTJ OBUSJVN LMPSJEB EJUBNCBILBO LF EBMBN DBJSBO FLTUSBTFMVMBS BJS SBEJPBLUJWJUBT TBNQFM EBSBI ZBOH CFSDBNQVS EBQBU EJVLVS EFOHBO DFQBU CFSEJGVTJ EBSJ TFM NFMBMVJ NFNCSBO TFM LF EBMBN EBOWPMVNFEBSBIUPUBMEBQBUEJIJUVOHEFOHBONFOHHVOBLBO DBJSBO FLTUSBTFMVMBS TBNQBJ LPOTFOUSBTJ BJS QBEB LFEVB TJTJ QSJOTJQ QFOHFODFSBO JOEJLBUPS ;BU ZBOH TFSJOH LBMJ EJQBLBJ NFNCSBO TBNB 4FCBMJLOZB KJLB TVBUV [BU UFSMBSVU TFQFSUJ VOUVL NFMBCFM TFM EBSBI NFSBI BEBMBI LSPNJVN SBEJPBLUJG OBUSJVN LMPSJEB EJLFMVBSLBO EBSJ DBJSBO FLTUSBTFMVMBS BJS BLBO $S ZBOHUFSJLBUFSBUEFOHBOTFMEBSBINFSBI CFSEJGVTJ EBSJ DBJSBO FLTUSBTFMVMBS NFMBMVJ NFNCSBO TFM EBO NBTVL LF EBMBN TFM ,FDFQBUBO EJGVTJ BJS JOJ EJTFCVU LFDFQBUBO PTNPTJT )VCVOHBO BOUBSB.PM EBO 0TNPM 0MFI LBSFOB LPOTFOUSBTJ Pengaturan Pertukaran Cairan dan Keseimbangan BJSEBSJTVBUVMBSVUBOCFSHBOUVOHQBEBKVNMBIQBSUJLFM[BUUFSMBSVU Osmotik antara Cairan Ekstraselular dan EBMBN MBSVUBO EJCVUVILBO TVBUV JTUJMBI LPOTFOUSBTJ VOUVL Intraselular NFOHHBNCBSLBO LPOTFOUSBTJ UPUBM QBSUJLFM [BU UFSMBSVU UBOQB NFNQFSIBUJLBO LPNQPTJTJOZB ZBOH QBTUJ +VNMBI UPUBM QBSUJLFM.BTBMBIZBOHTFSJOHLBMJUJNCVMEBMBNNFOBOHBOJQBTJFOZBOH EBMBNTVBUVMBSVUBOEJVLVSEBMBNPTNPM4BUVPTNPM PTN TBNB TBLJU CFSBU BEBMBI NFNQFSUBIBOLBO DBJSBO ZBOH BEFLVBU QBEB EFOHBONPM Y QBSUJLFM[BUUFSMBSVU0MFILBSFOBOZB TBUV BUBV LFEVB LPNQBSUFNFO JOUSBTFM EBO FLTUSBTFM 4FQFSUJ TVBUVMBSVUBOZBOHNFOHBOEVOHNPMHMVLPTBEBMBNTFUJBQMJUFS ZBOHEJCBIBTEJ#BCEBOLFNVEJBOEBMBNCBCJOJ KVNMBISF NFNQVOZBJLPOTFOUSBTJPTN-+JLBTVBUVNPMFLVMCFSEJTPTJBTJ 290 Bab 25 Komparternen Cairan Tubuh: Cairan Ekstraselutar dan Intraselutar; Ederna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hU)PGG LJUB EBQBU NFOHIJUVOH UFLBOBO PTNPUJL QPUFOTJBM TVBUV MBSVUBO EFOHBO NFOHBOHHBQ CBIXB NFNCSBO TFM CFSTJGBU JNQFSNFBCFM Keseimbangan Osmotik Dipertahankan antara UFSIBEBQ [BU UFSMBSVU $POUPIOZB UFLBOBO PTNPUJL MBSVUBO Cairan Intraselular dan Cairan Ekstraselular QFSTFO OBUSJVN LMPSJEB EJIJUVOH TFCBHBJ CFSJLVU -BSVUBO %FOHBO QFSVCBIBO LPOTFOUSBTJ ZBOH SFMBUJG LFDJM QBEB [BU QFSTFOCFSBSUJCBIXBUFSEBQBU HSBNOBUSJVNLMPSJEBQFS UFSMBSVU EBMBN DBJSBO FLTUSBTFMVMBS UFLBOBO PTNPUJL ZBOH NM MBSVUBO BUBV H- 0MFI LBSFOB CFSBU NPMFLVM OBUSJVN CFTBS EBQBU UFSCFOUVL EJ TFQBOKBOH NFNCSBO TFM 4FQFSUJ LMPSJEBBEBMBI HNPM NPMBSJUBTMBSVUBOBEBMBIH-EJCBHJ ZBOH UFMBI EJCBIBT TFCFMVNOZB VOUVL TFUJBQ HSBEJFO HNPM BUBVTFLJUBS NPM-0MFILBSFOBTFUJBQNPMFLVM LPOTFOUSBTJ NJMJPTNPM TVBUV [BU UFSMBSVU JNQFSNFBCFM [BU OBUSJVNLMPSJEBTFUBSBEFOHBOPTNPM PTNPMBSJUBTMBSVUBOJBMBI UFSMBSVU ZBOH UJEBL EBQBU NFOFNCVT NFNCSBO TFM Y BUBV PTN-0MFILBSFOBJUV PTNPMBSJUBTMBSVUBO EJIBTJMLBO UFLBOBO PTNPUJL TFLJUBS NN )H EJ JOJBEBMBIN0TN-5FLBOBOPTNPUJLQPUFOTJBMMBSVUBOJOJ TFQBOKBOH NFNCSBO TFM +JLB NFNCSBO TFM UFSQBKBO BJS BLBO NFOKBEJ N0TN- Y NN )HN0TN - BUBV NVSOJ EBO PTNPMBSJUBT DBJSBO JOUSBTFMVMBS BEBMBI TFCFTBSNN)H N0TN- NBLB UFLBOBO PTNPUJL QPUFOTJBM ZBOH EBQBU 1FOHIJUVOHBO JOJ IBOZBMBI TVBUV QFSLJSBBO LBSFOB JPO UJNCVM EJ TFQBOKBOH NFNCSBO TFM BEBMBI MFCJI EBSJ OBUSJVN EBO LMPSJEB UJEBL TFMVSVIOZB CFCBT EBMBN MBSVUBO NN )H )BM JOJ NFNQFSMJIBULBO CBIXB EJCVUVILBO EBZB BLJCBU BEBOZB EBZB UBSJL BOUBS JPOJPO JOJ ,JUB EBQBU ZBOH CFTBS VOUVL NFNJOEBILBO BJS BHBS EBQBU NFMJOUBTJ NFOHPSFLTJ EFWJBTJ JOJ CFSEBTBSLBO QSFEJLTJ IVLVN WBOhU )PGG NFNCSBOTFMCJMBDBJSBOJOUSBTFMVMBSEBOFLTUSBTFMVMBSUJEBL EFOHBO NFOHHVOBLBO GBLUPS LPSFLTJ ZBOH EJTFCVU LPFGJTJFO CFSBEBEBMBNLFTFJNCBOHBOPTNPUJL"LJCBUEBZBUFSTFCVU PTNPUJL 6OUVL OBUSJVN LMPSJEB LPFGJTJFO PTNPUJLOZB TFLJUBS QFSVCBIBO ZBOH SFMBUJG LFDJM QBEB LPOTFOUSBTJ [BU UFSMBSVU .BLB PTNPMBSJUBTTFCFOBSOZBEBSJMBSVUBOOBUSJVNLMPSJEB JNQFSNFBCFM EBMBN DBJSBO FLTUSBTFMVMBS TVEBI EBQBU QFSTFO JBMBI Y BUBV TFLJUBS N0TN- 6OUVL NFOZFCBCLBOQFSVCBIBOCFTBSQBEBWPMVNFTFM BMBTBO QSBLUJT LPFGJTJFO PTNPUJL EBSJ CFCFSBQB [BU UFSMBSVU $BJSBO *TPUPOJL )JQPUPOJL EBO )JQFSUPOJL &GFL LBEBOHLBEBOH EJBCBJLBO EBMBN NFOFOUVLBO PTNPMBSJUBT EBO QFSCFEBBOLPOTFOUSBTJ[BUUFSMBSVUJNQFSNFBCFMEBMBNDBJSBO UFLBOBOPTNPUJLMBSVUBOGJTJPMPHJT FLTUSBTFMVMBSUFSIBEBQWPMVNFTFMUFSMJIBUQBEB(BNCBS +JLB TVBUV TFM EJMFUBLLBO QBEB TVBUV MBSVUBO EFOHBO [BU UFSMBSVU JNQFSNFBCFM ZBOH NFNQVOZBJ PTNPMBSJUBT N0TN- TFMUJEBLBLBONFOHFSVUBUBVNFNCFOHLBLLBSFOB 291 Unit V Cairan Tubuh dan Ginjal MTUJMBI IJQFSPTNPUJL EBO IJQPPTNPUJL TFDBSB CFSUVSVU UVSVU NFSVKVL QBEB MBSVUBO ZBOH NFNQVOZBJ PTNPMBSJUBT MFCJIUJOHHJBUBVMFCJISFOEBI EJCBOEJOHLBOEFOHBODBJSBO FLTUSBTFMVMBS OPSNBM UBOQB NFNQFSIBUJLBO LFNBNQVBO [BU UFSMBSVUUFSTFCVUVOUVLNFOFNCVTNFNCSBOTFM;BU[BUZBOH TBOHBU QFSNFBCFM TFQFSUJ VSFVN EBQBU NFOZFCBCLBO QFSHF TFSBOTFNFOUBSBWPMVNFDBJSBOBOUBSBDBJSBOJOUSBTFMVMBSEBO m sm FLTUSBTFMVMBS UFUBQJ NFNCFSJLBO DVLVQ XBLUV TBNQBJ N BLIJSOZB LPOTFOUSBTJ [BU[BU JOJ NFOKBEJ TBNB QBEB LFEVB idak ada peruba an LPNQBSUFNFOEBONFNCFSJTFEJLJUFGFLQBEBWPMVNFJOUSBTFM EBMBNLFBEBBONBOUBQ ,FTFJNCBOHBO0TNPUJLBOUBSB$BJSBO*OUSBTFMVMBSEBO &LTUSBTFMVMBS %JDBQBJ EFOHBO $FQBU 1FSQJOEBIBO DBJSBO ZBOHNFMJOUBTJNFNCSBOTFMUFSKBEJTFEFNJLJBODFQBUTFIJOHHB TFUJBQ QFSCFEBBO PTNPMBSJUBT BOUBSB LFEVB LPNQBSUFNFO JOJ m sm m sm CJBTBOZB BLBO EJLPSFLTJ EBMBN XBLUV CFCFSBQB EFUJL BUBV P N PE N VNVNOZB EBMBN CFCFSBQB NFOJU 1FSHFSBLBO BJS ZBOH DFQBU el membengkak el menu sut JOJ UJEBL CFSBSUJ CBIXB LFTFJNCBOHBO MFOHLBQ ZBOH UFSKBEJ Gambar - E ek larutan isotonik ipertonik dan BOUBSB LPNQBSUFNFO FLTUSBTFM EBO JOUSBTFM EJ TFMVSVI UVCVI ipotonik ter adap volume sel UJNCVMEBMBNXBLUVZBOHTJOHLBUTFDBSBCFSTBNBBO"MBTBOOZB BEBMBI CBIXB DBJSBO CJBTBOZB NFNBTVLJ UVCVI NFMBMVJ VTVT EBO IBSVT EJUSBOTQPSUBTJ PMFI EBSBI LF TFMVSVI KBSJOHBO LPOTFOUSBTJ BJS EBMBN DBJSBO JOUSBTFMVMBS EBO FLTUSBTFM BEBMBI TFCFMVN UFSKBEJ LFTFJNCBOHBO PTNPUJL MFOHLBQ #JBTBOZB TBNB EBO [BU UFSMBSVU UJEBL EBQBU NBTVL BUBV LFMVBS EBSJ TFM EJCVUVILBO XBLUV TFLJUBS NFOJU TFCFMVN UFSDBQBJOZB -BSVUBOTFQFSUJJOJEJTFCVUJTPUPOJLLBSFOBUJEBLNFOJNCVMLBO LFTFJNCBOHBOPTNPUJLEJTFMVSVIUVCVITFUFMBINJOVNBJS QFOHFSVUBO NBVQVO QFNCFOHLBLBO TFM $POUPI MBSVUBO JTPUPOJL NFMJQVUJ MBSVUBO QFSTFO OBUSJVN LMPSJEB BUBV MBSVUBO HMVLPTB QFSTFO -BSVUBOMBSVUBO JOJ QFOUJOH EBMBN Volume dan Osmolalitas Cairan Ekstraselular dan QFOHPCBUBO TFDBSB LMJOJT LBSFOB EBQBU EJJOGVT LF EBMBN EBSBI Intraselular pada Keadaan Abnormal. UBOQBBEBOZBCBIBZBZBOHNFOHBODBNLFTFJNCBOHBOPTNPUJL BOUBSBDBJSBOJOUSBTFMVMBSEBOFLTUSBTFMVMBS #FCFSBQB GBLUPS ZBOH EBQBU NFOZFCBCLBO QFSVCBIBO OZBUB +JLB TFCVBI TFM EJMFUBLLBO EBMBN MBSVUBO IJQPUPOJL ZBOH QBEB WPMVNF DBJSBO JOUSBTFMVMBS EBO FLTUSBTFM BEBMBI NFNQVOZBJLPOTFOUSBTJ[BUUFSMBSVUJNQFSNFBCFMMFCJISFOEBI NFNJOVN BJS EFIJESBTJ JOGVT JOUSBWFOB CFSCBHBJ KFOJT N0TN- BJS BLBO CFSEJGVTJ LF EBMBN TFM EBO NFOZF MBSVUBO LFIJMBOHBO TFKVNMBI CFTBS DBJSBO EBSJ USBLUVT CBCLBOTFMNFNCFOHLBLBJSBLBOUFSVTCFSEJGVTJLFEBMBNTFM HBTUSPJOUFTUJOBM EBO LFIJMBOHBO DBJSBO NFMBMVJ LFSJOHBU ZBOH BLBO NFOHFODFSLBO DBJSBO JOUSBTFMVMBS EBO KVHB BUBVNFMBMVJHJOKBMZBOHCFSMBOHTVOHBCOPSNBM NFNFLBULBO DBJSBO FLTUSBTFMVMBS TBNQBJ LFEVB MBSVUBO NFNQVOZBJ PTNPMBSJUBT ZBOH TBNB -BSVUBO OBUSJVN LMPSJEB ,JUB EBQBU NFOHIJUVOH QFSVCBIBO WPMVNF DBJSBO EFOHBO LPOTFOUSBTJ LVSBOH EBSJ QFSTFO CFSTJGBU IJQPUPOJL FLTUSBTFMVMBS EBO JOUSBTFMVMBS TFSUB KFOJT UFSBQJ ZBOH IBSVT EBONFOZFCBCLBOQFNCFOHLBLBOTFM EJCFSJLBO KJLBQSJOTJQQSJOTJQEBTBSCFSJLVUJOJEJJOHBUEFOHBO +JLB TFCVBI TFM EJMFUBLLBO EBMBN MBSVUBO IJQFSUPOJL ZBOH CBJL NFNQVOZBJ LPOTFOUSBTJ [BU UFSMBSVU JNQFSNFBCFM ZBOH MFCJI 1. "JS CFSHFSBL DFQBU NFMJOUBTJ NFNCSBO TFM LBSFOBOZB UJOHHJ BJS BLBO NFOHBMJS LFMVBS EBSJ TFM LF EBMBN DBJSBO PTNPMBSJUBT DBJSBO JOUSBTFMVMBS EBO FLTUSBTFMVMBS UFUBQ FLTUSBTFMVMBS%BMBNIBMJOJ TFMBLBONFOHLFSVUTBNQBJLFEVB IBNQJS TBNB TBUV TBNB MBJO LFDVBMJ QBEB CFCFSBQB NFOJU LPOTFOUSBTJNFOKBEJTBNB-BSVUBOOBUSJVNLMPSJEBZBOHMFCJI TFUFMBIQFSVCBIBOTBMBITBUVLPNQBSUFNFO CFTBSEBSJ QFSTFOCFSTJGBUIJQFSUPOJL 2..FNCSBO TFM IBNQJS TFQFOVIOZB JNQFSNFBCFM UFSIBEBQ $BJSBO *TPTNPUJL )JQFSPTNPUJL EBO )JQPPTNPUJL *TUJ CBOZBL [BU UFSMBSVU PMFI LBSFOBOZB KVNMBI PTNPM EBMBN MBI JTPUPOJL IJQPUPOJL EBO IJQFSUPOJL NFSVKVL QBEB EBQBU DBJSBO FLTUSBTFMVMBS BUBV JOUSBTFM VNVNOZB UFUBQ LPOTUBO UJEBLOZB TVBUV MBSVUBO NFOZFCBCLBO QFSVCBIBO WPMVNF TFM LFDVBMJ KJLB [BU UFSMBSVU EJUBNCBILBO BUBV EJLVSBOHJ EBSJ ,FLFOUBMBO MBSVUBO CFSHBOUVOH QBEB LPOTFOUSBTJ [BU UFSMBSVU LPNQBSUFNFOFLTUSBTFM JNQFSNFBCFM /BNVO CFCFSBQB [BU UFSMBSVU EBQBU NFOFNCVT NFNCSBOTFM-BSVUBOEFOHBOPTNPMBSJUBTZBOHTBNBEFOHBOTFM %FOHBO QSJOTJQ EBTBS JOJ LJUB EBQBU NFOHBOBMJTJT FGFL EJTFCVU JTPTNPUJL UBOQB NFNQFSIBUJLBO [BU UFSMBSVU UFSTFCVU CFSCBHBJ LPOEJTJ DBJSBO BCOPSNBM UFSIBEBQ WPMVNF EBO EBQBUNFOFNCVTNFNCSBOTFMBUBVUJEBL PTNPMBSJUBTDBJSBOFLTUSBTFMVMBSEBOJOUSBTFMVMBS 292 Bab 25 Komparternen Cairan Tubuh: Cairan Ekstraselutar dan Intraselutar; Ederna Pengaruh Penambahan Larutan Salin Ke Cairan LMPSJEB IJQFSUPOJL QFSTFO LF EBMBN LPNQBSUFNFO DBJSBO Ekstraselular FLTUSBTFMVMBS TFPSBOH QBTJFO EFOHBO CFSBU CBEBO LJMPHSBN EFOHBOPTNPMBSJUBTQMBTNBBXBMN0TN- BQBZBOHBLBO +JLBMBSVUBOTBMJOJTPUPOJLEJUBNCBILBOLFLPNQBSUFNFODBJSBO UFSKBEJ QBEB PTNPMBSJUBT EBO WPMVNF DBJSBO FLTUSBTFMVMBS EBO FLTUSBTFMVMBS PTNPMBSJUBT DBJSBO FLTUSBTFMVMBS UJEBL BLBO JOUSBTFMTFUFMBILFTFJNCBOHBOPTNPUJLUFSCFOUVL CFSVCBI LBSFOBOZB UJEBL BEB PTNPTJT ZBOH UFSKBEJ NFMBMVJ UNIT V -BOHLBIQFSUBNBBEBMBINFOHIJUVOHLPOEJTJBXBMNFMJQVUJ NFNCSBO TFM 4BUVTBUVOZB FGFL JBMBI QFOJOHLBUBO WPMVNF WPMVNF LPOTFOUSBTJ EBONJMJPTNPMUPUBMQBEBNBTJOHNBTJOH DBJSBO FLTUSBTFMVMBS (BNCBS " /BUSJVN EBO LMPSJEB LPNQBSUFNFO %FOHBO NFOHBOHHBQ CBIXB WPMVNF DBJSBO TFCBHJBO CFTBS UFUBQ CFSBEB EBMBN DBJSBO FLTUSBTFMVMBS LBSFOB FLTUSBTFMVMBSTFCFTBSQFSTFOCFSBUCBEBOEBOWPMVNFDBJSBO NFNCSBO TFM CFSUJOEBL TFPMBIPMBI IBNQJS CFSTJGBU JOUSBTFMVMBS TFCFTBS QFSTFO CFSBU CBEBO NBLB WPMVNF EBO JNQFSNFBCFMUFSIBEBQOBUSJVNEBOLMPSJEB LPOTFOUSBTJDBJSBOCFSJLVUJOJEBQBUEJIJUVOH +JLB MBSVUBO IJQFSUPOJL EJUBNCBILBO EBMBN DBJSBO FLTUSBTFMVMBS PTNPMBSJUBTFLTUSBTFMBLBONFOJOHLBUEBONFOZF CBCLBO PTNPTJT BJS LFMVBS EBSJ TFM LF EBMBN LPNQBSUFNFO FLTUSBTFM MJIBU (BNCBS # 4FLBMJ MBHJ IBNQJS TFNVB Langkah 1. Kondisi Awal OBUSJVN LMPSJEB ZBOH EJUBNCBILBO UFUBQ CFSBEB EBMBN LPNQBSUFNFO FLTUSBTFM EBO DBJSBO CFSEJGVTJ EBSJ TFM LF EBMBN Volume Konsentrasi Total SVBOH FLTUSBTFM VOUVL NFODBQBJ LFTFJNCBOHBO PTNPUJL &GFL (Liter) (mOsm/L) (mOsm) BLIJSJBMBIQFOJOHLBUBOWPMVNFFLTUSBTFM MFCJICFTBSEBSJQBEB WPMVNFDBJSBOZBOHEJUBNCBILBO QFOVSVOBOWPMVNFJOUSBTFM Cairan ekstraselular 14 280 3,920 EBOQFOJOHLBUBOPTNPMBSJUBTEJLFEVBLPNQBSUFNFO Cairan intraselular 28 280 7,840 +JLB MBSVUBO IJQPUPOJL EJCFSJLBO LF DBJSBO FLTUSBTFMVMBS Total cairan tubuh 42 280 11,760 PTNPMBSJUBT DBJSBO FLTUSBTFMVMBS BLBO NFOVSVO EBO TFKVNMBI BJS EBSJ DBJSBO FLTUSBTFMVMBS CFSEJGVTJ LF EBMBN TFM TBNQBJ LPNQBSUFNFO JOUSBTFM EBO FLTUSBTFM NFNQVOZBJ PTNPMBSJUBT ZBOH TBNB MJIBU (BNCBS $ 7PMVNF JOUSBTFM NBVQVO -BMV LJUB NFOHIJUVOH NJMJPTNPM UPUBM EBMBN - MBSVUBO FLTUSBTFM NFOJOHLBU EFOHBO QFOBNCBIBO DBJSBO IJQPUPOJL OBUSJVN LMPSJEB QFSTFO ZBOH EJUBNCBILBO LF DBJSBO XBMBVQVOQFOJOHLBUBOWPMVNFJOUSBTFMMFCJICBOZBL FLTUSBTFMVMBS-BSVUBO QFSTFOCFSBSUJBEB HNM BUBV HSBNOBUSJVNLMPSJEBQFSMJUFS0MFILBSFOBCFSBUNPMFLVM 1FOHIJUVOHBO1FSHFTFSBO$BJSBOEBO0TNPMBSJUBTTFUFMBI OBUSJVN LMPSJEB JBMBI HNPM IBM JOJ CFSBSUJ CBIXB BEB MOGVT -BSVUBO 4BMJO )JQFSUPOJL ,JUB EBQBU NFOHIJUVOH NPM OBUSJVN LMPSJEB QFS MJUFS MBSVUBO.BLB VOUVL - TFSBOHLBJBO FGFL QFNCFSJBO JOGVT CFSCBHBJ KFOJT MBSVUBO MBSVUBO BEB NPM OBUSJVN LMPSJEB 0MFI LBSFOB NPM UFSIBEBQ WPMVNF EBO PTNPMBSJUBT DBJSBO FLTUSBTFMVMBS EBO OBUSJVNLMPSJEBTFUBSBEFOHBOPTNPM LBSFOBOBUSJVNLMPSJ JOUSBTFMNJTBMOZB KJLBLJUBNFOHJOGVT-MBSVUBOOBUSJVNLMP EBNFNQVOZBJEVBQBSUJLFMPTNPUJLBLUJGQFSNPM FGFLBLIJS airan intraselular airan Ekstraselular eadaan normal Penamba an Na isotonik 300 m lar a 200 100 0 10 20 30 40 V lume l er Penamba an Na ipotonik Penamba an Na l Gambar - E ek penamba an larutan isotonik ipertonik dan ipotonik pada airan ekstraselular setela keseimbangan osmotik terbentuk eadaan normal ditunjukkan dengan garis utu dan pergeseran dari normal diperli atkan dengan daera bergaris putus-putus olume kompartemen airan ekstraselular dan intraselular diperli atkan pada masing-masing absis diagram dan osmolaritas masing-masing kompartemen ini diperli atkan sebagai ordinat 293 Unit V Cairan Tubuh dan Ginjal EBSJ QFOBNCBIBO - MBSVUBO JOJ JBMBI QFOBNCBIBO +BEJ EBSJ DPOUPI UFSTFCVU LJUB EBQBU NFMJIBU CBIXB N0TNOBUSJVNLMPSJEBLFDBJSBOFLTUSBTFMVMBS QFOBNCBIBO - MBSVUBO OBUSJVN LMPSJEB IJQFSUPOJL 1BEBMBOHLBILF LJUBNFOHIJUVOHQFOHBSVITFLFUJLBEBO NFOZFCBCLBO QFOJOHLBUBO MFCJI EBSJ - EBMBN WPMVNF QFOBNCBIBO N0TN OBUSJVN LMPSJEB LF DBJSBO DBJSBO FLTUSBTFMVMBS TFEBOHLBO WPMVNF DBJSBO JOUSBTFMVMBS FLTUSBTFMVMBS CFSTBNB - WPMVNF 5JEBL BLBO BEB QFSVCBIBO UVSVOIBNQJSTFCBOZBL- QBEB LPOTFOUSBTJ BUBV WPMVNF DBJSBO JOUSBTFMVMBS EBO UJEBL.FUPEF QFOHIJUVOHBO QFSVCBIBO WPMVNF EBO PTNPMBSJUBT BLBO BEB LFTFJNCBOHBO PTNPUJL /BNVO QBEB DBJSBO DBJSBO JOUSBTFMVMBS EBO FLUSBTFM JOJ EBQBU EJUFSBQLBO EJ IBNQJS FLTUSBTFMVMBS BLBO BEB UBNCBIBO N0TN [BU UFSMBSVU TFNVBNBTBMBILMJOJTEBSJQFOHBUVSBOWPMVNFDBJSBO1FNCBDB UPUBM ZBOH NFOHIBTJMLBO NJMJPTNPM UPUBM TFCFTBS 0MFI IBSVT NFOHFOBMJ QFOHIJUVOHBO JOJ EFOHBO CBJL LBSFOB LBSFOB LPNQBSUFNFO FLTUSBTFM TFLBSBOH NFNQVOZBJ WPMVNF QFOHFSUJBO BTQFL NBUFNBUJT LFTFJNCBOHBO PTNPUJL BOUBSB - LPOTFOUSBTJ EBQBU EJIJUVOH EFOHBO NFNCBHJ LPNQBSUFNFO DBJSBO FLTUSBTFMVMBS EBO JOUSBTFMVMBS TBOHBU N0TN EFOHBO - TFIJOHHB EJQFSPMFI LPOTFOUSBTJ QFOUJOHVOUVLNFNBIBNJIBNQJSTFNVBLFMBJOBODBJSBOEBMBN N0TN- +BEJ OJMBJOJMBJ CFSJLVU JOJ BLBO UFSKBEJ TFLFUJLB UVCVIEBOQFOBOHBOBOOZB TFUFMBIQFOBNCBIBOMBSVUBO Langkah 2. Pengaruh Seketika Penambahan 2 Liter Glukosa dan Larutan Lain yang Diberikan untuk Natrium Kloridda 3,0 Persen Tujuan Nutrisi Volume Konsentrasi Total 5FSEBQBU CBOZBL KFOJT MBSVUBO ZBOH EBQBU EJCFSJLBO TFDBSB (Liter) (mOsm/L) (mOsm) JOUSBWFOB VOUVL NFNCFSJ OVUSJTJ CBHJ PSBOH ZBOH UJEBL EBQBU NFNQFSPMFIOZB TFDBSB BEFLVBU EFOHBO DBSB MBJO -BSVUBO Cairan ekstraselular 16 373 5,971 HMVLPTBEJHVOBLBOTFDBSBMVBT TFEBOHLBOMBSVUBOBTBNBNJOP Cairan intraselular 28 280 7,840 EBO MFNBL ZBOH EJIPNPHFOJTBTJ MFCJI TFEJLJU EJHVOBLBO #JMB Total Cairan tubuh 44 Tidak seimbang 13,811 MBSVUBOJOJEJCFSJLBO LPOTFOUSBTJ[BUZBOHBLUJGTFDBSBPTNPUJL CJBTBOZB EJTFTVBJLBO IBNQJS NFOEFLBUJ JTPUPOJTJUBT BUBV 1BEB MBOHLBI LFUJHB LJUB NFOHIJUVOH WPMVNF EBO MBSVUBO JOJ EJCFSJLBO QFSMBIBOMBIBO TFIJOHHB UJEBL LPOTFOUSBTJ ZBOH BLBO UFSKBEJ EBMBN CFCFSBQB NFOJU TFUFMBI NFOHHBOHHV LFTFJNCBOHBO PTNPUJL DBJSBO UVCVI 4FUFMBI LFTFJNCBOHBO PTNPUJL UFSCFOUVL %BMBN IBM JOJ LPOTFOUSBTJ HMVLPTB BUBV [BU OVUSJTJ MBJO EJNFUBCPMJTNF TFSJOH NBTJI EBMBN LPNQBSUFNFO DBJSBO JOUSBTFMVMBS EBO FLTUSBTFM BLBO UFSEBQBU LFMFCJIBO BJS LIVTVTOZB KJLB BEB DBJSBO UBNCBIBO TFUBSB EBO EBQBU EJIJUVOH EFOHBO NFNCBHJ NJMJPTNPM UPUBM ZBOHEJNJOVN#JBTBOZB HJOKBMNFOHFLTLSFTJDBJSBOJOJEBMBN EBMBN UVCVI EFOHBO WPMVNF UPUBM ZBOH TFLBSBOH CFOUVL VSJOF ZBOH TBOHBU FODFS 0MFI LBSFOBOZB IBTJM BLIJS TFCFTBS-%BSJTJOJBLBOEJQFSPMFILPOTFOUSBTJTFCFTBS QFOBNCBIBO MBSVUBO EJ BUBT IBOZBMBI CFSVQB QFOBNCBIBO [BU N0TN-0MFILBSFOBJUV TFMVSVILPNQBSUFNFODBJSBOUVCVI OVUSJTJQBEBUVCVI BLBO NFNQVOZBJ LPOTFOUSBTJ ZBOH TBNB TFUFMBI UFSDBQBJOZB LFTFJNCBOHBO PTNPUJL %FOHBO NFOHBOHHBQ CBIXB UJEBL BEB [BU UFSMBSVU BUBV BJS ZBOH LFMVBS EBSJ UVCVI EBO UJEBL BEB Kelainan Klinis Pengaturan Volume Cairan: QFSHFSBLBOOBUSJVNLMPSJEBLFEBMBNBUBVLFMVBSTFM NBLBLJUB Hiponatremia dan Hipernatremia EBQBUNFOHIJUVOHWPMVNFLPNQBSUFNFOJOUSBTFMEBOFLTUSBTFM 7PMVNF DBJSBO JOUSBTFMVMBS EJIJUVOH EFOHBO NFNCBHJ 1FOHVLVSBO QSJNFS ZBOH NVEBI EJQFSPMFI QBSB LMJOJTJ VOUVL NJMJPTNPM UPUBM EBMBN DBJSBO FLTUSBTFMVMBS EFOHBO NFOJMBJTUBUVTDBJSBOQBTJFOBEBMBILPOTFOUSBTJOBUSJVNQMBTNB LPOTFOUSBTJ N0TN- BLBO EJIBTJMLBO WPMVNF - 0TNPMBSJUBT QMBTNB UJEBL TFDBSB SVUJO EJVLVS UBQJ LBSFOB 7PMVNF DBJSBO FLTUSBTFMVMBS EJIJUVOH EFOHBO NFNCBHJ OBUSJVNEBOBOJPOZBOHUFSLBJU UFSVUBNBLMPSJEB CFSUBOHHVOH NJMJPTNPM UPUBM EBMBN DBJSBO FLTUSBTFMVMBS EFOHBO KBXBC BUBT MFCJI EBSJ QFSTFO [BU UFSMBSVU EBMBN DBJSBO LPOTFOUSBTJ N0TN- EBO NFOHIBTJMLBO WPMVNF FLTUSBTFMVMBS NBLB LPOTFOUSBTJ OBUSJVN QMBTNB NFSVQBLBO --BHJMBHJQFSIJUVOHBOJOJCFSEBTBSLBOQBEBBOHHBQBOCBIXB JOEJLBUPS ZBOH DVLVQ CBJL CBHJ PTNPMBSJUBT QMBTNB QBEB OBUSJVNLMPSJEBZBOHEJUBNCBILBOLFDBJSBOFLTUSBTFMVMBSUFUBQ CBOZBL LFBEBBO 4FTFPSBOH EJLBUBLBO IJQPOBUSFNJB CJMB CFSBEBEJTJUVEBOUJEBLCFSQJOEBILFEBMBNTFM LPOTFOUSBTJ OBUSJVN QMBTNB EBMBN UVCVIOZB UVSVO MFCJI EBSJ CFCFSBQBNJMJFLJWBMFOEJCBXBIOJMBJOPSNBM TFLJUBSN&R - #JMBLPOTFOUSBTJOBUSJVNQMBTNBNFOJOHLBUEJBUBTOPSNBM angka Pengaru Penamba an iter Natrium lorida NBLBTFTFPSBOHEJLBUBLBOIJQFSOBUSFNJB Persen setela eseimbangan smotik erbentuk Volume Konsentrasi Total Penyebab Hiponatremia: Kelebihan Air atau Kehilangan (Liter) 9mOsm/L) (mOsm) Natrium Cairan ekstraselular 19.02 313.9 5,971 ,FIJMBOHBOOBUSJVNLMPSJEBEBSJDBJSBOFLTUSBTFMVMBSBUBVQFOBN Cairan intraselular 24.98 313.9 7,840 CBIBO BJS ZBOH CFSMFCJIBO QBEB DBJSBO FLTUSBTFMVMBS BLBO NF Total cairan tubuh 44.0 313.9 13,811 OZFCBCLBOQFOVSVOBOLPOTFOUSBTJOBUSJVNQMBTNB 5BCFM 294 Bab 25 Kompartemen Cairan Tubuh: Cairan Ekstraselutar dan Intrasetular; Edema Tabel 25-4 Abnormalitas Pengaturan Volume Cairan Tubuh: Hiponatremia dan Hipernatremia Abnormalitas Penyebab Konsentrasi Na* Volume Cairan Volume Cairan Plasma Ekstraselular Intraselular Hiponetremia-dehidrasi Adrenal insufficiency; overuse n l UNIT V of diuretics Hiponatrmia-hiperhidrasi Kelebihan ADH (SIADH); tumor bronkogenik Hipernatremia-dehidrasi Diabetes insipidus; excessive sweating Hipernatremia-hiperhidrasi Penyakit Cushing; aldosteronisme primer ADH, antidiuretic hormone; SIADH, syndrome of inappropriate ADH ,FIJMBOHBO OBUSJVN LMPSJEB QSJNFS CJBTBOZB UFSKBEJ QBEB "LBO UFUBQJ QFSQJOEBIBO [BU UFSMBSVU EBSJ EBMBN TFM TFMBNB EFIJESBTJ IJQPOBUSFNJB EBO CFSIVCVOHBO EFOHBO QFOVSVOBO CFSMBOHTVOHOZB IJQPOBUSFNJB MBNCBU EBQBU NFOZFCBCLBO WPMVNF DBJSBO FLTUSBTFMVMBS ,POEJTJLPOEJTJ ZBOH EBQBU LFSVTBLBOKBSJOHBOPUBLEFOHBONVEBI LBMBVIJQPOBUSFNJBOZB NFOZFCBCLBO IJQPOBUSFNJB CFSIVCVOHBO EFOHBO QFOHFMVBSBO EJLPSFLTJ UFSMBMV DFQBU #JMB QFOBNCBIBO DBJSBO IJQFSUPOJT OBUSJVN LMPSJEB BOUBSB MBJO EJBSF EBO NVOUBINVOUBI VOUVL NFOHPSFLTJ IJQPOBUSFNJB EJCFSJLBO UFSMBMV DFQBU JOJ 1FOHHVOBBO EJVSFUJL TFDBSB CFSMFCJIBO ZBOH NFOHIBNCBU BLBO NFMBNQBVJ LFNBNQVBO PUBL VOUVL EBQBU NFOZFSBQ [BU LFNBNQVBO HJOKBM VOUVL NFNQFSUBIBOLBO OBUSJVN EBO ZBOHUFMBIIJMBOHEBSJEBMBNTFM TFIJOHHBEBQBUNFOJNCVMLBO CFCFSBQBKFOJTQFOZBLJUHJOKBMZBOHNFOHFMVBSLBOOBUSJVN KVHB HBOHHVBO PTNPUJL OFVSPOOFVSPO ZBOH EJIVCVOHLBO EFOHBO EBQBU NFOZFCBCLBO IJQPOBUSFNJB EFSBKBU TFEBOH "LIJSOZB EFNJFMJOJTBTJ ZBJUV IJMBOHOZB TFMVCVOH NJFMJO EBSJ TBSBG QFOZBLJU "EEJTPO ZBOH EJBLJCBULBO PMFI QFOVSVOBO TFLSFTJ %FNJFMJOJTBTJOFVSPOOFVSPOZBOHEJTFCBCLBOPMFIQFSVCBIBO IPSNPO BMEPTUFSPO NFOHHBOHHV LFNBNQVBO HJOKBM VOUVL PTNPUJL JOJ EBQBU EJDFHBI EFOHBO NFOHVSBOHJ LFDFQBUBO NFSFBCTPSCTJ OBUSJVN EBO EBQBU NFOZFCBCLBO IJQPOBUSFNJB LPSFLTJ IJQPOBUSFNJB LSPOJT LVSBOH EBSJ NNPM- EBMBN EFSBKBUTFEBOH KBNBUBVLVSBOHEBSJNNPM-EBMBNKBN )JQPOBUSFNJB KVHB EBQBU EJTFCBCLBO PMFI SFUFOTJ BJS ZBOH ,FDFQBUBO LPSFLTJ ZBOH MBNCBU JOJ NFNCFSJ LFTFNQBUBO CFSMFCJIBO ZBOH BLBO NFOHFODFSLBO OBUSJVN EBMBN DBJSBO QBEB TFM PUBL VOUVL NFNVMJILBO PTNPM ZBOH IJMBOH ZBOH FLTUSBTFMVMBS ZBJUV TVBUV LPOEJTJ ZBOH EJTFCVU IJQPOBUSFNJB UFSKBEJTFCBHBJIBTJMBEBQUBTJUFSIBEBQIJQPOBUSFNJBLSPOJT IJQFSIJESBTJ$POUPIOZB TFLSFTJCFSMFCJIBOIPSNPOBOUJEJVSFUJL ZBOHNFOZFCBCLBOUVCVMVTHJOKBMNFSFBCTPSQTJBJSMFCJICBOZBL EBQBUNFOZFCBCLBOUFSKBEJOZBIJQPOBUSFNJBEBOIJQFSIJESBTJ Penyebab Hipernatremia: Kehilangan Air atau Kelebihan Natrium Konsekuensi Hiponatremia: Pembengkakan Sel 1FOJOHLBUBO LPOTFOUSBTJ OBUSJVN QMBTNB ZBOH KVHB NFOZF FCBCLBO QFOJOHLBUBO PTNPMBSJUBT EBQBU EJTFCBCLBO PMFI 1FSVCBIBO WPMVNF TFM ZBOH DFQBU ZBOH EJTFCBCLBO PMFI LFIJMBOHBO BJS EBO MBSVUBO FLTUSBTFM ZBOH NFNFLBULBO JPO IJQPOBUSFNJB EBQBU NFOJNCVMLBO FGFL ZBOH CFTBS QBEB OBUSJVN BUBV LBSFOB LFMFCJIBO OBUSJVN EBMBN DBJSBO GVOHTJ KBSJOHBO EBO PSHBO UFSVUBNB PUBL 1FOVSVOBO LBEBS FLTUSBTFMVMBS #JMB UFSEBQBU LFIJMBOHBO QSJNFS BJS EBSJ DBJSBO OBUSJVN QMBTNB ZBOH DFQBU NJTBMOZB EBQBU NFOJNCVMLBO FLTUSBTFMVMBS IBM UFSTFCVU BLBO NFOHBLJCBULBO UJNCVMOZB QFNCFOHLBLBO TFM PUBL EBO HFKBMB OFVSPMPHJL TFQFSUJ TBLJU IJQFSOBUSFNJBEFIJESBTJ ,POEJTJ JOJ EBQBU UFSKBEJ BLJCBU LFQBMB NVBM EBO LFMFTVBO EBO EJTPSJFOUBTJ #JMB LBEBS LFUJEBLNBNQVBOVOUVLNFOZFLSFTJIPSNPOBOUJEJVSFUJL ZBOH OBUSJVN QMBTNB UVSVO TBNQBJ EJ CBXBI TBNQBJ EJCVUVILBOPMFIHJOKBMVOUVLNFOBIBOBJS"LJCBUUJEBLBEBOZB NNPM- QFNCFOHLBLBOPUBLEBQBUNFOZFCBCLBOLFKBOH IPSNPO BOUJEJVSFUJL JOJ HJOKBM NFOHFMVBSLBO VSJOF FODFS TFJ[VSF LPNB LFSVTBLBO PUBL EBO LFNBUJBO ,BSFOB EBMBNKVNMBIZBOHTBOHBUCFTBS LFMBJOBOZBOHEJTFCVUTFCBHBJ UFOHLPSBL JUV LBLV NBLB QFOBNCBIBO WPMVNF PUBL UJEBL EJBCFUFT JOTJQJEVT ZBOH NFOZFCBCLBO UJNCVMOZB EFIJESBTJ EBQBU MFCJI EBSJ QFSTFO UBOQB NFOFSPCPT LF BSBI MFIFS EBO QFOJOHLBUBO LPOTFOUSBTJ OBUSJVN LMPSJEB EBMBN DBJSBO IFSOJBTJ ZBOH BLBO NFOHHJSJOHOZB QBEB LFSVTBLBO PUBL FLTUSBTFMVMBS 1BEB KFOJTKFOJT QFOZBLJU HJOKBM UFSUFOUV HJOKBM ZBOHQFSNBOFOEBOLFNBUJBO UJEBL CFSFTQPOT UFSIBEBQ IPSNPO BOUJEJVSFUJL ZBOH KVHB #JMBIJQPOBUSFNJBCFSMBOHTVOHMBNCBUTFMBNBCFCFSBQBIBSJ NFOZFCBCLBO KFOJT LFMBJOBO ZBOH EJTFCVU EJBCFUFT JOTJQJEVT PUBL EBO KBSJOHBOKBSJOHBO MBJO BLBO CFSFTQPOT EFOHBO OFGSPHFOJL 1FOZFCBC IJQPOBUSFNJB ZBOH MFCJI VNVN BLJCBU NFNJOEBILBOOBUSJVN LMPSJEB LBMJVN CBIBOPSHBOJLUFSMBSVU QFOVSVOBOWPMVNFDBJSBOFLTUSBTFMVMBSBEBMBIEFIJESBTJBLJCBU TFQFSUJHMVUBNBUEBSJTFMLFLPNQBSUFNFOFLTUSBTFM1FOVSVOBO BTVQBOBJSZBOHMFCJITFEJLJUEBSJQBEBQFOHFMVBSBOOZB TFQFSUJ PTNPUJL JOJ NFOZFCBCLBO NBTVLOZB BJS LF EBMBN TFMTFM ZBOH UJNCVM QBEB LFBEBBO CFSLFSJOHBU TFMBNB BLUJWJUBT CFSBU TFIJOHHBKBSJOHBONFNCFOHLBL (BNCBS ZBOHCFSLFQBOKBOHBO 295 Unit V Cairan Tubuh dan Ginjal +BEJ EBMBN NFOHBOBMJTJT LFMBJOBO LPOTFOUSBTJ OBUSJVN QMBTNBEBONFNVUVTLBOUFSBQJZBOHUFQBU LJUBIBSVTMFCJIEVMV NFOFOUVLBO BQBLBI LFMBJOBO JOJ EJTFCBCLBO PMFI LFIJMBOHBO BUBV QFOBNCBIBO OBUSJVN QSJNFS BUBV LFIJMBOHBO BUBV QFOBNCBIBOBJSQSJNFS Konsekuensi Hipernatremia: Sel Menyusut )JQFSOBUSFNJB MFCJI KBSBOH UFSKBEJ EJCBOEJOHLBO EFOHBO IJQPOBUSFNJB EBO HFKBMB ZBOH NFOPOKPM CJBTBOZB IBOZB QBEB QFOJOHLBUBO LPOTFOUSBTJ OBUSJVN QMBTNB ZBOH DFQBU EBO CFTBS rm na rem a EJ BUBT TBNQBJ NNPM- 4BUV BMBTBO VOUVL JOJ BEBMBI CBIXB IJQFSOBUSFNJB NFOJNCVMLBO SBTB IBVT ZBOH MVBS CJBTB ZBOHNFMJOEVOHJUVCVIEBSJQFOJOHLBUBOOBUSJVNEBMBNQMBTNB EBODBJSBOFLTUSBTFMVMBS TFQFSUJZBOHUFMBIEJCBIBTQBEB#BC "LBOUFUBQJIJQFSOBUSFNJBZBOHCFSBUEBQBUUFSKBEJQBEBQBTJFO ZBOHNFOHBMBNJMFTJIJQPUBMBNJLZBOHNFOHHBOHHVTFOTBTJSBTB IBVT QBEBCBZJZBOHUJEBLEBQBUMBOHTVOHNFOEBQBUNJOVNBO BUBVQBEBQBTJFOUVBZBOHNFOHBMBNJHBOHHVBONFOUBM ,PSFLTJ IJQFSOBUSFNJB EBQBU EJMBLVLBO EFOHBO NFNCFSJLBO MBSVUBOOBUSJVNLMPSJEBZBOHIJQPPTNPUJLBUBVEFOHBOMBSVUBO EFLTUSPTB "LBO UFUBQJ TBOHBUMBI QFOUJOH CBIXB QFNCFSJBO MBSVUBO UFSTFCVU QBEB QFOEFSJUB EFOHBO QFOJOHLBUBO LBEBS OBUSJVN ZBOH LSPOJT IBSVTMBI EFOHBO LFDFQBUBO ZBOH MBNCBU "MBTBOOZB BEBMBI IJQFSOBUSFNJB KVHB NFOJOHLBULBO BLUJWJUBT na rem a a u NFLBOJTNF QFSUBIBOBO ZBOH NFMJOEVOHJ TFM EBSJ QFSVCBIBO WPMVNF.FLBOJTNF QFSUBIBOBO JOJ TFCBMJLOZB EBSJ BQB ZBOH UFSKBEJ QBEB IJQPOBUSFNJB UFSEJSJ BUBT NFLBOJTNF ZBOH NFOJOHLBULBOLBEBSOBUSJVNJOUSBTFMEBO[BUUFSMBSVUMBJOOZB Edema: Kelebihan Cairan dalam Jaringan &EFNB NFOVOKVLLBO BEBOZB DBJSBO CFSMFCJIBO EJ KBSJOHBO UVCVI 1BEB TFCBHJBO CFTBS LFBEBBO FEFNB UFSVUBNB UFSKBEJ QBEB LPNQBSUFNFO DBJSBO FLTUSBTFMVMBS UBQJ EBQBU KVHB NFMJCBULBOLPNQBSUFNFODBJSBOJOUSBTFMVMBS na rem a r n Edema Intrasel 5JHB LPOEJTJ ZBOH NFNVEBILBO UFSKBEJOZB QFNCFOHLBLBO Gambar - Pengaturan volume sel otak selama JOUSBTFM IJQPOBUSFNJBTFQFSUJUFMBIEJKFMBTLBOTFCFMVNOZB iponatremia elama iponatremia akut terjadi di usi - ke dalam sel dan pembengkakan jaringan otak disebabkan ole EFQSFTJTJTUFNNFUBCPMJTNFKBSJOHBOEBO UJEBLBEBOZBOVUSJTJ ilangn a ion Na atau kelebi an al ini akan merangsang TFM ZBOH BEFLVBU $POUPIOZB CJMB BMJSBO EBSBI LF KBSJOHBO transpor Na dan at organik terlarut ke luar sel ang NFOVSVO QFOHJSJNBOPLTJHFOEBOOVUSJFOCFSLVSBOH+JLBBMJSBO kemudian men ebabkan air berdi usi ke luar dari sel Pada EBSBI NFOKBEJ TBOHBU SFOEBI VOUVL NFNQFSUBIBOLBO iponatremia kronis pembengkakan otak akan berkurang ole NFUBCPMJTNF KBSJOHBO OPSNBM NBLB QPNQB JPO NFNCSBO TFM adan a transpor at terlarut dari NFOKBEJ UFSUFLBO #JMB IBM JOJ UFSKBEJ JPO OBUSJVN ZBOH CJBTBOZB NBTVLLFEBMBNTFMUJEBLEBQBUMBHJEJQPNQBLFMVBSEBSJTFM EBO )JQFSOBUSFNJB KVHB EBQBU UFSKBEJ BLJCBU QFOBNCBIBO LFMFCJIBO JPO OBUSJVN JOUSBTFM NFOJNCVMLBO PTNPTJT BJS LF OBUSJVN LMPSJEB ZBOH CFSMFCJIBO QBEB DBJSBO FLTUSBTFMVMBS )BM EBMBN TFM ,BEBOHLBEBOH IBM JOJ EBQBU NFOJOHLBULBO WPMVNF JOJ TFSJOH UFSKBEJ QBEB IJQFSOBUSFNJBIJQFSIJESBTJ LBSFOB JOUSBTFM TVBUV KBSJOHBO CBILBO QBEB TFMVSVI UVOHLBJ ZBOH LFMFCJIBOOBUSJVNLMPSJEBFLTUSBTFMCJBTBOZBKVHBCFSIVCVOHBO JTLFNJL DPOUPIOZBTBNQBJEVBBUBVUJHBLBMJWPMVNFOPSNBM#JMB EFOHBO CFCFSBQB EFSBKBU SFUFOTJ BJS PMFI HJOKBM $POUPIOZB IBM JOJ UFSKBEJ CJBTBOZB NFSVQBLBO BXBM UFSKBEJOZB LFNBUJBO TFLSFTJ CFSMFCJIBO EBSJ IPSNPO BMEPTUFSPO ZBOH NFSFUFOTJ KBSJOHBO OBUSJVN EBQBU NFOZFCBCLBO IJQFSOBUSFNJB SJOHBO EBO &EFNB JOUSBTFM KVHB EBQBU UFSKBEJ QBEB KBSJOHBO ZBOH NFSB PWFSIJESBTJ "MBTBO CBIXB IJQFSOBUSFNJB JOJ UJEBL MFCJI CFSBU EBOH 1FSBEBOHBO CJBTBOZB NFOJOHLBULBO QFSNFBCJMJUBT NFNC JBMBICBIXBQFOJOHLBUBOTFLSFTJBMEPTUFSPONFOZFCBCLBOHJOKBM SBO TFM TFSUB NFNVOHLJOLBO OBUSJVN EBO JPOJPO MBJO CFSEJGVTJ NFSFBCTPSCTJBJSEBOOBUSJVNEBMBNKVNMBIZBOHMFCJICFTBS NBTVLLFEBMBNTFM ZBOHEJJLVUJEFOHBOPTNPTJTBJSLFEBMBNTFM 296 Bab 25 Kompartemen Cairan Tubuh: Cairan Ekstraselular dan Intraselular; Edema Edema Ekstrasel 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Unit V Cairan Tubuh dan Ginjal PDF

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