GENERAL SURGERY SERIES : BASIC FLUID THERAPY / FLUID RESUCITATION

CHAPTER I
INTRODUCTION

As we know, most of the human body consists of a liquid whose numbers vary depending on age and gender as well as the amount of fat in the body. With eating and drinking the body to get water, electrolytes and other nutrients. Within 24 hours the amount of water and electrolytes into the equivalent of the amount that comes out. Of fluid and electrolytes from the body may be urine, feces, sweat and water vapor during breathing.
fluid therapy is needed when the body can not memasukka water, electrolytes and nutrients into the body orally for example, when patients need to fast longer, because gastrointestinal surgery, bleeding a lot, hypovolemic shock, severe anorexia, nausea, vomiting and others. Fluid therapy with electrolyte da water needs will be met. Besides fluid therapy can also be used to incorporate drugs and food substances or also routinely used to maintain the acid-base balance.

CHAPTER II
REVIEW REFERENCES

I. Definition of body fluid
body fluid is a liquid suspension of cells in the body of multicellular creatures such as humans or animals that have specific physiological functions.

II. Body Fluid and Electrolyte Physiology

A. The distribution of body fluids
Water is a solvent (solvent) most important in the liquid composition of living things. Percentage of total body water (Total Body Water) on body weight change with age, decreased rapidly in early life. At birth, TBW 78% weight loss. In the first few months of life, TBW decreased rapidly approaching adult levels of 55-60% weight loss at 1 year of age. At puberty, changes in TBW next. Because fat has a lower water content, the percentage of TBW to body weight was lower in adult women who have more body fat (55%) than men, which has less fat. Distributed throughout the body fluid into the intracellular compartment and extracellular compartments.
 Intracellular fluid
contained in the fluid between cells is called intracellular fluid. In adults, approximately two-thirds of its body fluids found in the intracellular (about 27 liters for an average adult male weighing about 70 kilograms), otherwise the baby is only half of their body weight is the intracellular fluid. Intracellular fluid is involved in the metabolic process that generates energy from nutrients in the body fluids.

 Fluid extracellular
fluid outside the cells is called extracellular fluid. Play a role in maintaining extracellular fluid circulation system, supplying nutrients to the cells, and dispose of toxic waste materials. The relative amount of extracellular fluid decreased with age. In newborns, about half of the body fluids found in the extracellular fluid.
extracellular fluid is divided into:

o Fluid Interstitial
fluid surrounding the cells including the interstitial fluid, approximately 11-12 liters in adults. Including the lymph fluid in the interstitial volume.

o intravascular fluid
is a liquid contained in the blood vessels (eg, plasma volume). The average adult blood volume about 5-6L which is a 3 liter plasma, the rest is made ​​up of red blood cells, white blood cells and platelets.

o Fluid transeluler
fluid is contained between certain body cavities such as cerebrospinal, pericardial, pleural, synovial joints, intraocular and gastrointestinal secretions. In the circumstances when, transeluler fluid volume is about 1 liter, but in large amounts of fluid can enter and exit the room transeluler.



Table 1. Distribution of body fluids



B. Components of body fluids

In addition to water, body fluids contain two types of substances are electrolytes and non electrolytes.

 Electrolyte
is a substance that dissociates in the liquid and conduct electric current. Electrolytes are divided into positive ions (cations) and negative ion (anion). The number of cations and anions in solution is always the same (measured in milliequivalents).

 cations: the major cations in the extracellular fluid is sodium (Na +), whereas the major cation in intracellular fluid is potassium (K +). A pump system is located in the cell wall of the body is pumping out sodium and potassium are.

 Sodium
Sodium as the major cation in extracellular fluid and the greatest role in regulating the fluid balance. Plasma sodium levels: Levels of sodium in the body 135-145mEq/liter.12 58.5 mEq / kg + 70% or where 40.5 mEq / kg can be fickle. Ekresi 100-180mEq/liter sodium in urine, faeces and sweat 58mEq/liter 35mEq/liter. Needs every day = 100mEq (6-15 g NaCl).
Sodium can move rapidly between the intravascular and interstitial spaces as well as into and out of cells. If the issuing body a lot of sodium (vomiting, diarrhea) while the intake is limited, there will be a state of dehydration with sodium deficiency. Lack of water and sodium in the plasma will be replaced with water and sodium from the interstitial fluid. If fluid loss continues, the water will be withdrawn from the cell and when the plasma volume remains untenable circulatory failure occurs.

 Potassium
Potassium is the major cation (99%) in the extracellular fluid plays an important role in the treatment of water and electrolyte balance disorders. Amount of potassium in the body about 53 mEq / kg in which 99% can change that can not be changed while the potassium is bound to proteins within the cell.
plasma potassium levels from 3.5 to 5.0 mEq / liter, needs every day 1-3 mEq / kg. Potassium balance is related to the concentration of extracellular H +. Excretion of potassium through the urine 60-90 mEq / liter, faeces 72 mEq / liter and sweat 10 mEq / liter.

 Calcium
Calcium can be in foods and beverages, especially milk, 80-90% is spent through the faeces and about 20% through the urine. Amount of expenditure is dependent on the intake, the amount of bone, endocrine state. Calcium metabolism is strongly influenced by the parathyroid glands, thyroid, testis, ovary, pituitary da. Most (99%) were found in teeth and + 1% in extracellular fluid and not present in the cell.

 Magnesium
Magnesium is found in all types of food. Needs of growing junior fashion + 10 mg / day. Issued through the urine and faeces.

 Anion: major anions in the extracellular fluid is chloride (Cl-) and bicarbonate (HCO3-), while the major anions in the intracellular fluid is a phosphate ion (PO43-).

 Carbonate
Carbonic acid and carbohydrate contained in the body as one of the final result rather than metabolism. Bicarbonate levels are controlled by the kidneys. Very little urine bicarbonate to be issued. Bicarbonate acid is controlled by the lungs and the very important role in acid-base balance.

 Non electrolyte
is a substance such as glucose and urea are not dissociated in the liquid. Other important substances including creatinine and bilirubin.

C. The movement process of the Body Fluids

Transfer of water and solutes between the body parts involved passive and active transport mechanisms. Passive transport mechanism does not require energy, while the mechanism of active transport requires energy. Diffusion and osmosis are passive transport mechanism. While active transport mechanisms associated with the Na-K pump that requires ATP.

The process of movement of body fluids between kompertemen can take place:

a. Osmosis
Osmosis is the movement of molecules (solutes) through a semipermeable membrane (selectively permeable) from a solution of a lower grade to higher grade solution to the same levels. Whole cell membranes and capillaries permeable to water, so the osmotic pressure of body fluids throughout the same compartment. Semipermeable membrane is a membrane that can pass water (solvent), but can not be passed solutes such as proteins.

Osmotic pressure of blood plasma is 285 ± 5 mOsm / L. Solution with an osmotic pressure approximately equal is called an isotonic (NaCl 0.9%, 5% Dextrose, Ringer lactate). Solution with a lower osmotic pressure are called hypotonic (distilled water), whereas higher-called hypertonic.

b. Diffusion
Diffusion is the movement of molecules through the pores. Solution will move from high concentration to the solution of lower concentration. Hydrostatic pressure of the blood vessels also pushed into the water diffuses through these pores. So the diffusion depends on the different concentration and hydrostatic pressure.

c. Sodium potassium pump
sodium potassium pump is a transport process that pumps sodium ions out through the cell membrane and at the same time pumps potassium ions from outside to inside. The purpose of the sodium potassium pump is to prevent hyperosmolar state in the cell.



D. Intake and excretion of fluid and electrolyte physiological

Homeostasis of body fluids that are normally regulated by the kidneys can be changed by the stress of surgery, the abnormal hormonal control, or even by the injury to the lungs, skin or gastrointestinal tract.

In normal circumstances, a person's average water consumption as much as 2000-2500 ml per day, in the form of liquids or solids with an average fluid loss of 250 ml of feces, 800-1500 ml of urine, and nearly 600 ml of fluid loss is not recognized (insensible water loss) of skin and lungs.

I. Changes in body fluids

Changes in body fluids can be categorized into three, namely:

A. Changes in volume

a. Volume deficit

Extracellular fluid volume deficit is the change in body fluids of the most common. The most common cause is loss of fluid in the gastrointestinal tract due to vomiting, nasogastric suction, diarrhea and fistula drainage. Other causes may include loss of fluid in soft tissue injury, infection, tissue inflammation, peritonitis, intestinal obstruction, and burns. Acute, rapid loss of fluid will cause signs of central nervous system disorders and heart. On a slow loss of fluid would be tolerable to the extracellular fluid volume defisi heavy going.

Dehydration
Dehydration is often categorized according to levels of serum sodium concentration into isonatremik (130-150 mEq / L), hiponatremik (<139 mEq / L) or hipernatremik (> 150 mEq / L). Isonatremik Dehydration is the most common (80%), whereas dehydration hiponatremik hipernatremik or about 5-10% of cases.

 Dehydration isotonic (isonatremik): occurs when fluid loss is almost equal to the concentration of sodium on blood. Loss of fluid and sodium in the same relative magnitude of the intravascular compartment and extravascular compartments.

 Dehydration hipotonis (hiponatremik): occurs when fluid losses with more sodium content of the blood (fluid loss hipertonis). Broadly speaking there to lose more sodium than water is lost. Because of low serum sodium levels, water moves into the intravascular compartment extravascular compartment, resulting in decreased volume intravaskular.15

 Dehydration hipertonis (hipernatremik): occurs when fluid losses with less sodium content of the blood (fluid loss hipotonis). Broadly speaking there to lose more water than sodium is lost. Due to the high sodium content, the water in the compartment ekstraskular move into the intravascular compartment, thereby minimizing the volume decrease intravaskular.15

b. Excess volume

Extracellular fluid volume overload is a condition caused by iatrogenic (such as sodium chloride intravenous infusion of fluids that cause excess water and NaCl or intravenous fluid administration glukosayang cause excess water) or be secondary to renal insufficiency (GFR interference), cirrhosis, or congestive heart kongestif.9 , 10 intaseluler Excess fluid can occur if there is excess fluid but the number of fixed NaCl or berkurang.10

2. Changes in concentration

a. Hyponatremia,
sodium levels are normal 135-145 mEq / L, when less than 135 mEq / L, was able to say hyponatremia. If <120 mg / L will give rise to symptoms of disorientation, mental disorders, lethargy, irritability, weakness and breathing stopped, whereas if the levels of <110 mg / L will give rise to symptoms of convulsions, coma. Hyponatremia can be caused by euvolemia (SIADH, psychogenic polidipsi), hypovolemia (renal tubule dysfunction, diarrhea, vomiting, third space losses, diuretics), hypervolemia (cirrhosis, nephroses). This condition can be treated with fluid restriction (Na + ≥ 125 mg / L) or 3% NaCl ssebanyak (140-X) xBBx0, 6 mg and 1.5 to 2.5 for pediatric mg/kg.12

Correction of hyponatremia that has lasted longer do SCARA gradual, while for the more aggressive acute hyponatremia. To calculate the required serum Na can use the formula:

Na = Na1 - x TBW Na0

Na Na = number needed for the correction (mEq)
Na1 = 125 mEq / L or a desired serum Na
Na serum Na0 = actual
TBW = total body water = 0.6 x weight (kg)

b. Hypernatremia
If levels of sodium over 145 mEq / L is called hyperkalemia. If sodium levels> 160 mg / L will give rise to symptoms of mental changes, lethargy, seizures, coma, weakness. Hipernatremi can be caused by fluid loss (diarrhea, vomiting, diuresis, diabetes insipidus, excessive sweating), less water intake, excessive intake of sodium. Therapeutic situation is fluid replacement with 5% dextrose in water as much as {(X-140) x BB x 0.6}: 140.12

c. Hypokalemia
if potassium <3 mEq / L. Can result from acute redistribution of potassium from the extracellular to intracellular fluid or chronic reduction in levels of total body potassium. Signs and symptoms of hypokalemia can be disritmik heart, ECG changes (QRS widening segment, ST segment depression, postural hypotension, skeletal muscle weakness, polyuria, glucose intolerance. Therapy hypokalemia may be a correction factor of precipitation (alkalosis, hipomagnesemia, drugs), infusion potassium chloride to 10 mEq / hour (for mild hypokalemia;> 2 mEq / L) or the infusion of potassium chloride and 40 mEq / h with monitoring by ECG (for severe hypokalemia; <2mEq / L with ECG changes, severe muscle weakness). 13 The formula for calculating the deficit kalium18:

K = K1 - K0 x 0.25 x BB

K = potassium is needed
K1 = desired serum potassium
K0 = serum potassium measured
BW = body weight (kg)

d. Hyperkalemia
occurs when potassium levels> 5 mEq / L, often due to renal insufficiency or a drug that limits the excretion of potassium (NSAIDs, ACE-inhibitors, cyclosporine, diuretics). Signs and symptoms primarily involve the central nervous system (paresthesias, muscle weakness) and the cardiovascular system (disritmik, ECG changes). Therapy for hyperkalemia may include intravenous calcium chloride 10% in 10 min, 50-100 mEq of sodium bicarbonate in 5-10 minutes, or diuretics, hemodialysis.

3. Changes in the composition

a. Respiratory acidosis (pH <3.75 and PaCO2> 45 mmHg)
This condition is associated with CO2 retention secondary to lower alveolar ventilation in surgical patients. Acute events are the result of inadequate ventilation include airway obstruction, atelectasis, pneumonia, pleural effusion, pain from upper abdominal incision, abdominal distension and excessive use of narcotics. Management involves adequate correction of the defect pulmonary, endotracheal intubation and mechanical ventilation if necessary. Strict attention to hygiene trakeobronkial postoperative time is very important.

b. Respiratory alkalosis (pH> 7.45 and PaCO2 <35 mmHg)
This condition is caused by fear, pain, hypoxia, CNS injury, and assisted ventilation. In the acute phase, normal serum bicarbonate concentration, and alkalosis occurs as a result of the rapid decrease in PaCO2. Therapies aimed at correcting the underlying problem, including appropriate sedation, analgesia, proper use of mechanical ventilator, and correction of potassium deficits occur.

c. Metabolic acidosis (pH <7.35 and bicarbonate <21 mEq / L)
condition is caused by the retention or addition of acid or loss of bicarbonate. The most common causes include kidney failure, diarrhea, small bowel fistula, diabetic ketoacidosis, and lactic acidosis. Initial compensation that occurs is the increase in ventilation and PaCO2 depression. The most common cause of shock, diabetic ketoacidosis, starvation, excessive aspirin and methanol poisoning. Therapy should be directed toward correcting the underlying abnormality. Bicarbonate therapy is only for the handling of severe acidosis and respiratory alkalosis only after compensation is used.

d. Metabolic alkalosis (pH> 7.45 and bicarbonate> 27 mEq / L)
disorder is a result of the loss or addition of acid and bicarbonate exacerbated by hypokalemia. A common problem in surgical patients is hipokloremik, hypokalaemic effect of extracellular volume deficit. Therapy used was isotonic sodium chloride and potassium deficiency replacement. Alkalosis should be gradual correction during the period of 24 hours during the measurement of pH, PaCO2 and serum electrolytes frequently.

II. Disorders of fluid and electrolyte balance in surgery

Disturbances in fluid and electrolyte balance is a common occurrence in surgical patients due to a combination of preoperative factors, intraoperative and postoperative.

A. Preoperative factors

A. Existing conditions
Diabetes mellitus, liver disease, or renal insufficiency may be aggravated by the stress of surgery.

2. Diagnostic procedure
arteriogram or intravenous pyelogram which require intravenous marker can lead to urinary excretion of fluid and electrolyte abnormalities due to the effects of diuresis
osmotic.

3. Drug delivery
drug delivery such as steroids and diuretics can affect water and electrolyte excretion

4. Surgical preparation
enema or laxatives can lead to increased water loss from the gastrointestinal tract and elekrolit.

5. Medical treatment of the condition of existing

6. Preoperative fluid restriction

Over a period of 6 hours of fluid restriction, healthy adult patients about 300-500 mL of fluid loss. Loss of fluid can be increased if the patient has a fever or the presence of abnormal fluid loss.

7. Fluid deficit that already exists
must be corrected before surgery to minimize the effects of anesthesia.

B. Intraoperative factors

A. Induction of anesthesia
can cause hypotension in patients with preoperative hypovolemia due to the loss of compensatory mechanisms such as tachycardia and vasoconstriction.

2. Abnormal blood loss

3. Abnormal loss of extracellular fluid into the third space (eg loss of extracellular fluid into the lumen of the bowel wall and the time of surgery)

4. Fluid loss due to evaporation from the surgical wound (usually on a large wound and prolonged surgical procedure)

C. Postoperative factors

A. The stress of surgery and postoperative pain
2. Increased catabolism of tissue
3. Decrease in effective circulating volume
4. The risk or presence of postoperative ileus

III. Fluid therapy
Fluid therapy is the action to maintain, replace fluids within physiological limits by infusion of crystalloid fluids (electrolyte) or colloid (plasma expanders) intravenously.
fluid therapy serves to replace the fluid deficit during fasting before and after surgery, replacing the need for routine at surgery, replacing bleeding occurred, and replace the fluids that move into the third cavity.
 Therapy fluid resuscitation
fluid resuscitation therapy is intended to replace the acute loss of body fluids or rapid expansion of intravascular fluid to improve tissue perfusion. For example, in a state of shock and burns. Resuscitation fluid therapy can be performed by infusion of Normal Saline (NS), Ringer's acetate (RA), or Ringer's lactate (RL) of 20 ml / kg for 30-60 minutes. In the hemorrhagic shock can be given 2-3 L in 10 minutes.
 Maintenance therapy
Maintenance therapy aims to maintain body fluid balance and nutrition. The average adult requires 30-35 ml fluid / kg / day and the main electrolytes Na + = 1-2 mmol / kg / K + = 1mmol/kgBB/hari haridan. The need for replacement fluid is lost due to the formation of urine, gastrointestinal secretions, perspiration (through the skin) and expenditures through the lungs, known as insensible water losses.
For children used Holiday Segar formula 4:2:1, namely:


Maintenance therapy may be given intravenous fluids containing electrolytes or carbohydrates that contain only carbohydrate infusion alone. Electrolyte solution that also contains carbohydrates is a solution of KA-EN, saline + dextran, DGAA, Ringer's dextrose, etc.. While the maintenance solution containing only carbohydrate is dextrose 5%. But without the electrolyte fluid quickly out of circulation and fill the space between cells, so dextrose does not play a role in hypovolemic.
the potassium balance of fluid maintenance therapy should be considered because, as already described excessive or deficient levels can cause harmful side effects. Generally, conventional RL infusion or NS are not able to supply the daily potassium needs. KA-EN infusion of potassium can supply the daily needs.
At surgery will cause the fluid to move into the third chamber, to the peritoneum, the outer body. To change depending on the size of surgery, namely:
• 6-8 ml / kg for major surgery
• 4-6 ml / kg for the surgery was
• 2-4 ml / kg for minor surgery

A. Types of Fluids
1. Crystalloid fluids

These fluids have a composition similar to extracellular fluid (CES = CEF). Crystalloid fluids when administered in adequate amounts (3-4 times a colloidal liquid) was as effective as colloid fluids for intravascular volume deficits. The half-life of crystalloid fluid in the intravascular space of about 20-30 minutes.

Lactate Ringer's solution is a crystalloid fluid is the most widely used for fluid resuscitation if a little hipotonis the arrangement that is almost like intravascular fluid. Lactate contained in the fluid will experience a metabolism in the liver to bicarbonate. Other crystalloid fluids are often used are 0.9%, but when given an excess can lead to hyperchloremic acidosis (hyperchloremic acidosis delutional) and decrease in plasma bicarbonate levels due to increased chloride.

Due to the nature of the difference between colloid and crystalloid which crystalloids will be more spread out into space interstitiel compared with the crystalloid colloid should be selected for fluid resuscitation in the interstitiel deficit.

In one study suggests that even small amounts of crystalloid solutions will enter interstitiel space causing pulmonary edema and peripheral tissue oxygenation and result in disruption of tissue injury and edema, if someone gets a 1 liter infusion of NaCl 0.9 In addition, excessive crystalloid fluid administration may also cause brain edema and increased intra-cranial pressure.

2. Colloid fluids

Also referred to as a plasma replacement fluids or so-called "plasma substitute" or a "plasma expander". Contained in the liquid colloidal substances / materials that have a high molecular weight by osmotic activity that causes the fluid is likely to persist for a long time (half-life 3-6 hours) in the intravascular space. Therefore, colloids are often used for rapid fluid resuscitation, especially in hypovolemic shock / hermorhagik or in patients with severe hypoalbuminemia and loss of many proteins (eg burns).

Based on its manufacture, there are two types of colloidal solutions:

a. Natural colloids:
That plasma protein fraction and 5% human albumin (5 and 2.5%). Made by heating plasma or placental 60 ° C for 10 hours to kill the hepatitis virus and other viruses. Plasma protein fraction in addition to containing albumin (83%) also containing alpha globulin and beta globulin.
b. Synthetic colloid:

A. Dextran:
dextran 40 (Rheomacrodex) with a molecular weight of 40,000 and dextran 70 (Macrodex) 60000-70000 molecular weight produced by the bacterium Leuconostoc mesenteroides B-growing in sucrose media. Although the volume expander dextran 70 is better than dextran 40, dextran 40 but can improve blood flow through the microcirculation because it can reduce the viscosity (viscosity) of blood. In addition it has the effect of anti-thrombotic dextran can reduce platelet adhesiveness, suppresses the activity of factor VIII, increases fibrinolysis and blood flow. Giving dextran exceed 20 ml / kg / day can interfere with cross match, extending bleeding time (dextran 40) and kidney failure. Dextran can cause anaphylactic reactions can be prevented by providing dextran 1 (Promit) first.



2. Hydroxylethyl Starch (starch Heta)
Available in a solution of 6% with a molecular weight of 10000-1000000, an average of 71 000, osmolarity 310 mOsm / L and oncotic pressure 30 30 mmHg. Provision of 500 ml of this solution in a normal person will be issued 46% through the urine within 2 days and the remaining 64% within 8 days. Colloidal solution can also cause anaphylactic reactions and may increase levels of serum amylase (although rare). Low molecullar Hydroxylethyl weight starch (Penta-Starch) Heta like starch, are capable of developing a plasma volume up to 1.5 times the volume is given and lasts for 12 hours. Because of its potential as a plasma volume expander is great with low toxicity and do not interfere with the coagulation Penta selected as a colloidal starch for fluid resuscitation in patients with life-threatening.

3. Gelatin
colloid solution in a balanced electrolyte from 3.5 to 4% with an average molecular weight of 35 000 was made ​​from animal collagen hydrolysis.
There are three kinds of gelatin, namely:
- modified fluid gelatin (Plasmion and Hemacell)
- Urea linked gelatin
- gelatin Oxypoly


B. Preoperative fluid therapy

Fluid deficit due to preparation for surgery and anesthesia (fasting, lavement) must be taken into account and where possible be replaced in the pre-operatively before induction. Following from the rest of the deficit that still exists is given in the first hour of surgery, while the rest are given at the next second. Loss of fluid in the ECF is quite replaced with physiological saline ciran hipotonis such, Ringer's lactate and Dextrose. In people with the disease do not receive adequate nutrition should be given the enteral or parenteral nutrition sooner. Adult patients who fasted because it will have surgery (elective) must get a replacement fluids as much as 2 ml / kg / hour long fasting. Deficit due to bleeding or fluid loss (hypovolemic, dehydrated) that often accompanies surgical complications should be replaced by or rehydration fluid resuscitation before induction of anesthesia.



C. Intraoperative Fluid Therapy

Amount of fluid replacement during surgery is calculated based on the basic needs coupled with fluid loss due to surgery (bleeding, fluid translocation and evaporation or evaporation). Depending on the type of fluids given to the operation, procedures and the amount of blood lost.

A. Surgery is quite small and not too traumatic for example, eye surgery (extraction, cataract) is only given maintenance fluids only during surgery.

2. With minor trauma such as surgery: appendectomy may be given fluids as much as 2 ml / kg / hour for the basic needs plus 4 ml / kg / hour for a replacement due to trauma surgery. The total given was 6 ml / kg / h of saline or Ringer's lactate balance as Normosol-R.

3. With the trauma of surgery is being given fluids as much as 2 ml / kg / hour for the basic needs plus 8 ml / kg / hour for the operation,. Total of 10 ml / kg / hour.

D. Postoperative fluid therapy

Postoperative fluid therapy is directed mainly on things below:

A. Fulfillment of basic needs / day of water, electrolytes and calories / nutrients. Water needs for people in the tropics in the basal state of approximately ± 50 ml/kgBB/24 hours. On the first day post-surgical administration of potassium is not recommended due to the release of potassium from the cells / tissues are damaged, the process of catabolism and blood transfusion. Stress due to surgery, will be released aldosterone and ADH are likely to result in water and sodium retention. Therefore, at 2-3 days post-surgery unnecessary administration of sodium. Patients with good general condition and minimum surgical trauma, administration of carbohydrate 100-150 mg / day is sufficient to meet the caloric needs, and can suppress protein breakdown by 50% albumin levels should be maintained more than 3.5 g%. Postoperative fluid replacement with enough fluids and if necessary hipotonis garamisotonis solution. Fluid therapy was continued until the patient can drink and eat.

2. Replacing lost fluids in the postoperative period:
- As a result of fever, fluid needs increase by about 15% per 1 ° C rise in
body temperature
- The gastric secretion of fluid through vomiting or gastric sonde.
- Patients with hyperventilation or breathing through a tracheostomy and
humidification.

3. Continuing the fluid deficit replacement surgery and during surgery is not done yet. When hemoglobin levels less than 10 g%, should be given blood transfusions to improve oxygen carrying capacity.

4. Correction of balance disorders are caused by fluid therapy. Monitoring of vital organs is carefully followed including blood pressure, pulse rate, diuresis, the level of consciousness, pupil diameter, airway, breathing frequency, body temperature and skin color.
CHAPTER III

CONCLUSION

Body contains 60% water which is also called the body fluids. Body fluids contained therein nutrients essential role in cell metabolism, so it is very important in sustaining life.
In surgery, the body is dehydrated because of bleeding during surgery plus fasting before and after surgery. Disturbances in fluid and electrolyte balance is a common occurrence in surgical patients due to a combination of factors of preoperative, perioperative, and postoperative.

Parenteral fluid therapy is used to maintain or restore normal volume and composition of body fluids. The need for fluid therapy should be considered according to age and state of the patient, and fluid infusion itself. Types of liquids that can be administered for therapy and crystalloid fluid is a liquid colloidal fluids.





REFERENCES

Adelmen, RD, Solhaug, MJ, 2000. Pathophysiology of Body Fluids and Fluid Therapy. In: Behrman, RE, Kliegman, RM, Arvin, Ann.M., Nelson Pediatrics 15th ed, vol 2. New York: EGC; 258-266

Hartanto, WW, 2007. Perioperative fluid and electrolyte therapy. Clinical Pharmacology and Therapeutics Section Faculty of Medicine, University of Padjadjaran

Hasan F. Fluid Therapy. , 2008. In the download of http://drfhasan.blogspot.com/2008/01/referat-terapi-cairan.html.

Latif AS, et al. Of 2002. Practical hints anesthesiology: fluid therapy in surgery. Ed.Kedua. Part of anesthesiology and intensive therapy, School of Medicine.