Krisis Hipertensi Dr.harnavi

HIPERTENSI Emergesi

Harnavi HarunSub Bagian Ginjal Hipertensi Bagian Ilmu Penyakit Dalam Fakultas Kedokteran UNAD/RS Dr. M. Jamil

TgljamTDMABPFNsikap11/7/1105.0005.1005.2005.3005.4005.50252/140235/135250/130240/120240/110230/9017716817016015313612012311911610298Drip perdipine 0,5 ug/kgbb/menit

Dosis naikan 1 ug/kgbb/menit

11/7/1106.0006.1006.2006.30 06.40230/90250/90220/95210/95210/851361231261231238976726976Dosis naikan 1,5 ug/kgBB/menit11/7/1108.0009.0010.0011.0012.0013.0014.00210/90210/80190/90186/90170/95160/80160/8713012312111611611611172697270727075Drpi perdipine 1,5 ug/kgbb/mnt

Drip perdipine 1 ug/kgbb/mnt11/7/1115.0017.0020.0024.00 160/80160/80155/85155/871101101o81097270747212/7/1101.0003.00160/70158/751081027472Drip perdipine 0,5 ug/kgbb/mnt06.00150/70967409.00140/8510364Perdipine StopGanti amlodipin 1x10 mg

Seorang pasien perempuan 42 th masuk rs dengan keluhan penurunan kesadaran sejak 2 jam sebelum dirawat. Dua hari sebelumnya pasien mengeluh sakit kepala hebat ,muntah darah,dada terasa berdebar, sesak nafas tidak ada dan Os segera dibawa ke IGD RS.4 tahun yang lalu os didiagnosis HT, saat itu keluhan sering sakit kepala. Enam bulan belakangan ini os tidak kontrol teratur dan tidak minum obat. Keluarga tidak tahu penyebab Hipertensi

RPD: Tidak ada yang penting RPK: Ayang meninggal, penyebab? Rpsos: Menikah, tidak bekerja, tidak merokok, menstruasi teratur, keguguran (-), suami bekerja sebagai buruh .

Pemeriksaan Fisik Keadaan Umum: tampak sakit berat TD 252/140 mmHg , Nadi 125x/mnt, Nafas 36x/mnt, S 38,5 C BB 40 kg, TB 150 cm Kulit : dbn Mata: konjungtiva anemis . pupil bulat isokor. Leher: JVP 5-2 cm, kaku kuduk (-) Jantung : bising (-), gallop (-). Apek 1 kari lateral LMCS RIC VI Paru: ves, rh +/+, wh -/- Abdomen: Hepar dan lein tak teraba Ekstremitas: hangat, edem -/- KBG: tidak membesar hemiparese tidak ada

EKG: Sinus takikardia, LAD, QRS rate 125x/men, P N, PR

*Pemeriksaan penunjang

Darah Perfer Lengkap

Hb 7.5/16/13500/179,000MCV 88/MCH 31/MCHC 36DC 0/2/4/67/26/1PT 13.3 (12,5), APTT 40.4(32.1) d Dimer 424 Ur 194, Cr 2.4, CCT 19, eGFR (MDRD) 14,17SGOT 45, SGPT 13, Albumin 2.8 Globulin 2,9Bil Tot 0.2/Bil D 0.1/Bil Ind 0.1GDS 122Na 140/K 4,6/Cl 111

Daftar Masalah

Hipertensi EmergencyAnemia NNAcute on CKDIschemik anterolateral inferiorHipoalbuminemiaRiwayat hematemesis melena

Pengkajian Dipikirkan : Hipertensi Emergency ( dengan target organ damage )

a/d Penurunan kesadaran, cefalgia PF: TD 252/130 mmHg MAP 160 mmHg Hb 7,5, Ur 194, cr 2.4 EKG : ischemik inferolateral Ro thorak : cardiomegali,

PDx EKG serial, Ur, cr serial, profil lipid, hemostasi lengkap Echo, USG abd, AGD, Ct Scan

TERAPIO2 2 lpm nkDiet cair via NGT rendah garam Penurunan TD 20%-25% dari MAP (ex: 40 mmhg) Setelah tercapai penurunan 30 mmhg dan stabil maka turunkan TD target 160/90-100 mmhg dalam waktu 2-6 jam (8 jam) Setelah 8 jam, turunkan TD menjadi 140/90 mmhg dalam 24-48 jam Setelah tekanan darah mulai terkontrol kombinasi dengan obat oral ?

Stroke 54%?, Peny Jantung Iskemik 47% ?, Ginjal 30%?87,5%

*Hipertensi PGK DMHamil HemodialisaHipokalemia ObesitasLansia Hormon

*Hipertensi Emergensi Hipertensi Emergensi 1-2 %

40% meninggal karena Gagal Ginjal 24 % meningal karena Stroke 11 % infark miokard 10 % gagal jantung

Hypertension is highly prevalent in elderly patientsThe greatest prevalence of hypertension is in patients aged >65 years10315372020406080Age (years)55644054>651839Prevalence of hypertension (%)AHA 2007 Heart Disease & Stroke Statistics: *72 million extrapolated based on NHANES 19992004, projected to US Census estimates for 2004; Equinox Hypertension Market Map, Sept 2007

*

Hipertensi Emergensi(Hipertensi + TOD)Kasus 1

Usia 68 thTD 252/140 mmHgPenurunan KesadaranPapil udemKelainan fungsi ginjal

Kasus 2

Usia 27 th TD 195/95 mmHgPenurunan Kesadaran Papil udem Kelainan Fungsi ginjal

Aliran Darah Otak

TEKANAN SISTOLIKTEKANAN DIASTOLIKALIRAN DARAH OTAK ALIRAN DARAH OTAK KOMBINASI SISTOLIK-DIASTOLIK(MEAN ARTERIAL PRESSURE)

Aliran Darah 0tak

ALIRAN DARAH OTAK

MAP = SISTOLIK+2 DIASTOLIK3

Aliran Darah Otak

ALIRAN DARAH OTAK Normal /70 mlMAP 60-120 mmHg INDIVIDU NORMAL INDIVIDU HIPERTENSI ALIRAN DARAH OTAK Normal /70 mlMAP 100-160 mmhg

Aliran Darah Otak

ALIRAN DARAH OTAK> 70 MAP 60-120 mmHg INDIVIDU NORMALTD 120/80 TD 170/100 (160/90) ALIRAN DARAH OTAK 70 MAP >120 mmHg Hiperperfusi otak

Aliran Darah Otak

ALIRAN DARAH OTAK> 70 MAP 100-160 mmHg INDIVIDU HIPERTENSITD >140/90TD 250/130 ALIRAN DARAH OTAK 70 MAP >160 mmhg Hiperperfusi otak

Pathophysiology

Hypertensi Encepalopati

Tekanan Darah ?

Dysfungsi Autoregulasi otak ?

Tidak ada batasan TD tertentu

1. INDIVIDUAL ?2.COMORBID FACTORS ?3. Laju perubahanTD4. Pregnant dan anak

*Prinsip Terapi Hipertensi Emergensi Turunkan Tekanan darah bertahap Tahap 1. Turunkan 20-25% MAP dalam waktu 1 jam 2. Turunkan TD menjadi 160/100 dalam waktu 2-6 jam 3. Turunkan TD menjadi 140/90 dalam waktu 12-48 jam

*Hipertensi Emergensi(Hipertensi+Stroke Iskemik) Terapi ??? (Tergantung keadaan pasien) 1. Observasi 1-2 jam !!! , bila TD tidak turun maka: Turunkan 15-20% MAP dalam waktu 1 jam : - Jika ada rencana Trombolisis - Jika ada cidera end organ non serebral akut - TD > 220/120 - MAP > 130 dan menetap2. Menunda penurunan TD : - Jika stroke dengan TD < 220/120 atau (tekanan darah tidak begitu tinggi) - setelah 3-5 hari akan normal kembali - Bila tidak turun berikan terapi oral.

*Meta analisa 32 penelitian"Belum cukup bukti untuk mengevaluasi hasil dari efek menurunkan TD" pada pasien strokeSemlecini 2003" Tekanan darah awal yang tinggi berhubungan dengan outcome neurologis yang lebih baik setelah stroke iskemik"

*Hipertensi Emergensi(Hipertensi+Stroke Hemoragik) AHA

" TD diturunkan bila TDS > 220 mmhg

*PreEKLAMSI-EKLAMSI Target TD Sistolik 140-150 mmhg Diastolik 90-100 mmhg

" Mempertahankan aliran darah plasenta adekuat"

We need only return the BP to a level where autoregulation restores normal perfusion pressure to vital organs, not to normal BP levels

It is important that blood pressure be lowered in a controlled manner to avoid risk for hypoperfusion of vital organs, which can cause ischemia and infarction.

To ensure controlled lowering of blood pressure, critical care nurses should monitor blood pressure every 5 to 10 minutes until goals are reached.

.

*Nicardipine (Perdipine)1 ampul = 10 mg Dosis : 5-15 mg / jam Onset: 5-10 menitDurasi; 15-30 menit, dapat melebihi 4 jamDosis awal 0,5 ug/kgbb/menit

*The 1st line treatment of Hypertensive Emergency Sodium Chloride / NaCl ( OTSU-NS : 100/250/500 ml ) Dextrose 5% ( OTSU-D5 : 100 / 250 / 500 ml ) Glucose 5% Potacol R Ringer Asetat KN 1A / 1B / 4A PERDIPINE Could be used :Couldnt be used : Sodium bicarbonat Ringer Laktat

*

Dosage and Administration

Start with the lowest dose. Eg 0.5 mcg/BW/min 15 drops monitoring, if in 5-15 minutes theres no significant blood pressure reducing Increasing drip until 20 drop , and then can be increased until desirable blood pressure achieved ( about 3-5 drops each after monitoring)Monitoring blood pressure and heart rate frequentlyBefore choose to switch to oral, 1 hour before Perdipine is stopped, give oral drugs and Perdipine is tappered of

*

Sheet1

PANDUAN DOSIS & PENGGUNAAN

PERDIPINE INJEKSI

INDIKASI

1. HIPERTENSI EMERGENSI

Dosis: 0,5 - 6 mcg/kgBB/menit (syringe pump / infus drip)

2. Krisis hipertensi akut selama tindakan operasi

Dosis: 2 - 10 mcg/kgBB/menit (syringe pump / infus drip)

: 10 - 30 mcg/kgBB/menit ( bolus I.V.)

SYRINGE PUMP

INDIKASIKRISIS HIPERTENSI AKUT SELAMA OPERASI

Perdipine InjeksiHIPERTENSI EMERGENSI

1 ampul 10mgBERATDOSIS PERDIPINE INJEKSI (mcg/kgBB/menit)

Spuit 50 ccBADAN0.51.01.52.03.04.05.06.07.08.09.010.0

( mL/jam)40 kg$6$12$1824$36$48$60$72$84$96$108$120

atau50 kg$8$15$2330$45$60$75$90$105$120$135$150

60 kg$9$18$2736$54$72$90$108$126$144$162$180

Pediatric Drip70 kg$11$21$3242$63$84$105$126$147$168$189$210

( 1cc = 60 tetes)80 kg$12$24$36$48$72$96$120$144$168$192$216$240

90 kg$14$27$41$54$81$108$135$162$189$216$243$270

Pelarut / Cairan infus yang dapat digunakan a.l :

Sodium Chloride / NaCl, Dextrose 5%, Potacol-R, Glucose 5%, Ringer Asetat, KN Solution 1A, KN Solution 1B, kecuali Sodium

bicarbonat & Ringer Laktat

Keterangan lebih lanjut hubungi :

P.T. YAMANOUCHI INDONESIA, Wisma Kyoei Prince Lt 11, Jl. Jend. Sudirman Kav.3

Jakarta 10220, Indonesia. Telepon 62-21 5724344 (Hunting), Fax. 62-21 5724345

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

Dalam larutan 100 ccBADAN0.51.01.52.03.04.05.06.07.08.09.010.0

( Tetes/menit)40 kg122436487296120144168192216240

50 kg1530456090120150180210240270300

Mikro Drip60 kg18365472108144180216252288324360

(1 cc = 60 tetes)70 kg21426384126168210252294336378420

80 kg24487296144192240288336384432480

90 kg275481108162216270324378432486540

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg6121824364860728496108120

50 kg815233045607590105120135150

Mikro Drip60 kg9182736547290108126144162180

(1 cc = 60 tetes)70 kg112132426384105126147168189210

80 kg122436487296120144168192216240

90 kg1427415481108135162189216243270

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg4812162432404856647280

50 kg510152030405060708090100

Makro Drip60 kg6121824364860728496108120

(1 cc = 20 tetes)70 kg71421284256708498112126140

80 kg816243248648096112128144160

90 kg9182736547290108126144162180

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg24681216202428323640

50 kg358101520253035404550

Makro Drip60 kg369121824303642485460

(1 cc = 20 tetes)70 kg4711142128354249566370

80 kg4812162432404856647280

90 kg5914182736455463728190

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg510152030405060708090100

50 kg6131925350637588100113125

Makro Drip60 kg815233045607590105120135150

(1 cc = 20 tetes)70 kg9182635537088105123140158175

80 kg102030406080100120140160180200

90 kg112334456890113135158180203225

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg3710132027334047536067

50 kg4813172533425058677583

Makro Drip60 kg510152030405060708090100

(1 cc = 20 tetes)70 kg6121823354758708293105117

80 kg71320274053678093107120133

90 kg815233045607590105120135150

Sheet2

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg71320274053678093107120133

50 kg8172533506783100117133150167

Makro drip60 kg102030406080100120140160180200

(1cc = 20 tetes)70 kg122335477093117140163187210233

80 kg1327405380107133160187213240267

90 kg1530456090120150180210240270300

PERDIPINE INJEKSI

INDIKASI

Dosis: 0,5 - 6 mcg/kgBB/menit (syringe pump / infus drip )

Dosis: 2 - 10 mcg/kgBB/menit (syringe pump / infus drip )

: 10 - 30 mcg/kgBB ( bolus I.V.)

Sheet3

INFUS DRIP

Makro drip (1 CC = 20 tetes/menit)

PELARUT / CAIRAN INFUS100 CC250 CC500 CC

PERDIPINE 10 mg1 - 2 ampul2 - 3 ampul3 ampul

Mikro drip (1 CC = 60 tetes)

PELARUT / CAIRAN INFUS100 CC

PERDIPINE 10 mg1 - 2 ampul

Sodium Chloride / NaCl, Dextrose 5%, Potacol-R, Glucose 5%, Ringer Asetat, KN Solution 1A,

KN Solution 1B, kecuali SODIUM BICARBONAT & RINGER LAKTAT

PENGGUNAAN BOLUS INJEKSI

yang dilanjutkan dengan maintenance drip infus/syringe pump.

Misal : BB = 60 kg

Dosis yang mau dipakai 20 mcg/kgBB

Catatan : Perdipine 1 mg = 1 cc

PERHITUNGAN DOSIS

SOAL :

dalam cairan infus 100 cc. (Makro drip --> 1 cc = 20 tetes)

Berapa tetes/menit yang diperlukan ??

JAWABAN :

Pada cairan infus/pelarut 100 cc, kita ambil 1 ampul Perdipine 10mg.

Maka pengencerannya adalah 1 x 10mg = 10mg x 1000 =10.000 mcg= 100 mcg/cc

100 cc

100

60 menit

Sheet5

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg71320274053678093107120133

50 kg8172533506783100117133150167

Makro drip60 kg102030406080100120140160180200

(1cc = 20 tetes)70 kg122335477093117140163187210233

80 kg1327405380107133160187213240267

90 kg1530456090120150180210240270300

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg71320274053678093107120133

50 kg8172533506783100117133150167

Makro drip60 kg102030406080100120140160180200

(1cc = 20 tetes)70 kg122335477093117140163187210233

80 kg1327405380107133160187213240267

90 kg1530456090120150180210240270300

Sheet4

PERDIPINE INJEKSI

INDIKASI

SYRINGE PUMP

Spuit 50 ccBADAN0.51.01.52.03.04.05.06.07.08.09.010.0

( mL/jam)40 kg$6$12$1824$36$48$60$72$84$96$108$120

atau50 kg$8$15$2330$45$60$75$90$105$120$135$150

60 kg$9$18$2736$54$72$90$108$126$144$162$180

( 1cc = 60 tetes)80 kg$12$24$36$48$72$96$120$144$168$192$216$240

90 kg$14$27$41$54$81$108$135$162$189$216$243$270

INFUS DRIP

( Tetes/menit)40 kg122436487296120144168192216240

50 kg1530456090120150180210240270300

Mikro Drip60 kg18365472108144180216252288324360

(1 cc = 60 tetes)70 kg21426384126168210252294336378420

80 kg24487296144192240288336384432480

90 kg275481108162216270324378432486540

INFUS DRIP

( Tetes/menit)40 kg6121824364860728496108120

50 kg815233045607590105120135150

Mikro Drip60 kg9182736547290108126144162180

(1 cc = 60 tetes)70 kg112132426384105126147168189210

80 kg122436487296120144168192216240

90 kg1427415481108135162189216243270

INFUS DRIP

( Tetes/menit)40 kg4812162432404856647280

50 kg510152030405060708090100

Makro Drip60 kg6121824364860728496108120

(1 cc = 20 tetes)70 kg71421284256708498112126140

80 kg816243248648096112128144160

90 kg9182736547290108126144162180

INFUS DRIP

( Tetes/menit)40 kg24681216202428323640

50 kg358101520253035404550

Makro Drip60 kg369121824303642485460

(1 cc = 20 tetes)70 kg4711142128354249566370

80 kg4812162432404856647280

90 kg5914182736455463728190

INFUS DRIP

( Tetes/menit)40 kg510152030405060708090100

50 kg6131925350637588100113125

Makro Drip60 kg815233045607590105120135150

(1 cc = 20 tetes)70 kg9182635537088105123140158175

80 kg102030406080100120140160180200

90 kg112334456890113135158180203225

INFUS DRIP

( Tetes/menit)40 kg3710132027334047536067

50 kg4813172533425058677583

Makro Drip60 kg510152030405060708090100

(1 cc = 20 tetes)70 kg6121823354758708293105117

80 kg71320274053678093107120133

90 kg815233045607590105120135150

INFUS DRIP

( Tetes/menit)40 kg71320274053678093107120133

50 kg8172533506783100117133150167

Makro drip60 kg102030406080100120140160180200

(1cc = 20 tetes)70 kg122335477093117140163187210233

80 kg1327405380107133160187213240267

90 kg1530456090120150180210240270300

*

Sheet1

PERDIPINE INJEKSI

INDIKASI

SYRINGE PUMP

Spuit 50 ccBADAN0.51.01.52.03.04.05.06.07.08.09.010.0

( mL/jam)40 kg$6$12$1824$36$48$60$72$84$96$108$120

atau50 kg$8$15$2330$45$60$75$90$105$120$135$150

60 kg$9$18$2736$54$72$90$108$126$144$162$180

( 1cc = 60 tetes)80 kg$12$24$36$48$72$96$120$144$168$192$216$240

90 kg$14$27$41$54$81$108$135$162$189$216$243$270

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg122436487296120144168192216240

50 kg1530456090120150180210240270300

Mikro Drip60 kg18365472108144180216252288324360

(1 cc = 60 tetes)70 kg21426384126168210252294336378420

80 kg24487296144192240288336384432480

90 kg275481108162216270324378432486540

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg6121824364860728496108120

50 kg815233045607590105120135150

Mikro Drip60 kg9182736547290108126144162180

(1 cc = 60 tetes)70 kg112132426384105126147168189210

80 kg122436487296120144168192216240

90 kg1427415481108135162189216243270

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg4812162432404856647280

50 kg510152030405060708090100

Makro Drip60 kg6121824364860728496108120

(1 cc = 20 tetes)70 kg71421284256708498112126140

80 kg816243248648096112128144160

90 kg9182736547290108126144162180

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg24681216202428323640

50 kg358101520253035404550

Makro Drip60 kg369121824303642485460

(1 cc = 20 tetes)70 kg4711142128354249566370

80 kg4812162432404856647280

90 kg5914182736455463728190

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg510152030405060708090100

50 kg6131925350637588100113125

Makro Drip60 kg815233045607590105120135150

(1 cc = 20 tetes)70 kg9182635537088105123140158175

80 kg102030406080100120140160180200

90 kg112334456890113135158180203225

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg3710132027334047536067

50 kg4813172533425058677583

Makro Drip60 kg510152030405060708090100

(1 cc = 20 tetes)70 kg6121823354758708293105117

80 kg71320274053678093107120133

90 kg815233045607590105120135150

Sheet2

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg71320274053678093107120133

50 kg8172533506783100117133150167

Makro drip60 kg102030406080100120140160180200

(1cc = 20 tetes)70 kg122335477093117140163187210233

80 kg1327405380107133160187213240267

90 kg1530456090120150180210240270300

PERDIPINE INJEKSI

INDIKASI

Dosis: 0,5 - 6 mcg/kgBB/menit (syringe pump / infus drip )

Dosis: 2 - 10 mcg/kgBB/menit (syringe pump / infus drip )

: 10 - 30 mcg/kgBB ( bolus I.V.)

Sheet3

INFUS DRIP

Makro drip (1 CC = 20 tetes/menit)

PELARUT / CAIRAN INFUS100 CC250 CC500 CC

PERDIPINE 10 mg1 - 2 ampul2 - 3 ampul3 ampul

Mikro drip (1 CC = 60 tetes)

PELARUT / CAIRAN INFUS100 CC

PERDIPINE 10 mg1 - 2 ampul

Sodium Chloride / NaCl, Dextrose 5%, Potacol-R, Glucose 5%, Ringer Asetat, KN Solution 1A,

KN Solution 1B, kecuali SODIUM BICARBONAT & RINGER LAKTAT

PENGGUNAAN BOLUS INJEKSI

yang dilanjutkan dengan maintenance drip infus/syringe pump.

Misal : BB = 60 kg

Dosis yang mau dipakai 20 mcg/kgBB

Catatan : Perdipine 1 mg = 1 cc

PERHITUNGAN DOSIS

SOAL :

dalam cairan infus 100 cc. (Makro drip --> 1 cc = 20 tetes)

Berapa tetes/menit yang diperlukan ??

JAWABAN :

Pada cairan infus/pelarut 100 cc, kita ambil 1 ampul Perdipine 10mg.

Maka pengencerannya adalah 1 x 10mg = 10mg x 1000 =10.000 mcg= 100 mcg/cc

100 cc

100

60 menit

Sheet5

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg71320274053678093107120133

50 kg8172533506783100117133150167

Makro drip60 kg102030406080100120140160180200

(1cc = 20 tetes)70 kg122335477093117140163187210233

80 kg1327405380107133160187213240267

90 kg1530456090120150180210240270300

PERDIPINE INJEKSI

INDIKASI

INFUS DRIP

( Tetes/menit)40 kg71320274053678093107120133

50 kg8172533506783100117133150167

Makro drip60 kg102030406080100120140160180200

(1cc = 20 tetes)70 kg122335477093117140163187210233

80 kg1327405380107133160187213240267

90 kg1530456090120150180210240270300

Sheet4

PERDIPINE INJEKSI

INDIKASI

SYRINGE PUMP

Spuit 50 ccBADAN0.51.01.52.03.04.05.06.07.08.09.010.0

( mL/jam)40 kg$6$12$1824$36$48$60$72$84$96$108$120

atau50 kg$8$15$2330$45$60$75$90$105$120$135$150

60 kg$9$18$2736$54$72$90$108$126$144$162$180

( 1cc = 60 tetes)80 kg$12$24$36$48$72$96$120$144$168$192$216$240

90 kg$14$27$41$54$81$108$135$162$189$216$243$270

INFUS DRIP

( Tetes/menit)40 kg122436487296120144168192216240

50 kg1530456090120150180210240270300

Mikro Drip60 kg18365472108144180216252288324360

(1 cc = 60 tetes)70 kg21426384126168210252294336378420

80 kg24487296144192240288336384432480

90 kg275481108162216270324378432486540

INFUS DRIP

( Tetes/menit)40 kg6121824364860728496108120

50 kg815233045607590105120135150

Mikro Drip60 kg9182736547290108126144162180

(1 cc = 60 tetes)70 kg112132426384105126147168189210

80 kg122436487296120144168192216240

90 kg1427415481108135162189216243270

INFUS DRIP

( Tetes/menit)40 kg4812162432404856647280

50 kg510152030405060708090100

Makro Drip60 kg6121824364860728496108120

(1 cc = 20 tetes)70 kg71421284256708498112126140

80 kg816243248648096112128144160

90 kg9182736547290108126144162180

INFUS DRIP

( Tetes/menit)40 kg24681216202428323640

50 kg358101520253035404550

Makro Drip60 kg369121824303642485460

(1 cc = 20 tetes)70 kg4711142128354249566370

80 kg4812162432404856647280

90 kg5914182736455463728190

INFUS DRIP

( Tetes/menit)40 kg510152030405060708090100

50 kg6131925350637588100113125

Makro Drip60 kg815233045607590105120135150

(1 cc = 20 tetes)70 kg9182635537088105123140158175

80 kg102030406080100120140160180200

90 kg112334456890113135158180203225

INFUS DRIP

( Tetes/menit)40 kg3710132027334047536067

50 kg4813172533425058677583

Makro Drip60 kg510152030405060708090100

(1 cc = 20 tetes)70 kg6121823354758708293105117

80 kg71320274053678093107120133

90 kg815233045607590105120135150

INFUS DRIP

( Tetes/menit)40 kg71320274053678093107120133

50 kg8172533506783100117133150167

Makro drip60 kg102030406080100120140160180200

(1cc = 20 tetes)70 kg122335477093117140163187210233

80 kg1327405380107133160187213240267

90 kg1530456090120150180210240270300

TERIMA KASIH

Hypertension prevalence increases with age. Approximately 70% of elderly patients have hypertension.

AbbreviationsBP= blood pressure

ReferenceAHA 2007 Heart Disease & Stroke Statistics: *72 million extrapolated based on NHANES 1999-2004, projected to US Census estimates for 2004.Equinox Hypertension Market Map, Sept 2007

Perdipine dapat dilarutkan dengan hampir seluruh jenis pelarut, keculai 2 yang perlu diingat yang tidak bisa dilarutkan dengan Perdipine adalah RL dan bicnatUntuk pemberian Perdipine kita anjurkan dimulai dengan dosis terendah dengan penambahan tetesan bisa 3-5 tetes setelah monitoring tiap 15 menit. Untuk penghentian Perdipine sebaiknya sebelum Perdipine di aff bisa diberikan obat oral terlebih dahulu 1 jam sebelum penghentianDengan infus drip 10 mg Perdipine dilarutkan dalam 100 cc larutan kemudian misal dengan dosis 0,5 mcg dan berat badan 40 kg, maka dosis Perdipine yang diberikan adalah 12 tetes/menitUntuk pemberian dengan syringe pump 1 ampul Perdipine dilarutkan dalam spuit 50 cc , jika kita memakai dosis terendah untuk mulai dengan pasien berat badan 40 kg, kita berikan 6 ml/jam

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Krisis Hipertensi Dr.harnavi