Upload
rsu-kumala-siwi-kudus
View
223
Download
0
Embed Size (px)
Citation preview
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
1/96
WindarwatiSMF PK dan kedokteran
Laboratorium RSUP Dr. sardjito
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
2/96
Snyder dan Pendergraph, Detection and Evaluation of CKD, American Family Physian,
2005New Jersey Academy of Family Physicians, lipid manag. of the CKD Patients,2011
NKF-KDOQI, Cinical Practice Guidelines for CKD : Evaluation, Classification andStratification, 2002
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
3/96
Snyder dan Pendergraph, Detection and Evaluation of CKD, American Family Physian,
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
4/96
Diagnosis and management of CKD, Scottish Intercolegiate Guidelinesnetwork, 2008
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
5/96
Proteinuria- Urine dipstick testing- Protein/creatinine ratio
- Albumin/creatinine ratioHematuriaRenal Tract Ultrasound
Diagnosis and management of CKD,Scottish Intercolegiate Guidelines network, 2008
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
6/96
Glomerular filtration rateThe volume of plasma which is filtered by theglomeruli per unit time and is usuallymeasured by estimating the rate of clearanceof a substance from the plasma.
Glomerular filtration rate varies with body
size and conventionally is corrected to a bodysurface area (BSA) of 1.73 m2.
Diagnosis and management of CKD,Scottish Intercolegiate Guidelines network, 2008
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
7/96
Creatinine24-hours urinary creatinine clearancePredictions equations
- Cockcroft and Gault creatinineclearance,
- Modification of Diet in Renal DiseaseGFR.
Cystatin C
Diagnosis and management of CKD,Scottish Intercolegiate Guidelines network, 2008
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
8/968
1. PERSIAPAN PASIEN:
Makanan dan Obat bersifat mereduksi : vitamin C,Penicilin, streptomicin, salisilatObat yang mengubah warna urin :PIRIDIUM mengganggu pemeriksaan bilirubin,urobilinogenPENAMPUNG : BERSIH, KERING & BERTUTUP RAPAT
LABEL
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
9/969
2. PENAMPUNG URIN:
LABEL:NAMA PASIEN, RUANGAN, WAKTU PENGAMBILAN, NAMADOKTER YG MEMINTAMELEKAT PADA BADAN PENAMPUNG
TIDAK DIANJURKAN MEMAKAI PENAMPUNG BEKAS PAKAI
PENAMPUNG DARI PLASTIK BERMULUT LEBAR , BERTUTUPRAPAT, BERSIH, KERING, TRANSPARAN & VOLUME 50 ML
URIN DITAMPUNG MINIMAL 15 ML DISERTAI DENGANFORMULIR PERMINTAAN
URIN YANG TIDAK JELAS IDENTITASNYA DITOLAK(CATAT TANGGAL, JAM PENERIMAAN & TAND A TANGAN)
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
10/9610
3. PENGAMBILAN URIN:
URIN RUTIN ATAU LENGKAP DITAMPUNGLANGSUNG KE DALAM PENAMPUNG, TIDAKDIPERLUKAN PENGAMBILAN KHUSUSUNTUK MENCEGAH KONTAMINASI HAID ATAUFLUOR ALBUS DISARANKAN URIN PORSI TENGAHMACAM PORSI URIN: URIN PAGI, URIN POSTPRANDIAL, URIN 24 JAM, URIN SEWAKTUPENUNDAAN PEMERIKSAAN PALING LAMA 1 JAMSETELAH BERKEMIH ATAU 2– 8 0C 8 JAM
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
11/9611
4. PENUNDAAN PEMERIKSAAN:
HARUS DIPERIKSA PALING LAMBAT 1 JAM SETELAH
URIN DITAMPUNG (URIN SEGAR)URIN TIDAK BOLEH MENGGUNAKAN PENGAWETPENUNDAAN PEMERIKSAAN PALING LAMA 1 JAMSETELAH BERKEMIH ATAU SIMPAN: 2 – 8 0C 8 JAM.PERUBAHAN TERJADI PADA :
ERITROSITLEUKOSITSILINDERGLUKOSA
KETONBILIRUBINUROBILINOGEN
BAHAN KONTROL URIN HARUS DISIMPAN DALAMSUHU 2 – 8 0C
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
12/96
12
1.PelaporanInterpretasiVerifikasi
2.Dokumentasi
1.Pemeriksa2.Reagensia3.Alat4.Cara Pemeriksaan
5.Identifikasi UnsurSedimen6.Bahan kontrol7.Keselamatan Kerja
1.Penampung Urin2.Cara Pengambilan3.Penundaan
Pemeriksaan
PASCAANALITIK
ANALITIKPRA ANALITIK
PEMERIKSAAN MIKROSKOPI (SEDIMEN URIN)
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
13/96
CARA KERJA TES MIKROSKOPI: Sampel tes sedimen, sebaiknya urin pagi
15 ml urin disentrifuse 5 menit pd 1500 –2000 rpm.Buang cairan atas hingga volume tinggal 0,5 –1ml,kocok untuk meresuspensikan sedimen.Letakkan 2 tetes suspensi di atas kaca objek tutup dgkaca penutup.
Periksa dg mikroskop: objektif 10X (LPK), objektif 40X(LPB).
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
14/96
a
b
c
a
bc
a: Sel Skuamousb: Leukositc: Silinder Granular
a: Leukositb: Eritrositc: Silinder Granular
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
15/96
b
a
a
b
b
a
c
a: Leukosit,
b: Silinder Epitel
a: Silinder Eritrositb: Eritrosit
a: Silinder Granular b: Bakteri c: Epitel Skuamous yang over ly ing
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
16/96
Unsur Sedimen Ringsrud &Linné
KovaSystem
Schumann Iris
Eritrosit
LekositEpitel tubulus ginjalEpitel transisionalEpitel skuamousBakteriSilinder hialinSilinder granular Kristal abnormal
0-2/LPB
0-5/LPBSedikit/LPBSedikit/LPBSedikit/LPBNegatip/LPB
0-2/LPK0Negatip/LPK
0-3/LPB
0-5/LPBNegatip/LPBNegatip/LPBNegatip/LPB0-5/LPB
0-1/LPKNegatip/LPKNegatip/LPK
0-5/LPB
0-5/LPB0-2/LPB0-5/LPBJarang/LPBNegatip/LPB
0-3/LPK0-1/LPKNegatip/LPK
0-3/LPB
0-5/LPB0-1/LPB0-2/LPB0-4/LPBNegatip/LPB
0-3/LPKNegatip/LPKNegatip/LPK
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
17/96
17
TES KIMIA URIN DENGAN REAGEN STRIP
Penilaian semikuantitatif dg melihat skala warna pdarea tes yg dibaca dg alat fotometer reflektans.
Sampel sebaiknya urin pagi tanpa pengawet & tidakperlu disentrifuse.
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
18/96
18
1 2 3
456
Cara pemeriksaan dengan reagen carik celup (Manual)
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
19/96
Cara pemeriksaan dengan reagen carik celup
(Semiotomatik/full otomatik
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
20/96
NO PARAMETER NILAI RUJUKAN1 Berat Jenis (BJ) 1,010 – 1,0202 pH 4,5 – 8,0.3 Leukosit negatif
4 Nitrit negatif 5 Protein negatif 6 Glukosa negatif 7 Keton negatif
8 Urobilinogen negatif / < 1 mg/dl.9 Bilirubin negatif 10 Eritrosit negatif
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
21/96
No Parameter Sensitivitas Range
1 Glukosa 50 mg/dL (3 mmol/L) 50-1000 mg/dL (3-60 mmol/dL)
2 Protein 15 mg/dL (0,15 g/L) 15-1000 mg/dL (0,15-10,0 g/L)
3 Bilirubin 0,5 mg/dL (8,5 µmol/L) 0,5- 6,0 mg/dL ( 8,5-100 µmol/L
4 Urobilinogen 2 mg/dL (35 µmol/L) 2 -8 mg/dL (35 -150 µmol/L)
5 pH 1,0 unit : 5-9 5-9
6 Berat jenis 1,000-1,030 1,000-1,030
7 Darah Hb 0,06 mg/dL,
eritrosit 20 / µL
Hb 0,06-1,0 mg/dL
8 Keton As. Aseoasetat 5 mg/dL (0,5 mmol/L) 5-150 mg/dL (0,5-15 mmol/L)
9 Nitrit 0,08 mg/dL 0,08 mg/dL
10 Leukosit 25 leukosit/ µL 25 leukosit/ µL
Aution sticks
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
22/96
No Parameter Spesifisitas
1 Glukosa β-D glukosa
2 Protein Albumin
3 Bilirubin Bilirubin direk
4 Urobilinogen Urobinogen di urin
5 pH 1 unit (pH 5-9)
6 Berat jenis 1,000-1,030
7 Darah Hemoglobin, mioglobin
8 Keton Asam asetoasetat lebih sensitif dari aseton
9 Nitrit nitrit
10 Leukosit Esterase leukosit
Aution sticks
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
23/96
No Parameter Prinsip kerja Negatif palsu Positif palsu
1 Glukosa GOD-POD Vit C, ISK Oksidatif (detergen)HCL
2 Protein Non spesific bindingto indicator day
Urin berwarna Urin > 9, detergen,
chlorhexidine, polivinylpyrrolidone
3 Bilirubin Reaksi Azo dan garamdiazonium
Vit C, nitrit ↑,paparan cahaya
Urin berwarna,Chlorpromazine
4 Urobilinogen Reaksi Erlich Formaldehyde,
paparan cahaya
Sulphonamide, urin
berwarna,porphobilinogen
Europan Urinalisis Guidelines ,2000Henry, et al. , 2001, Basic Examination of urine
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
24/96
No Parameter Prinsip kerja Negatif palsu Positif palsu
5 pH 2 indikator Methylred & bromthymol blue
↓: F ormaldehid
6 Berat jenis Ion dalam urinberekasi dengan polyelectrolytes
↓ : Glukosa, urea,urin alkali
↑ : Protein > 1 g/L,ketonuria, asam laktat
7 Eritrosit Pseudoperoxidase Nitrit ↑ , pem.tertunda, BJ ↑,formaldehid.
Bakteri, oksidatif (deterjen), HCL
8 Keton Reaksi Rothera Penyimpanantdk sesuaistandar
Sulfhidryl bebas :captopril, L-dopa
Europan Urinalisis Guidelines ,2000Henry, et al. , 2001, Basic Examination of urine
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
25/96
No
Parameter Prinsip kerja Negatif palsu Positif palsu
9 Leukosit Aktivitas esteraseleukosit
Vit C,protein > 5 g/L,kontaminasi mukus,cephalosporins,nitrofurantoin,asam borat
Oksidatif (detergen),formaldehid,sodium azide,urin berwarna
10 Nitrit Azo dye Sayuran
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
26/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
27/96
PRAANALITIKPersiapan pasien : Tdk ada
Jenis sampel : urin sewaktu, urin 24 jam
Persiapan sampel :- Sebaiknya urin segar. Tes dilakukan < 2 jamsetelah urin dikemihkan
- Wadah penampung urin dari plastik, tanpabahan pengawet
- Albumin urin stabil pada suhu 4˚ C 1 minggu.Sampel simpan lama, albumin urin stabil padasuhu - 20 ˚ C s/d - 80 ˚ C
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
28/96
Prinsip tes :Berdasarkan ikatan kuat antara sulfonephthalein
dg albumin menghasilkan perubahan warna laludiukur secara fotometrik
Alat dan Bahan : Alat Clinitek,reagen strips : Multistix
ANALITIKCara kerja : Sesuai dengan alat yang digunakanNilai rujukan :
< 20 mg/L (
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
29/96
Intended useIn vitro test for the quantitative determination ofalbumin in human urine, serum, plasma and CSF(albumin CSF/serum ratio) on Roche/Hitachicobas c systems.
Test principleImmunoturbidimetric assay.Anti-albumin antibodies react with theantigen in the sample to formntigen/antibodycomplexes which, following agglutination, aremeasured turbidimetrically.
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
30/96
SpecimenUrine , Serum, Plasma: Li-heparin and K2-EDTAplasma, CSF
Urine Spontaneous, 24-hour urine/2nd morning urine .
Stability urine:7 days at 15-25 °C1 month at 2-8 °C6 months at (-15)-(-25) °C
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
31/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
32/96
Stability serum, plasma
Expected values
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
33/96
PASCA ANALITIKInterpretasi:
Kategori Urin 24 jam Urin waktu ttt Urin sewaktu
mg/24 jam mg/menitmg/mgkreatinin
Normal < 30 < 20 < 30
Mikro-albuminuria 30 -299 20 - 199 30 - 299
Makro-abuminuria
> 300 ≥ 200 ≥ 300
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
34/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
35/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
36/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
37/96
Intended useIn vitro test for the quantitative determinationof creatinine concentration in human serum,plasma and urine.
The enzymatic method is based on the establisheddetermination of sarcosine after conversion ofcreatinine with the aid of creatininase, creatinase, and
sarcosine oxidase. The liberated hydrogen peroxide ismeasured via a modified Trinder reaction. Moreover,the results of this method correlate with thoseobtained by ID/MS.
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
38/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
39/96
Serum.
Plasma: Li-heparin and K2-EDTA plasmaUrine: Collect urine without using preservatives
Stability in serum/plasma:7 days at 15-25 °C7 days at 2-8 °C3 months at (-15)-(-25) °C
Stability in urine:2 days at 15-25 °C6 days at 2-8 °C6 months at (-15)-(-25) °C
Centrifuge samples containing precipitates beforeperforming the assay
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
40/96
Serum/plasma : 5-2700 μmol/L (0.06-30.5 mg/dL)
Urine : 100-54000 μmol/L (1.1-610 mg/dL)
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
41/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
42/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
43/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
44/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
45/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
46/96
Kt/V urea : pedoman yang akurat untukmerencanakan peresepanUrea reduction ratio = Rasio reduksi ureum(RRU)
National Cooperative Dialysis Study (NCDS) :
Kt/V < 0,8 meningkatnya morbiditasKt/V : 1,0-1,2 mortalitas yang rendah
National Kidney Foundation-Dialysis Outcome Quality Initiative(NKF -DOQI) memakai batasan bahwa HD harus dilakukan denganRRU ≥ 65 .
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
47/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
48/96
BUN pra HDAV-vistula atau graft jalur arteri sebelumdihubungkan dengan blood linePastikan tdk ada cairan lain pada jarum arteri
BUN post HDEquilibrium 30-60 menit post HD
Gedess CC dkk : 4 menit setelah berhentinyacairan dialisat sama antara arteri dgn vena
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
49/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
50/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
51/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
52/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
53/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
54/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
55/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
56/96
HypertensionDyslipidemia : LDL, HDL, TG, Chol totAnemia : As per the Kidney Disease
Outcomes Quality Initiative guidelines,the goal for hemoglobin levels is 100 –120 g/L, and it is recommended thatpatients be treated with erythropoiesis-
stimulating agents (ESAs) if hemoglobinis found to be less than 100 g/L
Ganesh & lee, UBCMJ, 2011
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
57/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
58/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
59/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
60/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
61/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
62/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
63/96
FerritinSaturasi Transferin
Goal for Iron Stores
1 HD - CKD PD-CKD
2 Ferritin > 200 ng/mLTSAT > 20%
Ferritin > 100 ng/mLTSAT > 20%
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
64/96
Hemato ogy
http://store3.yimg.com/I/cardianet_1782_7824http://store3.yimg.com/I/cardianet_1782_7824
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
65/96
e ato ogyAutomati on
Two General Principles◦ Electronic resistance ( impedance)◦ Light scattering
http://store3.yimg.com/I/cardianet_1782_7824http://store3.yimg.com/I/cardianet_1782_7824
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
66/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
67/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
68/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
69/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
70/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
71/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
72/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
73/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
74/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
75/96
Kriteria Pengendalian Kriteria A1c (%)
Baik < 6,5
Sedang 6,5 - 8
Buruk > 8
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
76/96
Lipid Management in yhe CKD Patient, NJAFP,2011
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
77/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
78/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
79/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
80/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
81/96
Lipid Management in yhe CKD Patient, NJAFP, 2011
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
82/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
83/96
Spektrofotometer : kuantitatif (mg / dl)ISE : Ionic Selective Electrode : kuantitatif (mmol/L)
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
84/96
Natrium/sodiumSpesimen : serum, plasma-whole blood heparinpemeriksaan tertunda 2-4ºC/freezerNilai rujukan : 136-145 mmol/LKalium/potassium
Spesimen : serum, plasma-whole bood heparinpemeriksaan tertunda : 2-4 ºCNilai rujukan : 3,5-5,1 mmol/L
ChoridaSpesimen : serum, plasma-whole blood heparinNilai rujukan : 98-107 mmol/L.
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
85/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
86/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
87/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
88/96
Choice of site
Fisrt choice
Alternative sitesAlternative sitesAlternative sites
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
89/96
pre-heparinized syringe; needles (20, 23 and 25 gauge)(a safety syringe with a needle cover ) *
a bandage to cover the puncture site after collectiona container with crushed ice (transportation laboratory)where applicable, local anesthetic and an additional single-use sterile syringe and needle.
Equipment and supplies
WHO guidelines on drawing blood: best practices in phlebotomy
© World Health Organization 2010
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
90/96
Deltran® Plus is an arterial blood sampling Anaerobic Pulsator Plus syringes
RAPIDLyte Arterial Blood Sampling Syringes BD A-Line Arterial Blood Collection Syringe
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
91/96
Radiometer's safe PICO blood gas syringes are preheparinised with dry,electrolyte-balanced heparin
http://www.radiometer.co.uk/en-gb/products/samplers/our-solutions/safepico-samplerhttp://www.radiometer.co.uk/en-gb/products/samplers/our-solutions/safepico-samplerhttp://www.radiometer.co.uk/en-gb/products/samplers/our-solutions/safepico-samplerhttp://www.radiometer.co.uk/en-gb/products/samplers/our-solutions/safepico-sampler
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
92/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
93/96
Spesimen should never be storedpH ↓ : 0,04 -0,08 unit/hr at 37°C: 0,008 unit/hr 4°C
PCO2 ↑ : ± 5 mmHg at 37°C0,5 mmHg at 2-4°C
PO2 ↓: 2 -6 mmHg/hr at room temperature4-12 mmHg at 37°C
Adverse effects of glicolysis on pH, ct CO2, pO2, PCO2are best avoided by analysis within 30 minutes
Burtis & ashwood, Tietz Fundamentals of Clinical Chemistry , 4th ed, 2006
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
94/96
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
95/96
Arteri Venacampuran
Vena
pH
PaO 2pCO 2Saturasi O 2HCO 3Base exsess
7,40
( 7,37 - 7,44 )80 – 100
35 - 45> 9522 - 26(- 2) - (+ 2)
7,36
( 7,31 – 7,41 )35 - 40
41 - 5160 - 8022 - 26
(- 2) - (+ 2)
7,36
( 7,31 – 7,41 )30 - 5040 - 5260 - 8522 - 28(- 2) - (+ 2)
8/19/2019 Pem.lab. Pasien Gagal Ginjal -Rev 2
96/96