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GATHERING WITH IPAI NATIONAL CONGGRES

(JAKARTA-APRIL 7th

2007)Budhi Sant!" #$ (#%di&a' Cn!u'tant PT Ot!u*a Indn%!ia)

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R%+'a&%

#aintain

R%+ai

A$n%&ma' '%ss )IT* 3&d

spa+e*On,%in, '%ss* septi+ andH-p%.%'emi+ s/%+

I12 u&ine

A+id $ase*e'e+t&%'-te im$a'an+es

BASIC PRINCIPLESBASIC PRINCIPLES

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Ratina' 4uid th%a+5(nut&iti%n supp%&t* dai'- 4ate& 5 e'e+t&%'-te

&e6ui&ements#

AB

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Internal data: NCE, West Java Peripheral Hospitals

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77

• !%&&e+t timin,

• !%&&e+t indi+ati%ns* d%sa,e• !%&&e+t p&%du+t (+%mp%siti%n*+%n+ent&ati%n#

• Tai'%&ed t% patient8s 9uid and

e'e+t&%'-te status* n%t dia,n%sis• )%%d m%nit%&in,

• !%st:e;e+ti.e

Rati%na' F'uid Re,imen

DN $o%o et al. &'K()

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Kua'ita! Inu! P'a.tt'%

• Ste&i'

•

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Softbag Hanya membandingkan Suhu pd sterilisasi akhir

Penyediaan air

demineralisata

121-140 oC

peralatan dan fasilitas produksi(Saturated Pure Steam) 121 oC

Bahan baku dengan

beban mikroba

dan endotoksin

(pirogen)

tidak melebihi batas

yang ditetapkan iltrasi dengan

filter

0!22 mikron

Pembuatan botol" pengisian danpenutupan botol

dengan Blo# moulding" dilakukanpada suhu 1$% oC &

Proses sterilisasi akhir dari

kemasan dan isi di otoklaf pada

suhu

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Korea Otsuka

Dong- Otsuka

Otsuka International Asia Arab Division

China Otsuka

!ai"an Otsuka

King Car Otsuka

Otsuka Philippines#K Otsuka

$uang Dong

Otsuka

!hai Otsuka

Otsuka Pakistan

%gypt Otsuka

E6+t t 8&unti%! 9i/i "

Sa,a"Tna "PNG

E6+t t 8 n%aa A!ia-Pa!i:*

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Rin,e&'atat

Ase&in,

"e@t&%seG

Na!' 07BG

N:" ")a

=AEN C

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TERAPI CAIRAN

RES3SITASI

KOLOI$KOLOI$ N3TRISIN3TRISI

Menggantikan

kehilangan akut

cairan tubuh

O!&'!() - * +

Memelihara

keseimbangan

cairan tubuh

dan nutrisi

K-%) 1 +

K-%) +

K-%) +

K-%) . +

K-%) . +

/0P(%) +

/0)O%*- 33 +

P)- /0) $ +

K-%) /$ +

/(!O& 13 +

R3#ATAN

KRISTALOI$KRISTALOI$ ELEKTROLITELEKTROLIT

&%(0)$ +

Otsu- (* +

Otsu- )& +

Repai&=!'*

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J%ni! 'autan %'%*t'it .%da!a*antni!ita!n5a

PlasmaPlasma Larutan elektrolit

isotonik

Larutan elektrolit

isotonik

Larutan elektrolit

Hipotonik

Larutan elektrolit

Hipotonik

Normal

saline

Ringer

asetat/ laktatKAEN 3B

290 308 273

278278

D5

290278

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A!%in" RL ; NSA!%in" RL ; NS

L

J00 m'

00 m'

S5* hi+'%,i* $ia% d%nan d%hida!i .% #untah-,untah h%.at $SS P%daahan

Lu*a Ba*a

K%dauatan .%dah

Inta+%ati

IN$IKASI

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Pasien Rawat Ina!Interna, Pediatric, Pulmonologi,

Cardiology, Obgyn, Neurologi

Stroke!

Post "erati#e!Surgery pts, Obgyn pts,

$%6t!a ;KAEN

$%6t!a ;KAEN

L

m'

J m'

IN$IKASI

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RES3SITASIRES3SITASI R3#ATANR3#ATAN

TERAPI CAIRAN I=

Infus Nat&ium K C00 mE62 atau %'%id 0:30 m',>am :3 2C0:C menit

Nat&ium &enda/

C (misa' , @C0@C0C @ Lm'>a

00 m'L >am

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(inger4s

a5etate +

®

Ringer’s acetate

First Lin

Fluid R suscitation Th rapyASERING

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NS, "L, Asering,

Colloids

"#$,"L#$,

"%#$,#&%%

KAEN3B

KAEN$%3

NaCl'(

NaHCO'

&lu )*(,+*(annitol

A&'te rela&ement

rehydrate,

restore perfusion!

aintenance

"epair

correct e-treme.

symptomatic electrolyte

derangement

F'uid T/e&ap-

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•Rin%>! 'a&tat%

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2A!TATE P&ima&i'- in t/e 'i.e&* and t% 'esse& de,&eet/e idne-* 'a+tate is meta$%'ied t% p-&u.ate* 4/i+/is t/en +%n.e&ted t% !O and HO (J0G# %& ,'u+%se

(0G#* and &e,ene&ati%n %f $i+a&$%nateC

A!ETATE meta$%'ied main'- in mus+'es and t% a

'esse& e@tent in tissues su+/ as idne-* /ea&t and 'i.e&

%cetate / H/00000000 %cetyl0Co%

Coen1yme %

Carbonic acid 00000000 bicarbonate

hydro*en sour+e

2reb3s cycle

"ef4 54"ose 6#4 Clinical Physiology of %cid06ase and 7lectrolyte #isorders4 c&ra80Hill +th ed 599+ p $$+

)4 a-8ell H, 2leeman C", Narins "&4 Clinical #isorders of :luid and 7lectrolyte etabolism4ac&ra80Hill 59;< +th edition p 5*='

LR &,+a% t ASERING@

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() *"DI+$ ,AK-A- . A-I

C#C#6O#7COO)a 8 CO2 8#2O )a#CO 8 C#C#6O#7COO# 6 *aktat 7

C#C#6O#7COO# 8 O2 CO2 8 #2O 9 !C Cy5le

2) *"DI+$ A*E-A- . "-"-

C#COO)a 8 CO2 8#2O

C#COO# 8 2 O2 2 CO2 8 2 #2O 9 !C Cy5le

)a#CO 8 C#COO# 6 setat 7

$*'kO&

$*0KO$%)$ - - P*- *K!!

P0('!

*D#

setil Ko

sintetase

&%!! setil - Ko

2 CO2 !C Cy5le #2O

#ETABOLIS#E ASERING@

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Na 2a+tateNa 2a+tate

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C2

#

O2

- 8 2O2

CO2

8 #2

O 8 #CO

-

6 5etate 7 6bi5arbonate7

C#:O- 8 O2 2CO2 8 2#2O 8 #CO

-

6 *a5tate 7 6bi5arbonate7

LACTATE =S ASERING@LACTATE =S ASERING@

(mus+'e#

(2i.e

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C7 SHO!= SYN"ROMESC7 SHO!= SYN"ROMES

In s/%+ states su+/ as septi+ s/%+* tissue

/-p%@ia and impai&ed /epati+ ,'u+% ne%,enesisand %@idati%n e'e.ate p'asma 'a+tate $- app&%@7L00G AR ma- $e $ette& a'te&nati.e t% 2R

In s/%+ states su+/ as septi+ s/%+* tissue

/-p%@ia and impai&ed /epati+ ,'u+% ne%,enesisand %@idati%n e'e.ate p'asma 'a+tate $- app&%@7L00G AR ma- $e $ette& a'te&nati.e t% 2R

olfe RR, Mller -I +ardo/as+ular and 0eta%ol+ responsesdurn* %urn sho+1 n the *unea p*. A0 2 Physol #3456!7#83!9834

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2 HEPATIC INS399ICIENC 2 HEPATIC INS399ICIENC

• AR .s 2R du&in, indu+ed /epati+ insu+ien+- in&a$$its7

• Hepati+ a&te&-* p%&ta' .ein and $i'e du+t 4e&e

'i,ated and .esse's 4e&e +'amp f%& 0 minutes7• AR %& 2R administe&ed 4it/in t/at 0 minutes7

• In 2R ,&%up G &edu+ti%n in ATP and a :f%'d in+&easein AMP

• !%n+'usi%n in /epati+ insu+ien+-* ,'u+%ne%,enesis isin/i$ited and t/e 'i.e& fai's t% meta$%'ie 'a+tate

• AR .s 2R du&in, indu+ed /epati+ insu+ien+- in&a$$its7

• Hepati+ a&te&-* p%&ta' .ein and $i'e du+t 4e&e

'i,ated and .esse's 4e&e +'amp f%& 0 minutes7• AR %& 2R administe&ed 4it/in t/at 0 minutes7

• In 2R ,&%up G &edu+ti%n in ATP and a :f%'d in+&easein AMP

• !%n+'usi%n in /epati+ insu+ien+-* ,'u+%ne%,enesis isin/i$ited and t/e 'i.e& fai's t% meta$%'ie 'a+tate

Na1atan :, et al. E;e+ts of Rn*er o++luson n ra%%ts. transplantaton #33?6?3&4(3?!9?4

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Masui 599$ #ec>++5)!?5=$+0=*

Naa-ama M* =a4ana S* Yamau+/i M* Tsu+/ida H*I4asaiH*Namii AUti'it- %f a+etated Rin,e& s%'uti%n asint&a%pe&ati.e 9uids du&in, /epate+t%m-7

Hem%d-nami+s* meta$%'ism* $'%%d ,asand &ena' 5 'i.e& fun+ti%ns7 T4ent- patientsC m',/& 4it/ t/e Q&st 00 m' and

t/e&eafte& &edu+ed t% C0 m',/&7

D Inta+%ati% 9'uid duin H%+at%&t,5

AR i t ti 4 id i

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0

5

(0

(5

20

25

30

35

10

15

50

Ringers la&tate

Ringers a&etate

Nakayama , 2a8ana S, @amauchi , Asuchida H, I8asaki H, Namiki %Btility of acetated

"inger solution as intraoperatiDe fluids during hepatectomyE, asui 599$ #ec>++5)!?5=$+0=*

Lactate LeDelmg.dl!

Lactate leDel at the end of operation!

+;4= / 5=4+

)945 / 5+4'

n F )*

AR a! inta+%ati% 4uid inh%+at%&t,5

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J Clin Anesth 1998 Fe!1"#1$:%&'(

2ashimoto S, et alC,+aati% %%&t! Rin%F! a&%tat% and 'a&tat% !'utin! ninta+%ati% &%nta' and +%i+h%a' t%,+%atu%!

P%AI7NAS? =* %S% physical status I and II patients undergoing

general surgery4

INA7"G7NAIONS? :ollo8ing induction 8ith $ mg.kg of thiamylal

and *45 mg.kg of Decuronium, patients 8ere randomly assigned to one

of four groups 5$ patients per group!4

Ahey receiDed inhalation anesthetics ==( nitrous o-ide BN)OE and

54*( to )4*( isoflurane or 54'( to )4=( seDoflurane! and L" or %"

Ee&t on 4ore -emerat're

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-mani& $em6rane -emerat're

p*4*$

Ee&t on 4ore -emerat're

temperature of tympanic membrane!

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!%mpa&ati.e E;e+ts %f Rin,e&8s A+etate (Ase&in,#

and Rin,e&8s 2a+tate %n +%&e tempe&atu&e and t/ef&e6uen+- %f s/i.e&in, in +esa&ean Se+ti%n unde&

Su$a&a+/n%id Anest/esia

Susi'% !/and&aEdd- Ha&i>ant%

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Stud- &esu'ts !%&e Tempe&atu&e

#inut%! Rin%>! 'a&atat% Rin%>! a&%tat% Sini:&an&% (+)

(Asering)

B%% SAB D

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!%n+'usi%n

C7 Rin,e&8s A+etate (A!%in# maintains +%&etempe&atu&e $ette& t/an Rin,e&8s 'a+tate inp&e,nant 4%men unde&,%in, +esa&eanse+ti%n unde& su$a&a+/n%id anest/esia*

si,niQ+ant'- %n t/* 0t/* t/* Lt/ minutes

7 A't/%u,/ t/e&e is n% si,niQ+ant di;e&en+ein t/e se.e&it- %f s/i.e&in, $et4een t/e

t4% ,&%ups* Rin,e&8s 'a+tate is ass%+iated4it/ ea&'ie& %++u&&en+e %f s/i.e&in, t/anA!%in

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asui 5999 Sep>+;9!?9 combined sinal an ei'ral

25 ml/kg/r A)etated *in+ers solution is etter than

la)tated *in+ers solution in rapid in-usion

e-ore )esarean se)tion e)ause o- the

)orre)tion o- neonatal la)ti) a)idosis4

"6stetri& +se

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P&ee+'ampsiaE+'ampsia

• A!%in #SO8 20

• #SO8(8 .'u!? ,%nit) /a,• Ju,'ah &aian inu! ?00-2000 ,'28 /a,

• Bi'a t%da+at hi+'%,ia .%i*an $%6tan80M ?00 ,'28/a,

• Pantau /u,'ah uin (N D0 ,'/a,)

/g&O. 23; artinya

dalam 133 ml ada 23 g=adi 1 ampul 2: ml

berisi : g

'ntuk drip 1 amp

dilarutkan dalam :33

ml sering

+sama Salha and ,ames , alker

.anagement options9 /odern management of e5lampsia

Postgrad! .ed! ,!" eb 1/// % $ - $2!

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ASERING@ in a+ute st&%e

patients

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%naesthesia 599+ Sep>+99!?

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%nesthesiology )*** NoD>9'$!?55

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)a8 > 1.3 m%?@*

Cl- > 132 m%?@*

&0D > A m%?@*

)a8 > 1:. m%?@*

Cl- > 1:. m%?@*

&0D > 3 m%?@*1 liter 1 liter

PLAS#A NaC' 0PLAS#A NaC' 0

&0D 9 A

Plasma NaCl 0.9%

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2 liter

ASI$OSIS HIPERKLORE#IK AKIBATASI$OSIS HIPERKLORE#IK AKIBAT

PE#BERIAN LAR3TAN NaC' 0PE#BERIAN LAR3TAN NaC' 0

<

&0D 9 1B&0D 9 1B sidosissidosis

)a8 > 61.381:.7@2 m%?@*> 1. m%?@*

Cl- > 61328 1:.7@2 m%?@*> 12A m%?@*

&0D > 1B m%?@*

Plasma

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)a8 > 1.3 m%?@*

Cl- > 132 m%?@*

&0D> A m%?@*

Cation8 > 1 m%?@*

Cl- > 13B m%?@*

setat- > 2A m%?@*

&0D > 3 m%?@*

1 liter 1 liter

PLAS#A Lautan ASERINGPLAS#A Lautan ASERING@@

&0D 9 A&0D 9 A

Plasma Ringer asetatAsetat cepatdimetabolisme

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2 liter

<

N,a' +H !%t%'ah +%,.%ianN,a' +H !%t%'ah +%,.%ianASERINGASERING@@

&0D 9 . lebih alkalosis 6dianggap )7

dibandingkan pemberian )aCl 3B;

)a8 > 61.3817@2 m%?@*> 1B m%?@*

Cl- > 61328 13B7@2 m%?@* > 13: m%?@*

setat- 6termetabolisme7 > 3 m%?@*

&0D > . m%?@*

Plasma

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%cta %naesthesiol Scand 599' Oct>'

2uitunen %, et al4 Hydro-yethyl starch as a prime for cardiopulmonary bypass?

effects of t8o different solutions on haemostasis4

:orty0fiDe patients undergoing coronary bypass grafting 8ere prospectiDely randomised to

three groups and receiDed in a double0blind manner as their CP6 prime either )* ml4kg05

LJ0H7S 8 5)*,***!, )* ml4kg05 HJ0H7S 8 +**,***! or "ingerKs acetate )*** ml4

Ahe final Dolume of the prime 8as completed to )*** ml 8ith "ingerKs acetate in the H7S groups4

%naesthesia and CP6 management 8ere standardised4 Plasma leDels of Don Jillebrand factor

antigen and factor GIII procoagulant actiDity 8ere significantly more depressed after CP6 in

both H7S0groups as compared 8ith the crystalloid prime group4 In addition, %PAA 8as more

prolonged and the ma-imal amplitude of thromboelastographic tracing 8as more decreased in the H7S0groups4

It is concluded that it may be adDisable to aDoid H7S solutions in

the CP6 prime, especially in patients 8ith an increased risk for

bleeding after cardiac operations4M

AR s'erior to E* as 4PB Prime

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%cta %naesthesiol Scand 599$ ul>'9$!?=

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ASERINGRinger’s acetate

First Line

Fluid Resuscitation Therapy

Man!aat lain dari ASERING

3 irekomendasikan oleh !5!+! untuk

pasien emam Berdarah engue

(B)!W.H.O. SEA Dept. of Communicable Disease. Regional Guidelines

on Dengue / DHF Pe!ention and Contoll. Regional Publ. "#. $###.

3 Pada stroke akut" pemberian 'S6789:

sesuai dengan konsep menghindari ';

.gS+4 sebanyak 10 " akan meningkatkan

tonisitas infus men>adi 8S+

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A,an di,unaan pada ana 5 $a-i7

2 $iindi*a!i*an untu &esusitasi ( misa'asus de/id&asi $e&at* S-% "

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• Rep'a+ement 9uid f%& &esus+itati%n ,ast&%ente&itis* $u&n*/em%&&/a,i+ s/%+* "SS

• Int&a%pe&ati.e

• P&imin, s%'uti%n f%&+a&di%pu'm%na&- $-pass (!P

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RES3SITASIRES3SITASI R3#ATANR3#ATAN

N3TRISIN3TRISI=&ista'%id=&ista'%id

Men,,anti e/i'an,an aut (/em%&&/a,e*

)I '%ss* &%n,,a e3#

Men,,anti e/i'an,an aut (/em%&&/a,e*

)I '%ss* &%n,,a e3#

C7 =e$utu/an n%&ma' (I12 u&in feses#7 "uun,an nut&isi

C7 =e$utu/an n%&ma' (I12 u&in feses#7 "uun,an nut&isi

TERAPI CAIRAN

K'idE'%*t'itE'%*t'it

Seri 2%07NSeri 2%07N

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7mbryo 9

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Rati%na'e %f maintenan+e

s%'uti%ns

Rati%na'e %f maintenan+e

s%'uti%ns

F'uid &edist&i$uti%n

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K%.utuhan haianM

Air 3050 m,/kgBB

Na= 2 me>/kgBBK = ( me>/kgBB

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Potassium Sodium

(mEq/kgBW/day) (mEq/kgBW/day)

Adult1

0.9 - 1.3 1.0 - 1.7

Fo i!"a!t to #$ild%!& ' as%d o! 100 ml o" at% "o %a#$ 100 k#al %*+%!d%d.

,ai!t%!a!#% %l%#t. %qui%m%!t ' 100 ml a!d &- mEq o" a a!d "o %%y 100 k#al %*+%!d%d.

u+ to 10 kg

11 - &0 kg

&0 kg

2aily Body Fluid &0 - 30 1.0

4om%ostasis3 (mi!imum) (mi!imum)

100 ml at% / kg

1000 ml 5 60 ml / kg "o %a#$ kg ao% 10 kg

1600 ml 5 &0 ml /kg "o %a#$ kg ao% &0 kg

Potassium Sodium


Adult1

0.9 - 1.3 1.0 - 1.7



u+ to 10 kg

11 - &0 kg

&0 kg


4om%ostasis3 (mi!imum) (mi!imum)

100 ml at% / kg

1000 ml 5 60 ml / kg "o %a#$ kg ao% 10 kg

1600 ml 5 &0 ml /kg "o %a#$ kg ao% &0 kg

1. Page C.P., Thomas C.H. and George M. Nutritional Assessment and Support. A primer 2nd Ed. P : 2. 1!!".

2. Martine#$%ian&hi, '., M(, Mi&helle, )P, M(., Mar* A.G., M(. Pediatri&s : 'omiting, (iarrhea, and (eh+dration in amil+

Pra&ti&e Hand-oo* rd Ed. /SA.

. 0o**o and Tannen. luid and Ele&trol+te rd Ed. % Saunders.

Pta!!iu, and Sdiu,H,%!ta!i! and $ai'5

R%ui%,%nt

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• Pe&'u men,eta/ui $e&apa e$utu/an ai&*e'et&%'it(Na*= #

• Pe&'u men,eta/ui status Nat&ium dan a'ium se&um

• Pe&'u men,eta/ui s-a&at e+epatan =

* dest&%sa*'ipid* AA

air 30-50 ml/kg; Na+

2 mEq/kg K +

1 mEq/kg

Na+ 135-145 mEq/L; K + 3,5-5 mEq/L

K + < 20 mEq/am!(5-10 mEq/am);"eks#r$sa

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A!a' LautanRu,atan

$i;ing,ar'tan Normal

*aline .Na= (51 mE>/,

,ar'tan

%l'kosa 5?

,ar'tan (/2 N* ,ar'tan (/3 N* ,ar'tan (/1 N* ,ar'tan (/5 N*

Na= 77 mE>/, Na= 5(mE>/, Na= 38 mE>/, Na= 3( mE>/,

,ar'tan KAEN ( A ,ar'tan KAEN 2 ,ar'tan KAEN 3 ,ar'tan KAEN 1

Suplementasi elektrolit Suplementasi air

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64/126

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are still "idely used

!or maintenance therapy

#

RL

#

$% & 'tros

# $% & 'tr( in Ring rs

What a% th% i,+a&t! What a% th% i,+a&t!

9a&t!M9a&t!M

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Kebutuhan ir 2333 m* (* 2 * K-%) + 2 *

)atrium :3 133 m%? 23 m%? 133 m%?

Kalium .: m%? A m%? .3 m%?

In!us RL bukan

)ntuk Terapi Rumatan

Ilustrasi 66 #e8asa Org Indonesia! ? $* kg

*A+EN ,A *A+EN ,-

(ational infusion solution for maintenan5e therapy 6age E years7

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*A EN ,-

*A+EN .- (ational infusion solution for maintenan5e therapy 6age < years7

'nak BB ? 20 kg

Kebutuhan ir 1: * (* 1: * K-%) + , 1: *

)atrium 3 133 m%? 1B: m%? : m%?

Kalium 23 - :3 m%? m%? 3 m%?

In!us RL bukan

)ntuk Terapi Rumatan

7ef!

1! 7ie 5! luid

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7TAHU =E

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$ / / i

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C7 Menata e$utu/an /a&ian =a'ium?

C7 Menata e$utu/an /a&ian =a'ium?

i d S di

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Potassium Sodium


Adult1

0.9 - 1.3 1.0 - 1.7



u+ to 10 kg

11 - &0 kg

&0 kg


4om%ostasis3

(mi!imum) (mi!imum)

100 ml at% / kg

1000 ml 5 60 ml / kg "o %a#$ kg ao% 10 kg

1600 ml 5 &0 ml /kg "o %a#$ kg ao% &0 kg

Potassium Sodium


Adult1

0.9 - 1.3 1.0 - 1.7



u+ to 10 kg

11 - &0 kg

&0 kg


4om%ostasis3

(mi!imum) (mi!imum)

100 ml at% / kg

1000 ml 5 60 ml / kg "o %a#$ kg ao% 10 kg

1600 ml 5 &0 ml /kg "o %a#$ kg ao% &0 kg

1. Page C.P., Thomas C.H. and George M. Nutritional Assessment and Support. A primer 2nd Ed. P : 2. 1!!".

2. Martine#$%ian&hi, '., M(, Mi&helle, )P, M(., Mar* A.G., M(. Pediatri&s : 'omiting, (iarrhea, and (eh+dration in amil+

Pra&ti&e Hand-oo* rd Ed. /SA.

. 0o**o and Tannen. luid and Ele&trol+te rd Ed. % Saunders.

Pta!!iu, and Sdiu,H,%!ta!i! and $ai'5R%ui%,%nt

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POTASSI3# 93NCTIONPOTASSI3# 93NCTION

• T/e p&in+ipa' int&a+e''u'a& +ati%n

• Mem$&ane &ep%'a&iati%n• Neu&%:aut%n%mi+• Neu&%mus+u'a& e@+ita$i'it-

• )'-+%,en dep%siti%n 5 P&%teinmeta$%'ism• Re'ease %f pan+&eati+ /%&m%ne• Int&a+e''u'a& pH

Rena' Tu$u'a& A$s%&pti%n

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Rena' Tu$u'a& A$s%&pti%n

Na/

2 /

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Renal -'6'lar A6sortion

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Asupan = C0 me6/a&iAsupan = C0 me6/a&i

$%:!it Ku,u'ati 2?0-D00 ,E da'a, 7-0 hai

:annen R.$ Potassu0 Dsorders. In Ko11o H :annen. lud andEle+trolytes.

B Saunders Co0pany 7rd ed, pp #!7

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Hip%a'emiaHip%a'emia

• In!id%n! 20 +ada +a!i%n aat-ina+ (3S)

• Pada dia% ; ,a'nuti!i

• P%n5%.a. .%aia!i

• I,+'i*a!i +ada +%n5a*it *adia!*u'aMhi+%t%n!i" +t%n!i int*!i*a!i diita'i!" CABG

• P%,.%ian Inu! 5 ,%nandun *a'iu, 20,EL u,u,n5a di+%'u*an +ada +a!i%n aat-ina+

• In!id%n! 20 +ada +a!i%n aat-ina+ (3S)

• Pada dia% ; ,a'nuti!i

• P%n5%.a. .%aia!i

• I,+'i*a!i +ada +%n5a*it *adia!*u'aMhi+%t%n!i" +t%n!i int*!i*a!i diita'i!" CABG

• P%,.%ian Inu! 5 ,%nandun *a'iu, 20

,EL u,u,n5a di+%'u*an +ada +a!i%n aat-ina+

>an*er M. -ypo1ale0a. e0ed+ne.+o0Fe0er*Ftop+!47.ht0l

Mana,ement %f Se.e&e

Mana,ement %f Se.e&e

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,H-p%a'emia in /%spita'ied

Patients

,H-p%a'emia in /%spita'ied

Patients• JLL patients 4it/ Se&um = 3 3 mm%'2

at admissi%n

• (L7G# /ad n% su$se6uentmesu&ement %f p%tassium 'e.e's

• L0 (30G# 4e&e dis+/a&,ed 4it/su$n%&ma' p%tassium 'e.e'

2AMA Jol. #5# No. 8, Aprl !7,!""#

Inad%uat%&'ini&a' ,ana%,%nt

h *a'%,ia

H ' i di I d iH ' i di I d i

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H-p%a'emia di Ind%nesiaH-p%a'emia di Ind%nesia

• 2imitted in+iden+ep&e.a'en+e data (3 +ente&s#

• Insiden di RSPA" )at%t S%e$&%t%* $a,ianpen-ait da'am V L G

• Penin,atan tenden+- pasien &a4at inapden,an /ip%a'emia V C* G (saat masu

ps* dan saat e'ua& men>adi pasien#

• 2imitted in+iden+ep&e.a'en+e data (3 +ente&s#

• Insiden di RSPA" )at%t S%e$&%t%* $a,ianpen-ait da'am V L G

• Penin,atan tenden+- pasien &a4at inapden,an /ip%a'emia V C* G (saat masu

ps* dan saat e'ua& men>adi pasien#

Sudomo, Untung. Marissa Ira. The Indonesian ournal o!" #astroenterolog$, %e&atolog$

and Digestive 'ndosco&$. December ())*. +ol., -o.. /.0010().

C7 RSPA" )ATOT SOE

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• P&e.a'ens V G• Penin,atan tenden+- /-p%a'emia

pasien saat &a4at inap (saat masu

pasien* e'ua& men>adi 3B pasien#

• P&e.a'ens V G• Penin,atan tenden+- /-p%a'emia


pasien* e'ua& men>adi 3B pasien#

D2oko 3idodo, 4udi Setia5an, 6hie 7hen, 8eonard -aenggolan, 3ida$at D2oko Santoso, The /revalence

%& '$kalemia in '$si#ali*e" #s i# .n&e#i$s iseases r$lem a# i#$angnksm$ '$si#al akar#a, Acta Medica Indonesiana +ol9, -o*, October ()):, &age ()(1()*.

7 SU

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• P&e.a'ens /-p%a'emia pts V 0 G• Penin,atan tenden+- /-p%a'emia


0 pasien* e'ua& men>adi L pasien#

• P&e.a'ens /-p%a'emia pts V 0 G• Penin,atan tenden+- /-p%a'emia


0 pasien* e'ua& men>adi L pasien#

-asronudin, %amidah, Ida 4agus 6risna, Suharto, 'dd$ Su5ando2o,

The &revalence o! %$&okalemia in In!ectious Diseases %os&itali;ed /atients, Medika +ol (

December ()):, &age"

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Men,apa /ip%a'emiau&an, dipe&/atian?

Men,apa /ip%a'emiau&an, dipe&/atian?

)e>a'a tida spesiQ dan umumn-a $a&umun+u' pada ada& = 3 mE62

Pada pasien n%n:a&dia tida dim%nit%& etat

Fasi'itas 2a$ tida memadai

A4a&eness

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"ep'esi a'ium >a&an, te&>adi

e&u ???

B%a+a Ban5a* K di+%'%h dai ,a*ana

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B%a+a Ban5a* K di+%'%h dai ,a*ana

Sa-u&an =entan,* $un+is 00 ,& =a+an, 000 ,&

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Ta*ut Hi+%*a'%,iad%nan +%,.%ian KAEN

KAEN3B mengan'ng kali'm (0 mE>/500 ml

KAEN3B mengan'ng kali'm (0 mE>/500 ml

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An/uanM 0 ,E/a,

g g >g g >

K%&%+atan Ru,atan ?00 ,'< /a,

Q 0 ,'/a, 20 t%t%!,%nit

atau Q "< ,E K

/a,

$a'a, +a*t%*M

Ri!i* Hi+%*a'%,ia ,ini,a'

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Ai d N Tid

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Ai& dan Na Tida

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P!t+%ati% #aint%nan&%

• M%st +%mm%n p&%$'em in p%st%pe&ati.e9uid $a'an+e is 9uid %.e&'%ad

• NS ma- a,,&a.ate 4ate& &etenti%n

• !u&&ent &e+%mmendati%n 2 9uidp%st%pe&ati.e'-W L0:C00 mE6 s%dium

• H-p%a'$uminemi+ patient ma- &e6ui&e'%4 s%dium

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•Edema pa&u $isa te&>adi da'am 3L >am pas+a $eda/ $i'a &etensi+ai&an me'e$i/i L m',d se$ain-a intae ai& 000 m'

•Pemu'i/an Fun,si sa'u&an +e&na 'e$i/ +epat pada e'%mp% pasien&esesi usus -an, mendapat +ai&an p%st%p 2W mE6 Nadi$andin,an e'%mp% K 3 2W C mE6 Na se$ain-a asupanNa pas+a $eda/ L0:C00 mE6

•Pasien /ip%a'$uminemia men,a'ami espansi +ai&an einte&stisia'* pem$e&ian nat&ium tin,,i men-e$a$an 'ua %pe&asi

su'it sem$u/

•Es&esi ai& dan nat&ium 'e$i/ 'am$at pada pasien p%st%p -an,mendapat +ai&an den,an andun,an nat&ium -an, 'e$i/ tin,,i

•=a'%&i minima' L00 +a' memi'ii efe men,/emat p&%tein(P&%tein:spa&in, e;e+t#

$. Aieff Allen . Fatal Postopeati!e Pulmona Edema. Pat(ogenesis 0 iteatue Re!ie'. CHES, $###1$$23$45$6$455

". obo D7 et al.Effect of salt and 'ate balance on eco!e of gastointestinal function afte electi!e colonic esection.

ancet "--" )a "2.42#824"-93$5#"64

4. Hill G.. Disodes of nutition and metabolism in clinical suge. C(uc(ill i!ingstone $##-

:. Fiona RE*D; Dileep 7. O

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ID F'uid O.e&'%adID F'uid O.e&'%adID F'uid O.e&'%adID F'uid O.e&'%ad

• "e+&ease mus+u'a& %@-,entensi%n and de'a- &e+%.e&- %f,ast&%intestina' fun+ti%n

• !ause ,ene&a' edema• Impede tissue /ea'in, and

+a&di%pu'm%na&- fun+ti%n

a nu & s a amp%pu'asi

http://www.emedicine.com/ped/topic2954.htm

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p p

Ind%nesia CBBJ TAR)ET +apita a'%&i 00 p&%tein

,mS=RT CBBJ a'%&i C0 p&%tein L,m

XO&an, Ind%nesia se$e'um >atu/sait

suda/ mende&ita deQsit nut&isi CG

8/18/2019 Otsuka Ipai 07.03.07

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sus boor" fistel usus-kulit

sus harus di-istirahatkan

9utrisi harus le#at ena (9P6)

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EDEMA ANASARKA + HEPATOMEGALI

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98/126

HARUS

8/18/2019 Otsuka Ipai 07.03.07

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$- 4ei,/in, -%u& patients p&e and p%st%pe&ati.e'-?

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O& $- &,+aatin%6+%i%n&%d p&e and p%st%pe&ati.e'-?

I'ust&asi Rumatan PasaI'ust&asi Rumatan Pasa

8/18/2019 Otsuka Ipai 07.03.07

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am

(di$e&ian sete'a/ J >am pas+a $eda#

.$.-ll. Dsorders of Nutrton and Meta%ols0 n Cln+al Sur*ery. Chru+hll $/n*stone #33!, p 5"

ol Na 4l K = K&al

NS $**

8/18/2019 Otsuka Ipai 07.03.07

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R2" R" Infus 'ain =AENM)3 Na/ )=* )9+ )** 5**

2 / ; ; '= +*2alori +** +** +** ;**

R2" R" Infus 'ain =AEN M)

Na

/

agak tinggi sangat tinggi sangat tinggi adekuat

2 / kurang kurang cukup adekuat

2alori kurang pas0pasan pas0pasan adekuat

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ASERIN) 5 =AEN 3

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ASERIN) 5 =AEN 3<%mpati$e' den,an %$atdi$a4a/ ini

• Nicholin

•Arental

•Sermion

•Aagamet

•Primperan

• Nicholin

•Arental

•Sermion

•Aagamet

•Primperan

•gSO+

• Neurobion

•Syntocinon

•%minophylline

•gSO+

• Neurobion

•Syntocinon

•%minophylline

*ntenal aboato Data 8BA O* Facto9

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PEMA=AIAN !AIRAN INFUS

"I RUMAH SA=IT

disesuaian den,an

sediaan infus -, ada dipasa&an

PE#AKAIAN IN93S $I 3G$

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S@O2 HIPOGOL7I2

A*ERIN%

2030 ml/kg/Cam

@a AI#%2

' tahun ' tahun

KAEN 1A KAEN (B2ecepatan? 66 5* kg? + ml.kg.Qam

550)* kg ? ) ml.kg.Qam

)$ kg ? 5 ml.kg4Qam

Contoh ? %nak $ tahun 66 5$ kg0

+ - 5* / ) - $ F

$* ml.Qam F 5) tetes.menit

Normo.hipo2 Normo.

hipo2

KAEN 1B KAEN 3B/$%3

ObserDasi.

monitor

nadi teraba

akral hangat

urine output /

kecepatan bisa

diturunkan 5*

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P'S869 SD+;

Asering TRIF2UI"

Tae /%me messa,es

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C7 Ase&in, (AR# is an a'te&nati.e t% 2RNS as &esus+itati%n 9uid7Fu&t/e& pu$'i+ati%n* su+/ maintain pe&i%pe&ati.e +%&e temp*maintenan+e f%& dia$etes et%a+id%sis* int&a: %pe&ati.e 9uid

t/e&ap- in .a&i%us su&,i+a' settin,s* !P

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111/126

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TERI#ATERI#A

Te&ima =asi/

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PLAS#A NaC' 0

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)a8 > 1.3 m%?@*

Cl- > 132 m%?@*

&0D > A m%?@*

)a8 > 1:. m%?@*

Cl- > 1:. m%?@*


PLAS#A NaC' 0

&0D 9 A

Plasma NaCl 0.9%

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PLAS#A NaC' 0

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)a8 > 1.3 m%?@*

Cl- > 132 m%?@*

&0D > A m%?@*

)a8 > 1:. m%?@*

Cl- > 1:. m%?@*


PLAS#A NaC' 0

&0D 9 A

Plasma NaCl 0.9%

ASI$OSIS HIPERKLORE#IK AKIBAT

Pada SS" ;' pemberian 9aCl 0!/= dalam>umlah besar bisa menyebabkan asidosis

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'ite&

PE#BERIAN LAR3TAN Na C' 0

<

&0D 9 1B sidosis

)a8 > 61.381:.7@2 m%?@*> 1. m%?@*

Cl- > 61328 1:.7@2 m%?@*> 12A m%?@*

&0D > 1B m%?@*

Plasma

> y

hiperkloremik

PLAS#A Lautan RINGER ASETAT

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)a8 > 1.3 m%?@*

Cl- > 132 m%?@*

&0D> A m%?@*

Cation8 > 1 m%?@*

Cl- > 13B m%?@*

setat- > 2A m%?@*

&0D > 3 m%?@*

C'ite&

C'ite&

PLAS#A Lautan RINGER ASETAT

&0D 9 A

Plasma Ringer AsetatAsetat cepat

dimetabolisme

RINGER ASETAT

(0)$%( &%!! garis pertama dalam resusitasi 5airan pada diare dgdehidrasi berat,DD dan DK

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'ite&

<

RINGER ASETAT

&0D 9 . lebih alkalosis dibanding Fika

diberikan )aCl 3B;

)a8 > 61.3817@2 m%?@*> 1B m%?@*

Cl- > 61328 13B7@2 m%?@* > 13: m%?@*

setat- 6termetabolisme7 > 3 m%?@*

&0D > . m%?@*

Plasma

PLAS#A Lautan N2-$?

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)a8 > 1.3 m%?@*

Cl- > 132 m%?@*

&0D> A m%?@*

Cation8 > m%?@*

Cl- > m%?@*

&0D > 3 m%?@*

C'ite&

C'ite&

PLAS#A Lautan N2-$?

&0D 9 A

Plasma N2/D5

N,a' +H !%t%'ah +%,.%ian

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'ite&

<

+ +N2$?

&0D 9 1B lebih asidosis dibanding Fika

diberikan (

)a8 > 61.387@2 m%?@*> 13A: m%?@*

Cl- > 61328 7@2 m%?@* > AB: m%?@*

*aktat- 6termetabolisme7 > 3 m%?@*

&0D > 1B m%?@*

Plasma

PLAS#A Lautan R SOL

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)a8 > 1.3 m%?@*

Cl- > 132 m%?@*

&0D> A m%?@*

)a88K88Ca88 > 1:. m%?@*

Cl- > 1::: m%?@*

&0D > -1: m%?@*

C'ite&

C'ite&

PLAS#A Lautan RSOL

&0D 9 A

Plasma R.Sol

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PLAS#A Lautan KAENDB

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125/126

)a8 > 1.3 m%?@*

Cl- > 132 m%?@*

&0D> A m%?@*

Cation8 > 3 m%?@*

Cl- > :3 m%?@*

*aktat- > 23 m%?@*

&0D > 3 m%?@*

C'ite&

C'ite&

PLAS#A Lautan KAENDB

&0D 9 A

Plasma KAEN3BLaktat cepat

dimetabolisme

N,a' +H !%t%'ah +%,.%ian

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'ite&

<

+ +KAENDB

Cation > 61.3837@2 m%?@*> 13: m%?@*

Cl- > 61328 :37@2 m%?@* > m%?@*

*aktatt- 6termetabolisme7 > 3 m%?@*

&0D > 2B m%?@*

Plasma

Documents

Otsuka Ipai 07.03.07