Balance Cairan : ____________ ccNo. RM :Nama : L / PUmur : tahunRuang :Diagnosa :

Tanggal Waktu BAB BAK Muntah IWL Total Balance Total Makan Minum IVFD BB LPD LPB

Keterangan:

BAB keras / biasa = 50 cc / BABBAB mencret = 100 cc / BAB______________ BAK aqua besar = 1500 ccBAK aqua sedang = 600 ccBAK aqua kecil = 240 cc____________________ Muntah = 50 cc / muntahMakan = 100 cc / makanIWL (Insensible Water Loss) = 500 cc

= 600 cc (bila demam)Balance

0 ccSirosis (-)CKD / GGK (+)Pemberian diuresis (-)

250 cc Oedem (Minimal) + Ascites ( Minimal)500 cc Oedem / Ascites

1000 cc Oedem + Ascites

cc/ 24 jam fls cairan infus20 gtt/i makro 1440 ± 310 gtt/i makro 720 ± 1.5

20 gtt/i mikro 480 ± 110 gtt/i mikro 240 ± 0.5

1 gtt/i makro = 3 gtt/i mikro

BALANCE CAIRAN