Water treatment UNSUR
Filter SEDIMEN
filter Softener CARBON
RO
Aluminium
v
Arsenic
v
Barium
v
Cadmium
v
Calcium
v
v
Chloramines
v
v
Chlorine
v
v
Chromium
v
Copper
v
Fluoride
v
Lead
v
Magnesium
v
v
Mercury
v
Nitrate
v
Potassium
v
Selenium
v
Silver
v
Sodium
v
Sulfate
v
Zinc
v
VIRUS
v
v
PENCEMARAN
v
v
ENDOTOXIN
v
BACTERIA
v v
PARTICLES
STANDARD
v
Cairan Dialisis Endotoxin Dapat hidup Endotoxin < 0.25 IU/ml n.s n.s n.s < 2.000 Bebas pyrogen
A IR
European Pharmacopoeia German Dialisis standard
(1997) (1993)
Dapat hidup < 100 < 200
Japanese society for dialisis
(1995)
n.s
n.s
<100
< 0.25
< 100 < 200 < 200
< 0.25 IU/ml < 1 ng/ml n.s
< 100 n.s < 2,000
< 0.25 n.s n.s
Product Air
Consentrate
Dial Dialis isat ate e
Dial Dialis isat ate e
TANPA DIASAFE
DIASAFE
Swedish pharmacopoeia (1997) Canadian standard Association (1986) AAMI standard USA (1996)
Standard kualitas Microbiological Hasil Microbial ( dalam CFU / ml )
< 100
< 1000
< 1000
<1
Hasil Endotoxin ( dalam IU / ml )
< 0.25
<1
< 1
< 0.03
Water Quality in hemodialysis, 1998 vol 1 AAMI : Association for the Advancement Of Medical Instrumentation
Akibat yang terjadi jika Air RO tercemar : NO Tercemar 1 Aluminium
Keadaan Akut Neurological symptoms
2 Aromatic hydrocarbons 3 Arsenic
? ?
4 Barium 5 Cadmium
? ?
6
Calsium
7 Chloramines 8 Ch C hlorine 9 Co Copper 10 Chromium 11 Fluoride
12 13 14 15 16
Formaldehyde Iron Hydrogen Peroxide Hypochlorite Lead
17 18 19 20 21 22 23
Magnesium Mercury Monochloramines Nitrate , nitrite Nitrosamine Peracetic Acid Pesticides
24
Potasium
25 Selenium 26 Silicon 27 Silver 28
Sodium
29 So S odium Azide
30 Sulfate 31 Zinc
Ha Hard water syndrom : Nausea , Hypertensi , Headache , Confusion , Seizures , memory loss, Judgment defect Hemolysis , methemoglobinemia Oxidative blood damage ? Ab Ability to form chloramine Hemolysis , fever ? Nausea , vomiting , arrythmias , tetany Hemorragic petechiae , ventilatory effort , Cardiac arrest, hypocalsemia , hyperkalemi Acidosis Hemolysis ? He Hemolysis He Hemolysis Colic, Obstipation, vomiting, Nervous system disorders Ha Hard water syndrom : ? Methemoglobinemia Hemolysis , methemoglobinemia ? He Hemolysis ? Hy Hyperkalemia : Bradyarrythmia Hypokalemia : Tachyarrythmia ? ? ? Hypernatremia: hypertensi Severe : in intracellular de dehydration ( nausea , vomiting, disorientasi , coma ) Hyponatremia : Hypotensi Severe : Water poisoning ( Cerebral edema , hemolysis ) Hypotensi , Blurred vision Abdominal pain , headache Loss of consciousness Nausea , vomiting , arrythmias , tetany Hemolysis
Keadaan kronis Dialysis dementia, osteomalacia Aplastic bone disease Abnormal myocardial function Anemia Carcinogen ? Contribution to uremic symptoms and neurological damage discussed ? Contribution to Anemia W eak progressive lethargy , weakness
Vomiting, Hypotensi , Lethargy , death Via generation of chloroform : Carcinogen ? Metallic taste , gastrointestinal discomfort refractory hypotensi , liver damage ? Osteomalacia, osteoporosis
? ? ? ? Nervous system disorders , anemia Burning skin sensation ? ? ? Carcinogen ? ? Polyneuropathy ? ? ? Contribution to neuropathy Bone and chest disease , anemia ? Hypertensi Augm en ented interdialytic weight ga gain
Neurotoxic ( damage in the white and grey matter ) ? Anemia , nausea , fever
Water Quality in hemodialysis 1998, vol 1
KUALITAS AIR BERSIH
KUALITAS AIR RO Parameter
AAMI
Parameter
European Pharmacopoeia
Standard
AIR BERSIH
Sifat fisik :
Unsur yang terkandung dalam cairan dialisis Calsium
2
( 0.1 mEq/l )
2
Keadaan
Magnesium
4
( 0.3 mEq/l )
2
Bau
Potasium
8
( 0.2 mEq/l )
2
Rasa
Sodium
70
( 0.3 mEq/l )
50
Suhu
Unsur yang mengandung RACUN
0C
Kekeruhan
NTU
Warna
Pt-Co
Udara 25 50
terdapat dalam AIR MINUM Arsenic
0.005
-
Barium
0.01
m-
Cadmium
0.001
-
Sifat kimia : pH Jumlah zat padat
mg mg/l
Chromium
0.014
-
Karbon dioksida bebas
Lead
0.005
-
Alkalinitas
Mercury
0.0002
0.001
Selenium
0.009
-
Silver
0.005
-
a. Phenolpthalin b. Total
mg mg / l mg / l
c. Hidroksida
mg / l
-
mg / l
500 500 1.0 0.5 1.0 10 10 600 400
Unsur lain yang mengandung RACUN
e. Bikarbonat
mg / l
Kesadahan
mg / l
Almunium
0.01
0.01
-
0.2
Kalsium
mg / l
Magnesium
mg / l
Chloramines
0.1
-
Free Chlorine
0.5
0.1
Mangan
Chloride
-
50
Almunium
Copper
0.1
-
Be s i
Nitrit Nitrat Angka Permanganat
0.2
0.2
Nitrate
Fluoride
2
2
Sulfate
100
50
Zinc
0.1
0.1
-
0.1
Logam berat
Standard AAMI menggunakan nilai maximum mg / l = ppm CFU : Colony Forming Units IU : International Units Water Quality in hemodialysis, 1998 vol 1 AAMI : Association for the Advancement Of Medical Instrumentation
500
d. Karbonat terdapat dalam DIALISIS dalam DIALISIS Ammonium
6.5 - 9.0 1500 -
Khlorida Sulfat