Simptomatik

Hiponatremia Rumus Koreksi

(Na < 135 mEq/L)
Asimptomatik (140 – Na Serum) x BB x 0.6
2(Na) + glukosa/18 + BUN/1.8
Hitung Osmolalitas (BUN = Ur/2.6)

Hypotonic Hypertonic
Isotonic Hyponatremia
Hyponatremia Hyponatremia
275 – 295 mOsm/kg
< 275 mOsm/kg > 295 mOsm/kg

Hiponatremia
Assess status volume Pseudo-hiponatremia
sekunder

Evaluasi tanda vital,

turgor, edema perifer, Assess etiologi
mukosa membrane, Terapi sesuai etiologi
JVP

Hypovolemia Euvolemia Hipotiroid Hypervolemia Renal Failure

Renal Loss : Malignansi
Diuresis osmotik Proses intrakranial
Penggunaan obat diuretic Non Renal Failure :
Defisiensi glukokortikoid
Aldosterone defisiensi
Restriksi cairan CHF
Onset > 48 jam SIADH Terapi
Onset < 48 jam Terapi etiologi Sirosis
NaCl 0,9% Extrarenal Loss : Drug use (antidepresan, Non Renal Failure :
Pertimbangkan NaCl 3% Sind. Nefrotik
Diare, vomitus antipsikotik)
Luka bakar Low intake - Onset > 48 jam :
Obstruksi sal. cerna
Restriksi cairan

- Onset < 48 jam :

NaCl 3% + Loop
diuretic

Renal Failure :
Terapi Hemodialisa
Akut simptomatik : 2 mEq/L/jam dalam 2-3 jam pertama

Kronik simptomatik : Koreksi dgn rate ≤ 0.5 mEq/L/jam

 Daftar Pustaka
1. Sabatine MS. Pocket medicine: The Massachusetts General Hospital Handbook of Internal Medicine. 7th
ed. Philadelphia: Wolters Kluwer; 2021.

2. J. Hoorn E, Zietse R. American Society of Nephrology. Journal of the American Society of Nephrology;
2017 [cited 2022Sep26]. Available from: https://jasn.asnjournals.org/

3. Goh KP. Management of hyponatremia [Internet]. American Family Physician. 2004 [cited 2022Sep26].
Available from: https://www.aafp.org/pubs/afp/issues/2004/0515/p2387.html

4. RH; S. Treatment of severe hyponatremia [Internet]. Clinical journal of the American Society of
Nephrology : CJASN. U.S. National Library of Medicine; 2018 [cited 2022Sep26]. Available from:
https://pubmed.ncbi.nlm.nih.gov/29295830/
 Rumus Koreksi
K def (mEq) = ΔK × kg × 0.4
1 mEq = 1 mmol

Pengenceran harus menggunakan

Hipokalemia NaCl 0,9%

Ringan Sedang Berat Kritikal

3.0 – 3.4 mmol/L 2.5 – 2.9 mmol/L 2.0 – 2.4 mmol/L < 2.0 mmol/L

Aritmia
Gagal jantung
Paralisis
Intoleransi oral kalium

• Observasi ICU
Koreksi Kalium IV line • Monitoring EKG
Suplementasi Kalium perifer • Koreksi Kalium IV line
3-4 kali per hari Tidak ada Ada sentral
20 mmol Kecepatan koreksi 8-10
mEq/jam Kecepatan koreksi 20
mEq/jam
 Daftar Pustaka
1. Sabatine MS. Pocket medicine: The Massachusetts General Hospital Handbook of Internal Medicine. 7th
ed. Philadelphia: Wolters Kluwer; 2021.

2. JM; SJA. Hypokalemia-induced arrhythmias and heart failure: New insights and implications for therapy.
Frontiers in physiology. U.S. National Library of Medicine; 2018 [cited 2022Sep26]. Available from:
https://pubmed.ncbi.nlm.nih.gov/30464746/

3. Palmer BF. Regulation of potassium homeostasis. American Society of Nephrology. American Society of
Nephrology; 2015 [cited 2022Sep26]. Available from: https://cjasn.asnjournals.org/content/10/6/1050

4. The Royal Children's hospital Melbourne. The Royal Children's Hospital Melbourne. 2019 [cited
2022Sep26]. Available from: https://www.rch.org.au/clinicalguide/guideline_index/Hypokalaemia/
• Musculoskeletal :
myopathy, rhabdomyolysis,
weakness
• Respiratory : respiratory failure
• Cardiovascular :
arrhythmias, cardiomyopathy
• Neurological :
irritability, confusion,
hallucinations, somnolence, coma
• Haematological : Hipofosfatemia
bleeding, infection, anaemia

Ringan Sedang Berat

0.6 – 0.8 mmol/L 0.4 – 0.5 mmol/L < 0.3 mmol/L

Terapi oral jika dibutuhkan

Asimptomatik Simptomatik
secara klinis

Terapi fosfat
Terapi oral
intravena
 Daftar Pustaka
1. Glaspy JA, Wolf M, Strauss WE. Intravenous iron-induced hypophosphatemia: An emerging syndrome.
Advances in Therapy. 2021;

2. Detlie TE, Lindstrøm JC, Jahnsen ME, Finnes E, Zoller H, Moum B, et al. Hypophosphatemia after high-
dose intravenous iron treatment in patients with inflammatory bowel disease: Mechanisms and possible
clinical impact. World Journal of Gastroenterology. 2021;27(17):2039–53.